[HN Gopher] US city-country mortality gap widens
___________________________________________________________________
US city-country mortality gap widens
Author : Brajeshwar
Score : 75 points
Date : 2024-04-10 13:04 UTC (9 hours ago)
(HTM) web link (kffhealthnews.org)
(TXT) w3m dump (kffhealthnews.org)
| toomuchtodo wrote:
| USDA Report:
| https://www.ers.usda.gov/webdocs/publications/108702/eib-265...
|
| Related:
|
| _US Rural Hospital Closures Since 2005_ -
| https://news.ycombinator.com/item?id=36302937 - June 2023 (153
| comments)
|
| UNC Rural Hospital Closures -
| https://www.shepscenter.unc.edu/programs-projects/rural-heal...
| imglorp wrote:
| If you live an hour from an emergency room, all kinds of urgent
| things will become more fatal statistically and lower life
| expectancy. Stroke, heart attack, trauma. EMS pays careful
| attention to the "golden hour" of receiving definitive care
| being a survival factor. If you have to wait longer for
| transport (because you're rural) and then wait longer to arrive
| at the ER, then your hour may be up before you're even seen.
|
| One mitigating factor is rural EMS sometimes has more advanced
| care options (allowed by their medical director) than urban BLS
| because they know it's a long ride.
| delfinom wrote:
| Lol, the joke here is depending on rural areas. You may wait
| a few hours just for an ambulance to show up in the first
| place.
| giantg2 wrote:
| A huge factor in my personal experience is the quality of
| care at the hospital. Many hospitals in more remote locations
| have poor care. Sometimes it's that doctors who can't get the
| higher paying jobs at the big hospitals go there, and the
| facilities have lower budgets for many things. I've had
| family in the medical field who have worked all over the
| world and have stated that a few specific hospitals serving
| rural areas are only slightly better than some of the 3rd
| world hospitals they've seen. They might be bigger or
| fancier, but the quality of care is poor and the rate of
| mistakes are high.
| lenerdenator wrote:
| Makes total sense; the rural areas have been manipulated by the
| shareholder class into selling out most of their quality-of-life-
| enabling institutions for scrap.
|
| I live in a relatively large Lower Midwestern city. The general
| attitude of capital and policymakers in the United States after
| the 1960s became one of confusion about the purpose of the area
| between the Appalachian Range and Rockies. California was
| booming, the cities on the East Coast were moving into a service
| economic model as their factories had been packed up. Why were
| these people still here? That applies to cities that used to
| participate in mercantile capitalism (St. Louis is a wonderful
| example of this) as well as small towns of 150 people. There's a
| lack of investment that would simply be unacceptable to people in
| the other parts of the country. Imagine if Amtrak's Northeast
| Corridor had the reliability of the various Midwestern routes.
| hx8 wrote:
| This brings up an interesting partial explanation that we might
| be able to explore with data. A portion of the healthier and
| more successful rural population will migrate to urban areas,
| while a portion of the least healthy and less successful will
| be stuck and unable to leave rural areas. Urbanization as
| selection.
| lenerdenator wrote:
| To a point; there's still widespread poverty in the cities
| these people eventually move to.
| red-iron-pine wrote:
| if they're healthy and successful why would they leave? the
| families with college kids of send their chilluns to school,
| but plenty return. and with high COL exploding in many
| cities, all the more reason to come home, esp. if their
| people are already successful in such areas
| jjk166 wrote:
| > if they're healthy and successful why would they leave?
|
| Because they could be even more healthy and even more
| successful, or simply just happier, elsewhere. People who
| can leave will always leave more often than people who
| can't.
|
| > the families with college kids of send their chilluns to
| school, but plenty return.
|
| And plenty don't. Again, those that never leave stay at a
| higher rate.
|
| > and with high COL exploding in many cities, all the more
| reason to come home, esp. if their people are already
| successful in such areas
|
| The more wealth you have, the less you are deterred by high
| COL. And COL only goes up in cities because people are
| willing to pay a premium to live there, often for the
| economic opportunities.
