Rural Americans are dying younger, living less healthy lives, report reveals(studyfinds.org)
studyfinds.org
Rural Americans are dying younger, living less healthy lives, report reveals
https://studyfinds.org/rural-americans-dying-younger/
38 comments
I would suggest "not at all".
Access to American health care has jack shit in common with being able to live a healthy lifestyle. You can learn the latter from personal trainers, self-help books, physical education, sports involvement, all sorts of ways. Then you summon the discipline to adhere to such a lifestyle, and there's nothing a physician can do to influence those decisions.
The American health care system may be useful in cases of GSW or cardiac events or broken limbs, but people who use it exceedingly sparingly are the ones who end up enjoying health and wellness, without being inexorably steered into a pharmacy or chemotherapy.
Follow the money here: look at some maps; I've found in my urban area that FQHCs open up to take Medicaid/Medicare dollars for services to the poor and vulnerable. In the affluent neighborhoods, you'll find cosmetic clinics and surgeons, along with massage, spas, and boutique concierge naturopaths and other alternative practitioners. (None of the above are proven to extend lifespans nor improve outcomes for the sick.)
Don't believe me? Ask practicing physicians, who are utterly exasperated and fed up with all the patients who abused/neglected their bodies and now expect medicine to "fix them up" like the Tech Support desk. They can do nothing of the kind. Hopefully, they are compassionate and honest about those limitations.
Access to American health care has jack shit in common with being able to live a healthy lifestyle. You can learn the latter from personal trainers, self-help books, physical education, sports involvement, all sorts of ways. Then you summon the discipline to adhere to such a lifestyle, and there's nothing a physician can do to influence those decisions.
The American health care system may be useful in cases of GSW or cardiac events or broken limbs, but people who use it exceedingly sparingly are the ones who end up enjoying health and wellness, without being inexorably steered into a pharmacy or chemotherapy.
Follow the money here: look at some maps; I've found in my urban area that FQHCs open up to take Medicaid/Medicare dollars for services to the poor and vulnerable. In the affluent neighborhoods, you'll find cosmetic clinics and surgeons, along with massage, spas, and boutique concierge naturopaths and other alternative practitioners. (None of the above are proven to extend lifespans nor improve outcomes for the sick.)
Don't believe me? Ask practicing physicians, who are utterly exasperated and fed up with all the patients who abused/neglected their bodies and now expect medicine to "fix them up" like the Tech Support desk. They can do nothing of the kind. Hopefully, they are compassionate and honest about those limitations.
> How much of this is simply a lack of healthcare availability in rural areas
Speaking as someone who lives in a rural area - this ain't it. The lifestyle choices are the biggest problem. Availability is just addressing the problem at the end of the problem.
Speaking as someone who lives in a rural area - this ain't it. The lifestyle choices are the biggest problem. Availability is just addressing the problem at the end of the problem.
I suspect this is in general across the US.
I have lost 35lbs so far this year and it is pretty shocking the health benefits of not over eating good tasting food.
I think we all know this too but are collectively in denial because it is so boring eating chicken breast, broccoli and mustard yet again as I am right now instead of the awesome tasting dish from the incredible restaurants we have all over.
That is even with not drinking, not smoking and going to the gym for years.
People don't just want their cake and eat it too they want their cigarettes/vapes and smoke them too, a six pack and drink it too, a pizza to eat before the cake,all while only abstaining from physical activity.
I have lost 35lbs so far this year and it is pretty shocking the health benefits of not over eating good tasting food.
I think we all know this too but are collectively in denial because it is so boring eating chicken breast, broccoli and mustard yet again as I am right now instead of the awesome tasting dish from the incredible restaurants we have all over.
That is even with not drinking, not smoking and going to the gym for years.
People don't just want their cake and eat it too they want their cigarettes/vapes and smoke them too, a six pack and drink it too, a pizza to eat before the cake,all while only abstaining from physical activity.
What do you see as the biggest lifestyle choices they're making having an impact on their health that folks from urban areas aren't making as much?
