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Rates of Premature Death Rise in Rural Counties

Wallis, Laura

AJN, American Journal of Nursing: June 2016 - Volume 116 - Issue 6 - p 14
doi: 10.1097/01.NAJ.0000484211.17608.96
In the News

Smoking patterns, diet, and a lack of access to care may account for large health disparities.

Laura Wallis

The U.S. population has gotten healthier in recent decades, thanks to changes in behavior, advances in automobile and workplace safety, and reductions in infectious diseases. According to a new report, however, the progress is uneven.

When gauging the relative health of the U.S. population, it isn't enough to look at the state-by-state picture. In fact, significant gaps in health exist between counties within each state. The 2016 County Health Rankings report from County Health Rankings and Roadmaps (CHRR), a program of the Robert Wood Johnson Foundation and the University of Wisconsin Population Health Institute, was released in March ( Among its key findings is that rates of premature death, higher in rural counties for many years, continue to rise in those areas even as they drop in urban areas.

Using a variety of national data sources, the report examines four categories of counties within each state—large urban metro, large suburban metro, smaller metro, and rural. Counties were ranked in terms of health outcomes (defined as a county's current health) and health factors (predictions of health in the future). Although no single factor explains the large disparities, many have an impact, including behaviors, such as smoking, diet and exercise, and sexual activity; access to clinical care; socioeconomic factors, such as employment and education; and physical environment, including water quality and housing. In most categories, rural areas fare the worst—in adult smoking, for instance, large urban areas had the lowest rates, whereas rural areas had the highest.

But even that picture isn't so simple. “While many urban counties are doing better overall, there are areas within those counties that are experiencing many of the same challenges as rural communities,” says Julie Willems Van Dijk, a nurse and CHRR codirector. Whether they live in large or small counties, she says, “we encourage community members to view these data as a starting point to pinpoint the most important issues contributing to health.”

The authors of the report acknowledge that a number of health measures provide good contextual information but don't lend themselves to ranking. Several new measures appear in the 2016 report, including residential segregation by race, which is linked to poor health outcomes; drug overdose rates, which have skyrocketed in the last decade, especially in rural areas; and insufficient sleep, which impacts health, but there is little difference between rural and urban areas.

“It is very important that people from across the community come together to identify priorities and implement evidence-informed strategies to address multiple factors,” says Willems Van Dijk. And she points out that nurses can work at many levels to improve health. That might mean counseling patients in healthful behaviors in clinical settings; working within institutions to set health-supporting pol-icies, such as healthful food or smoke-free campuses; or even serving on school boards or working with the local business community to encourage economic development. “Nurses are trusted leaders in their communities and often have their finger on the pulse of what is driving health,” she says.—Laura Wallis

Copyright © 2016 Wolters Kluwer Health, Inc. All rights reserved.