My experience for years living in several very rural areas of the US leads me to believe that one big factor is "positive peer pressure" and quality food availability.
"Southern" people's rural lives may be calmer and richer in nature, but their hobbies and lifestyle are quite unhealthy.
In big cities there is more social pressure for being good-looking, mainly a healthy BMI and muscles, both which are protective against cancer.
They're also "food deserts" where supermarkets and restaurants with healthy food are extremely scarce. I've been to towns where you'd be hard-pressed to find any vegetables in their menu besides tomato sauce and a pickle. Health literacy is also abysmal. I don't see how they can avoid a heart attack with such food menus.
It's quite ironic that rural living is devolved to processed food garbage in America. I come from rural Poland, vegetables were very much on the table every day be it fresh or pickled. Rural regions are the ones that should be more capable of being self-sufficient compared to say a city because you actually have fucking land.
> The researchers found the expanding gap was driven by rapid growth in the number of women living in rural places who succumb young to treatable or preventable diseases. [...] Pregnancy-related deaths also played a role, accounting for the highest rate of natural-cause mortality growth for women ages 25 to 54 in rural areas.
If I read Figure 1 correctly, overall mortality has actually declined (minus Covid). Even in rural areas mortality has continued to decline while this statistic was tracked. What appears to be the case is its declined _faster_ in urban areas.
Figure 2 shows BOTH metro and non-metro increases in mortality for age groups 25-29 and 30-34.
I think this somewhat makes intuitive sense. I think most people caught Covid. Covid was most risky for people who had other illnesses. In the universe without Covid, many of those people would have died anyway.
The people who survived Covid were on average healthier than the people it killed... so the life expectancy should go up post-peak-Covid.
If you live an hour from an emergency room, all kinds of urgent things will become more fatal statistically and lower life expectancy. Stroke, heart attack, trauma. EMS pays careful attention to the "golden hour" of receiving definitive care being a survival factor. If you have to wait longer for transport (because you're rural) and then wait longer to arrive at the ER, then your hour may be up before you're even seen.
One mitigating factor is rural EMS sometimes has more advanced care options (allowed by their medical director) than urban BLS because they know it's a long ride.
> America’s rural health safety net has been in crisis mode for nearly 15 years. Rural hospital closures, decreasing reimbursements, declining operating margins, and staffing shortages have all coalesced to undermine the delivery of care in communities whose populations are older, less healthy, and less affluent. The mission of the safety net to serve under-resourced communities
is unraveling. The latest research conducted by the Chartis Center for Rural Health points to a startling new phase of this crisis as rural hospitals fall deeper into the red, “care deserts” widen throughout rural communities, and the increasing penetration of Medicare Advantage could further disrupt rural hospital revenue.
I wonder what effect the proliferation of rural dollar stores has had. More junk food and fewer health care facilities is probably not a good combo... And has smoking become more common?
Exercise through everyday walking likely plays a key role. Rural Americans drive everywhere and their most significant walking typically will take place only within stores while shopping.
These particular numbers do not include suicide, but those numbers are very bad too. This Time article was written about our county a couple of years ago. I know a few of the people quoted.
White men in particular are checking out at an alarming rate.
So while this is an "external" cause not counted in the stats of the article, I can't help but assume common causes. The kind of depression that makes you want to die also makes you not want to take care of yourself.
It isn't difficult to get state paid medical care here, except for the distance. Appointments at the two small clinics are not far in the future and the medical staff is competent. I doubt doubling or tripling spending there would have much if any effect.
I think it's more about people who have chosen to live a more traditional lifestyle and discovering that it's an increasingly poor fit for the modern world. A plague of psychiatrists could descend on our county like locusts and bury every depressed person in talk therapy, and I doubt it would help.
Men used to commit suicide at about ~4x the rate of women, now it's closer to ~3.6x.
White people commit suicide at high rates - and have for a long time (compared to other races) - and the growth in suicide in white people is outpacing other groups - but the growth rate is actually higher for white women (~68% vs ~41%).
I'm a bit skeptical of the age grouping. 25-54 is a very wide range, and I would assume cities have more 25-year-olds, whereas the countryside will have more 54-year-olds.