Here's an anecdote: where I live the closest gym is 19 miles away. The closest park that has walking trails is a little over 12 miles away. Walking/running/cycling on the county roads is not wise. There is a seasonal farmer's market in the closest city to us (~15 miles away), but it's only open one day a week for 4 hours. The closest "healthy" grocery store (like Sprouts, Whole Foods, Trader Joe's) is 32.9 miles away (just had to look this up). For the local grocery stores, the organic, health options are rather minimal compared to the rest of the store's footprint, if they even exist at all. Organic produce doesn't exactly fit Dollar General's target market. Delivery doesn't always come through: there are some parts of my county that do not even get Amazon deliveries. Delivery from other providers can tend towards cost prohibitive. Most of my neighbors are blue collar (trades, construction), so even if they wanted better health and food options they're not about to drive to get it after spending a good part of the day on the road traveling to/from work sites when there's a Walmart nearby with super cheap unhealthy food.
It's almost like the poor lifestyle choice they made was living in a rural area and not keeping a garden.
My perspective may be skewed by my relatives who live in rural Appalachia. They keep gardens, have physical jobs, and hunt for meat. They live a few miles outside of a small town whose hospital just closed - the only one in the county. They do have a proper emergency care center that's designed to be able to get you stabilized and then transfer you to a hospital outside of the county.
You're right though - the people that live "in town", population 6,000, tend to live like urban folk without the urban amenities like you mentioned. I have no idea why people choose to live like that.
My perspective may be skewed by my relatives who live in rural Appalachia. They keep gardens, have physical jobs, and hunt for meat. They live a few miles outside of a small town whose hospital just closed - the only one in the county. They do have a proper emergency care center that's designed to be able to get you stabilized and then transfer you to a hospital outside of the county.
You're right though - the people that live "in town", population 6,000, tend to live like urban folk without the urban amenities like you mentioned. I have no idea why people choose to live like that.
> It's almost like the poor lifestyle choice they made was living in a rural area
It is more that the poor lifestyle choices were already made, so it is most convenient to live in a rural area where there isn't as much social pressure to change. You can easily hide when you live on a desolate backroad. It is hard to hide when stepping outside means immediately running into hundreds of people ready to judge your "undesirable" behaviour.
> population 6,000, tend to live like urban folk
The USA defines urban as a population of at least 2,000 people, so those in that place with 6,000 people don't just live like urban folk. They are urban folk!
It is more that the poor lifestyle choices were already made, so it is most convenient to live in a rural area where there isn't as much social pressure to change. You can easily hide when you live on a desolate backroad. It is hard to hide when stepping outside means immediately running into hundreds of people ready to judge your "undesirable" behaviour.
> population 6,000, tend to live like urban folk
The USA defines urban as a population of at least 2,000 people, so those in that place with 6,000 people don't just live like urban folk. They are urban folk!
> It's almost like the poor lifestyle choice they made was living in a rural area
> I have no idea why people choose to live like that.
Many, if not most, times it's not a choice. Limited skills, limited education, limited drive, and limited exposure leads you to stick around where you are because you don't know any better.
> and not keeping a garden
I'll give you this. It was a thing, a big thing, when I was younger. It makes me think people have honestly gotten lazier - there seems to be no drive or desire to do so.
> I have no idea why people choose to live like that.
Many, if not most, times it's not a choice. Limited skills, limited education, limited drive, and limited exposure leads you to stick around where you are because you don't know any better.
> and not keeping a garden
I'll give you this. It was a thing, a big thing, when I was younger. It makes me think people have honestly gotten lazier - there seems to be no drive or desire to do so.
This may vary by the particular store, but Walmart doesn't seem to be any worse than other grocery stores in terms of selling unhealthy food. There's little or no evidence that "organic" food is actually healthier.
And even if organic food is healthier, it's definitely better to eat non-organic vegetables over no vegetables.
I eat some meals that are healthy, and some that aren't. None of them are organic.
I eat some meals that are healthy, and some that aren't. None of them are organic.
We should do more to expand access to healthcare in rural areas, but healthcare services beyond the basics (immunization, antibiotics, trauma care) do little to increase lifespan at the aggregate population level. Causes of death are mostly chronic diseases brought on by lifestyle factors and even the best treatments for those conditions usually only delay death by a little.
Should we? Or should we put those dollars where they would help the most people, in urban areas that are also chronically underserved.
Upward social mobility for rural women have increased as because of social media they manage to move to cities, find work, employment and a partner.
The same is true for men of rural areas who are left to perish and become hopeless.
You'll die faster from hopelessness than any lifestyle choice.
The same is true for men of rural areas who are left to perish and become hopeless.
