Suburban Americans outlive the nation's urban and rural denizens, have lower infant mortality rates and are more likely to lead generally healthy lifestyles, says a new government report.
"Geography alone does not determine health status, but this report performs a valuable service by helping us understand where the most rural and urban communities can target public health efforts to close the gaps," says Health and Human Services Secretary Tommy Thompson, in a statement. "We want all Americans, regardless of where they live, to have an equal chance for a healthy life."
Although the 460-page report is the 25th annual statistical snapshot of the nation's health, it's the first to directly compare rural, urban and suburban living. It was prepared by the National Center for Health Statistics, a division of the Centers for Disease Control and Prevention.
Working-age adults in the most rural and urban areas have higher rates of death than those in the suburbs, and mortality rates are highest among children and young adults in the countryside, the report reveals.
Americans in the most rural corners are more likely to die of accidental injuries, and especially auto wrecks, while those in the inner cities face the highest rates of death by murder.
However, experts stress that location may be important, but lifestyle as well as racial and socioeconomic factors trump people's addresses when it comes to health. Suburbanites get more exercise and are more likely to have health insurance than their inner-city and country counterparts, for instance, while women in the suburbs have lower rates of obesity than those in the rest of the nation, the report says.
Men in rural regions are more likely than those in city areas to report consuming five or more alcoholic drinks a day. And rural teens smoke more than those elsewhere in the land, aggravating their risk later in life of cancer, cardiovascular disease and other potentially deadly health problems.
Urban areas have 308 doctors for every 100,000 people, compared with 80 per 100,000 in the most rural communities, says Mark Eberhardt, a government epidemiologist who worked on the report. For the suburbs, the ratio is 223 doctors per 100,000 residents, but experts point out that residents of metropolitan areas have ready access to major teaching hospitals, generally located in cities, while country dwellers typically have to travel long distances to reach these facilities, Eberhardt says.
Despite disparities of place, which often reflect racial and income differences, Americans in general do appear to be getting healthier in several key measures, the report says. Average life span in 1999 remained at 1998's all-time high of 76.7 years. For black and white men, life span hit a new peak of 67.8 and 74.6 years, respectively.
Death rates fell for each of the top three killers -- heart disease, cancer and stroke -- as did mortality from homicide and unintended injuries, officials say. The number of smokers continues to drop, and so, too, do cholesterol levels and blood pressure, all of which are major risk factors for cardiovascular diseases.
The share of women who receive early prenatal care rose during the 1990s, from 76 to 83 percent, the report says. And the number of toddlers who get all their vaccinations jumped from 69 percent in 1994 to 78 percent in 1999.
"The background trends are showing that health in the nation is improving," Eberhardt says. "But rural and urban residents often have a worse level, depending on what you look at." In addition, some important health measures -- like obesity -- are looking worse, he adds.
Alan Morgan, a spokesman for the National Rural Health Association, says the latest figures underscore the long-standing demographic inequity in the United States.
"It's hard to think of 61 million people as a disadvantaged group," says Morgan, referring to the number of Americans living outside of metropolitan regions. "But in fact that's the case, and that's what this report shows."
To remedy the problem, Morgan says, the government needs to increase its insurance reimbursements to rural doctors and hospitals and to offer more incentives for physicians to practice outside of urban areas. While nearly 20 percent of the nation's population lives in rural regions, only 9 percent of its doctors work there, he says.
"Rural patients see doctors less often and usually later in the course of an illness," Morgan adds. As the report notes, rural Americans are also less likely to see a dentist than other citizens.
What To Do
For more on the government report, go to the National Center for Health Statistics.
To learn more about the problems confronting rural health care in America, visit the National Rural Health Association. And for more on those of the inner city, check out the National Association of Community Health Centers or the National Association of Public Hospitals and Health Systems.