Quality of Life on a Downhill Slope in Rural Communities

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Rural communities are far less healthy than urban communities. Rural communities have higher rates of chronic diseases and engage more in risky health-related behaviors.


Rural community residents have significant health disparities such as greater rates of chronic diseases, mortality rates and disability. They are more likely to have more risky health-related behaviors and healthcare access is lacking due to fewer healthcare providers. Federal and State Agencies are working to reduce these disparities.

Rural Communities Defined

Rural areas are defined by the USDA as any property in open country that is not part of or associated with an urban area. Rural areas are more closely defined as any town, village, city or densely settled area that has a population of less than 10,000 residents.

Rural Populations Less Healthy

A large majority of the rural population reports fair to poor physical and mental health. Adults in rural communities experience higher rates of health disparities, they seemingly engage in riskier health-related behaviors. The residents remain uninsured for longer periods of time and have restricted access to receive any kind of healthcare due to fewer healthcare providers. Chronic conditions such as heart disease are higher in this population. These conditions include;


Researchers from the University of Kansas conducted the first analysis of obesity predominance in rural and urban adults using body mass index with height and weight. The results found that obesity predominance was 39.6% among rural adults and 33.4% among urban adults, The association remained after taking into account diet, physical activity, Race/ethnicity and percent of calories from fat. The team concluded obesity deserves greater attention in rural America.( The Journal of Rural Health, 28: 392–397. doi:10.1111/j.1748-0361.2012.00411.x)


An analysis confirmed the predominance of self-reported diabetes in adults in 17% higher in rural communities. (American Journal of Public Health, 94(1), 66–70.) Rural communities have disadvantages when it comes to diabetes which includes limited access to healthcare and to specialists such as endocrinologists, little exposure to diabetes education, restricted access to safe sidewalks, exercise facilities and grocery stores that have affordable produce.


Rural residents were more likely to report having been told they have hypertension than urban residents. Rural residents that are African American have a higher predominance of high blood pressure than their urban counterpart’s urban counterparts (33.5% to 28.7% respectively). Hypertension among Hispanics was 16.2% to urban 15.9%. Among white males rural were 25.0 to urban 22.3%. Among other races hypertension was more common among rural residents 23.3% to urban 15.8%.

Heart Disease

Heart disease is the leading cause of death in the United States that claims the lives of around 600,000 Americans each year. Coronary artery disease or ischemic heart disease accounts for more than 60 percent of all heart disease death. Adults 20 years old and older death rates from ischemic heart disease for men and women was highest in the most rural communities. For men, the rate was 271 deaths per 100,000, which is about 18 percent higher than in urban counties. The death rate for women in the most rural counties was 153 per 100,000 which is 20% higher than the smallest urban counties.

Breast Cancer

A University of Missouri researcher Faustine Williams, a doctoral student in the Department of Rural Sociologist in the College of Agriculture, Food and Natural Resources found that rural women are more likely to be diagnosed with late-stage breast cancer. Among Williams’s findings were women who travel 50 to 75 miles to a healthcare facility ae 10 percent more likely to be diagnosed with late-stage breast cancer.


Research from the Centers of Disease Control and Prevention presented research at the CHEST 2012 Annual Meeting of the American College of CHEST Physicians had found COPD mortality is highest in rural and poor areas. According to the CDC, chronic lower respiratory disease (primarily COPD) is the third leading cause of death in the United States, and cigarette smoking remains the dominant risk factor for COPD and COPD mortality.


Rural communities are largely under-served medically despite the fact they have higher rates of chronic diseases. They have few interventions that address lifestyle risk factors. These residents lack access to healthcare and healthcare resources. More tailor-made interventions that increase physical activity and consumption of a healthy diet is warranted. (Journal Georgia Public Health Association 2016 Vol. 5 No.4)

Risky Behaviors

Overall, marginally larger portions of adults in rural areas compared to urban areas engage in risky health-related behaviors. More rural adults currently smoke more than urban adults, consume on average five or more alcoholic drinks daily.


Residents in rural communities are more likely to use tobacco products more heavily, start smoking at a younger age and be more heavily exposed to second hand smoke at work at home more than their urban counterparts. A national survey found 27.8 % rural residents smoke compared to 22.7% urban residents. Rural smokers are less likely to smoke less than six cigarettes a day and more likely to smoke more than 15 a day.

Children whose mothers smoke while pregnant are at a much greater risk for a range of health problems. According to a American Lung Association analysis of national survey data 27.4% of rural pregnant women smoke through pregnancy compared to 11.2& of urban women.