That is the range of ages for which they found an increase but the biggest increase is in the 30-34 age subgroup. The report is not hard to skim, the overall picture is rural populations particularly in southern states are dying much more of "natural" causes like heart disease and cancer, and that divergence from urban populations started in the mid 80s. There's some speculation in the report as to why.
I think that's part of the point: US agricultural policy since at least the 1970s has been "get big or get out", so you'd expect remaining rural populations to be more marginal.
(It's possible to still have viable family farms in 2024, but it requires a willingness to have both (a) economic inefficiencies, and (b) legislative restrictions; although the Home of the Brave might be willing to implement a similar program, the Land of the Free is certainly not)
>I would assume cities have more 25-year-olds, whereas the countryside will have more 54-year-olds.
Would that be true?
For the same total population on each (say, 1M in cities vs 1M in the countryside) I'd expect the countryside to have higher birth rates and younger marrying couples, so younger demographics. Whereas cities have more career focused people, who marry later (if ever), have less kids, and have them at a greater age.
> Within the prime working-age group, cancer and heart disease were the leading natural causes of death
I have a lot of extended family and in-laws who live in rural locations.
The lifestyle differences between what I see in the city and what I see in their rural locations are stark. The norms around diet, exercise, drinking, and smoking are completely different.
Even norms around personal safety and protective gear are completely different. Most of my rural extended family will do things like casually spray pesticides or paint without a mask. I was mocked for pulling out safety glasses and hearing protection for power tools when we worked on a project together once.
The study classifies things like heart disease and cancer as “natural causes” and blames lack of healthcare, but my anecdotal experience is that the lifestyle differences could easily explain the difference in heart disease and probably a significant number of the cancer diagnoses as well.
Even when healthcare is available, many of them don’t trust it. Statins are still a common debate when I visit, with many of the people in mid-life telling me that they don’t work and it’s just a big pharma cash grab conspiracy (even though statins are dirt cheap now). Refusing to take doctor-directed medication is a point of pride for some, though they tend to reverse course in older life when they see their peers start dying young. Many refuse vaccines for themselves and children due to things they heard on podcasts or social media. And mental health? Don’t dare even suggest that one.
It's a machismo built up around preventative behaviors that cost short-term money.
If you're a farmer trying to compete in the last 50 years, your concern isn't with the possibility that you might get cancer in 20 years from the neonicotinoids you're spraying; it's making enough money to cover expenses now.
But your friend who helps you do all sorts of farm chores, he wants to wear protection when he sprays. He's spent money on this protective gear, money that could have been put towards new machinery or the mortgage. He spends five minutes "dickin' 'round" putting it on. Five minutes that could be spent spraying. Since the span of five minutes is easier for the human mind to comprehend than the possibility of health problems months, years, or decades away, you choose to value the five minutes and tell him to get a move on. When he insists, you call him a wimp. He's now been shamed out of the preventative behavior.
Even among some doctors, researchers, and former users there is debate. Not debate about their effectiveness in general, but about which situations should warrant them. There are several common side effects that can significantly impact quality of life.
It's understandable that some people are skeptical of statins based on the history of pharma and their current proposals. For example, I heard a year or two ago that they were looking into recommending statins for everyone over 70. The cholesterol level for when statins are recommended dropped about 50-100 points just a few years ago too.
"The lifestyle differences between what I see in the city and what I see in their rural locations are stark."
Are you comparing neighborhoods of similar socioeconomic characteristics? I've seen plenty of your types of example in urban and rural areas. The big difference is money. The more well-off people in either location tend to be more conscience - diet, exercise, PPE use - than the poorer people.
I can’t even get my parents to care about mold after their basement floods for the 10th time in 10 years. They will worry about superstitions about eclipses, but not any long term health consequence from any source that could be labeled “science”.
My friend (urbanite) was offered statins but declined and instead went on a "P90x" home gym program. Six months later, his doctor agreed that statins weren't needed provided he stayed in shape. Of course, you have to actually do the exercise :)
I think a lot of these studies must either not be considering social factors, or maybe their authors aren't familiar with the worldview of rural America. I grew up in a place where some of those ideas are more popular, and the people around me regularly derided (what I now understand to be) healthy habits as things that 'sissy liberals' did. It was not socially acceptable to be on a diet, go to the gym, wear protective equipment, etc.
