The Highest Permanent Human Settlements
Photo: Yevgeniya Fedorova / Pexels
At 5,100 meters (16,732 feet) above sea level, higher than any Everest base camp, sits a town of tens of thousands of people. La Rinconada, Peru holds the record for the highest permanent human settlement on Earth, according to Guinness World Records. It exists for one reason: gold. Understanding why people live there, and what that altitude does to the human body, reveals as much about economic incentive as it does about physiology, and about how differently populations across the planet have adapted to a world with half the oxygen.
Where La Rinconada sits, and why it exists at all
La Rinconada clings to the side of Mount Ananea in Peru's Puno region, directly below a glacier locals call La Bella Durmiente, "the Sleeping Beauty," according to NASA's Earth Observatory. The town's elevation is reported inconsistently across sources, ranging from about 4,900 to 5,300 meters depending on which part of the sprawling, unplanned settlement is measured, but its upper reaches sit close to 5,100 meters (16,700 feet), a figure confirmed by NASA's satellite imaging of the site.
Population figures vary just as widely as the elevation readings. Official census data put La Rinconada at roughly 30,000 residents as of the mid-2020s, but researchers and journalists who have visited the town, including reporting cited by the American Association for the Advancement of Science, estimate the true number closer to 50,000 to 70,000 people when transient miners are counted, according to Science magazine's coverage of the settlement. That gap exists because the population is fluid. Miners arrive when gold prices rise and leave when the ore runs thin, which is part of why no formal city government has ever been able to plan streets, sewers, or a water system for the place.
There is no urban planning, no sewage system, and no reliable road; access is via a difficult mountain path that switches back up the mountainside for hours. People live there almost entirely because of gold mining, drawn by cachorreo, a traditional pay arrangement in which miners work without wages for roughly thirty days in exchange for keeping whatever ore they can carry out on one final, unpaid day, a practice documented by National Geographic's reporting from the settlement. It is a wager: most days yield nothing extra, but a lucky final day can hand a miner gold worth many months of ordinary wages. That gamble, repeated by thousands of people every month, is the entire economic engine keeping a town at 5,100 meters populated.
Gold prices rose roughly 235 percent between 2001 and 2009, and La Rinconada's population swelled from a small prospector's camp to a small city over the same period, according to figures cited in Wikipedia's summary of municipal and demographic sources for the town. The correlation is not subtle. When gold is expensive, more people are willing to trade their lungs and their long-term health for a shot at it.
What thin air actually does to the body
Atmospheric pressure drops steadily with altitude, thinning out the oxygen molecules packed into every lungful of air. At sea level, air pressure pushes oxygen into your blood efficiently across the thin membranes of your lungs. At 5,000 meters, that pressure is roughly half of what it is at sea level, meaning your lungs have to work with an air supply that is, in a real sense, already "used up" before it reaches you.
The body's main compensation is producing more red blood cells, the oxygen-carrying cells that shuttle oxygen from your lungs to every tissue in your body. Hemoglobin — the iron-rich protein inside red blood cells that actually binds and carries oxygen molecules — increases in concentration as the body tries to squeeze more oxygen-carrying capacity out of thinner air. This response, called polycythemia, is useful up to a point. Beyond that point, it becomes the problem itself.
Overproducing red blood cells thickens the blood, the way adding too much flour to a sauce eventually turns it from pourable to nearly solid. Thicker blood is harder for the heart to pump, raises the risk of clots forming inside blood vessels, and puts sustained strain on the right side of the heart, which handles pumping blood to the lungs. This is the physiological chain behind chronic mountain sickness, sometimes called Monge's disease after Peruvian physician Carlos Monge Medrano, who first formally described the condition among Andean highland populations in the 1920s and 1930s.
Why does chronic mountain sickness hit some residents harder than others?
Chronic mountain sickness tends to strike hardest among people who moved to extreme altitude as adults rather than those born and raised there, because lifelong highland residents often develop compensating adaptations gradually, over childhood and adolescence, that recent arrivals never get the chance to build. Age, sex, and individual variation in the hypoxia response also play measurable roles, which is why not every long-term resident develops the condition even under identical conditions.
Why do people stay if the altitude is this harmful?
The gold beneath La Rinconada is valuable enough, and cachorreo's promise of a debt-free share of ore compelling enough, that economic necessity outweighs the well-documented health costs for many residents. It is a pattern common to extraction boomtowns throughout history, from Gold Rush-era mining camps in California and the Yukon to modern resource frontiers in remote parts of the world, where the presence of a valuable, geographically fixed resource pulls settlement into places that would otherwise never support permanent population.
Three populations, three different evolutionary answers to the same problem
La Rinconada's residents mostly arrived within the last few decades, which is why chronic mountain sickness runs so high there. But humans have also lived at extreme altitude for thousands of years in three separate regions of the world, and in each case, natural selection solved the low-oxygen problem in a genuinely different way.