Drug Use

A report based on the Treatment Episode Data Set (TEDS) examined how drug use and treatment compares between rural and urban areas. The TEDS used guidelines established by the National Center for Health Statistics in order to determine what constituted an urban versus a rural environment. Rural admissions into substance abuse programs were from criminal justice referrals. Urban residents were more likely to enter voluntarily. Rural residents were more likely to seek treatment for prescription painkillers and stimulants and urban residents for heroin and cocaine.(The TEDS Report July 31, 2012)

Alcohol Abuse

Rural youth ages 12-17 are more likely to consume alcohol than urban youth. Rural youth are more likely to abuse alcohol if either parent is absent from household. In rural areas alcohol abuse programs are far away and there are few of them available compared to urban areas,

Mental Health

Mental health is a concern across the country. Teens and older adults in rural areas have a significantly higher rate of suicide compared to urban areas. Rural residents have more stress due to natural disasters, isolation and cyclical farm crises. In many rural communities there are no mental health facilities or health services due to availability and accessibility. Even though rural residents have demonstrated a need for these services they are less likely to have health insurance that covers mental health and behavioral health services compared to urban residents. (Mental Health: Overlooked and Disregarded in Rural America No.4 May 2009)

Testing for Chronic Conditions

Rural women were less likely to report having received age appropriate pap test for cervical cancer (84.3%) compared to urban women (86.6%). Rural women were less likely to be in compliance with mammography recommendations (77.9%) compared to urban women (82.2%). Rural residents age 50 and older were less likely to be screened for colorectal cancer (46.3%) compared to urban residents (49.2%). Rural residents are less likely to receive preventive services such as screenings due to lack of insurance. (South Carolina Rural Health Research Center Pol9icy Brief 1 June 2009)

Rural Residents Most Likely to be Uninsured

A 2014 analysis by Kaiser Family Foundation revealed rural Americans are poorer and most likely to have jobs that don’t offer health insurance compared to urban Americans. The analysis found rural Americans fall into a gap called Medicaid “coverage gap” they are left without affordable options for health insurance because their state does not expand Medicaid to more low income.

Healthcare Disparities

Less than 10% of physicians practice in rural areas. Rural residents need to travel far to access healthcare services that are small and have limited services. Response time for an ambulance for emergency care and transport times to hospitals are greater than urban areas.

Dental Health

A 2015 report from Pew Charitable Trusts revealed those in rural areas are poorer and less likely to have dental insurance compared to urban areas. Rural residents are less likely to have fluoridated water and live in an area with few dentists and those do not accept government health insurance.


A study in the journal Preventive Medicine found life expectancy was shorter for rural areas. Life expectancy in large urban cities was 79.1 years 76.9 in small urban and 76.7 in rural areas. Cardiovascular disease, COPD with lung cancer and accidents had counted for 70 percent of the urban-rural gap. Causes of death contributing most to the increasing rural–urban disparity and lower life expectancy in rural areas include heart disease, unintentional injuries, COPD, lung cancer, stroke, suicide, and diabetes. ( Widening Rural–Urban Disparities in Life Expectancy, U.S., 1969–2009 Singh, Gopal K. et al. American Journal of Preventive Medicine , Volume 46 , Issue 2 , e19 - e29)


Rural Health Information Hub
Georgetown University Health Policy Institute
USDA Home Loans & Mortgages
DeNoon, D. (2013, June 19). Cities can learn lessons about diabetes from rural areas - Harvard health Blog.
University South Carolina Report; Hypertension, Diabetes, Cholesterol, Weight and Weight Control Activities Among Non-Metro Minorities December 2002
Rural-Urban Disparities in Heart Disease Policy Brief #1 from the 2014 Update of the Rural-Urban Chartbook
MU news bureau News Release 2011Women in Rural Areas More Likely to Be Diagnosed with Most Serious Form of Breast Cancer, MU Researcher Finds
American College of Chest Physicians. "Poverty, rural living linked to increased COPD mortality in the US." ScienceDaily, 22 October 2012. <www.sciencedaily.com/releases/2012/10/121022080655.htm>.
Carsey Institute at the University of New Hampshire, Substance Abuse in Rural America Fact Sheet O1 Summer 2006
Sanford Medicine eCampus Rural Health


Chronic Disease, Dental Health, Disparities, Health, Insurance, Lifestyle, Risky Behaviors, Rural

Meet the author

author avatar authordeb
Author of the Love and Laughter series
Alternative Medicine Practitioner
Freelance Health Write
Works with Media companies for interviews and articles such as Howie Mandel for Afib,

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author avatar Appvn
25th Jan 2017 (#)

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