Speak Your Piece: We’re Dying Here

Once an indicator of longevity, a rural address now correlates with a shorter life expectancy. Is America content just to tell rural residents to drop dead?

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Not so very long ago living a rural life was considered as near to healthful as a man or woman had the natural right to expect. At the turn of the 20th century, in fact, selling life insurance to a ruralite, especially if they were a farmer, made for wicked good business. In that Populist gloaming, plowmen and -women practically always outlived even the crustiest actuary’s best estimates of their mortality, and no less than the New York Times reported that farmers were second only to clergymen in longevity, with 40 out of every 100 expected to live past 70. And that was in 1893.

These days, if you look closely at newspaper obituaries published in towns like mine across rural America, you’ll see a shocking number of fatalities of men and women in their 40s, 50s, and 60s. Indeed, as I write this, the week’s crop of premature male deaths listed in our country newspaper includes two rural men aged 46 and 41 years respectively. One, though our newspaper editor mercifully omitted the fact, was widely understood to have been a suicide.

Wrong-headed technocrats and cosmopolitans would have you believe that such morbid numbers in morbidity—an average age of male death of 43.5 for our two weeks worth of obits—represent local anomalies. But when homegrown “anecdotal evidence” joins with empirical research, you have that rare beast otherwise known as fact—real, palpable and (almost) unspinnable.

The week my father’s obituary ran in our local paper, the average age of the male deceased barely topped the age of Social Security eligibility. My father, a corn farmer, passed away just a few months shy of his 61st birthday, and like any rural son I spent more time feeling guilty for whatever lifestyle and risk factors might have taken my dad from us too soon than engaged in the harder problem of solving for demographic x. I recalled my father saying, “You can never save people from themselves,” and so I sat there, obit in hand, thinking that somehow his untimely passing must have been inevitable or somehow earned for failing to live up to some standard of how good and healthy people lived elsewhere—whoever and wherever they were. “No rest for the wicked and the good don’t need it,” my long-lived grandfather, likewise a farmer, always said, and for decades the plowman’s corollary was that if you worked hard, stayed active and “kept your nose clean and your breath sweet,” as my Grampy was fond of saying, you’d be a good bet to dance a jig at your 80th birthday.

Such sweet and enduring agrarian colloquialisms as these may have held true when Ike was president, but no longer. In today’s rural America, Baby Boomer sons who work the land are too often outlived by their own fathers, intimating a trend as spiritually and existentially heartbreaking as it is physiologically unthinkable.


“Mortality Rates Diverge”

Back when Barack Obama was still the apple of Iowa’s eye, I was invited to attend the President’s Rural Economics Forum in Peosta— more of an election-year PR opportunity for the White House, really, than a substantive discussion of rural issues. On my way out I picked up a publication no thicker than my small-town phonebook. “Jobs and Economic Security for Rural America” its title read, and like any Middle American swayed by the enticement of free literature, I flipped through what was intended to be the good-news.

This mortality chart shows how the rate diverges for rural and urban. It was part of a White House white paper.

But as I thumbed to the middle of the government white paper—the burial place of choice for inconvenient truths—I learned that an urban resident was between 10 and 15 percentage points more likely to have attended college than a rural resident. A few more pages in a grim figure titled “Metropolitan and Non-metropolitan Mortality Rates,” stopped me cold, showing as it did two sharply diverging lines. The graph was followed by this coy bit of GovernmentSpeak: “Since the early 1990s, mortality rates in urban and rural areas have diverged.” The cause of the divergence was unclear, the report concluded in bureaucratese, but any rural family could have given the ag experts gathered in Peosta that day an earful of examples of 55- and 60- and 65-year-old nephews and uncles and fathers and even grandfathers taken too soon from them, and in the end would have reached the same sincere conclusion: “We’re dying here.”

