City-country mortality gap widens amid persistent holes in rural health care access

Rural-Urban Mortality Gap in the United States Widens, Highlighting the Need for Stronger Policies on Rural Health

In a recent report by the Department of Agriculture’s Economic Research Service, it was found that the gap in mortality rates between rural and urban Americans has been growing. The study analyzed death data from the Centers for Disease Control and Prevention and compared two three-year periods, 1999-2001 and 2017-2019. The researchers discovered that rural Americans aged 25 to 54 had significantly higher rates of natural-cause mortality, such as chronic diseases and cancer, compared to their urban counterparts. The gap between the two groups increased from 6% in 1999 to 43% in 2019.

Key Findings:

1. The expanding gap in mortality rates was driven by a rapid increase in the number of women living in rural areas who died young from treatable or preventable diseases.
2. Cancer and heart disease were the leading causes of death for both men and women in both rural and urban areas.
3. Lung disease and hepatitis had higher incidence rates in rural areas compared to urban areas among women.
4. Pregnancy-related deaths accounted for the highest rate of natural-cause mortality growth among women aged 25 to 54 in rural areas.
5. Rural non-Hispanic American Indian and Alaska Native people experienced particularly pronounced disparities, with a 46% increase in natural-cause mortality rates over two decades.

The study highlighted the negative impact of these increasing mortality rates on population health, local economies, and employment. Access to and quality of health services in rural areas have been declining, which calls for stronger policies focused on rural health.

Causes and Solutions:

• The report did not specifically address the causes for the increase in mortality rates, but it noted that differences in health care resources could compromise the accessibility, quality, and affordability of care in rural areas.
• Persistently higher rates of poverty, disability, and chronic disease in rural areas, along with fewer physicians per capita and the closure of hospitals, contribute to the health disparities.
• Efforts to sustain hospitals in rural communities may not be the most effective approach to addressing the inequities. A community-based approach that focuses on keeping the community alive as a whole is suggested.
• State lawmakers can play a crucial role by advocating for Medicaid expansion, which would increase access to health care in rural areas. Two-thirds of people living in nonexpansion states support Medicaid expansion.

Implications and Recommendations:

The widening rural-urban mortality gap calls for greater attention from state and national leaders. The study emphasizes the need for policies that address the underlying factors contributing to poor health outcomes in rural areas, such as poverty, limited access to care, and chronic diseases. Efforts should be made to improve access to affordable and quality health services in rural communities, including expanding Medicaid coverage. Additionally, more research is needed to understand the impact of the COVID-19 pandemic on rural-urban life expectancies.

By prioritizing rural health and implementing sustainable solutions, progress can be made towards achieving the Sustainable Development Goals (SDGs), particularly Goal 3: Good Health and Well-being, Goal 1: No Poverty, and Goal 10: Reduced Inequalities.

This article was reprinted from khn.org, a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF – the independent source for health policy research, polling, and journalism.

SDGs, Targets, and Indicators

1. Which SDGs are addressed or connected to the issues highlighted in the article?

• SDG 3: Good Health and Well-being
• SDG 10: Reduced Inequalities
• SDG 11: Sustainable Cities and Communities

2. What specific targets under those SDGs can be identified based on the article’s content?

• SDG 3.4: By 2030, reduce by one-third premature mortality from non-communicable diseases through prevention and treatment and promote mental health and well-being.
• SDG 10.3: Ensure equal opportunity and reduce inequalities of outcome, including by eliminating discriminatory laws, policies, and practices and promoting appropriate legislation, policies, and action in this regard.
• SDG 11.1: By 2030, ensure access for all to adequate, safe, and affordable housing and basic services and upgrade slums.

3. Are there any indicators mentioned or implied in the article that can be used to measure progress towards the identified targets?

• Mortality rates of people living in rural areas compared to urban areas.
• Natural-cause mortality rates for different age groups in rural areas.
• Increase in natural-cause mortality rates for women in rural areas.
• Leading natural causes of death for different demographic groups in rural and urban areas.
• Disparities in Medicaid expansion and its impact on access to healthcare in rural areas.

Table: SDGs, Targets, and Indicators

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Source: news-medical.net

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