You'll die faster from hopelessness than any lifestyle choice.
Life in rural America has always been difficult. Appalachia, for example, has a history of severe poverty that in some ways still exists.
https://www.reddit.com/r/Appalachia/comments/vizs8f/it_blows...
https://www.reddit.com/r/Appalachia/comments/vizs8f/it_blows...
Appalachia is particularly cursed by geography. Mountainous areas can't support much large-scale economic activity beyond subsistence farming, resource extraction, and tourism. It's just too expensive to move things around. We see the same issues in other countries as well.
The Nordic economies were also characterized by low-intensity agriculture, resource extraction, and tourism, as well as a remarkably similar 28M population vs 26M Appalachians. Topographically, Appalachia isn't much different from places like Norway. Yet the Nordic situation couldn't be more different.
The issues with Appalachia aren't the result of some impossible geographic curse, they're the accumulation of countless political and economic decisions against trying to improve the region. All it would take to fix it is decades of coordinated efforts at every level of society. Obviously that's not going to happen, but recognizing that it's possible is better than pretending that we don't have the ability to change anything about the situation.
The issues with Appalachia aren't the result of some impossible geographic curse, they're the accumulation of countless political and economic decisions against trying to improve the region. All it would take to fix it is decades of coordinated efforts at every level of society. Obviously that's not going to happen, but recognizing that it's possible is better than pretending that we don't have the ability to change anything about the situation.
Norway isn't really comparable. Their population is concentrated along the coastline and can use the sea to cheaply transport goods.
Certainly the situation in Appalachia could be improved. The point is that their geography is a handicap which makes almost everything a little harder.
Certainly the situation in Appalachia could be improved. The point is that their geography is a handicap which makes almost everything a little harder.
Hasn't the opioid epidemic really screwed up a lot of rural America? I see interviews online, and it seems like half the people are struggling with addiction. And a lot of others are loaded up with prescription psychotropics. These things may be related, what with "self-meducation". And perhaps there are selection effects -- the mentally well ones got out? But there's some kind of cocktail of drugs and mental illness out there.
> self-meducation
That was supposed to be "self-medication", but we may have stumbled upon another idea here.
That was supposed to be "self-medication", but we may have stumbled upon another idea here.
I grew up in a small town, about 1000 people. I can only visit for 2 or 3 days because there is zero options for eating healthy. The gas station has pizza and subs, Dollar General has no produce, and the one restraunt is burgers and fries. I feel tired and gross after a few days. I can't image what years of that diet would do to a person.
I can imagine what years of that diet would do to a person because, like you, I come from a small town with similar food options. The poor diet made my father morbidly obese and diabetic; he died at 60. My mother is also morbidly obese. I am addicted to sugar and can barely keep myself just out of the overweight category with intense effort, including dietary coaching and a personal trainer.
The entire food system is fucked, and it takes Herculean strength to overcome it.
The entire food system is fucked, and it takes Herculean strength to overcome it.
I venture that, if you counted calories, you could eat, like, hamburger patties, with onions and some french fries (no bun), and supplement with a multivitamin, and be mostly ok. Fat/grease isn't completely awful, so long as you actually include it in your count, and stick to under 2,000 kcal/day. You'll just find that relatively small volumes of food are required.
Potatoes you don't want to go overboard on, but as carbs go they're among the better ones -- better than bread -- because their glycemic index is lower. And with the skins on they have nontrivial vitamin/mineral content.
If you did a little more cooking at home, particularly with beans (not in sugary ketchup, just beans with butter and spices -- salt, pepper, cumin, say), then you'd be a bit better, on account of the fiber. Add frozen or, failing that, canned vegetables, and you're almost actually good.
Often you can find canned chilli that's nutritionally pretty good; just make sure it doesn't have sugar; they put sugar in too much stuff.
Getting more of your calories from nuts is also a good option. Surely you can get a jar of peanuts? A large handful is 300 kcal. A couple of those spaced over the day can fuel you quite well with a slow burn.
The car-deprndrnce of the country is an issue; you probably would not naturally walk far enough. If there's some way to schedule in about two miles a day -- walk to the gas station for a black coffee? -- then that'd help to maintain some minimal baseline levels of activity.
Stick to the calorie count and maintain some (frankly modest) level of light exercise and you can maintain your health in a fairly wide range of circumstances.
...
