America's Health Rankings, United Health Foundation Logo

Supplemental Measures: Community & Environment

Disconnected Youth, 2018 Annual Report
Measure: Disconnected Youth, 2018 Annual Report

Why does this matter?

Being in school or the workforce connects teens and young adults with people, institutions and experiences that help them develop knowledge, skills, maturity and a sense of purpose required to live rewarding lives as adults.


Depression, anxiety and isolation are common among teens and young adults who are neither working nor in school, as are unhealthy behaviors including violence (i.e. being in physical fights), smoking cigarettes and using marijuana. The limited education, lack of work experience, minimal professional networks and social exclusion of disconnected youth have consequences into adulthood and may affect earnings and self-sufficiency, physical and mental health, and relationship quality and family formation.


In 2017, 4.5 million, or one in nine, young Americans were disconnected. It is estimated that the lost revenue and social services investments for disconnected youth cost approximately $93 billion a year and $1.6 trillion over their lifetimes in lost revenues and increased social services.

  • Measure of America, Youth Disconnection Report, 2016

Median Household Income, 2018 Annual Report
Measure: Median Household Income, 2018 Annual Report

Why does this matter?    

The median household income indicates the relative wealth of a geographic area; the higher the median household income, the wealthier the area. Median household income tends to more accurately reflect the typical household of a geographic area than average household income, which can be distorted by a few extremely wealthy households. Median household income reflects a household’s ability to support a healthy lifestyle with quality food, housing, education, preventive medicine and curative care. Individuals with a low household income tend to have a higher prevalences of diseases and die earlier compared with people with higher household incomes, even after taking into account the effect of overall health on their income. There is an increase in stress associated with being in the lower end of the income spectrum, which is associated with unhealthy behaviors and outcomes. Individuals who have a higher burden of stress in adulthood tend to have higher body mass indexes, higher smoking rates, higher alcohol consumption and lower physical activity after adjusting for age.


The median household income in the United States in 2018 was $63,179, which is not significantly different than 2017. This ends three years of increases in median household income.

  • U.S. Census Bureau, Current Population Survey, Annual Social and Economic Supplement, 2017

Severe Housing Problems, 2018 Annual Report
Measure: Severe Housing Problems, 2018 Annual Report

Why does this matter?

Housing influences health and well-being. Those lacking at least one basic household necessity (bathtub/shower, sink with faucet, stove, or refrigerator) have higher rates of being uninsured. Poor quality of housing can cause disease and injury and affect a child’s development, while other housing-related factors such as neighborhood environment and overcrowding can lead to mental and physical health problems. 

Housing-related factors and their associated health consequences include, but are not limited to:

  • Affordability: Cost-burdened families may have difficulty affording other basic needs such as health care, food and heat. Individuals who had difficulty affording housing were more likely to report fair or poor health, certain chronic conditions and non-adherence to prescriptions due to cost. Housing has become less affordable over time as rents have risen more quickly than incomes. Between 2001 and 2019, median rent increased by 15.0%, but median renter household income rose only 3.4% over the same period (numbers adjusted for inflation). This finding underscores the continued importance of federal and local housing subsidies. Nearly 10 million renters were severely cost-burdened in 2018, paying more than 50% of their income toward rent. 
  • Hazards: Hazards in the home (such as lead paint, allergens, water leaks, poor ventilation and inadequate heating, cooling or plumbing) are associated with poor respiratory health and disease, increased risk of cardiovascular conditions and developmental delays in children. 
  • Overcrowding: Overcrowding is defined as having more than one person per room in a residence. It is associated with an increased risk of poor mental health and physical illness, such as tuberculosis and other infectious diseases.
  • U.S. Department of Housing and Urban Development, Comprehensive Housing Affordability Strategy, 2011-2015

Underemployment Rate, 2018 Annual Report
Measure: Underemployment Rate, 2018 Annual Report

Why does this matter?

Underemployment is associated with poorer physical and mental health, similar to the effects of unemployment though its effects have been studied far less. The underemployed are more likely to report lower general well-being as well as lower self esteem, depression, psychological stress, feeling a loss of control, and strained relationships with their spouse, family and friends than adequately employed adults.


The effects of underemployment on the family are profound. Underemployment may lead to breakups or divorce among couples, likely from the strain of depression and financial stress. The stress of underemployment may strain the relationship between parents and children resulting in a less positive household atmosphere. Children may be impacted as they may no longer be able to afford new clothes or participate in activities with their friends.

  • U.S. Department of Labor, Bureau of Labor Statistics, 2017

Unemployment Rate, 2018 Annual Report
Measure: Unemployment Rate, Annual, 2018 Annual Report

Why does this matter?

There is a strong relationship between employment status and mental and physical health. A stable, safe and well-paying job makes it easier for people to live in healthier neighborhoods, provide quality child care and education for their families, afford nutritious food and access medical care — all critical factors to maintaining good health that are jeopardized by unemployment. Unemployment is associated with a higher risk of all-cause mortality, especially among adults ages 18-24. Unemployment may also lead to lower self-esteem, higher levels of depression, straining of family ties and the loss of work friends. The effects of job loss are not limited to the individual: studies have shown that there is a profound effect on impacted spouses and children.

High unemployment rates increase the economic burden on states due to decreased revenue from income taxes and increased demand for unemployment insurance and social welfare programs. Adults who are unemployed have a 2.6 times higher prevalence of being uninsured compared to those that are employed.

  • U.S. Department of Labor, Bureau of Labor Statistics, 2017

Voter Registration, 2018 Annual Report
Measure: Voter Registration, 2018 Annual Report

Why does this matter?

Voting is a form of social engagement and community participation. Active social engagement is associated with better health and health outcomes. Many studies have identified associations between low levels of social participation and mortality even after controlling for baseline health. This relationship is explained two ways, either that higher levels of social participation yields benefits for health and therefore reduces mortality risk, or that low levels of social participation is associated with poor health and therefore increases mortality risk. Similar relationships have been studied between social engagement and physical health, disability, cognitive functioning, cognitive decline and risk of dementia. While these relationships are complex, researchers suggest that active social engagement may help modify the effects of morbidity and mortality by providing adults, particularly older adults, with a greater sense of purpose, control and overall self-efficacy. 


By voting, United States citizens have the opportunity to participate in government by electing leaders and representatives. How people vote may affect various aspects of life including individual wealth, rights, access, health care, education, and social services and programs. In order to vote, citizens must first register to vote. Voter registration eligibility varies from state to state as it is governed by state laws. A considerable number of people are unable to register to vote despite meeting citizen and age requirements.

  • U.S. Census Bureau, Current Population Survey, Voting and Registration Supplement, 2016

Please tell us a little more about you

We appreciate you taking the time to help America’s Health Rankings better understand our audiences. Your feedback will allow us to optimize our website and provide you with additional resources in the future. Thank you.

Please select one option which best describes your profession or field of expertise

Journalist or media professional
Health Policy Professional
Public health professional (state, local, or community level)
Health care provider or administrator
Member of an advocacy group or trade organization
Academic, student, or researcher
Government administrator, legislator, or staffer
Concerned citizen
Don't show me this again
Please take a quick survey.