| jt2190 wrote:
| Article title is "City-Country Mortality Gap Widens Amid
| Persistent Holes in Rural Health Care Access"
|
| > The study does not address causes for the increase in mortality
| rates... differences in health care resources could compromise
| the accessibility, quality, and affordability of care in rural
| areas. Hospitals in small and remote communities have long
| struggled, and continued closures or conversions limit health
| care services in many places. [perhaps also] persistently higher
| rates of poverty, disability, and chronic disease in rural areas,
| compounded by fewer physicians per capita and the closure of
| hospitals, affect community health.
| Aurornis wrote:
| > Within the prime working-age group, cancer and heart disease
| were the leading natural causes of death
|
| I have a lot of extended family and in-laws who live in rural
| locations.
|
| The lifestyle differences between what I see in the city and what
| I see in their rural locations are stark. The norms around diet,
| exercise, drinking, and smoking are completely different.
|
| Even norms around personal safety and protective gear are
| completely different. Most of my rural extended family will do
| things like casually spray pesticides or paint without a mask. I
| was mocked for pulling out safety glasses and hearing protection
| for power tools when we worked on a project together once.
|
| The study classifies things like heart disease and cancer as
| "natural causes" and blames lack of healthcare, but my anecdotal
| experience is that the lifestyle differences could easily explain
| the difference in heart disease and probably a significant number
| of the cancer diagnoses as well.
|
| Even when healthcare is available, many of them don't trust it.
| Statins are still a common debate when I visit, with many of the
| people in mid-life telling me that they don't work and it's just
| a big pharma cash grab conspiracy (even though statins are dirt
| cheap now). Refusing to take doctor-directed medication is a
| point of pride for some, though they tend to reverse course in
| older life when they see their peers start dying young. Many
| refuse vaccines for themselves and children due to things they
| heard on podcasts or social media. And mental health? Don't dare
| even suggest that one.
| lotsofpulp wrote:
| I can't even get my parents to care about mold after their
| basement floods for the 10th time in 10 years. They will worry
| about superstitions about eclipses, but not any long term
| health consequence from any source that could be labeled
| "science".
| lenerdenator wrote:
| It's a machismo built up around preventative behaviors that
| cost short-term money.
|
| If you're a farmer trying to compete in the last 50 years, your
| concern isn't with the possibility that you _might_ get cancer
| in 20 years from the neonicotinoids you 're spraying; it's
| making enough money to cover expenses _now_.
|
| But your friend who helps you do all sorts of farm chores, he
| wants to wear protection when he sprays. He's spent money on
| this protective gear, money that could have been put towards
| new machinery or the mortgage. He spends five minutes "dickin'
| 'round" putting it on. Five minutes that could be spent
| spraying. Since the span of five minutes is easier for the
| human mind to comprehend than the possibility of health
| problems months, years, or decades away, you choose to value
| the five minutes and tell him to get a move on. When he
| insists, you call him a wimp. He's now been shamed out of the
| preventative behavior.
| jajko wrote:
| Yeah, but its still outright stupid behavior, no matter how
| you wrap it. And stupidity will always be punished eventually
| in this world (which is the only way to 'fight' it, since as
| we know its endless and unlimited in mankind).
|
| 'I saved 5 minutes (or half an hour, who cares) so I can die
| 30 years younger than I had to, yeeehaaa'. Lack of good
| education, or intelligence, or both.
| kube-system wrote:
| I think a lot of these studies must either not be considering
| social factors, or maybe their authors aren't familiar with the
| worldview of rural America. I grew up in a place where some of
| those ideas are more popular, and the people around me
| regularly derided (what I now understand to be) healthy habits
| as things that 'sissy liberals' did. It was not socially
| acceptable to be on a diet, go to the gym, wear protective
| equipment, etc.
| shrubble wrote:
| My friend (urbanite) was offered statins but declined and
| instead went on a "P90x" home gym program. Six months later,
| his doctor agreed that statins weren't needed provided he
| stayed in shape. Of course, you have to actually do the
| exercise :)
| datavirtue wrote:
| These same social norms exist in city areas as well. Get a job
| in a factory and try to get your hands on adequate personal
| protective gear. You will not last long.
|
| This brain dead machoism is rampant, half the population is
| promoting a know-nothing facsist pig for president so that they
| can hammer the last nail in their own coffin.
