In a week when national health care legislation is being substantially revised comes a report on health disparities between rural and urban Americans. While all-cause mortality has been declining, rural communities are seeing slower rates of improvement than urban communities, resulting in a substantial difference in mortality rates. The report focuses on 5 leading causes of death–heart disease, cancer, unintentional injury, chronic lower respiratory disease, and stroke–and discusses risk factors that differ between the two populations and how to mitigate those risks in rural settings. For example, the rate of tobacco smoking is higher in rural populations which is one reason why chronic lower respiratory disease is more prevalent. Reducing smoking through prevention and cessation should therefore help reduce the disparity in mortality rate, although achieving goals of reduced smoking is not trivial.
Particularly relevant to current legislative priorities is the observation that fewer people have health insurance in rural communities than in urban ones. They also have less access to health care which manifests in a variety of ways, from fewer physicians overall to fewer available specialty practices. Exacerbating the lack of health care providers is a lack of transportation options to get to the physicians and treatment facilities that are available. Public policy and legislative priority will determine whether and how these gaps in access and insurance between rural and urban communities get closed.
It is worth reiterating that the gap in mortality rate is the result of health factors getting better at different paces rather than getting worse. At the same time, health is not guaranteed to improve indefinitely for any group. Structural and behavioral risk factors are particularly susceptible to change, as we are currently seeing with increases in opioid abuse and suicide. New health challenges can also emerge, as the story of a multi-drug-resistant infection in Nevada reminds us. We can and should be optimistic for our collective future health, we just have to remember that progress or even maintaining the status quo is not automatic. And as we care for our future health, we should be mindful that no one is being left behind.