The worst places to live in America may be worth avoiding, due to problems like rampant crime, economic instability, poor education and public health systems.
To find out what states may be lagging in all these areas, we studied Quality of Life, one of the 10 categories of competitiveness in CNBC's annual America's Top States for Business 2019 study, worth 300 out of 2,500 total points. The category is key in our study because it is one of the most important things businesses look at when deciding where to locate or expand. We use hard data to evaluate all 50 states as places to live — factors including economic opportunity, local attractions, public health, crime, environmental quality and inclusiveness, as measured by legal protections written into state laws.
These 10 states are America's worst places to live in 2019.
10. South Carolina
The Palmetto State derives its nickname from the state tree, the sabal palmetto. It is a hardy tree, known for withstanding extreme weather and disease. It may not be the best metaphor for South Carolinians, who report some of the worst health outcomes of any state. South Carolina has the fifth highest rate of diabetes in the nation, and the 10th highest premature death rate. The state also has a high rate of violent crime.
2019 Quality of Life score: 117 out of 325 points (Top States Grade: F)
Weaknesses: Health, crime rate
Strengths: Air quality, attractions
2018 Quality of Life rank: 9th worst (tie)
9. Mississippi
One of Mississippi's nicknames is the Hospitality State, but the state's famous Southern hospitality does not apply universally to everyone. According to the National Conference of State Legislatures, Mississippi is one of only five states with no protections against discrimination for non-disabled individuals. The health of Mississippians is dismal. The state has the nation's highest cardiovascular death rate and the highest infant mortality rate.
2019 Quality of Life score: 114 out of 325 points (Top States Grade: F)
Weaknesses: Health, inclusiveness
Strengths: Air quality, crime rate
2018 Quality of Life rank: 9th worst (tie)
8. Missouri
Show me a way to stay safe in the Show Me State, which has the sixth highest violent crime rate in the country, according to the FBI. And the violence is not limited to the big cities of St. Louis and Kansas City. Non-metropolitan and rural areas reported 65 murders in 2017 alone. Overall health leaves plenty to be desired. Missouri has the 11th highest rate of preventable hospitalizations in the nation.
2019 Quality of Life score: 110 out of 325 points (Top States Grade: F)·
Weaknesses: Crime, health
Strengths: Air quality, attractions
2018 Quality of Life rank: 6th worst
7. (tie) Indiana
What exactly is a Hoosier? We still do not know for sure, but the numbers suggest it is someone in relatively poor health. The state has one of the highest rates of people who smoke — nearly 23% of adults admit they light up. Public health funding is among the lowest in the nation, and it is unusually difficult to find a dentist, with fewer than 48 dentists for every 100,000 people. Indiana offers no statewide protections against discrimination on the basis of age, marital status, sexual orientation or gender identity.
2019 Quality of Life score: 101 out of 325 points (Top States Grade: F)
Weaknesses: Health, inclusiveness
Strengths: Crime rate, attractions
2018 Quality of Life rank: 5th worst
7. (tie) New Mexico
The state is not trying to be ironic with its nickname, The Land of Enchantment. It is just that by the numbers, it is not living up to the moniker. New Mexico has a serious violent-crime problem — the second highest rate in the country, according to the FBI. This state of just over 2 million people logged nearly 150 murders in 2017 alone. The state also had the 7th highest rate of drug deaths last year.
2019 Quality of Life score: 101 out of 325 points (Top States Grade: F)
Weaknesses: Crime, health
Strengths: Inclusiveness, air quality
2018 Quality of Life rank: 10th worst
5. Oklahoma
People in the Sooner state could stand to get to the gym a little bit sooner. With one of the highest rates of physical inactivity, this state has America's third highest obesity rate. Oklahoma also has the second highest rate of people without health insurance — 14% of the population lacks coverage, second only to neighboring Texas. Oklahoma finishes a sad No. 45 in Gallup's annual well-being index, surveying residents on their attitudes toward their careers, social relationships, financial security, community pride, and physical well-being.
2019 Quality of Life score: 99 out of 325 points (Top States Grade: F)
Weaknesses: Health, well-being
Strength: Air quality
2018 Quality of Life rank: 6th worst
4. Louisiana
The Pelican State's Cajun and Creole cuisine is legendary. It is also not terribly good for you, and that helps to explain why this is America's unhealthiest state. But it is not just the rich food. Louisianans are heavy smokers, they suffer high rates of mental stress; child poverty and the crime rate are high. While there is much to love about the home of the Big Easy, life here can be unusually hard.
2019 Quality of Life score: 94 out of 325 points (Top States Grade: F)
Weaknesses: Health, crime
Strengths: Attractions, air quality
2018 Quality of Life rank: 2nd worst
3. Tennessee
Criminals are hard at work in the Volunteer State, with particularly high rates of burglary and aggravated assault. Like many of its fellow southern states, Tennessee faces serious health challenges. The state has the nation's fifth highest rate of cancer deaths and the sixth highest rate of diabetes. It also suffers from a shortage of mental health providers.
2019 Quality of Life score: 86 out of 325 points (Top States Grade: F)
Weaknesses: Crime, health
Strengths: Attractions, air quality
2018 Quality of Life rank: 4th worst
2. Alabama
Sweet Home Alabama is not necessarily as sweet for those who are not young, white, male and straight. The state is one of only five with no statewide protections against discrimination for non-disabled individuals. This is also one of America's least healthy states, with high death rates from cancer and cardiovascular disease. And this sweet home ranks sixth in the nation for diabetes.
2019 Quality of Life score: 82 out of 325 points (Top States Grade: F)
Weaknesses: Inclusiveness, health, crime
Strength: Air quality
2018 Quality of Life rank: 3rd worst
1. Arkansas
When the Arkansas legislature adopted the official nickname The Natural State in 1995, it said the label recognized the state's "unsurpassed scenery, clear lakes, free-flowing streams, magnificent rivers, meandering bayous, delta bottomlands, forested mountains and abundant fish and wildlife." All of those features still exist, but so do a high crime rate; poor health care, including the nation's fifth highest rate of infectious disease; a lack of some key protections against discrimination; and a bar against localities enacting stronger protections of their own. Landing at the bottom of our list for a second consecutive year, one might say that poor quality of life is the natural state in Arkansas.
2019 Quality of Life score: 76 out of 325 points (Top States Grade: F)
Weaknesses: Crime, health, inclusiveness
Strength: Air quality
2018 Quality of Life rank: Worst