| giantg2 wrote:
| "Statins are still a common debate"
|
| Even among some doctors, researchers, and former users there is
| debate. Not debate about their effectiveness in general, but
| about which situations should warrant them. There are several
| common side effects that can significantly impact quality of
| life.
|
| It's understandable that some people are skeptical of statins
| based on the history of pharma and their current proposals. For
| example, I heard a year or two ago that they were looking into
| recommending statins for _everyone_ over 70. The cholesterol
| level for when statins are recommended dropped about 50-100
| points just a few years ago too.
|
| "The lifestyle differences between what I see in the city and
| what I see in their rural locations are stark."
|
| Are you comparing neighborhoods of similar socioeconomic
| characteristics? I've seen plenty of your types of example in
| urban and rural areas. The big difference is money. The more
| well-off people in either location tend to be more conscience -
| diet, exercise, PPE use - than the poorer people.
|
| Edit: why disagree?
| pbnjay wrote:
| Lifestyle differences in rural areas are much more sedentary now
| that broadband internet is more available. In urban areas you
| have social factors and other reasons to walk around or stand up
| for longer periods.
|
| Couple that with the mentioned shrinking of hospital and
| healthcare access and yeah you've got a double whammy.
| apwheele wrote:
| I think this is right. For counterpoint though, there will of
| course be variance, but an opposite hypothesis is a larger
| proportion have labor jobs (men moreso than women).
|
| Grew up in rural PA (mostly farming, some factory work). They
| exact a significant toll (part of the reason opioid dependence
| grew IMO).
|
| But most of the metrics I have been seeing in terms of death
| rates show it is both for men and women, so I don't think labor
| jobs can explain it.
| forgetfreeman wrote:
| Hold up a sec, are you proposing that life in the country is
| _more_ sedentary than in urban areas? I 'm guessing you've
| never bailed hay.
| triceratops wrote:
| > I'm guessing you've never bailed hay
|
| Never had my boat fill up with hay so...no. I'd also guess
| most country people don't bale hay every day.
| jimbokun wrote:
| Neither have most people living in rural areas.
| redserk wrote:
| As someone who grew up and lived in a very rural area, most
| rural people don't bale hay.
|
| Most rural people live like those in the suburbs but are just
| physically farther away from other people.
| klyrs wrote:
| A cursory search indicates that the giant marshmallow looking
| haybales that modern farming produces are formed by a machine
| which you tow behind a tractor. I'm just a city gal, but how
| much of a workout is that, really?
|
| Edit: also, why are we speculating on stereotypes and not
| consulting actual data collected on exactly this question?
| https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7182355/
|
| It seems that people living in rural areas are, on average,
| more sedentary than their urban counterparts, despite the
| overwhelmingly popular stereotype that rural folk are svelte
| and outdoorsy.
| mecsred wrote:
| It's a pretty significant workout. Hooking up, detaching,
| cleaning and maintaining a bailer is a lot more effort than
| even a good distance walk. The statistics you're quoting
| are more so due to the fact that most people in rural areas
| don't operate a bailer or really any farm machinery. Which
| showcases one of the problems with relying on "actual data"
| without having a good understanding of the situation.
| drawkward wrote:
| Yes "actual data " is the problem. You even point out
| yourself
|
| >most people in rural areas don't operate...really any
| farm machinery"
|
| Which would be consistent with that damn actual data
| showing that rural folk are more sedentary than urban
| folk, in aggregate or on average.
| klyrs wrote:
| > most people in rural areas don't operate a bailer or
| really any farm machinery.
|
| This was effectively the claim made in the top-level
| comment; I responded to somebody countering that with
| weird claims about baling as if that's a typical activity
| for rural residents to engage in. But it's not, according
| to you and according to the data. What problem do you
| think this is showcasing?
| mecsred wrote:
| The comment you made questions how much excersise
| operating a bailer involves, which is what I responded
| to. I don't see anything in your comment or the parent
| talking about how common that excersise is, which is why
| I offered it as an explanation of the incongruence
| between your dataset and your implication that bailing is
| effortless because it involves a machine.