Tibetan populations on the Tibetan Plateau carry variants of a gene called EPAS1, which regulates how the body responds to low oxygen, that are associated with lower hemoglobin concentrations rather than higher ones, according to research on natural selection signatures in Tibetan and Andean genomes published in PLOS Genetics. Rather than thickening their blood to carry more oxygen per liter, Tibetan highlanders appear to have evolved a strategy that avoids the polycythemia problem altogether, keeping blood viscosity closer to sea-level norms while their bodies extract oxygen more efficiently through other means, such as increased blood flow. Some geneticists trace part of the unique Tibetan EPAS1 variant to ancient interbreeding with Denisovans, an extinct relative of modern humans, a genetic legacy found almost nowhere else on Earth.
Andean populations in the Peruvian and Bolivian highlands, by contrast, do show elevated hemoglobin concentrations relative to sea-level populations, following something closer to the "more red blood cells" strategy, though the genetic signal at EPAS1 is measurably weaker in Andean genomes than in Tibetan ones, according to the same PLOS Genetics comparative analysis. This is a meaningfully different adaptation strategy solving the identical problem: not enough oxygen, arrived at through different genetic routes over a similar multi-thousand-year timescale of highland residence.
Ethiopian highland populations in the Semien Mountains and surrounding regions present a third, independent case. Researchers studying Ethiopian highlanders have identified candidate adaptation genes, including THRB and ARNT2, that show no overlap with the specific genes implicated in Tibetan or Andean adaptation, according to a study published in Molecular Biology and Evolution and follow-up work in PLOS ONE research. Yet both of those genes act on the same underlying biological pathway, called HIF-1, that the Tibetan and Andean adaptations also modify. That combination, three unrelated human populations independently landing on solutions that converge on the same molecular pathway while using different genes to get there, is a textbook example of convergent evolution: separate populations facing the same environmental pressure and arriving at functionally similar outcomes through independent genetic paths.
La Rinconada's population, drawn largely from lower-altitude regions of Peru within the last two generations, has not had anywhere close to that amount of evolutionary time to accumulate protective variants, which helps explain why illness rates there run so much higher than in long-settled highland communities elsewhere in the Andes.
The three stages of altitude sickness, and where La Rinconada fits
Altitude illness is not one condition but a spectrum, and understanding where La Rinconada sits on that spectrum clarifies why its situation is unusual even among high-altitude settlements. Acute mountain sickness (AMS) is the mildest and most common form, typically appearing within hours of a rapid ascent above roughly 2,500 meters and causing headache, nausea, fatigue, and disturbed sleep. Most people who fly into a high-altitude city like La Paz, Bolivia experience some version of AMS in their first day or two, and it usually resolves on its own within 48 to 72 hours as the body begins to adjust.
High-altitude pulmonary edema (HAPE) and high-altitude cerebral edema (HACE) are the severe, acute forms, involving fluid buildup in the lungs or brain, respectively. Both are medical emergencies that can be fatal within hours if untreated, and both are the reason mountaineers ascending peaks like Aconcagua or the Himalayan giants are trained to descend immediately at the first sign of confusion, loss of coordination, or breathlessness at rest. These acute conditions are triggered by fast ascent, which is why the standard climbing advice is to gain no more than 300 to 500 meters of sleeping elevation per day above 3,000 meters.
Chronic mountain sickness, the condition most associated with La Rinconada, is different again. It is not a rapid-ascent emergency but a slow-building consequence of years spent living at extreme altitude without the specific genetic adaptations that protect long-settled highland populations. Where AMS, HAPE, and HACE are acute reactions to sudden low oxygen, chronic mountain sickness is closer to a wear-and-tear condition, developing gradually as the body's short-term compensation mechanism, extra red blood cells, becomes a long-term liability. A resident of La Rinconada might feel perfectly fine on arrival, spend AMS-free weeks at the settlement, and only develop symptoms of chronic mountain sickness years into their residence, once their hemoglobin concentration has climbed to a level their cardiovascular system struggles to manage.
Can chronic mountain sickness be reversed?
Descending to a lower altitude is the most effective treatment for chronic mountain sickness, since it removes the low-oxygen trigger that drives excess red blood cell production, and hemoglobin concentrations typically begin normalizing within weeks of relocating to lower elevation. For residents whose livelihoods depend on staying at altitude, treatment options are more limited, sometimes involving medication to reduce blood cell counts or supplemental oxygen, though neither fully replaces the option of simply leaving.
Other extreme-altitude settlements through history
La Rinconada is the current record holder, but it is not the first time humans have pushed settlement to the physiological edge. The Inca Empire, which dominated the Andes from the early 15th century until Spanish conquest in the 1530s, maintained administrative centers, agricultural terraces, and religious sites at elevations above 4,000 meters across what is now Peru and Bolivia, relying on generations of accumulated Andean physiological adaptation that predates the empire itself by thousands of years. Unlike La Rinconada's recent, gold-driven population, those historical Andean communities were largely composed of people whose ancestors had lived at altitude for many centuries, giving them a very different starting point physiologically.
