Death by Zip Code – It’s a Culture Thing

April 20, 2021

Rural counties, by Zip Code, have a higher rate of premature death, smoking, obesity, child poverty, and teen births. The 2016 County Health Rankings, a study funded by the Robert Wood Johnson Foundation and the University of Wisconsin Population Health Institute can be found here ( You can look up the ranking of your own county if you’re curious!

These rankings compared health differences between almost all the counties in the U.S. looking at more than 30 factors, including education, housing, exercise, and commuting time. The report shows dramatic differences between rural and urban counties on a number of measures, most notably premature death rates. Like so many of the differences in the U.S., these disparities are not only socioeconomic, they are cultural and based on differing beliefs, behavioral rules, traditions, and rituals.

Rural counties have higher rates of smoking, obesity, child poverty, and teen births, as well as higher numbers of uninsured adults than their urban counterparts. Large urban counties have lower smoking and obesity rates, fewer injury deaths and more residents who attended some college.

The socioeconomic argument would suggest that in rural areas, there is a smaller population, fewer businesses, and a smaller tax base. Therefore, many rural counties have challenges in offering their residents similar opportunities as larger urban areas – including medical services – ultimately having a significant impact on health.

There is also a demographic piece that must be considered. Rural populations are also aging faster than urban areas. Millennials from rural areas, in particular but not exclusively, who go to college away from their rural roots tend not to return to those roots. They are choosing to live and work in urban environments. This leaves rural areas with far older population as the younger population leaves the rural counties.

The cultural piece has to do with the differences in the beliefs, behavioral rules, traditions, and rituals between people in rural vs. urban areas. While there are many differences in rural vs. urban culture that can activate the political polarization that is so prevalent in this country, let’s look at a difference that is apolitical – physical activity. Residents of rural counties often believe that the work they do is very physical in nature (and in farming communities, this is particularly true), so they tend not to take additional opportunities to take part in physical activity according to this study. Residents of urban counties tend to seek out additional physical activities and have invested in sidewalks and other amenities that encourage walking and other physical activities.

Rural counties have consistently had the highest premature death rates and following a few years of improvement, overall rates of premature death in rural counties are increasing, according to the report. While there is no single variable to explain this trend, findings point to socioeconomic and demographic trends and cultural behaviors.

In this study, premature death is defined as any death, by any means, before the age of 75. If a person dies at the age of 74, the community has lost that person’s contribution to society for about 1 year. If a community loses a child, society has lost that child’s potential contribution throughout its life. Neither death diminishes the pain and suffering experienced experienced by family and friends. Nothing ever does. It is the loss to the greater community and society that the study considers.

Keep cultivating your culture!

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