Where you live should not determine how long you live, particularly if you're one of the 61 million people – nearly 20% of the U.S. population – living in rural America. According to a 2020 presidential advisory from the American Heart Association, the leading voluntary health organization devoted to a world of longer, healthier lives for all, people who live in rural communities live three fewer years than people in urban areas and death rates from heart disease and stroke are noticeably higher among people who live in rural versus metropolitan and urban areas of the country.
According to data reported in the Call to Action: Rural Health: A Presidential Advisory From the American Heart Association and American Stroke Association, people living in rural parts of the U.S. are 40% more likely to develop heart disease and have a 30% higher risk of stroke than people who live in urban areas. Unique health challenges related to individual risk factors, social determinants of health and lack of access to health care drive these disparities.
The advisory notes that some of the factors that attribute to poor health among people in rural areas include:
- Physical access to health care, including clinical and mental health care providers, is often difficult in rural areas due to geographical terrain and a lack of local public transportation.
- Health behaviors that increase cardiovascular risks, such as tobacco use and lack of physical activity, are more common among rural populations, as is poorer mental health.
- In recent years, the opioid crisis has contributed to soaring rates of drug use and overdose in rural communities, with opioid-related mortality substantially higher in some rural regions of the country compared to urban areas.
- Social determinants of health contribute to poor cardiovascular outcomes in rural populations as compared to urban populations. Income, education, employment, housing, transportation, food insecurity all contribute to one's health – rural populations fare less well on average for all these indicators.
The American Heart Association is working to help increase healthy life expectancy in the rural U.S. by bringing awareness to hypertension prevention, improving access to care and addressing CPR training and cardiac response times in outlying communities. Telehealth and digitally enabled health care is leveraged for patients in communities with broadband, though technology is lagging in the most remote areas.
"The American Heart Association is cognizant to the fact that America's rural regions are very unique and that there's not a one-size-fits-all approach to eliminating rural health disparities," said Joseph C. Wu, M.D., Ph.D., FAHA, American Heart Association volunteer president, director of the Stanford Cardiovascular Institute and Simon H. Stertzer Professor of Medicine & Radiology at the Stanford School of Medicine. "While there are some commonalities among rural areas, we must tailor our strategies to meet the needs of all communities from the Arkansas Delta to the prairies of Wyoming, the plains of Texas, the mountains of Appalachia and beyond. Within a matter of miles, people can have vastly different experiences that impact their health outcomes."
While most rural communities are predominantly white (80%), there are significant race and ethnicity differences across the country. According to a , the rural South has a large population of non-Hispanic Black individuals, the rural Southwest is home to many Hispanic individuals and rural Oklahoma, Alaska, the Great Plains and the Southwest are home to high percentages of American Indian/Alaska Native individuals. Rural areas also have a higher percentage of elderly individuals and experience lower population growth and higher rates of poverty compared to urban and suburban populations.
"Addressing the unique needs of rural populations to improve health and well-being is critically important for the overall health and well-being of the nation," Wu said. "Broad, innovative and sustained approaches are needed that address the tough underlying structural, social and policy issues that have challenged other areas of the country and health care systems and have manifested themselves as particularly severe and vexing in rural areas and populations."
The American Heart Association has an ongoing commitment to improving the health and health care access of people living in rural America and continues to add new initiatives targeting these special challenges.
- With support from the Helmsley Charitable Trust and from Public Health AmeriCorps, a partnership between AmeriCorps and the Centers for Disease Control and Prevention, the Association launched HeartCorps, an initiative to support the recruitment, training and development of a new generation of public health leaders. Plans call for 100 HeartCorps members to be deployed to many rural communities comprising 30 states across the country (see the full list of states included here). The program will prioritize areas with high rates of uncontrolled blood pressure or cardiovascular disease, increased social vulnerability and shortages of health professionals.
- In June, the Association awarded $20 million in research funding through the Health Equity Research Network on Improving Access to Care and other Health Inequities in Rural America. The research initiative comprises a network of special projects focused on advancing the understanding of the factors that impact health in rural America.
- Last year, the American Heart Association launched its Rural Health Care Outcomes Accelerator to provide up to 700 rural hospitals with no-cost access to Get With The Guidelines® quality programs for coronary artery disease, heart failure and stroke. In addition, the Association established a rural recognition program for these hospitals to assist in communicating their commitment to care excellence with the communities they serve.
Learn more about how the American Heart Association is working to improve health and health care in rural areas of the U.S. and around the world at heart.org.