> Even when healthcare is available, many of them don’t trust it.
Right, due to bad healthcare. The industry is riddled with bad actors, bad ideology, and patient hostile practices.
From what I've seen of the system it doesn't surprise me that people die instead of getting medical treatment. There's a lot of propaganda and need for reforms.
These same social norms exist in city areas as well. Get a job in a factory and try to get your hands on adequate personal protective gear. You will not last long.
This brain dead machoism is rampant, half the population is promoting a know-nothing facsist pig for president so that they can hammer the last nail in their own coffin.
Article title is “City-Country Mortality Gap Widens Amid Persistent Holes in Rural Health Care Access”
> The study does not address causes for the increase in mortality rates… differences in health care resources could compromise the accessibility, quality, and affordability of care in rural areas. Hospitals in small and remote communities have long struggled, and continued closures or conversions limit health care services in many places. [perhaps also] persistently higher rates of poverty, disability, and chronic disease in rural areas, compounded by fewer physicians per capita and the closure of hospitals, affect community health.
Makes total sense; the rural areas have been manipulated by the shareholder class into selling out most of their quality-of-life-enabling institutions for scrap.
I live in a relatively large Lower Midwestern city. The general attitude of capital and policymakers in the United States after the 1960s became one of confusion about the purpose of the area between the Appalachian Range and Rockies. California was booming, the cities on the East Coast were moving into a service economic model as their factories had been packed up. Why were these people still here? That applies to cities that used to participate in mercantile capitalism (St. Louis is a wonderful example of this) as well as small towns of 150 people. There's a lack of investment that would simply be unacceptable to people in the other parts of the country. Imagine if Amtrak's Northeast Corridor had the reliability of the various Midwestern routes.
This brings up an interesting partial explanation that we might be able to explore with data. A portion of the healthier and more successful rural population will migrate to urban areas, while a portion of the least healthy and less successful will be stuck and unable to leave rural areas. Urbanization as selection.
it would be more interesting to see the health differences by profession. It's a lot easier on your body to sit in front of a computer than be a lineman working for the county.
I think you have to work very hard before it's worse for your body than extended sitting. I make my living in front of a screen so try to mitigate it by going out in the yard and simulating someone who physically works for a living.
Lifestyle differences in rural areas are much more sedentary now that broadband internet is more available. In urban areas you have social factors and other reasons to walk around or stand up for longer periods.
Couple that with the mentioned shrinking of hospital and healthcare access and yeah you’ve got a double whammy.
I think this is right. For counterpoint though, there will of course be variance, but an opposite hypothesis is a larger proportion have labor jobs (men moreso than women).
Grew up in rural PA (mostly farming, some factory work). They exact a significant toll (part of the reason opioid dependence grew IMO).
But most of the metrics I have been seeing in terms of death rates show it is both for men and women, so I don't think labor jobs can explain it.
it's crazy how something seemingly minor, the necessity to walk some real distance for meeting daily needs, has such a wide range of benefits. Unconsciously, it makes you eat better and less, otherwise the walking would be very uncomfortable. It also makes you care about your immediate environment more, because you experience it a lot more directly.
When you don't have that, it's an uphill battle. You have to carve out dedicated time to exercise, and you have to be very conscious of your diet.
Walking makes for a healthier life, it really does, rather than only the healthy opting in for walking.
Can you clarify what you mean by "social politics?"
I ask because rural health is effectively its own subspecialty in family medicine. There doesn't seem to be a locality equivalent for other geographic subgroups. This implies, to me, an extra level of focus on the needs of a population.
Can't afford to see a doctor. Last Doctor I did see told me they would not do a sweat salinity test because I couldn't afford a diagnosis.
Can't buy Sudafed; pharmacies treat the request like you asked them for their virgin daughter.
Can't buy anitbiotics at the feed stores no more; FDA took care of that.
I've got my own individual reasons to doubt the medical industry; I see my neighbors finding many of their own. We're going to need witch doctors and other unlicensed caregivers before long.
