Rankings Illustrate Health Challenges for Rural America

The latest County Health Rankings report shows dramatic differences between rural and urban counties on several measures, problems that are exacerbated by a lack of access to healthcare.

Another study has quantified the health hazards faced by many rural Americans.

The 2016 County Health Rankings compares health disparities in more than 3,100 counties across 30 measures that include social determinants such as education, jobs, housing, exercise, and commuting times.

As in its previous six annual editions, the latest report shows dramatic differences between rural and urban counties on several measures, most notably premature death rates, for which the gap is widening. Rural counties have higher rates of premature death and one-in-five rural counties saw rises in premature death rates over the past decade while most urban counties improved on that measure.

Much of this could be attributed to rural America’s higher rates of smoking, obesity, child poverty, and teen births, and higher numbers of uninsured adults, says Bridget Catlin, co-director of County Health Rankings.

“Across the nation in general, everybody is getting healthier. But it doesn’t apply to every location and this is the wake-up call,” Catlin says. “A lot of people tend to think there are not a lot of people in rural areas, but that is not true either, because one-in-six Americans lives in a rural county.”

Catlin says problems around rural health are exacerbated by a lack of access to healthcare.

“It is difficult for rural residents to have access to medical care and it is difficult for the healthcare system to provide services,” she says. “You cannot build a hospital in every rural town. It is not sustainable or feasible. What you can start doing is moving towards telemedicine services. There are a lot of medical services where there is no physician contact between the provider and the patient, so those services can be provided remotely.”

Other Lagging Indicators

The data also show that many rural counties are lagging on other health behaviors.

“There are still higher numbers of smokers in rural communities, and the level of obesity is higher in rural communities,” Catlin says. “People have an image of rural living as active on the farm and moving all the time so you don’t need exercise. That is not the reality. A lot of people living in rural areas are not that physically active during the day, but they also can’t get out and walk down the street or exercise after work because rural areas don’t have sidewalks and there certainly isn’t a gym on every corner to use when the weather is bad.”

And there are social and economic barriers that make life stressful for rural Americans.  

“Those are things like good jobs that pay at least a living wage, and education that helps you get a good job, and public transit [which is]is few and far between in rural areas,” Catlin says.

The 2016 Rankings include new health-related measures and found that:

• Residential segregation between African-Americans and whites, a fundamental cause of health disparities, is highest in counties in the Northeast and Great Lakes regions and lowest along the Southeastern seaboard. In areas where African-American and white residential segregation is highest, there are typically vast differences in health, well-being, opportunity, and quality of life.

• Drug overdose deaths have increased 79% nationwide since 2002 and are reaching epidemic proportions in parts of the nation. The highest death rates are in counties in northern Appalachia and parts of the West and Southwest.    

• One-in-three adults don’t get enough sleep, less than seven hours a night. Lack of sleep is tied to higher levels of stress and depression, hypertension, heart and kidney disease, motor vehicle accidents, and suicide. The highest rates of insufficient sleep are found in counties in the Southeast states and the lowest rates are in the Plains states.

Many of the metrics in these Rankings play off of one another in one unhealthy loop. Teen births lead to childhood poverty and low educational attainment, which leads to low-wage jobs and economic insecurity, which creates stress that leads to depression, which leads to self-medication because of a lack of access to mental health resources. A lack of access to healthy foods leads to poor diet choices, which leads to obesity, which leads to diabetes and other chronic health issues, which leads to depression, and so on.

But these are not fore-ordained, hard-and-fast determinants. People overcome disadvantageous economic, social and health-related circumstances every day. The data, however, clearly shows a linkage.

“Many of them are related, and that is why we encourage communities to look at their entire snapshot, all of the factors, and think about picking several of them that are closely related and looking for solutions,” Catlin says. “Look at your current needs and assets and pick areas to focus on. You can’t work on everything at once but pick a few important areas and look for solutions.”

The Rankings also provides a data base that pairs different strategies to address specific challenges such as smoking cessation and obesity, along with studies that show which strategies work and which don’t.

Catlin says healthcare providers and advocates should use the Rankings as a “call to action.”

“Everybody can do something to improve their environment. You don’t have to sit back and wait for others to do things,” she says. “I wish it were easy, that there was a single magic bullet that would help reverse this worsening trend. There isn’t. It’s going to take action on a number of different fronts. There is more to health than healthcare.”