| trgn wrote:
| it's crazy how something seemingly minor, the necessity to walk
| some real distance for meeting daily needs, has such a wide
| range of benefits. Unconsciously, it makes you eat better and
| less, otherwise the walking would be very uncomfortable. It
| also makes you care about your immediate environment more,
| because you experience it a lot more directly.
|
| When you don't have that, it's an uphill battle. You have to
| carve out dedicated time to exercise, and you have to be very
| conscious of your diet.
|
| Walking makes for a healthier life, it really does, rather than
| only the healthy opting in for walking.
| xenospn wrote:
| Every time I'm in Europe I'm just delighted at how much I
| walk without having to use any other form of transport.
| Virtually impossible at home (LA).
| trgn wrote:
| I miss it after moving back here (midwest).
| chasd00 wrote:
| it would be more interesting to see the health differences by
| profession. It's a lot easier on your body to sit in front of a
| computer than be a lineman working for the county.
| delichon wrote:
| I think you have to work very hard before it's worse for your
| body than extended sitting. I make my living in front of a
| screen so try to mitigate it by going out in the yard and
| simulating someone who physically works for a living.
| forgetfreeman wrote:
| News for you, sitting on your ass is way harder on the body
| than actually working for a living.
|
| https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7700832/
| 01HNNWZ0MV43FF wrote:
| This is gonna sound silly but, I never sit in chairs normally
| unless I'm being watched.
|
| I've presently got one leg folded under me, and the other
| tucked up, so I'm not sitting on my ass, I'm sitting on a
| shin and a foot. And I will probably move in a couple
| minutes.
|
| Is that the same as "Sitting on one's ass", or..?
| jltsiren wrote:
| That's not what the article says.
|
| The article is about the health risks of a sedentary
| lifestyle, which means a lot of sitting with limited physical
| activity. But even as little activity as 60-75 minutes of
| brisk walking per day seems to be enough to compensate.
|
| It also mentions that watching TV is worse than more active
| forms of sitting, such as office work.
| chasd00 wrote:
| i grew up in rural areas around West and North Texas, every
| single person and relatives i knew that worked in those hard,
| labor intensive jobs, had bad knees and backs by the age of
| 55 and were basically crippled by retirement age.
| softwaredoug wrote:
| If I read Figure 1 correctly, overall mortality has actually
| declined (minus Covid). Even in rural areas mortality has
| continued to decline while this statistic was tracked. What
| appears to be the case is its declined _faster_ in urban areas.
|
| Figure 2 shows BOTH metro and non-metro increases in mortality
| for age groups 25-29 and 30-34.
| cozzyd wrote:
| I wonder what effect the proliferation of rural dollar stores has
| had. More junk food and fewer health care facilities is probably
| not a good combo... And has smoking become more common?
| wnorris wrote:
| Exercise through everyday walking likely plays a key role.
| Rural Americans drive everywhere and their most significant
| walking typically will take place only within stores while
| shopping.
| forinti wrote:
| It seems to me that they lost their good habits (manual
| labour and walking a lot) but kept their bad habits (diet and
| smoking).
| patwolf wrote:
| Having lived in rural areas, suburban areas, and urban areas,
| I don't see there being much difference in walking between
| rural and suburban.
|
| My guess is that it's a combination of rural areas being
| poorer (less access to healthy food and extra curricular
| activities) and the lack of societal pressure to be healthy
| that comes from living in a more isolated environment.
| SauciestGNU wrote:
| I suspect if you closely examined activity levels by
| distance from city center, you'd see something like a log
| curve with moderate activity for city dwellers, decreasing
| as you get farther from the core, to the point where
| suburban/exurban/rural dwellers have very similar activity
| levels.
| giantg2 wrote:
| I think one would have to adjust for occupations. I would
| assume certain types of jobs are more prevalent in one are or
| the other. For example, you're not likely to find many office
| workers in a location without large office buildings.
| jajko wrote:
| You can exercise all you want (not saying its not good for
| health, in contrary!), if you eat consistently crap unhealthy
| food and too much of it it doesn't matter long term (both
| consistent problems in US population as viewed from literally
| anywhere else in the world, for past few decades).