Still graver, less sanitized stats can be confirmed in any number of reputable places, including a 2010 study in the Journal of the American Medical Association (JAMA), which found that three-quarters of the counties with the worst declines in life expectancy were rural. The authoritative JAMA study, reflecting changes in longevity between 1985 and 2010, returned a slew of rural counties where, for example, female life expectancies in places counties like Fayette County, Alabama, over the same 25-year period had actually decreased by nearly four years. Predictably the big losers were in a broad swath of non-metro counties in rural, Middle American states like Kentucky and Tennessee and Kansas and Oklahoma. On the flip side of the Death coin was the big winner—New York City—with a net change of life expectancy over the same years of more than 8 years for women and nearly 13 for men.

State Averages Hide Regional Differences

In the Census year of 2000, the New York Times’s Verlyn Klinkenborg trumpeted how my native commonwealth of Iowa ranked first in percentage of population over 80 years of age. Yet a closer look at the JAMA data in 2010 demonstrated that state-level data obscured alarming differences. Any rural Iowan could easily have guessed the counties in her home state where her brothers and uncles were likely to live the longest…and she’d be dead right—Johnson, Linn, Story, Winneshiek. Such geographic markers as these mean little to an out-of-stater, but the pattern likely holds true in your home state: The greatest percentage of happy and healthy gray-hairs can predictably be found in the most metropolitan counties or those housing university or college towns. In other words, it’s the usual suspects.

The year my father passed away, for example, male life expectancy in Cedar County, Iowa, where he was born and raised, lagged behind Iowa City, home to the University of Iowa and just a 40-minute drive away, by nearly 2.5 years. Or consider the difference in 2010 between Story County, site of my alma mater Iowa State University, and its country cousin Marshall County—separated by 40 miles and an unthinkable five-plus years difference in male longevity. That works out to roughly 50 days of extra life for every mile the unsuspecting ruralite might drive west toward the gleaming Oz of a university town.

The new national demographics show just as starkly the grim effects of geography on longevity, pinpointing and projecting where the aged are located—and it’s decidedly not the frozen Midwestern states one might have historically suspected—places like Minnesota, North Dakota, South Dakota and Iowa that less than a decade ago ruled the roost of octogenarians. In the new math of morbidity, states like Iowa, Kansas, Nebraska and the Dakotas barely topped single digits in percentage change from 2000 to 2010 in population aged 85 years or over, while states like Arizona, Colorado and the rest of the West tripled and quadrupled their Midwestern counterparts, boasting a percentage change in number of octogenarians, nonagenarians and centenarians living within their borders at close to 50 percent.

Rejecting Geographic Discrimination

As politicians and planners in my home commonwealth and those like it initiate wishful campaigns to become the healthiest states in America by the year 2016, one can’t help but wonder if we once fiercely egalitarian Middle Americans are OK accepting whole-hog the undemocratic notion that one’s zip code can so dramatically determine one’s attainment of a college education or longevity. The Iowa I knew as a boy would never have accepted a nearly 15-year longevity gap between New York, New York, and Floyd County, Kentucky, nor a nearly 45-percentage point difference in bachelor degree attainment between the residents of Iowa City and the denizens of the small rural towns caught in its outsized orbit. And since when did a young ruralite, whether she be Nebraskan or Arkansan, face such a stark choice between living (and dying) where they love, and loading up the U-Haul to join the new winners in places with the highest percentage of folks aged 65 and over—places like Honolulu or Scottsdale or—surprise, surprise—Surprise City, AZ.

As recently as a generation ago America acknowledged the importance of offering its citizens, regardless of where they hung their hat, something close to geographic parity when it came to the essentials in life—clean air, decent water, passable schools, access to basic health care and a higher education—as part of the democratic ideal. No more. Now, indifferent or just plain ignorant urbanites seem to regard rural living as a self-inflicted health hazard or risk factor…something like smoking or drinking or drug-addiction…a dangerous lifestyle choice accompanied by grave “consequences.” One day soon the well-preserved city slicker attending the wake of his country cousin will pause before his kinfolk’s open casket and offer this dry-eyed if not sober lament: “If only the poor soul would have moved.”

Zachary Michael Jack is the seventh generation in his family to make his home on an eastern Iowa farm. He is the great-grandson of farm and conservation writer Walter Thomas Jack and the author, most recently, of The Midwest Farmer’s Daughter: In Search of an American Icon. He teaches courses in Place Studies and Writing at North Central College. 

 

 

Topics: Health
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