Potosí, Bolivia, sitting at roughly 4,090 meters (13,420 feet), offers an instructive historical parallel to La Rinconada that predates it by about 500 years. Spanish colonizers discovered vast silver deposits at Potosí's Cerro Rico ("Rich Mountain") in 1545, and the city that grew around the mine briefly became one of the largest and wealthiest cities in the world during the 16th and 17th centuries, populated by both Indigenous Andean laborers, many of whom carried generations of high-altitude adaptation, and Spanish colonial administrators, who did not. Historical records of the period describe widespread altitude-related illness among newly arrived Spanish residents, a pattern that echoes what modern researchers now document among recent arrivals to La Rinconada.
Wamena, in the highlands of Indonesian Papua, sits at a comparatively modest 1,600 meters (5,250 feet), too low to trigger the severe adaptations seen in the Andes, Tibet, or Ethiopia, but it illustrates how "high-altitude settlement" spans an enormous range of severity. At Wamena's elevation, chronic mountain sickness is essentially unheard of; the physiological stress only becomes serious well above 2,500 to 3,000 meters, and severe cases cluster overwhelmingly above 4,000 meters, which is precisely why La Rinconada's altitude, more than 3,000 meters higher than Wamena, puts it in a fundamentally different physiological category.
For context, commercial airliners typically cruise at around 10,000 to 12,000 meters, more than double La Rinconada's elevation, but passengers survive comfortably because the cabin is artificially pressurized to simulate roughly 2,400 meters. Aconcagua, the tallest peak outside Asia, tops out around 6,961 meters. La Rinconada sits closer to base camps for major Himalayan peaks than to any other inhabited town on Earth, which is why acclimatization matters even for short visits, let alone permanent residence.
It is not the only high-altitude settlement worth knowing, just the most extreme one. The table below places several well-documented high-altitude towns and cities side by side.
| Settlement | Country | Approximate Elevation | Primary Reason for Settlement |
|---|---|---|---|
| La Rinconada | Peru | 5,100 m (16,700 ft) | Gold mining |
| El Alto | Bolivia | 4,150 m (13,615 ft) | Adjacent capital-region metro area |
| Potosí | Bolivia | 4,090 m (13,420 ft) | Historic silver mining |
| Colquechaca | Bolivia | 4,170 m (13,681 ft) | Mining |
| Namche Bazaar | Nepal | 3,440 m (11,286 ft) | Trekking hub and acclimatization stop |
| La Paz (city center) | Bolivia | 3,869 m (12,690 ft) | Seat of government, historic settlement |
El Alto and La Paz together form the highest metropolitan area on Earth with a population above two million, according to reporting from Geographical magazine, but no single settlement in that pairing approaches La Rinconada's extreme elevation or its tiny, single-industry economy.
Namche Bazaar in Nepal, roughly 3,440 meters (11,286 feet) above sea level, functions as the last major acclimatization stop for trekkers heading toward Everest Base Camp, according to travel and mountaineering guides describing the route. It sits well below La Rinconada, but its role illustrates a useful comparison point: at Namche Bazaar's elevation, most healthy travelers can acclimatize within a few days. At La Rinconada's elevation, acclimatization is incomplete even after years of residence for a meaningful share of the population.
Think of the human body at extreme altitude like an engine tuned for one fuel mixture suddenly forced to run on a leaner one: it can adapt over time, producing more "fuel-carrying" red blood cells or adjusting how efficiently it extracts oxygen, but the adaptation itself carries mechanical costs. In La Rinconada's case, that cost is thicker blood that is harder for the heart to pump. A second useful comparison: living permanently at La Rinconada's elevation is closer to spending your entire life at Everest Base Camp than to living in any other inhabited city on Earth, since Everest Base Camp itself sits at around 5,364 meters, only slightly higher than La Rinconada's upper edge.
What daily life looks like at the extreme edge of human settlement
Beyond the physiological toll, La Rinconada faces infrastructure problems that compound the altitude challenge. Mercury, used in gold extraction to bind with fine particles of ore, contaminates local water and soil, adding a chemical exposure risk on top of the oxygen deficit, according to National Geographic's on-the-ground reporting from the settlement. There is no municipal waste management, so garbage and mining tailings accumulate around the town's edges. Temperatures at night regularly drop below freezing even though the town sits near the equatorial latitudes of Peru, because elevation dominates over latitude in determining cold at this scale.
