The Declining Health of Rural America


Public health researchers have always posited that where you live has a significant impact on your health and well-being. While health outcomes between rural and urban America have historically been different, newly released data from the CDC shows that mortality rates in rural areas are actually plateauing or even increasing. Compared to people living in urban or suburban areas, rural Americans are more likely to die from heart disease, cancer, unintentional injuries, chronic lower respiratory diseases (CLRD), and stroke -- the five leading causes of death in the U.S.

According to the charts below, rates of heart disease, cancer, and stroke in rural areas have decreased or plateaued since 1999, but at a much slower pace than in urban areas. And after years of this decline, researchers now see a troubling uptick in the number of premature deaths. The rural-urban gap is most striking in deaths from unintentional injury and CLRD.


Compared to urban Americans, people living in rural pockets are 50% more likely to die from unintentional injuries like suicide or drug overdoses. The opioid epidemic is partly to blame, as it is largely concentrated in rural America. But the CDC also points to lack of access to trauma facilities that could provide quick treatment. Rural Americans are also much more likely to die from CLRDs, due in large part to the higher prevalence of smoking. 

People living in rural pockets face numerous barriers to healthcare that only widen the gap, including lack of preventive or screening services, timely emergency services, and health workforce shortages. In fact, only 11% of physicians choose to practice in rural areas, which also lack critical subspecialty care (such as oncology). In addition, rural counties have a higher uninsured rate, longer service times due to distance from care, and limited transportation options.

Researchers found that better public health resources and health care access in rural areas could have prevented 70,000 deaths, including 25,000 heart disease deaths and 19,000 cancer deaths. However, they argue that focusing solely on improving access to care is insufficient. Substance abuse services are critical to preventing and treating overdose victims. Resources should be allocated based on unique health needs of each community and also address the specific risk factors that widen the urban-rural health gap. 

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