Rural Americans – particularly men – are expected to live significantly shorter, less healthy lives than their urban counterparts, according to our research, recently published in the Journal of Rural Health.
We found that a 60-year-old man living in a rural area is expected on average to live two fewer years than an urban man. For women, the rural-urban gap is six months.
A key reason is worse rates among rural people for smoking, obesity and chronic conditions such as high blood pressure and heart disease. These conditions are condemning millions to disability and shortened lives.
What’s more, these same people live in areas where medical care is evaporating. Living in rural areas, with their relatively sparse populations, often means a shortage of doctors, longer travel distances for medical care and inadequate investments in public health, driven partly by declines in economic opportunities.
Our team arrived at these findings by using a simulation called the Future Elderly Model. With that, we were able to simulate the future life course of Americans currently age 60 living in either an urban or rural area.
The model is based on relationships observed in 20 years of data from the Health and Retirement Study, an ongoing survey that follows people from age 51 through the rest of their lives. Specifically, the model showed how long these Americans might live, the expected quality of their future years, and how certain changes in lifestyle would affect the results.
We describe the conditions that drive our results as “diseases of despair,” building off the landmark work of pioneering researchers who coined the now widely used term “deaths of despair.” They documented rising mortality among Americans without a college degree and related these deaths to declines in social and economic prospects.
The main causes of deaths of despair – drug overdoses, liver disease and suicide – have also been called “diseases of despair.” But the conditions we study, such as heart disease, could similarly be influenced by social and economic prospects. And they can profoundly reduce quality of life.
We also found that if rural education levels were as high as in urban areas, this would eliminate almost half of the rural-urban life-expectancy gap. Our data shows 65% of urban 60-year-olds were educated beyond high school, compared with 53% of rural residents the same age.
One possible reason for the difference is that getting a bachelor’s degree may make a person more able or willing to follow scientific recommendations – and more likely to work out for 150 minutes a week or eat their veggies as their doctor advises them to.
Why it matters
The gap between urban and rural health outcomes has widened over recent decades. Yet the problem goes beyond disparities between urban and rural health: It also splits down some of the party lines and social divides that separate U.S. citizens, such as education and lifestyle.
Scholarship on the decline of rural America suggests that people living outside larger cities are resentful of the economic forces that may have eroded their economic power. The interplay between these forces and the health conditions we study are less appreciated.
Economic circumstances can contribute to health outcomes. For example, increased stress and sedentary lifestyle due to joblessness can contribute to chronic health issues such as cardiovascular disease. Declines in economic prospects due to automation and trade liberalization are linked to increases in mortality.
But health can also have a strong influence on economic outcomes. Hospitalizations cause high medical costs, loss of work and earnings, and increases in bankruptcy. The onset of chronic disease and disability can lead to long-lasting declines in income. Even health events experienced early in childhood can have economic consequences decades later.
In tandem, these health and economic trends might reinforce each other and help fuel inequality between rural and urban areas that produces a profoundly different quality of life.
What still isn’t known
It should be noted that our results, like many studies, are describing outcomes on average; the rural population is not a monolith. In fact, some of the most physically active and healthy people we know live in rural areas.
Just how much your location affects your health is an ongoing area of research. But as researchers begin to understand more, we can come up with strategies to promote health among all Americans, regardless of where they live.
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