Of course, it could be a question of metrics vs incentives, too. Who gets promoted when they juke the stats to say there isn't a problem? "Rural Healthcare" is one of those lovely nebulous goals that can soak up nearly infinite amounts of grant money without ever having to show real results.
[+] [-] hereme888|1 year ago|reply
"Southern" people's rural lives may be calmer and richer in nature, but their hobbies and lifestyle are quite unhealthy.
In big cities there is more social pressure for being good-looking, mainly a healthy BMI and muscles, both which are protective against cancer.
They're also "food deserts" where supermarkets and restaurants with healthy food are extremely scarce. I've been to towns where you'd be hard-pressed to find any vegetables in their menu besides tomato sauce and a pickle. Health literacy is also abysmal. I don't see how they can avoid a heart attack with such food menus.
[+] [-] delfinom|1 year ago|reply
[+] [-] kixiQu|1 year ago|reply
> The researchers found the expanding gap was driven by rapid growth in the number of women living in rural places who succumb young to treatable or preventable diseases. [...] Pregnancy-related deaths also played a role, accounting for the highest rate of natural-cause mortality growth for women ages 25 to 54 in rural areas.
[+] [-] softwaredoug|1 year ago|reply
Figure 2 shows BOTH metro and non-metro increases in mortality for age groups 25-29 and 30-34.
[+] [-] persolb|1 year ago|reply
The people who survived Covid were on average healthier than the people it killed... so the life expectancy should go up post-peak-Covid.
[+] [-] softwaredoug|1 year ago|reply
[+] [-] toomuchtodo|1 year ago|reply
Related:
US Rural Hospital Closures Since 2005 - https://news.ycombinator.com/item?id=36302937 - June 2023 (153 comments)
UNC Rural Hospital Closures - https://www.shepscenter.unc.edu/programs-projects/rural-heal...
[+] [-] imglorp|1 year ago|reply
One mitigating factor is rural EMS sometimes has more advanced care options (allowed by their medical director) than urban BLS because they know it's a long ride.
[+] [-] toomuchtodo|1 year ago|reply
https://www.chartis.com/sites/default/files/documents/charti... ("Unrelenting Pressure Pushes Rural Safety Net Crisis into Uncharted Territory")
> America’s rural health safety net has been in crisis mode for nearly 15 years. Rural hospital closures, decreasing reimbursements, declining operating margins, and staffing shortages have all coalesced to undermine the delivery of care in communities whose populations are older, less healthy, and less affluent. The mission of the safety net to serve under-resourced communities is unraveling. The latest research conducted by the Chartis Center for Rural Health points to a startling new phase of this crisis as rural hospitals fall deeper into the red, “care deserts” widen throughout rural communities, and the increasing penetration of Medicare Advantage could further disrupt rural hospital revenue.
[+] [-] cozzyd|1 year ago|reply
[+] [-] wnorris|1 year ago|reply
[+] [-] jollyllama|1 year ago|reply
[+] [-] delichon|1 year ago|reply
https://time.com/6218385/suicide-rate-new-mexico/
White men in particular are checking out at an alarming rate.
So while this is an "external" cause not counted in the stats of the article, I can't help but assume common causes. The kind of depression that makes you want to die also makes you not want to take care of yourself.
It isn't difficult to get state paid medical care here, except for the distance. Appointments at the two small clinics are not far in the future and the medical staff is competent. I doubt doubling or tripling spending there would have much if any effect.
I think it's more about people who have chosen to live a more traditional lifestyle and discovering that it's an increasingly poor fit for the modern world. A plague of psychiatrists could descend on our county like locusts and bury every depressed person in talk therapy, and I doubt it would help.
[+] [-] onlyrealcuzzo|1 year ago|reply
Due to random noise, there's bound to be some small county with shockingly high suicide rates.
This would be a better, less alarmist, way to look at suicide rates: https://www.cdc.gov/nchs/data/hestat/suicide/rates_1999_2017...
Men used to commit suicide at about ~4x the rate of women, now it's closer to ~3.6x.
