If you want a longer, healthier life, would you opt for green acres or a penthouse view?
Apologies for the dated TV sitcom reference ("Green Acres" can be found on YouTube, kiddos), but if you choose green acres you're in for a surprise.
"There is an abundance of research, especially in recent years, showing really horrific health disparities for rural residents," said Carrie Henning-Smith of the University of Minnesota's Rural Health Research Center.
Henning-Smith is deputy director of the center and lead author of a policy brief released last month that analyzes the rural-urban health gap. It also looks at the ethnic and racial gap.
The study is based on the rate of premature deaths (defined as before the age of 75), among non-Hispanic blacks and American Indian/Alaskan Native groups in comparison with non-Hispanic whites in every county (or similar jurisdiction) in the nation. The data also was applied to each county based on whether it's considered rural or urban.
The conclusion: Persons of color are more likely to die prematurely than whites; people in rural areas are more likely to die prematurely than people in urban counties.
In terms of racial and ethnic composition, Native Americans are hit the hardest. In the 26 counties with a majority American Indian or Alaskan Native population, the premature death rate per 100,000 people is 16,255, according to the report, compared with 7,872 in the 2,767 counties with a majority non-Hispanic white population. The 99 counties with a majority Hispanic population fare even better, with a premature death rate of 7,693.
A U.S. map accompanying the brief shows the majority racial composition of each county. Most U.S. counties are shown to be majority white, with most of the exceptions in the Southwest, to a lesser extent in the Southeast and in Alaska and Hawaii. Not surprisingly, Minnesota and Wisconsin appear to be almost entirely white.
"That's not to say that there isn't a lot of diversity hidden underneath that," Henning-Smith said in a telephone interview. "Even in counties that are majority white, like St. Louis, Lake and Cook and all those others in Northeastern Minnesota, there are plenty of folks who live in those counties who are not white. In particular in Minnesota we have a very strong and somewhat sizable indigenous population."
The non-white populations aren't faring well in Minnesota, she added.
"We know Minnesota has fantastic health outcomes on average," Henning-Smith said. "We also know that Minnesota as a state has some of the worst health disparities in the nation. That's shameful, and that's something that many folks ... (are) working really hard to address."
But those efforts often focus on metropolitan areas, she said, and don't always address significant numbers of Native Americans who always have lived in rural areas as well as "substantial immigration patterns into rural areas."
Henning-Smith ticked off a number of barriers to good health results in rural areas, including disparities in economic and employment opportunities, a slower recovery from the Great Recession and health care that may be unavailable or far away. She pointed to examples in rural Northeastern Minnesota, where both Ely Bloomenson Hospital and Cook County North Shore Hospital ended labor and delivery services in July 2015.
"In your area of the state there has been a lot of attention to obstetric unit closers," Henning-Smith said. "But I really think that's just the tip of the iceberg."