Report Explores the Impact of Severe Housing Cost Burden on Residents

Beaufort County ranks healthiest in South Carolina and Lee County is the least healthy county in the state, according to the annual County Health Rankings, released today by the Robert Wood Johnson Foundation (RWJF) and the University of Wisconsin Population Health Institute (UWPHI). The Rankings are available at

An easy-to-use snapshot that compares counties within states, the Rankings show that where you live influences how well and how long you live. Housing is part of the foundation for living long and well. High housing costs can force some families to live in unsafe or overcrowded housing or even into homelessness. This year’s Rankings State Reports show stark differences across and within counties in the opportunity to afford a home, especially for those with low incomes and people of color. This year’s analyses show that a lack of opportunity for a safe, secure and affordable home is tied to poor health.

The Rankings State Reports call attention to key drivers in health such as severe housing cost burden and its connection to other factors like children in poverty. Among South Carolina’s children living in poverty, 49 percent were living in a household that spends more than half of its income on housing. High housing costs make it difficult for families to afford other essentials that contribute to good health, such as healthy food, medicine or transportation to work or school. Looking at differences by place and race offers a more complete picture of health. In South Carolina, 13 percent of households spend more than half of their income on housing costs but when we look by race—even deeper differences emerge with households headed by Black residents most burdened by severe housing costs at 20 percent compared to White resident households at 10 percent. County by county, severe housing cost burden ranges from 8 percent to 18 percent of households.

When we talk about the overall picture of health and wellness in South Carolina, it is important to remember that it’s not only about access to clinical care, but a collaborative, community-based approach to a healthier state for all residents,” said South Carolina Institute of Medicine and Public Health senior director of strategic engagement Megan Weis. “That’s why our communities, state agencies, businesses, health care providers, policy makers and other partners are working together on initiatives including Live Healthy South Carolina – a united effort supporting the state health improvement plan that outlines priorities and spurs action to improve overall well-being in the Palmetto State.

According to the 2019 Rankings, the five healthiest counties in South Carolina, starting with the most healthy, are Beaufort County, followed by York County, Charleston County, Edgefield County and Greenville County. The five counties in the poorest health, starting with the least healthy, are Lee County, Dillon County, Marlboro County, Marion County and Williamsburg County.

“Our homes are inextricably tied to our health,” said Richard Besser, MD, RWJF president and CEO. “It’s unacceptable that so many individuals and families face barriers to health because of what they have to spend on housing. This leaves them with fewer dollars to keep their families healthy. Imagine the stress and pain that come with unplanned moves. We are all healthier and stronger together when everyone has access to safe and affordable housing, regardless of the color of their skin or how much money they make.”

In addition to the county-level data, the Rankings also features What Works for Health, a database of more than 400 evidence-informed strategies to support local changemakers as they take steps toward expanding opportunities. Each strategy is rated for its evidence of effectiveness and likely impact on health disparities. The Take Action Center also provides valuable guidance for communities who want to move with data to action.

“All communities have the potential to be places where everyone enjoys full and equal opportunity. But the data show that’s not happening in most communities yet. Children of color face a greater likelihood of growing up in poverty, and low-income families struggle to pay rent and get enough to eat,” said Sheri Johnson, PhD, acting director of County Health Rankings & Roadmaps. “It is time to do the difficult work of coming together to undo policies and practices that create barriers to opportunity. The Rankings can help communities ground these important conversations in data, evidence, guidance and stories about challenges and success.”

About the Robert Wood Johnson Foundation
For more than 45 years the Robert Wood Johnson Foundation has worked to improve health and health care. We are working alongside others to build a national Culture of Health that provides everyone in America a fair and just opportunity for health and well-being. For more information, visit Follow the Foundation on Twitter at or on Facebook at

About the University of Wisconsin Population Health Institute
The University of Wisconsin Population Health Institute advances health and well-being for all by developing and evaluating interventions and promoting evidence-based approaches to policy and practice at the local, state, and national levels. The Institute works across the full spectrum of factors that contribute to health. A focal point for health and health care dialogue within the University of Wisconsin-Madison and beyond, and a convener of stakeholders, the Institute promotes an exchange of expertise between those in academia and those in the policy and practice arena. The Institute leads the work on the County Health Rankings & Roadmaps and the RWJF Culture of Health Prize. For more information, visit