The 2022 County Health Rankings report, shared in advance with ABC News, offers a unique snapshot of whether and how Americans are thriving -- or as it may be, surviving.
Metrics like these are meaningful as the nation emerges from the COVID-19 pandemic and contends with the "intertwined crises of structural racism and economic exclusion" to examine how living wages or lack thereof "can impact a just recovery," the report said.
"The data reinforces what we've known for some time. People in both rural and urban communities face long-standing barriers, systemic barriers -- avoidable barriers -- that get in the way of groups of people and places in our country from being able to live long and well," Sheri Johnson, co-director of County Health Rankings & Roadmaps and director of the University of Wisconsin Population Health Institute, told ABC News.
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The rankings find "troubling issues" affecting women and families with children regarding economic security and family support, underscoring what the pandemic has repeatedly laid bare: "glaring failures" within the infrastructures of wage equity, child care costs and school funding.
Equal pay is not just a 'women's issue'
Women earn little more than 80 cents for every dollar men earn, on average, for the same work, the rankings find. But that's not all.
To earn the $61,807 average salary of a white man, an Asian woman must work an extra 34 days, the report said.
A white woman must work 103 more days to earn that same $62,000 salary.
The report said a Black woman must work 223 days to make up that difference, while an American Indian/Alaska Native woman would have to work 266 days.
A Hispanic woman would have to work 299 days to make up that salary difference.
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COVID's prolonged toll "exposed the labor force barriers that prevent full participation of women and caregivers" and "places an additional burden on women with low incomes and women of color, who are the least likely to have employer-provided benefits," the study said.
An economic security infrastructure that is inequitable for some weakens the entire system, Johnson said.
"There are consequences when we haven't constructed community conditions for everyone to thrive," Johnson said.
Child care costs exceed what many Americans can afford:
Across counties, a family with two children spends, on average, a quarter of its household income on child care, the report said.
For those making the hourly $7.25 federal minimum wage, child care costs would take up nearly 90% of their annual income.
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By that math, the average child care provider likely cannot afford their own services, which would consume more than half their average $25,460 annual income if they had two children.
"That's pretty striking," Johnson said -- especially when contrasted with the government's suggestion that families not spend more than 7% of their income on child care.
The rankings find that during the pandemic, the lack of affordable child care forced parents - especially mothers - out of the workforce and also hit child care providers, who were disproportionately women, which harmed families' and communities' well-being.
Stark differences in school funding across rural, urban and suburban communities
Half of all counties included in this analysis had school districts operating at a deficit, the rankings find. Among those districts, per-pupil spending, on average, was $3,000 below the annual estimated amount needed to support average test scores.
While schools in large urban metro counties, on average, operated under large deficits, schools in rural counties - the majority of all U.S. counties - were overrepresented among counties with inadequate school funding.
There are "patterns of disinvestment" reflected by the disproportionate geographic spread of school funding deficits, Johnson said.
Many counties in the western and southern U.S. operate with funding deficits. School districts in these counties, on average, spend less than what is estimated to be necessary to achieve national average test scores.
Counties with higher proportions of Black, Hispanic, and American Indian & Alaska Native populations experience funding deficits notably greater than most U.S. counties, the report found. Funding deficits are especially high in the Southern Black Belt region.
A solution - relieving the "stress pathways" that exacerbate poor health among those who were already hurting, Johnson said -- such as "ensuring equal pay for equal work through policies such as paid family leave, paid sick leave, universal basic income, living wage laws, Child Tax Credit expansion, and the Earned Income Tax Credit," the report says.
"We can expect more of the same if we do nothing," Johnson said. "And the same is not fair. It's not just, and it's not necessary."
ABC News' Sony Salzman contributed to this report.