These are America’s 10 worst states to live and work in for 2023, and there’s a big surprise at the very bottom

With nearly twice as many job openings nationwide as there are workers available to fill them, companies are setting up shop where the workers are.

Each year, as part of our overall assessment of state business climates, CNBC’s America’s Top States for Business study considers how welcoming each state is to workers and their families.

Life, Health and Inclusion is one of the study’s ten categories of competitiveness. And this year, with the nationwide worker shortage so severe, the category is taking on increased importance in our methodology.

We consider multiple quality of life factors, including crime rates, environmental quality, and health care. We also look at the quality and availability of childcare, which is one of the most important factors in getting parents back into the workforce.

Casting the widest possible net for workers means not turning anyone away. So we consider inclusiveness in state laws by measuring protections against discrimination, as well as voting rights. And with surveys showing a substantial percentage of women considering abortion restrictions when making a choice of where to live in the wake of the Supreme Court overturning Roe v. Wade, reproductive rights are part of this year’s equation as well.

As North Carolina Governor Roy Cooper, a Democrat, told CNBC after being named the No. 1 State for 2023, he is worried about gains that southern states have made to become economic powerhouses in recent decades. “You still see people going to Florida and Texas, but you begin to see deterioration over time. Site selectors will tell you these issues matter when it comes time for businesses to make tough decisions.”

Some states are putting out the welcome mat to attract the biggest, happiest, and most diverse workforce — America’s Best States to Live and Work In. These are not those states. By the numbers, these are America’s worst states to live and work in for 2023.

Florida Gov. Ron DeSantis hopes to ride his “War on Woke” to the White House, but it is not winning his state points for quality of life. Supporters of the state’s “Stop WOKE Act”, which DeSantis signed into law in 2022, say it protects employees from diversity, equity and inclusion (DEI) initiatives that DeSantis says are toxic. But many companies consider DEI an economic imperative, and courts have struck down parts of the law. The recent Supreme Court decision on affirmative action in higher education, however, is expected to lead to new legal challenges related to DEI programs in the corporate world.

Florida is also one of the most difficult states to vote in, according to researchers at Northern Illinois University. DeSantis argues that none of this is stopping huge numbers of people from moving to Florida, and he has a point. The state leads the nation in just about every measure of migration. But rated strictly on Life, Health and Inclusion, the Sunshine State can be a dreary place.

2023 Life, Health & Inclusion Score: 129 out of 350 points (Top States Grade: D)

Strengths: Air Quality, Childcare, Worker Protections

Weaknesses: Inclusiveness, Reproductive Rights

Few states have suffered as badly from the scourge of illegal drugs as Arkansas, which has one of the highest violent crime rates in the country, according to FBI statistics. Gov. Sarah Huckabee Sanders blamed the crime problem on lax penalties, as well as prison overcrowding that is forcing the state’s prison system to release some violent offenders before they complete their entire sentences. In April, she signed legislation to stiffen penalties, curtail early releases, and fund new prison space. But crime is just one of the Natural State’s problems. Another is health care, with, for example, just 42 dentists for every 100,000 residents, according to the United Health Foundation.

2023 Life, Health & Inclusion Score: 118 out of 350 points (Top States Grade: D-)

Strengths: Childcare, Air Quality

Weaknesses: Crime, Inclusiveness, Reproductive Rights, Health Care

Tennessee has enthusiastically passed laws targeting LGBTQ+ rights, even if it has meant crossing the bounds of constitutionality — like a ban on drag shows where children are present, which a federal judge struck down in June. Or another law struck down by a federal judge in 2021 that would have required businesses to post a warning sign on restrooms where transgender people are allowed. But plenty of other laws have survived, like a transgender youth sports ban, and laws that provide religious exemptions allowing health care and child welfare professionals to deny service to transgender people.

2023 Life, Health & Inclusion Score: 115 out of 350 points (Top States Grade: D-)

Strengths: Childcare, Air Quality

Weaknesses: Inclusiveness, Crime, Voting Rights

With fewer than 10 licensed childcare facilities per 100,000 residents, the Hoosier State is making it hard for some families to fully participate in the workforce. It is the second-worst figure in the nation (behind Louisiana), according to the advocacy group Child Care Aware. Protections against discrimination under state law are limited as well.