White people commit suicide at high rates - and have for a long time (compared to other races) - and the growth in suicide in white people is outpacing other groups - but the growth rate is actually higher for white women (~68% vs ~41%).
[+] [-] KittenInABox|1 year ago|reply
The distance can matter a ton, especially if you're already sick.
[+] [-] wolverine876|1 year ago|reply
[+] [-] unknown|1 year ago|reply
[deleted]
[+] [-] HPsquared|1 year ago|reply
[+] [-] hedgehog|1 year ago|reply
[+] [-] 082349872349872|1 year ago|reply
https://en.wikipedia.org/wiki/Earl_Butz#Secretary_of_Agricul...
(It's possible to still have viable family farms in 2024, but it requires a willingness to have both (a) economic inefficiencies, and (b) legislative restrictions; although the Home of the Brave might be willing to implement a similar program, the Land of the Free is certainly not)
[+] [-] coldtea|1 year ago|reply
Would that be true?
For the same total population on each (say, 1M in cities vs 1M in the countryside) I'd expect the countryside to have higher birth rates and younger marrying couples, so younger demographics. Whereas cities have more career focused people, who marry later (if ever), have less kids, and have them at a greater age.
[+] [-] Aurornis|1 year ago|reply
I have a lot of extended family and in-laws who live in rural locations.
The lifestyle differences between what I see in the city and what I see in their rural locations are stark. The norms around diet, exercise, drinking, and smoking are completely different.
Even norms around personal safety and protective gear are completely different. Most of my rural extended family will do things like casually spray pesticides or paint without a mask. I was mocked for pulling out safety glasses and hearing protection for power tools when we worked on a project together once.
The study classifies things like heart disease and cancer as “natural causes” and blames lack of healthcare, but my anecdotal experience is that the lifestyle differences could easily explain the difference in heart disease and probably a significant number of the cancer diagnoses as well.
Even when healthcare is available, many of them don’t trust it. Statins are still a common debate when I visit, with many of the people in mid-life telling me that they don’t work and it’s just a big pharma cash grab conspiracy (even though statins are dirt cheap now). Refusing to take doctor-directed medication is a point of pride for some, though they tend to reverse course in older life when they see their peers start dying young. Many refuse vaccines for themselves and children due to things they heard on podcasts or social media. And mental health? Don’t dare even suggest that one.
[+] [-] lenerdenator|1 year ago|reply
If you're a farmer trying to compete in the last 50 years, your concern isn't with the possibility that you might get cancer in 20 years from the neonicotinoids you're spraying; it's making enough money to cover expenses now.
But your friend who helps you do all sorts of farm chores, he wants to wear protection when he sprays. He's spent money on this protective gear, money that could have been put towards new machinery or the mortgage. He spends five minutes "dickin' 'round" putting it on. Five minutes that could be spent spraying. Since the span of five minutes is easier for the human mind to comprehend than the possibility of health problems months, years, or decades away, you choose to value the five minutes and tell him to get a move on. When he insists, you call him a wimp. He's now been shamed out of the preventative behavior.
[+] [-] giantg2|1 year ago|reply
Even among some doctors, researchers, and former users there is debate. Not debate about their effectiveness in general, but about which situations should warrant them. There are several common side effects that can significantly impact quality of life.
It's understandable that some people are skeptical of statins based on the history of pharma and their current proposals. For example, I heard a year or two ago that they were looking into recommending statins for everyone over 70. The cholesterol level for when statins are recommended dropped about 50-100 points just a few years ago too.
"The lifestyle differences between what I see in the city and what I see in their rural locations are stark."
Are you comparing neighborhoods of similar socioeconomic characteristics? I've seen plenty of your types of example in urban and rural areas. The big difference is money. The more well-off people in either location tend to be more conscience - diet, exercise, PPE use - than the poorer people.
Edit: why disagree?
[+] [-] lotsofpulp|1 year ago|reply
[+] [-] shrubble|1 year ago|reply
[+] [-] kube-system|1 year ago|reply
[+] [-] P_I_Staker|1 year ago|reply
Right, due to bad healthcare. The industry is riddled with bad actors, bad ideology, and patient hostile practices.
From what I've seen of the system it doesn't surprise me that people die instead of getting medical treatment. There's a lot of propaganda and need for reforms.