I get what you mean though. There's a real class difference. You go to higher class places and there are plenty of salad places around. You go to low class places and there's fast food junk. The latter isn't even much cheaper. It's enough to make you start wondering if people are in the classes they are because of the standards they have. That's not a comfortable thought, but, when you look at how all the bankers seem to also have good gym routines, you really do start to wonder.
...
You don't need to do anything superhuman though. You don't need to even summon the willpower to hit the elliptical machine every day. If you just think about what you're eating, count calories, reduce sugar and fast carbs, and walk a bit, you'll do pretty well.
Potatoes you don't want to go overboard on, but as carbs go they're among the better ones -- better than bread -- because their glycemic index is lower. And with the skins on they have nontrivial vitamin/mineral content.
If you did a little more cooking at home, particularly with beans (not in sugary ketchup, just beans with butter and spices -- salt, pepper, cumin, say), then you'd be a bit better, on account of the fiber. Add frozen or, failing that, canned vegetables, and you're almost actually good.
Often you can find canned chilli that's nutritionally pretty good; just make sure it doesn't have sugar; they put sugar in too much stuff.
Getting more of your calories from nuts is also a good option. Surely you can get a jar of peanuts? A large handful is 300 kcal. A couple of those spaced over the day can fuel you quite well with a slow burn.
The car-deprndrnce of the country is an issue; you probably would not naturally walk far enough. If there's some way to schedule in about two miles a day -- walk to the gas station for a black coffee? -- then that'd help to maintain some minimal baseline levels of activity.
Stick to the calorie count and maintain some (frankly modest) level of light exercise and you can maintain your health in a fairly wide range of circumstances.
...
I get what you mean though. There's a real class difference. You go to higher class places and there are plenty of salad places around. You go to low class places and there's fast food junk. The latter isn't even much cheaper. It's enough to make you start wondering if people are in the classes they are because of the standards they have. That's not a comfortable thought, but, when you look at how all the bankers seem to also have good gym routines, you really do start to wonder.
...
You don't need to do anything superhuman though. You don't need to even summon the willpower to hit the elliptical machine every day. If you just think about what you're eating, count calories, reduce sugar and fast carbs, and walk a bit, you'll do pretty well.
> The latter isn't even much cheaper.
For the customer, perhaps. Higher margin, though, so the business can survive with fewer customers.
I think it is pretty clear that "high class" places attract more restaurant traffic. Case in point: The town I grew up in, of 1,000 people but a town of the rich and famous (you're probably familiar with quite a few of them), there are 15 restaurants (was 16, but one recently burnt down). The town where I live now, which is the next one up the road but more of a working man's town, has 3,000 people yet only seven restaurants.
For the customer, perhaps. Higher margin, though, so the business can survive with fewer customers.
I think it is pretty clear that "high class" places attract more restaurant traffic. Case in point: The town I grew up in, of 1,000 people but a town of the rich and famous (you're probably familiar with quite a few of them), there are 15 restaurants (was 16, but one recently burnt down). The town where I live now, which is the next one up the road but more of a working man's town, has 3,000 people yet only seven restaurants.
> The latter isn't even much cheaper
Last time I was in McD the price of a salad (even without a chicken!) was close to the cost of BigMac.
But the most amusing is what I opened mcdonalds.com and there is no salads in the menu at all.
Last time I was in McD the price of a salad (even without a chicken!) was close to the cost of BigMac.
But the most amusing is what I opened mcdonalds.com and there is no salads in the menu at all.
I was raised and live in an area of Central Texas with some of the highest growth rates in the US. It might be that a sort of rural gentrification is just destroying a lifestyle that was always taken for granted. Small farms/ranches around here are economically unfeasible. Small businesses cannot compete with large well established/funded corporations. Handyman jobs (still needed) are commodified and often the answer is just "tear it down" and build something new. Land prices have skyrocket along with taxed food prices and everything else. "Food deserts" are sort of real but it just results in giant tax breaks to bulldoze fields and put in 50 acre of parking lots and giant box stores. Local governments are supporting new development with roads, city services. There is not much opportunity (or incentive) for anyone that has been living in the area for all their lives.
Earl Butz said "get big or get out" half a century ago, so if anyone was taking their lifestyle for granted maybe they hadn't been paying attention to the Secretary of Agriculture?
