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.
Much of rural America grows corn or soybeans. You can drive for literally hundreds of miles and only see these two crops. And it’s not even a corn that is edible, it’s grown to be processed or fed to other animals. Vegetable production is isolated to a few areas. Even then they are often limited to a few crops with narrow seasonality. You can grow vegetables in these areas but it’s not profitable.
Yes but the push towards expansion and financial leverage means that you and your family are out working all day every day. So you have land but you don’t have any fucking time. Beef jerky and Red Bull it is then.
> 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.
A huge factor in my personal experience is the quality of care at the hospital. Many hospitals in more remote locations have poor care. Sometimes it's that doctors who can't get the higher paying jobs at the big hospitals go there, and the facilities have lower budgets for many things. I've had family in the medical field who have worked all over the world and have stated that a few specific hospitals serving rural areas are only slightly better than some of the 3rd world hospitals they've seen. They might be bigger or fancier, but the quality of care is poor and the rate of mistakes are high.
> 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.
Having lived in rural areas, suburban areas, and urban areas, I don't see there being much difference in walking between rural and suburban.
My guess is that it's a combination of rural areas being poorer (less access to healthy food and extra curricular activities) and the lack of societal pressure to be healthy that comes from living in a more isolated environment.
You can exercise all you want (not saying its not good for health, in contrary!), if you eat consistently crap unhealthy food and too much of it it doesn't matter long term (both consistent problems in US population as viewed from literally anywhere else in the world, for past few decades).
Who eat more healthy? More intelligent (since they grok how important it is long term, despite less initial appeal compared to more stronger basic fat&salty&sugary taste), more wealthy (so they can afford it compared to processed junkfood prices pushed to absolute minimum).
Who cooks for themselves from raw ingredients (which ends up being healthier food in general due to many factors)? Again same as above, you need to either have it hardcore baked in your culture like say Italians or French have, or just realize facts, and have some money to afford the extra time (and not juggle 2-3 shitty jobs trying to stay afloat and hovering just above burnout).
Even in major cities in the US, the vast majority of people still drive most places. Sure, downtown office workers can usually walk to get lunch, but that's about the extent of it. Also, exercise is much harder in urban areas, cities have crowded gyms making it harder to work out at peak times, crowded roads making it harder to bike, and constant crosswalks making it hard to get in a consistently-paced run. Rural/suburban people just run on their land/around their neighborhood.
I think one would have to adjust for occupations. I would assume certain types of jobs are more prevalent in one are or the other. For example, you're not likely to find many office workers in a location without large office buildings.
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 don't understand the focus on relative growth rates of very differently-sized groups. If the country had only these two groups and we had seen 100 additional deaths, that would mean ~70 additional male deaths and ~30 additional female deaths. While it is significant on its own that women made up an even smaller portion historically, it doesn't seem to me that that is a better description of the problem at large.
Not that I think this is a gendered issue; suicide attempt rates are about equal between men and women, and the fact that men more often succeed doesn't really have any bearing on their relative mental health.
Free rides are available on request. The clinics are in the only places with any population density, and it wouldn't be practical to add more, which would be in the middle of nowhere. It does contribute to the problem, but there's not much to be done about it.
I'm not sure they're saying that nothing can be done, just that increased healthcare and therapy is unlikely to make a large impact. Addressing the actual problems driving them to suicide could reduce the numbers. They have some programs about USDA aid, lawyers, accountants, etc that farmers can use to address some of the issues.
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.
I'd also guess rural areas have higher birth rates and younger marriages. By the time those kids reach 25, though, a lot of them will have moved to cities. That could still mean HPsquared is correct. I'd need to look up stats to be sure.
Regardless of where you're born, high-paying jobs and the promise of professional growth are in the city.
So 18+ (heading-to-college-and-after) leave their rural homes and rarely go back. Even if they manage to go to a local university, schooling leads to a niche job in some /other/ city far away from home.
Not only that, but agricultural jobs have been dwindling for decades.
Anecdotally, (before my time) my high school used to shut down in the middle of spring so all the teenagers could harvest tobacco. These days that's just grandpa on a giant harvester.
> 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.
Yeah, but its still outright stupid behavior, no matter how you wrap it. And stupidity will always be punished eventually in this world (which is the only way to 'fight' it, since as we know its endless and unlimited in mankind).
'I saved 5 minutes (or half an hour, who cares) so I can die 30 years younger than I had to, yeeehaaa'. Lack of good education, or intelligence, or both.
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.
There is debate, because while statins effectively lower cholesterol, the results don't correlate that people on statins live longer or better - though they often are less likely to die of heart disease.
The effect on mobility, muscle health, and skin health are all downsides of statins.
> 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 don't think that's because of the money. I think their lifestyle choices, natural abilities, worldviews, and other personal factors are the cause of both their limited income, and their attitude towards the health choices they make.
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 medications like that are basically a substitute for a healthier lifestyle. Not everyone can pull off the healthier lifestyle, so the drugs are good for them, but for others, they wouldn't be getting prescribed these drugs if they lived healthier to begin with.
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.
Readit News
"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.
> 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.
Figure 2 shows BOTH metro and non-metro increases in mortality for age groups 25-29 and 30-34.
The people who survived Covid were on average healthier than the people it killed... so the life expectancy should go up post-peak-Covid.
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...
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.
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.
My guess is that it's a combination of rural areas being poorer (less access to healthy food and extra curricular activities) and the lack of societal pressure to be healthy that comes from living in a more isolated environment.
Who eat more healthy? More intelligent (since they grok how important it is long term, despite less initial appeal compared to more stronger basic fat&salty&sugary taste), more wealthy (so they can afford it compared to processed junkfood prices pushed to absolute minimum).
Who cooks for themselves from raw ingredients (which ends up being healthier food in general due to many factors)? Again same as above, you need to either have it hardcore baked in your culture like say Italians or French have, or just realize facts, and have some money to afford the extra time (and not juggle 2-3 shitty jobs trying to stay afloat and hovering just above burnout).
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.
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%).
The trend follows even when evaluated nationally for the urban vs rural rate.
https://www.cdc.gov/ruralhealth/Suicide.html
Not that I think this is a gendered issue; suicide attempt rates are about equal between men and women, and the fact that men more often succeed doesn't really have any bearing on their relative mental health.
The distance can matter a ton, especially if you're already sick.
https://www.opb.org/article/2021/08/03/farmers-are-at-risk-o...
Deleted Comment
Wealth is a proxy for better healthcare, diet and education.
City people are generally richer and walk more.
Rural residents are poorer and drive everywhere.
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)
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.
People often want to raise kids in the type of environment they grew up in.
So 18+ (heading-to-college-and-after) leave their rural homes and rarely go back. Even if they manage to go to a local university, schooling leads to a niche job in some /other/ city far away from home.
Not only that, but agricultural jobs have been dwindling for decades.
Anecdotally, (before my time) my high school used to shut down in the middle of spring so all the teenagers could harvest tobacco. These days that's just grandpa on a giant harvester.
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.
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.
Deleted Comment
'I saved 5 minutes (or half an hour, who cares) so I can die 30 years younger than I had to, yeeehaaa'. Lack of good education, or intelligence, or both.
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?
The effect on mobility, muscle health, and skin health are all downsides of statins.
I don't think that's because of the money. I think their lifestyle choices, natural abilities, worldviews, and other personal factors are the cause of both their limited income, and their attitude towards the health choices they make.
Dead Comment
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.
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.
> 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.