"Just like the country as a whole, it's not necessarily where we have shortages of healthcare professionals or facilities. What we have is a maldistribution issue where they are concentrated in the major population areas. Therefore, people who live away from those areas have a much more difficult time to try to get care."
One disturbing commonality between the urban and rural poor is the effect of stress on their health. "It's not just thinking about stress as 'what kind of a day do you have?'" Ludke says. "There is clearly a body of literature out there that says that early in life, even before we are born, we are exposed to stress and it builds up over time to the point where it leads to the onset of disease."
Are people poor because they are stressed, or are they stressed because they are poor? It's a chicken-or-egg question. Regardless, Ludke says there is a link.
"People living in lower socioeconomic conditions are living in environments where there is a higher degree of negative environmental exposure," he says. "They are living under higher stress than people not living in those environments to the point where they would be more susceptible to disease."
Bottom line: No matter where you live, poverty isn't easy.