The Death-Rate Divergence: Urban vs. Rural
Rural Americans aren’t living as long as urban residents, and a national advisory committee wants to know why. A Thursday, January 28, webinar gives the public a chance to join the discussion about a complex problem that involves healthcare, economics, personal choice, and other factors.
Rural America’s above-average mortality rate ought to be getting more attention than it is, according to a former federal health official who will be part of a presentation this week on rural life expectancy.
“Several million people dying too soon is as important as a terrorist attack, but it’s not on the candidate debates or the evening news,” said Wayne Myers, who was head of the federal Office of Rural Health Policy during the Clinton administration.
From 2005 – 2009, the rural mortality rate was 13% higher than the mortality rate for urban residents, according to a policy brief from the National Advisory Committee on Rural Health and Human Services. Until 1990, both urban and rural death rates were improving at about the same pace (see graph above). But since then rural America has not been keeping pace with improvement in urban areas. Over the past quarter century, the gap has widened.
That’s bad news for the country as a whole, not just rural areas, according to Myers. The same trends may be affecting metropolitan areas but be harder to spot, he said.
“In a large complex city you may have all sorts of trends in different demographic groups headed in different directions and cancelling each other out: trends in prosperity, security, access to medical care, drug use. You can see effects sooner on smaller, more homogenous rural populations. We need some smart statisticians willing to work on smaller populations to sort this out.”
Myers is one of the participants in a Thursday, January 28, webinar that will review the National Advisory Committee’s findings. (The webinar is free and open to anyone who is interested and free. Registration information.)
“I hope the webinar will get some more people wanting to know why too many rural people are dying young,” Myers said. “I think that is really important. Eventually I’d like to see a group convened to sort out what is scientifically known about (1) the impact of social and economic change on people’s health, and (2) what actually works to improve the health of groups of people.”
There are many reasons the rural and urban mortality rates have diverged, according to the National Advisory Committee on Rural Health and Human Services. Rural America is “older, poorer, and sicker than urban America,” they write. Other factors include a rising rate of accidental “poisoning” (which is a polite way to say “drug overdose”), poverty, unintentional injuries (car and ATV wrecks, gun accidents, etc.) and proximity to emergency health services and lack of reliable transportation to get to medical attention. These factors have converged to make rural life expectancy, which was pretty dead even in 1969, a full two years short of urban life expectancy (see Figure 2).
The brief notes that “social circumstances and behavior” are major factors in premature rural deaths, contributing in more than half of rural deaths.
“When discussing mortality and life expectancy—inextricably linked to population and individual health—it is also necessary to examine aspects outside of health care that both lead to poor health and can be used to improve it,” the brief states. “This includes factors in households, schools, places of employment, transportation, and physical environments,” the brief reports.
The brief was presented to Secretary of the Department of Health & Human Services Sylvia Mathews Burwell. Among policy suggestions were support for more research and increased funding for rural medical personnel and programs.