Medical care is limited. The nearest hospital equipped to handle serious altitude-related complications, such as advanced chronic mountain sickness or high-altitude pulmonary edema, requires a multi-hour trip down the mountain, according to reporting cited by Science magazine's coverage of the settlement. For a population already weakened by chronic low oxygen, that distance matters in genuine emergencies.
Children born and raised in La Rinconada face a somewhat different physiological trajectory than adult migrants, since growing up at altitude allows some degree of developmental adaptation that arriving as an adult does not. Even so, researchers studying the settlement have found elevated rates of altitude-related complications among children as well, underscoring that La Rinconada sits close to, and in some individual cases may exceed, the outer edge of what sustained human physiology can comfortably tolerate.
Common misconceptions about high-altitude living
A common misconception is that humans simply "get used to" high altitude with no lasting cost, the way a swimmer gets used to cold water after a few minutes. Some acclimatization happens, largely through gradually increased breathing rate and modest, temporary boosts in red blood cell production. But chronic exposure at extremes like La Rinconada carries measurable, ongoing health risks that do not fully resolve the longer someone stays, and in the case of chronic mountain sickness, symptoms often worsen with cumulative years of exposure rather than fading.
Another misconception is that La Rinconada is uniquely inhospitable because of cold alone. Temperature is a real factor and nights there are frequently below freezing, but the primary physiological challenge is oxygen availability, a distinct problem from cold exposure that no amount of warm clothing solves. A well-insulated person at 5,100 meters is still breathing air with roughly half the oxygen molecules of sea level.
A third misconception treats "highest inhabited place" and "highest city" as interchangeable, when definitions matter enormously. La Rinconada is usually described as the highest permanent settlement, a distinct category from the highest capital city (La Paz, Bolivia) or the highest major metropolitan area (the El Alto–La Paz conurbation), because those categories weigh population size and administrative status differently than raw elevation of a continuously inhabited site.
A fourth misconception is that everyone at extreme altitude adapts the same way. As the Tibetan, Andean, and Ethiopian comparison shows, "adaptation" is not one universal biological trick; it is at least three separate evolutionary solutions to the same environmental pressure, arrived at independently over thousands of years, which is precisely why comparing those three populations tells scientists so much about how natural selection actually works.
The takeaway
La Rinconada demonstrates that humans can sustain permanent settlements at altitudes once considered survivable only for short expeditions, but that survival comes with a measurable biological cost, not effortless adaptation. Its existence is less a triumph of universal human adaptability than a case study in how a valuable, immovable resource can pull settlement past what the body comfortably tolerates, and how differently the human genome has answered the same low-oxygen challenge in Tibet, the Andes, and the Ethiopian highlands over thousands of years of separate evolutionary history.
Read next:
- The most isolated inhabited places
- The oldest ice ever found on Earth
- Why blood types matter for transfusions
FAQ
Q: What is the highest permanent human settlement in the world?
La Rinconada, Peru, at an elevation of roughly 5,100 meters (16,700 feet), holds the Guinness World Record for the highest-altitude permanent human settlement, according to Guinness World Records and NASA's Earth Observatory.
Q: Why do people live in La Rinconada despite the extreme altitude?
Gold mining is the primary reason. Many workers operate under cachorreo, a traditional arrangement where they work unpaid for roughly thirty days in exchange for keeping any ore they can carry out on a designated final day.
Q: What health problems does high-altitude living at La Rinconada cause?
Roughly one in four residents is estimated to suffer from chronic mountain sickness, sometimes called Monge's disease, caused by overproduction of red blood cells in response to chronically low oxygen, which thickens the blood and increases the risk of heart strain and clotting.
Q: How does oxygen availability change at extreme altitude?
At La Rinconada's elevation, atmospheric pressure is roughly half that of sea level, meaning each breath delivers roughly half the oxygen molecules a person at sea level would take in.
Q: Did Tibetan, Andean, and Ethiopian populations adapt to high altitude the same way?
No. Genomic research shows each population evolved largely distinct genetic adaptations, involving different genes such as EPAS1 in Tibetans and THRB and ARNT2 in Ethiopian highlanders, that nonetheless converge on the same oxygen-signaling pathway, an example of convergent evolution.
Q: What is the highest city or metropolitan area in the world, as opposed to the highest settlement?
The El Alto–La Paz metropolitan area in Bolivia, home to more than two million people at an average elevation of roughly 3,869 meters, is generally cited as the highest metropolitan area on Earth, distinct from La Rinconada's status as the highest permanent settlement of any size.
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About the Author
SciHub101 is an independent science and technology publication founded and edited by Buğra Sözeri, a software engineer and app developer based in Türkiye. AI tools assist with drafting and research. Source documentation in the existing archive is uneven, and articles are being reviewed and corrected. The Editorial Team byline identifies editorial responsibility; it does not certify specialist or independent human review. Where we compare products, anything built by our own team is labelled as such — see the editorial guidelines and About page for how corrections and disclosures work.
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