South Carolina residents are dying younger—and not by chance. In a country already struggling with declining longevity, the Palmetto State has fallen further behind. In 2022, its average life expectancy stood at 73.5 years, four full years below the U.S. average of 77.5, according to the National Center for Health Statistics.
That gap reflects a complex interplay of preventable risk factors: air pollution, chronic disease, limited healthcare access, and mental illness. Unlike in many high-performing states, public infrastructure in South Carolina fails to consistently support healthy behaviors or provide timely, continuous care.
A report from Earth.com highlights South Carolina’s lagging performance across multiple health indices, including access to parks, smoking prevalence, and food environment quality. Together, these indicators point to a population exposed to cumulative risk—and a state system that struggles to mitigate it.
According to CDC data, life expectancy in the United States rebounded slightly in 2022 following a COVID-induced drop, but improvements are uneven. South Carolina’s figures remain well below the national mean, a red flag for both state and federal health planners.
Air Pollution and Its Long Tail on Public Health
One of the more insidious but well-documented drivers of early mortality is fine particulate matter, especially PM2.5—particles smaller than 2.5 microns in diameter. As detailed by the U.S. Environmental Protection Agency, these pollutants can enter the lungs and bloodstream, exacerbating heart disease, asthma, and other chronic conditions.
While South Carolina doesn’t consistently exceed EPA thresholds for PM2.5, regional exposure hotspots remain, particularly in urban centers and along industrial corridors. The Healthy States Index notes that South Carolina has a low density of public green spaces and a disproportionately high number of unhealthy food outlets—both of which discourage physical activity and limit access to healthier lifestyles.
These factors aren’t incidental. The EPA warns that even low to moderate exposure to PM2.5 can increase the risk of premature death, particularly among older adults and individuals with preexisting heart or lung disease. South Carolina’s uneven air quality and built environment reflect national trends in health disparity—rural, low-income, and nonwhite communities tend to bear the heaviest burden.
Mental Illness Cuts Deeper Than Suicide
A pivotal meta-analysis published in JAMA Psychiatry analyzed over 200 studies and found that individuals with mental disorders face more than double the risk of early death compared to the general population. On average, mental illness shortens life by 10 years—often not through suicide, but through natural causes like cardiovascular disease, infection, and diabetes.
The review found that 67.3% of deaths in people with mental disorders were due to physical illness, not external causes. Despite this, many states—including South Carolina—lack adequate psychiatric infrastructure. Rural areas in particular remain designated as Mental Health Professional Shortage Areas, according to data from the Health Resources & Services Administration.
Compounding the issue, mental illness is tightly linked to higher rates of tobacco use, sedentary behavior, and poor diet—each of which magnifies risk for premature death. The state’s elevated smoking prevalence, cited in the Earth.com report, remains above national averages despite public health campaigns.
Broken Links in Care and Follow-up
Another structural issue driving South Carolina’s longevity gap is continuity of care. According to the Earth.com analysis, the state shows elevated hospital readmission rates, suggesting significant deficiencies in post-discharge support and care coordination. For patients with chronic illnesses, follow-up visits, access to medications, and transportation to clinics are often lacking—especially in rural or low-income zip codes.
Readmission rates serve as a proxy for overall system performance. High figures often point to underinvestment in preventive care, primary medicine, and social support services. In a region with high rates of obesity, hypertension, and type 2 diabetes, these gaps can compound quickly into excess mortality.
Data from the CDC further reinforce the link between chronic disease and early death. In 2022, heart disease and cancer remained the two leading causes of mortality nationwide. Both are heavily influenced by behavior, environment, and system-level access to early detection and treatment.
The Geography of Health Inequality
South Carolina’s four-year life expectancy gap is not an anomaly—it is an early warning. The disparity reflects a widening health divide between high-income, infrastructure-rich regions and those where systems are under-resourced or absent altogether.
The implications are economic as well as epidemiological. Poorer health outcomes increase state healthcare costs, reduce workforce productivity, and impose a heavier burden on safety-net services. Public health is infrastructure, and its erosion has measurable downstream effects.
State averages can also obscure deep intra-state variation. Some counties in South Carolina outperform the national average, while others lag by nearly a decade. These pockets of high risk, shaped by poverty, pollution, and limited access to services, reinforce the urgent need for targeted intervention.