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TIL Pietism, the common backdrop of both Veblen, Hesse, and a vast swath of rural america.
See also Merton Thesis,Mertonian Norms (dont know if that ever inspired sci-fi?)
「Becker 1992」
Question: are the Mertonian norms fundamentally inhospitable to meritocracy, so that they may yet serve as a viable target for the transmogrification of socalled antiintellualism?
>the scientific ethos does not have [its] theoreticians… but it has [its] [designori]
See also Merton Thesis,Mertonian Norms (dont know if that ever inspired sci-fi?)
「Becker 1992」
Question: are the Mertonian norms fundamentally inhospitable to meritocracy, so that they may yet serve as a viable target for the transmogrification of socalled antiintellualism?
>the scientific ethos does not have [its] theoreticians… but it has [its] [designori]
I'd originally pattern matched on a very different Merton: https://en.wikipedia.org/wiki/The_Seven_Storey_Mountain
What's the clash with meritocracy? Disinterest?
Interesting to see Mennos classified here as "radical pietists" when I normally read of them as being "fancy anabaptists", where fancy is the opposite of radical in that it's a pejorative for an overly conformational* relation with the world.
FWIW, I've run across a "protestant ethic" ascribed also to the Starovery (russian "old believers"); my current explanation is that whenever a marginal group finds the traditional low-risk cursus closed (whether due to exclusion by the external majority, or to disapproval by their in-group) they tend to reinvest in speculative ventures (and as long as they're doing so jointly, they ought to have sufficient diversification to thrive under this allocation?).
EDIT: a deeper Q from Pietism: to what extent must an organisation behave in ways that are comprehensible to its rank and file? (1984 argues that it's important enough that comprehensibility should override consistency?)
EDIT2: * in order to get "in the world" vs "of the world", we possibly need english prepositions, and definitely need to read John classically, as if the world is clopen and therefore not out of the world equivales in the world. What about the boundary of the world? (yet another open question for Algebraic Theology)
What's the clash with meritocracy? Disinterest?
Interesting to see Mennos classified here as "radical pietists" when I normally read of them as being "fancy anabaptists", where fancy is the opposite of radical in that it's a pejorative for an overly conformational* relation with the world.
FWIW, I've run across a "protestant ethic" ascribed also to the Starovery (russian "old believers"); my current explanation is that whenever a marginal group finds the traditional low-risk cursus closed (whether due to exclusion by the external majority, or to disapproval by their in-group) they tend to reinvest in speculative ventures (and as long as they're doing so jointly, they ought to have sufficient diversification to thrive under this allocation?).
EDIT: a deeper Q from Pietism: to what extent must an organisation behave in ways that are comprehensible to its rank and file? (1984 argues that it's important enough that comprehensibility should override consistency?)
EDIT2: * in order to get "in the world" vs "of the world", we possibly need english prepositions, and definitely need to read John classically, as if the world is clopen and therefore not out of the world equivales in the world. What about the boundary of the world? (yet another open question for Algebraic Theology)
Unscheduled saturation of b/w this week so i shant be able to get to deeper [QEDITS1|2:]for a while.
Yes. And communism — esp. the secrecy aspect, in relation to YC/SIGINT.. “waste is inevitable but rivalry is optional” {waste->pleasure,rivalry->reward} in same snowclone, so… universalism, too. And organized skepticism (like those paradoxical games where victory is uncorrelated with effort,motivation,or intent; Simplicitas’ dual, sprezzatura misses the point)
Wont be surprised if Nikolai Feodorovich turns out to have been a crypto-raskolnik all along
>Fyodorov opposed the idea of property of books and ideas and never published anything during his lifetime.
Right. Pietists would not be classified as weird in the Rao taxonomy, so radical pietists sounds just like hypernormal. So who indeed are the proweird antimeritocrats? Practical (entheogenic,texting) sufi-taoists? Such that friendly neighborhood incomprehensibility is very much an organization feature?
Yes. And communism — esp. the secrecy aspect, in relation to YC/SIGINT.. “waste is inevitable but rivalry is optional” {waste->pleasure,rivalry->reward} in same snowclone, so… universalism, too. And organized skepticism (like those paradoxical games where victory is uncorrelated with effort,motivation,or intent; Simplicitas’ dual, sprezzatura misses the point)
Wont be surprised if Nikolai Feodorovich turns out to have been a crypto-raskolnik all along
>Fyodorov opposed the idea of property of books and ideas and never published anything during his lifetime.
