Life expectancy in the United States has risen steadily over the past five decades, climbing from 70.8 years in 1970 to 77.5 years by 2022 according to the Centers for Disease Control and Prevention. Yet this national figure masks wide variation at the county level. In North Dakota, where the state average sits at 78.1 years, several counties fall short of that benchmark. Understanding why some North Carolina counties with the lowest life expectancy face similar challenges helps frame the discussion for North Dakota. The factors that shorten life spans track closely with infrastructure quality, economic structure, healthcare access, and the built environment. For construction professionals and real estate developers, these patterns offer a clear signal: communities that need better design and healthier infrastructure are often the same ones where life expectancy trails the state average.
About 25 percent of human lifespan is determined by genetics, according to the National Library of Medicine. The remaining 75 percent depends on environmental, behavioral, and socioeconomic conditions. Research from the National Institutes of Health shows that health habits including diet, not smoking, minimal alcohol intake, maintaining a healthy weight, and regular physical activity can add more than a decade to life expectancy. But those habits are shaped by where people live. Access to sidewalks, grocery stores, healthcare facilities, clean water, and safe housing all influence how long residents live. When these infrastructure elements are missing, life expectancy falls.
Life Expectancy Across North Dakota: County-Level Patterns
North Dakota’s overall life expectancy of 78.1 years places it near the middle of the national range. The spread between counties is substantial. Data from the 2024 County Health Rankings and Roadmaps, produced by the University of Wisconsin Population Health Institute, combined with mortality data from the National Vital Statistics System, reveals which counties lag behind. The counties with the shortest life expectancies tend to share several characteristics: lower population density, higher poverty rates, fewer healthcare resources per capita, and economies tied to resource extraction or agriculture.
How the built environment and rural infrastructure affect life expectancy in South Dakota counties mirrors what researchers see across the border in North Dakota. A 2020 study from Penn State, West Virginia University, and Michigan State University found that communities with higher population density, more fast food restaurants, and high concentrations of extraction industry jobs tend to have shorter life expectancies. These factors compound health risk. A county with a booming oil economy may generate wealth for some residents while exposing others to air pollution, industrial accidents, and stress from rapid population change.
| County | Life Expectancy (Years) | Difference from State Average | Primary Economic Sector |
|---|---|---|---|
| Williams County | 78.0 | -0.1 | Energy (Bakken Shale Oil), Agriculture |
| Rolette County | 76.5 | -1.6 | Healthcare, Government, Agriculture |
| Benson County | 76.2 | -1.9 | Agriculture, Government |
| Sioux County | 75.8 | -2.3 | Government, Agriculture |
| McKenzie County | 77.2 | -0.9 | Energy (Bakken Shale Oil), Agriculture |
Williams County: Energy Boom and Infrastructure Pressure in the Bakken Region
Williams County, anchored by the city of Williston, sits at the center of the Bakken shale oil formation. The county has experienced one of the most dramatic economic booms in recent American history. Housing construction has raced to keep up with an influx of workers. Roads, water systems, and healthcare facilities have all been stretched thin. Despite this growth, Williams County records a life expectancy of 78.0 years, 0.1 years below the state average. The gap is small but significant given the resources flowing into the region.
How Rapid Development Affects Community Health
Rapid population growth in Williams County has created infrastructure challenges that directly affect health outcomes. Housing shortages have led to overcrowding and temporary worker camps. Water and wastewater treatment facilities have required major upgrades to handle increased demand. Emergency medical services face longer response times as the geographic spread of development outpaces road improvements. These are the kinds of infrastructure deficits and construction challenges in California’s lower life expectancy counties that appear across the country.
Air Quality and Industrial Emissions
Oil and gas extraction in Williams County releases volatile organic compounds, nitrogen oxides, and particulate matter into the air. Studies have linked these pollutants with higher rates of respiratory illness, cardiovascular disease, and premature mortality. The proximity of drilling sites to residential areas, schools, and healthcare facilities means the health burden falls unevenly. Residents near extraction sites face higher health risks than those farther away, a pattern that mirrors environmental justice concerns in other energy-producing regions.
Socioeconomic Drivers of Low Life Expectancy in North Dakota Counties
Beyond the energy sector, several North Dakota counties struggle with life expectancy due to persistent socioeconomic challenges. Poverty, unemployment, low educational attainment, and limited healthcare access all contribute to shorter life spans. The Arkansas counties where residents live longest show the mirror image: higher income, better education, and stronger healthcare infrastructure all correlate with longer life. The same principles apply in North Dakota, where counties with higher poverty rates and fewer healthcare resources per capita tend to have lower life expectancy.