2023 Life, Health & Inclusion Score: 113 out of 350 points (Top States Grade: D-)

Strength: Crime Rate

Weaknesses: Childcare, Inclusiveness

The Show Me State is showing abortion opponents the way. In 2019, the state became the first to enact a so-called “trigger law,” which went into effect moments after the Supreme Court overturned Roe v. Wade in 2022. The law, one of the strictest in the nation, bans all abortions except in the case of a medical emergency, which the abortion provider must prove. Also, Missouri’s violent crime rate is among the nation’s highest.

2023 Life, Health & Inclusion Score: 98 out of 350 points (Top States Grade: F)

Strength: Air Quality

Weaknesses: Voting Rights, Reproductive Rights, Crime

Alabama is one of America’s unhealthiest states, with the fourth-highest rate of premature deaths. It is also one of the most difficult states to vote in, with no in-person early voting and restrictions on voting by mail, according to the Center for Election Innovation and Research. Worker protections are limited, as are protections against discrimination.

2023 Life, Health & Inclusion Score: 86 out of 350 points (Top States Grade: F)

Strength: Air Quality

Weaknesses: Voting Rights, Worker Protections, Inclusiveness, Health

South Carolina is an unhealthy state, both at home and on the job. The state has the nation’s fifth-highest rate of occupational deaths, and it finishes in the top ten for frequent physical and mental distress overall. Legal protections for workers are limited, and the state’s violent crime rate also finishes in the top ten.

2023 Life, Health & Inclusion Score: 86 out of 350 points (Top States Grade: F)

Strength: Air Quality

Weaknesses: Health, Worker Protections, Inclusiveness, Crime, Voting Rights

With just 76 licensed childcare facilities in a state of 4.6 million people, no state does worse than Louisiana in this increasingly important quality of life metric. State lawmakers have begun trying to remedy that, approving $44 million in new funding in the final hours of the 2023 legislative session, quickly signed into law by Gov. John Bel Edwards. Louisiana won’t solve its childcare problem overnight, but the new funding is a down payment on an improvement in the Pelican State’s poor quality of life.

2023 Life, Health & Inclusion Score: 76 out of 350 points (Top States Grade: F)

Strengths: No metrics in the top 25

Weaknesses: Child Care, Crime, Reproductive Rights

Overall health in Oklahoma is not okay, with one of the nation’s highest rates of drug abuse, and the second-highest rate of people without health insurance. The Sooner State‘s 1910 abortion ban remains among the strictest in the nation, even after its state supreme court struck down some parts of it, like the provision that required a medical emergency to justify an abortion. The law makes performing an abortion a felony punishable by up to five years in prison, unless the procedure is necessary to preserve the mother’s life.

2023 Life, Health & Inclusion Score: 75 out of 350 points (Top States Grade: F)

Strength: Air Quality

Weaknesses: Reproductive Rights, Health, Voting Rights

How could 200,000 college educated workers moving to Texas each year possibly be wrong? It depends on how you look at it. With the nation’s highest percentage of people without health insurance and the second lowest number of primary care physicians per capita, all those new Texans are arriving to find a dismal health care system. Texas has the nation’s thirteenth-highest violent crime rate, and it ranks thirty seventh for licensed childcare facilities per capita.

The Lone Star State keeps hacking away at inclusiveness, with laws targeting the LGBTQ+ population, voting rights, and the nation’s strictest abortion ban. Yes, there are enormous economic opportunities in Texas, and it is attracting people from far and wide. But this state also has some Texas-sized issues when it comes to life, health and inclusion. And it is one of the reasons that the state fell out of the overall top five for the first time in the 16-year history of CNBC’s rankings.

2023 Life, Health & Inclusion Score: 53 out of 350 points (Top States Grade: F)

Strengths: No metrics in the top 25

Weaknesses: Reproductive Rights, Health, Voting Rights, Worker Protections, Inclusiveness