[+] [-] datavirtue|1 year ago|reply
This brain dead machoism is rampant, half the population is promoting a know-nothing facsist pig for president so that they can hammer the last nail in their own coffin.
[+] [-] jt2190|1 year ago|reply
> The study does not address causes for the increase in mortality rates… differences in health care resources could compromise the accessibility, quality, and affordability of care in rural areas. Hospitals in small and remote communities have long struggled, and continued closures or conversions limit health care services in many places. [perhaps also] persistently higher rates of poverty, disability, and chronic disease in rural areas, compounded by fewer physicians per capita and the closure of hospitals, affect community health.
[+] [-] unknown|1 year ago|reply
[deleted]
[+] [-] ChrisArchitect|1 year ago|reply
Actual article: https://www.cbsnews.com/news/city-country-mortality-gap-wide...
[+] [-] ZeroGravitas|1 year ago|reply
What is the policy position that explains this decision?
[+] [-] lenerdenator|1 year ago|reply
I live in a relatively large Lower Midwestern city. The general attitude of capital and policymakers in the United States after the 1960s became one of confusion about the purpose of the area between the Appalachian Range and Rockies. California was booming, the cities on the East Coast were moving into a service economic model as their factories had been packed up. Why were these people still here? That applies to cities that used to participate in mercantile capitalism (St. Louis is a wonderful example of this) as well as small towns of 150 people. There's a lack of investment that would simply be unacceptable to people in the other parts of the country. Imagine if Amtrak's Northeast Corridor had the reliability of the various Midwestern routes.
[+] [-] hx8|1 year ago|reply
[+] [-] chasd00|1 year ago|reply
[+] [-] delichon|1 year ago|reply
[+] [-] forgetfreeman|1 year ago|reply
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7700832/
[+] [-] pbnjay|1 year ago|reply
Couple that with the mentioned shrinking of hospital and healthcare access and yeah you’ve got a double whammy.
[+] [-] apwheele|1 year ago|reply
Grew up in rural PA (mostly farming, some factory work). They exact a significant toll (part of the reason opioid dependence grew IMO).
But most of the metrics I have been seeing in terms of death rates show it is both for men and women, so I don't think labor jobs can explain it.
[+] [-] trgn|1 year ago|reply
When you don't have that, it's an uphill battle. You have to carve out dedicated time to exercise, and you have to be very conscious of your diet.
Walking makes for a healthier life, it really does, rather than only the healthy opting in for walking.
[+] [-] forgetfreeman|1 year ago|reply
[+] [-] _psxl|1 year ago|reply
This isn’t an armchair statement.
Reduced institutional emphasis and engagement isn’t the cause of these trends, but it isn’t helpful.
Rural places would benefit from targeted loosening of healthcare regulations. More local experimentation. Clear eyed view of the road to recovery.
Groups like the Cicero Institute have put effort here. Their approach is pragmatic and appears to be effective.
Breakthroughs will not come from traditional institutions.
[+] [-] genericresponse|1 year ago|reply
I ask because rural health is effectively its own subspecialty in family medicine. There doesn't seem to be a locality equivalent for other geographic subgroups. This implies, to me, an extra level of focus on the needs of a population.
[+] [-] unknown|1 year ago|reply
[deleted]
[+] [-] h2odragon|1 year ago|reply
Can't buy Sudafed; pharmacies treat the request like you asked them for their virgin daughter.
Can't buy anitbiotics at the feed stores no more; FDA took care of that.
I've got my own individual reasons to doubt the medical industry; I see my neighbors finding many of their own. We're going to need witch doctors and other unlicensed caregivers before long.
Of course, it could be a question of metrics vs incentives, too. Who gets promoted when they juke the stats to say there isn't a problem? "Rural Healthcare" is one of those lovely nebulous goals that can soak up nearly infinite amounts of grant money without ever having to show real results.
[+] [-] OfficeChad|1 year ago|reply
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[+] [-] ofcourseyoudo|1 year ago|reply
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[+] [-] spiderfarmer|1 year ago|reply
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[+] [-] lettergram|1 year ago|reply
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