|
| Who eat more healthy? More intelligent (since they grok how
| important it is long term, despite less initial appeal
| compared to more stronger basic fat&salty&sugary taste), more
| wealthy (so they can afford it compared to processed junkfood
| prices pushed to absolute minimum).
|
| Who cooks for themselves from raw ingredients (which ends up
| being healthier food in general due to many factors)? Again
| same as above, you need to either have it hardcore baked in
| your culture like say Italians or French have, or just
| realize facts, and have some money to afford the extra time
| (and not juggle 2-3 shitty jobs trying to stay afloat and
| hovering just above burnout).
| FraterSKM wrote:
| Even in major cities in the US, the vast majority of people
| still drive most places. Sure, downtown office workers can
| usually walk to get lunch, but that's about the extent of it.
| Also, exercise is much harder in urban areas, cities have
| crowded gyms making it harder to work out at peak times,
| crowded roads making it harder to bike, and constant
| crosswalks making it hard to get in a consistently-paced run.
| Rural/suburban people just run on their land/around their
| neighborhood.
| jollyllama wrote:
| Good point but I would describe it as the death of proper
| grocery stores. This reflects a reduction in the standard of
| living.
| delichon wrote:
| These particular numbers do not include suicide, but those
| numbers are very bad too. This Time article was written about our
| county a couple of years ago. I know a few of the people quoted.
|
| https://time.com/6218385/suicide-rate-new-mexico/
|
| White men in particular are checking out at an alarming rate.
|
| So while this is an "external" cause not counted in the stats of
| the article, I can't help but assume common causes. The kind of
| depression that makes you want to die also makes you not want to
| take care of yourself.
|
| It isn't difficult to get state paid medical care here, except
| for the distance. Appointments at the two small clinics are not
| far in the future and the medical staff is competent. I doubt
| doubling or tripling spending there would have much if any
| effect.
|
| I think it's more about people who have chosen to live a more
| traditional lifestyle and discovering that it's an increasingly
| poor fit for the modern world. A plague of psychiatrists could
| descend on our county like locusts and bury every depressed
| person in talk therapy, and I doubt it would help.
| onlyrealcuzzo wrote:
| There's only ~3500 people that live in the county.
|
| Due to random noise, there's bound to be some small county with
| shockingly high suicide rates.
|
| This would be a better, less alarmist, way to look at suicide
| rates:
| https://www.cdc.gov/nchs/data/hestat/suicide/rates_1999_2017...
|
| Men used to commit suicide at about ~4x the rate of women, now
| it's closer to ~3.6x.
|
| White people commit suicide at high rates - and have for a long
| time (compared to other races) - and the growth in suicide in
| white people is outpacing other groups - but the growth rate is
| actually higher for white women (~68% vs ~41%).
| jibe wrote:
| Not because the male suicide rate is declining, but because
| the female suicide rate is rising faster than the male
| suicide rate is rising.
| giantg2 wrote:
| "There's only ~3500 people that live in the county."
|
| The trend follows even when evaluated nationally for the
| urban vs rural rate.
|
| https://www.cdc.gov/ruralhealth/Suicide.html
| onlyrealcuzzo wrote:
| Yeah, but it's 22 per 100,000 nationally, not 63.2 per
| 100,000 like in the small outlier county.
|
| That's about 1/3rd the rate in the time article - that
| seems alarmist and cherry-picking a small county to make a
| big story out of a smaller story.
| giantg2 wrote:
| Eh, the article acknowledges that it's the highest rate
| nationally and provides the national rate (better
| disclosure than most articles). Their intent was to
| interview people affected by it. It's not a study but a
| news story. It makes sense they'd go to a more afflicted
| area to make their job easier and get some better
| ratings. It doesn't make the stories any less insightful
| to some of the issues faced by similar people. It's just
| like how the vast majority of gun crime doesn't involve
| schools, but school shootings get the bulk of the air
| time while the day to day problems aren't covered in
| detail, if they're covered at all. They're looking for
| the most impactful and easy story.
| ToValueFunfetti wrote:
| I don't understand the focus on relative growth rates of very
| differently-sized groups. If the country had only these two
| groups and we had seen 100 additional deaths, that would mean
| ~70 additional male deaths and ~30 additional female deaths.
