[Previous: The lights are flickering in Red America]
Rural Americans are white, conservative, and Republican. That pattern holds overwhelmingly true, and it explains almost all of the political divide in America, even if some experts shy away from the implications.
I make no claims to be impartial about this. But if you can judge a political ideology by anything, you should judge it by the success or failure it produces. When that ideology gets to govern, do its followers thrive, or do they suffer? Do they have stable, prosperous, happy lives, or do they spiral down a vortex of misery?
Let’s consider a new piece of evidence summed up by this headline: “The urban-rural death divide is getting alarmingly wider for working-age Americans“.
As recently as 25 years ago, urban and rural areas had comparable death rates among working-age adults. But since that time, cities have been improving, while rural areas are faring worse and worse. A new report from the Department of Agriculture’s Economic Research Service shows just how wide the gap has gotten:
The report focused in on a key indicator of population health: mortality among prime working-age adults (people ages 25 to 54) and only their natural-cause mortality (NCM) rates — deaths among 100,000 residents from chronic and acute diseases — clearing away external causes of death, including suicides, drug overdoses, violence, and accidents. On this metric, rural areas saw dramatically worsening trends compared with urban populations.
…In 1999, the NCM rate in 25- to 54-year-olds in rural areas was 6 percent higher than the NCM rate of this age group in urban areas. In 2019, the gap had grown to a whopping 43 percent. In fact, prime working-age adults in rural areas was the only age group in the US that saw an increased NCM rate in this time period.
Rural areas have higher rates of drug overdose, suicide, alcoholism and other ills than cities, per capita. However, this conclusion holds true even if you exclude those causes and focus only on so-called natural deaths.
Your first thought might be that COVID accounts for a big chunk of the difference, but no. The researchers specifically excluded 2020 from their data set, because they considered it an outlier. However, including COVID would make this already huge gap into an even wider chasm, considering that the reddest parts of America had a COVID death rate almost six times higher than the blue ones.
There are no plagues that are unique to rural America. Red-state residents die from the same causes as residents of blue cities. They just die from them more often:
Among all rural working-age residents, the leading natural causes of death were cancer and heart disease — which was true among urban residents as well. But, in rural residents, these conditions had significantly higher mortality rates than what was seen in urban residents.
Why do rural residents die in larger numbers? A big part of the problem is that, because they’re more spread out to begin with, doctors and hospitals are few and far between. That makes it harder for them to get the medical care they need, both on a regular basis and in emergencies.
That problem is rapidly getting worse, because the health-care system in rural America is running on fumes. With each passing year, more and more rural hospitals are losing money, forcing them to pare back services or close entirely:
A recently released report from the health analytics and consulting firm Chartis paints a clear picture of the grim reality Ryerse and other small-hospital managers face. In its financial analysis, the firm concluded that half of rural hospitals lost money in the past year, up from 43% the previous year. It also identified 418 rural hospitals across the United States that are “vulnerable to closure.”
…According to Chartis, nearly a quarter of rural hospitals have closed their obstetrics units and 382 have stopped providing chemotherapy.
The harm inflicted by hospital closures goes beyond the sick people who are most directly affected. It tears holes in the social fabric. People with means won’t move to places where they can’t get medical care. Young people who want to start families will avoid places without labor and delivery wards. (Some rural states, like Idaho, are losing so many obstetrics wards that they may soon become maternity deserts in their entirety.)
When people don’t want to live in these places, employers will move away because they can’t attract talent. That creates a brain drain, worsening poverty and leading to a death spiral:
While people in rural America are more likely to die of cancer than people in urban areas, providing specialty cancer treatment also helps ensure that older adults can stay in their communities. Similarly, obstetrics care helps attract and keep young families.
Whittling services because of financial and staffing problems is causing “death by a thousand cuts,” said [Michael] Topchik [co-author of the Chartis study], adding that hospital leaders face choices between keeping the lights on, paying their staff, and serving their communities.
The article proposes, hopefully, that Congressional support will be needed to keep the lights on in rural hospitals. The brutal reality is that this isn’t going to happen, because there’s no constituency for it.
As the last few years have demonstrated, most voters living in these white rural enclaves don’t value their own health. More than that, they fight furiously against efforts to improve it. They’re loud supporters of Republicans whose only concern is punishing women for having abortions, or gay people getting married, or transgender people using bathrooms, or immigrants coming to this country to find jobs, or whatever culture-war noise Fox News is telling them to care about today. The politicians they elect do nothing tangible to improve their lives, and they seem content with that.
Meanwhile, the biggest policy proposals that would make a positive difference to rural voters’ lives – like the Medicaid expansion, or COVID vaccination programs, or infrastructure spending, or stronger unions, or even single-payer health care – are Democratic initiatives, and they resist all of them with furious tenacity. As long as they cling to these attitudes, their doctors will keep fleeing, their hospitals will keep closing, and they’ll keep getting sicker and living shorter lives. They’re literally dying of whiteness, and it seems that’s the way they prefer it.