Study sheds light on urban vs. rural life expectancy

Those of us who live in rural America like to point out that our way of life — living in the country — is just better. We have less violent crime, less traffic congestion, more peace and quiet, and less smog than our urban neighbors. Simply put, the grass is greener on our side of the fence — and the sky is bluer, the air is cleaner, the water is purer, etc.

The problem is that these things aren’t helping us out-live our urban counterparts. However advantageous it may be to live in the country as opposed to living in a suburb or — even worse — in an urban environment, the fact is that our life expectancy is lower and our death rate is higher.

This chart, prepared by The Washington Post, is a good visual aid:


You don’t need overlays for population density or income per capita to realize that widespread, below-average life expectancy is largely in America’s poverty-stricken rural areas. Take away portions of the Dakotas and the South sticks out on that map like a sore thumb. Part of it is geographical, of course. There is plenty of rural America to be found in the northern Plains, the Rockies, and etc., and those areas — with some notable exceptions — are not only meeting but in many cases exceeding the national average.

But the combination of geography and income is evident. Take Tennessee, for example. There’s only one county in the Volunteer State with that nice deep teal color that signals a life expectancy of 80 years or greater. And that is Williamson County — by far the state’s most affluent county. And the areas with the lowest life expectancy are centered outside the metropolitan areas of Knoxville, Nashville, Chattanooga and Memphis.

All of this is based on a study released today by JAMA Internal Medicine. In its story on the report, The Washington Post spells it out: “People are less likely to live longer if they are poor, get little exercise and lack access to health care, the researchers found. Mokdad said the quality and availability of that health care — for example, access to screening for signs of cancer — has a significant effect on health outcomes.”

If it were just geography, the report might be easy to dismiss. But the fact that some areas have a difference of 20+ years in life expectancy from one county to the next indicates that this is an issue over which we have much control. As America debates the way forward for health care, that’s worth remembering — and it’s worth having rural-minded representatives in Congress who will carry the fight for those of us who live outside of suburbia (I’m talking to you, Congressman Fleischmann. You, too, Senator Alexander. And Corker.

Here’s the reality, according to the data: If you live in Scott County, Tennessee, the numbers say that you will die three years sooner than the average Tennessean, and six years sooner than the average American. The life expectancy here is 73.4 years, while the average life expectancy in the Volunteer State is 76.3 years and the average life expectancy in the U.S. is 79.1 years.

Does that alarm you? It should. Because, on the whole, the Upper Cumberland region has one of the shortest life expectancies in the entire southeastern United States — and, as the map above shows, the southeastern U.S. is lagging well behind much of the rest of the nation when it comes to how long we’re living. In Williamson County, meanwhile, life expectancy is a whopping 81.9 years. So why should a resident of Williamson County live nearly a decade longer than a resident in Scott County?

Or, perhaps another question is this: Is America not wealthy enough that we can build a health care system that transcends socioeconomic factors?

Behavioral experts would be quick to tell you that it’s not a black-and-white issue, because some of the same factors that drive lower per-capita income and higher poverty rates in rural America also drive poorer health. They’ll point to less education in rural America, which often fails to produce ambitious entrepreneurs that employ their friends and neighbors, fails to attract relocating companies that offer higher wages, and, unfortunately, also spurs a lack of self-health awareness. (Some of the more arrogant — if not downright misinformed — behaviorists would even suggest that laziness prompts both poverty and poor health.)

But there are also some truths that cannot be ignored. If you’ve been paying attention to the news, you’re aware of how Scott County and other rural counties with limited access to health care providers are being left behind by the crumbling status of Obamacare. And while politicians in Washington continue to bicker over whether Americans with pre-existing conditions should be entitled to health care coverage, as if America isn’t prosperous enough to care for all of its own, the situation continues to worsen.

At the end of the day, though, this is an issue that goes beyond the national debate over health care coverage. It is an issue that demands we ask serious questions — hard questions — about why our health care picture is what it is in our rural community. We know from previous reports that Scott County ranks at the very bottom among Tennessee counties when it comes to physical inactivity. That’s a good place to start, because it doesn’t matter whether you’re rich or poor, you can lace up your shoes and walk — or run, or ride a bike, or just do sit-ups in your living room floor. From there, a conversation needs to be had. Because the study indicates this: Among 95 Tennessee counties, only two have lower life expectancies than Scott County (Cocke and Grundy counties). And that should be unacceptable to us.

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