Poverty and Access to Healthcare
In counties like Rolette, Benson, and Sioux, poverty rates exceed 20 percent and in some areas approach 30 percent. These counties also have fewer physicians per capita, longer travel times to hospitals, and higher rates of uninsured residents. When people cannot afford regular care or must travel far to reach a provider, preventable conditions such as hypertension, diabetes, and heart disease go untreated and shorten life expectancy. The lack of preventive care infrastructure in these counties results from construction and investment patterns that have left rural areas behind.
Housing quality is another critical factor. Homes with lead paint, mold, poor heating, and bad ventilation contribute to chronic illness. In counties with older housing stock and limited new construction, residents are more likely to live in units that harm their health. Retrofitting substandard housing is a major opportunity for construction firms and developers who understand the health impacts of their work.
Food Access and the Built Environment
Counties with low life expectancy in North Dakota often qualify as food deserts, where residents have limited access to fresh produce and healthy food options. The 2020 study linking fast food restaurant density to shorter life expectancy is relevant here. When the only nearby food options are convenience stores and fast food outlets, diet quality suffers regardless of individual motivation. Building grocery stores, farmers markets, and community gardens in underserved areas is a construction-driven intervention with measurable health benefits.
Rural Infrastructure Deficits and Their Health Consequences
Infrastructure that supports healthy living is not evenly distributed across North Dakota. Rural counties face deficits in transportation, water quality, broadband internet, and recreational facilities that compound health risks. Roads in poor condition increase accident rates and delay emergency response times. Aging water systems expose residents to contaminants including lead, arsenic, and nitrates. Limited broadband access restricts telemedicine use, especially damaging in areas where the nearest hospital is an hour or more away.
Transportation Infrastructure and Emergency Response
For every minute between a cardiac event and emergency medical intervention, survival odds drop. In rural North Dakota counties, ambulance response times routinely exceed national guidelines. Long distances, poorly maintained roads, and limited emergency medical service staffing mean treatable emergencies become fatal at higher rates. Investing in road improvements, ambulance station placement, and emergency communication systems is a direct investment in community health and life expectancy.
Water and Wastewater Infrastructure
Access to clean drinking water is fundamental to public health. In several North Dakota counties with low life expectancy, water infrastructure is aging and underfunded. Well contamination from agricultural runoff, oil and gas operations, and failing septic systems exposes residents to bacteria, nitrates, and industrial chemicals. Chronic exposure to contaminated water contributes to gastrointestinal illness, kidney disease, and certain cancers. Replacing and upgrading water treatment plants, distribution lines, and household well systems requires coordinated construction programs with measurable returns in population health.
Construction and Community Design Strategies for Longer Life Expectancy
The link between the built environment and life expectancy is a practical framework for prioritizing construction projects, allocating infrastructure funding, and designing communities that support longer, healthier lives. Building quality infrastructure to improve life expectancy in New Jersey counties demonstrates how targeted construction investments produce measurable health outcomes. The same approach applies in North Dakota, where counties with the greatest infrastructure needs are also those with the shortest life expectancies.
Walkable Communities and Active Transportation
Sidewalks, bike lanes, and connected street networks encourage physical activity and reduce health risks of sedentary lifestyles. In North Dakota’s rural counties, many communities lack basic pedestrian infrastructure. Roads are designed primarily for vehicles, making walking and cycling dangerous. Construction projects that add sidewalks, crosswalks, multi-use paths, and safe road crossings give residents practical options for daily physical activity. Benefits of regular walking include reduced risk of heart disease, stroke, diabetes, and depression.
Healthcare Facility Design and Placement
Where healthcare facilities are built matters as much as what services they offer. In counties with low life expectancy, hospitals and clinics tend to be concentrated in county seats, leaving outlying residents with long travel times. Decentralized models including rural health clinics, telehealth hubs, and mobile health units can extend access without requiring every resident to drive to a central location. Construction of these facilities should be guided by geographic health data to ensure new infrastructure reaches populations that need it most.
The relationship between housing density and health outcomes deserves attention from developers and planners. Higher density developments, when designed well, can reduce vehicle dependence, improve access to services, and create social connections that support mental health. But the 2020 study also found that higher population density correlates with more fast food restaurants and shorter life expectancy when not accompanied by thoughtful community design. The key is not density itself but the quality of the built environment. Mixed-use developments that include grocery stores, healthcare services, parks, and affordable housing in walkable configurations outperform single-use developments on every health metric.
The data from North Dakota counties with short life expectancy tells a clear story. Communities that rank lowest on this metric are not doomed by genetics or geography. They face systematic disadvantages in infrastructure, economic opportunity, and access to healthy environments. These are problems that construction, engineering, and real estate development can address directly. Every sidewalk built, every water line replaced, every clinic constructed represents a measurable step toward closing the life expectancy gap between North Dakota counties. The construction industry has a central role in shaping communities where residents live longer, healthier lives. Improving life expectancy through quality community design in North Carolina reinforces the same lesson: the built environment is a determinant of health, and those who build it carry responsibility for the health outcomes it produces.