By AMERICAN HEART ASSOCIATION NEWS
Rural counties nationwide are grappling with a higher rate of premature deaths and other measures of poor health than urban counterparts, according to the seventh annual County Health Rankings and Roadmaps report released Wednesday by the Robert Wood Johnson Foundation and University of Wisconsin Population Health Institute.
Based on an analysis of urban, suburban and rural counties in the United States, University of Wisconsin researchers found that premature death rates from any cause have increased in about 20 percent of rural counties over the past decade, while premature death rates in large urban counties have steadily declined. The report said no single factor can explain the disparity.
However, rural areas have fewer businesses and less access to jobs, health care, healthy foods and adequate housing, said Bridget Catlin, Ph.D., co-director of County Health Rankings and Roadmaps at the University of Wisconsin Population Health Institute in Madison. People in rural counties were more likely to smoke, be obese and be less active.
“For too many Americans, their well-being has been unfairly based on limits rather than possibilities,” said Don Schwarz, a vice president at RWJF. “It is hard to have good health if you don’t have good jobs, safe housing or a quality education.”
Despite having much higher populations, large urban areas have more people who attended college, don’t smoke and are not obese.
“It sounds a bit counterintuitive,” Catlin said.
Urban areas have more parks, gyms and sidewalks, and people walk more, as opposed to rural counties that use their land for farming and require more driving.
Yet not all urban areas have ideal health factors, Catlin said.
The Wisconsin researchers first ranked county health data in their home state, then partnered with the RWJF in 2010 to rank the health of nearly every county in the country.
Researchers base county rankings on health behaviors such as tobacco use, obesity, diet, exercise, alcohol and drug use and teen births. They also consider the accessibility and quality of health care, socioeconomic factors and physical environment, such as air pollution and housing.
This year, the report added three new measures of health: insufficient sleep, drug overdose deaths and residential segregation.
One in three Americans do not get at least seven hours of sleep, according to the report, with rates of insufficient sleep highest in Southeastern states. A regular lack of sleep is linked to depression, high blood pressure and heart disease, the report said.
“We provide an easy-to-use snapshot. The purpose is to show that where we live matters to our health,” Catlin said. “Good health comes about from more factors than just access to care.”
Health gaps were also seen among counties within the same state. For the uninsured, Alaska had the biggest gap. Florida had the largest gap in adult obesity, and South Dakota had the widest gap in child poverty.
State, county and community leaders can use the report to see where they are doing well and where they can improve, Schwarz said.
The Bronx in New York City and Menominee Nation in Wisconsin received RWJF awards last year for their creative approaches to improving the health and quality of life for residents.
Using the hashtag #Not62, the Bronx used its low ranking in 2010 to rally for change. The county, which still ranks No. 62 overall in the new report, created parks and trails around the Bronx River, improved jobs and housing, and worked to offer healthy foods. Between 1985 and 2013, life expectancy increased by 9.7 years for Bronx men and 6.5 years for Bronx women, according to RWJF.
Although Menominee County continues to rank last among the 72 counties in Wisconsin, they are installing sidewalks and streetlights to encourage walking and planting gardens at schools. Moniminee Nation melded Native American culture and healthy practices for its young people, improving graduation rates from less than 60 percent in 2008 to nearly 99 percent in 2015, according to RWJF.
The institute’s Roadmaps to Health provides online support, tools and guidance to communities that want to make improvements. RWJF provides community coaches at no charge.
“Achieving a culture of health means opportunities for all in our society to be healthy and thrive,” Schwarz said.