Right. Pietists would not be classified as weird in the Rao taxonomy, so radical pietists sounds just like hypernormal. So who indeed are the proweird antimeritocrats? Practical (entheogenic,texting) sufi-taoists? Such that friendly neighborhood incomprehensibility is very much an organization feature?
Friendly neighborhood incomprehensibility sounds like something up Nasruddin's alley:
Having been engaged by a nearby village to present his philosophy over a three-day series of lectures, Nasruddin started on the first day:
— O Villagers, do you know what I'm about to tell you?
— No, Mullah, we do not!
— Well, I'm certainly not going to waste my time lecturing the ignorant!
and he promptly left on his donkey.
On the second day:
— O Villagers, do you know what I'm about to tell you?
— Yes, Mullah, we do!
— Well, I'm certainly not going to waste my time belabouring the obvious!
and he promptly left on his donkey.
On the third day, the villagers (having stayed up late in conference the night before crafting their strategy) were more excited than ever to hear Nasruddin speak:
— O Villagers, do you know what I'm about to tell you?
— Some of us, Mullah, know, and some do not!
— Excellent! Let those who know instruct those who do not.
and he promptly left on his donkey.
Having been engaged by a nearby village to present his philosophy over a three-day series of lectures, Nasruddin started on the first day:
— O Villagers, do you know what I'm about to tell you?
— No, Mullah, we do not!
— Well, I'm certainly not going to waste my time lecturing the ignorant!
and he promptly left on his donkey.
On the second day:
— O Villagers, do you know what I'm about to tell you?
— Yes, Mullah, we do!
— Well, I'm certainly not going to waste my time belabouring the obvious!
and he promptly left on his donkey.
On the third day, the villagers (having stayed up late in conference the night before crafting their strategy) were more excited than ever to hear Nasruddin speak:
— O Villagers, do you know what I'm about to tell you?
— Some of us, Mullah, know, and some do not!
— Excellent! Let those who know instruct those who do not.
and he promptly left on his donkey.
For all that JNG talks smack about HKH, it seems like he's revealed a preference for stringing together glass beads in various magazines instead of forming Turn- und Sportabteilungen?
EDIT: "I must grow my granfalloon" says the one who, looking at their pocketwatch, dangles total comp, but the great one attracts (as t->oo) a karass with but a bare hook?
EDIT: "I must grow my granfalloon" says the one who, looking at their pocketwatch, dangles total comp, but the great one attracts (as t->oo) a karass with but a bare hook?
REDIT: Granfalloon -> “Nasrallah” Karass -> “Nasruddin” ?
https://archive.org/download/Demian_201305/Demian_text.pdf
“How TM met HKH” backstory summarized for the proles here by yet another Nasr- https://archive.is/3JwSV
So the man called HKH a [Sith?] princebishop there? (No need to find the german edition as TM targeted an american audience)
“Ctrl-f River” will also direct you to the essential bits ;)
https://archive.org/download/Demian_201305/Demian_text.pdf
“How TM met HKH” backstory summarized for the proles here by yet another Nasr- https://archive.is/3JwSV
So the man called HKH a [Sith?] princebishop there? (No need to find the german edition as TM targeted an american audience)
“Ctrl-f River” will also direct you to the essential bits ;)
Nasser is said to have been inspired by Kutuzov during the 6-day war: having first lured the israelis across the Sinai and deep into egypt, the only thing he subsequently needed to do was wait for General Winter to arrive...
And the MCP said unto Cain, Where is Abel thy ⊓-er? And he said, I know not: Am I my meter's keeper? http://cap-lore.com/CapTheory/upenn/Gnosis/Gnosis.html
And the MCP said unto Cain, Where is Abel thy ⊓-er? And he said, I know not: Am I my meter's keeper? http://cap-lore.com/CapTheory/upenn/Gnosis/Gnosis.html
Looks like the article points towards smoking and obesity mostly. Could be worse due to food deserts and lack of health care.
Consider that cardiovascular issues are one of the leading causes of death in the US. Time is of the essence. If your local hospital has been closed, your emergency services have been consolidated in your county, you're much more likely to be DOA than someone in the city.
Also, didn't the opioid crises primarily occurred in rural areas? That's going to affect the stats, too.