| While it is significant on its own that women made up an even
| smaller portion historically, it doesn't seem to me that that
| is a better description of the problem at large.
|
| Not that I think this is a gendered issue; suicide _attempt_
| rates are about equal between men and women, and the fact
| that men more often succeed doesn 't really have any bearing
| on their relative mental health.
| KittenInABox wrote:
| > It isn't difficult to get state paid medical care here,
| except for the distance.
|
| The distance can matter a ton, especially if you're already
| sick.
| delichon wrote:
| Free rides are available on request. The clinics are in the
| only places with any population density, and it wouldn't be
| practical to add more, which would be in the middle of
| nowhere. It does contribute to the problem, but there's not
| much to be done about it.
| KittenInABox wrote:
| I'm only pointing out that I think you're minimizing the
| effects lack of close accessibility to healthcare is on,
| well, healthcare.
| delichon wrote:
| I'd guess it has less effect than the difficulty in
| getting fresh food. Most of the population here has to
| drive for long distances to get to a mini market filled
| with ultra processed food-like substances.
|
| If we could deliver a doctor or groceries to their front
| door the later would probably do more good.
| paulryanrogers wrote:
| Why?
| delichon wrote:
| I think that the bulk of medical care goes to chronic
| diseases that have, in my case, been treated more
| effectively by a better diet. My diabetes, etc. got worse
| while I was taking medication, and better when I stopped
| the meds and switched to a better diet.
| wolverine876 wrote:
| I'd say the primary problem is the attitude that there's
| nothing you or anyone can do about it.
| giantg2 wrote:
| I'm not sure they're saying that nothing can be done, just
| that increased healthcare and therapy is unlikely to make a
| large impact. Addressing the actual problems driving them to
| suicide could reduce the numbers. They have some programs
| about USDA aid, lawyers, accountants, etc that farmers can
| use to address some of the issues.
|
| https://www.opb.org/article/2021/08/03/farmers-are-at-
| risk-o...
| docdocgoose wrote:
| The social politics of public health and medical schools is
| heavily slanted against focusing on rural Americans.
|
| This isn't an armchair statement.
|
| Reduced institutional emphasis and engagement isn't the cause of
| these trends, but it isn't helpful.
|
| Rural places would benefit from targeted loosening of healthcare
| regulations. More local experimentation. Clear eyed view of the
| road to recovery.
|
| Groups like the Cicero Institute have put effort here. Their
| approach is pragmatic and appears to be effective.
|
| Breakthroughs will not come from traditional institutions.
| genericresponse wrote:
| Can you clarify what you mean by "social politics?"
|
| I ask because rural health is effectively its own subspecialty
| in family medicine. There doesn't seem to be a locality
| equivalent for other geographic subgroups. This implies, to me,
| an extra level of focus on the needs of a population.
| datavirtue wrote:
| Some people have been able to map increased glyphosate usage to
| the rise of chronic disease. I was surprised to learn that
| glyphosate ("Roundup") was patented as an antibiotic. I was not
| terribly surprised to learn that it is found throughout our
| environment. In rural areas you are basically doused in it.
| Supposedly the effect is to disrupt the gut microbiome,
| ultimately resulting in persistent inflammation which of course
| leads to chronic disease and cancer.
| ZeroGravitas wrote:
| The main thrust of the article appears to be that it's
| Republicans killing these people by opposing Medicaid Expansion.
|
| What is the policy position that explains this decision?
| silverquiet wrote:
| Think about putting people into a spreadsheet (and remember
| that you probably exist in a few yourself, starting with an
| employer). Presumably your life has some value in expected
| economic output, and some cost associated with providing
| medical care. If the second number is greater than the first,
| then what is society to do?
|
| I say this as someone who lives with some physical disability
| (who fortunately at least has a bit of enough wits to do non-
| physical work) - it's a rather uncaring country for those with
| medical needs; particularly those parts of the country governed
| by the right (I live in South Texas, but not the rural part).
| readthenotes1 wrote:
| TANSTAAFL.
|
| E.G., https://thefga.org/research/medicaid-expansion-is-
| closing-ho...
| h2odragon wrote:
| Can't afford to see a doctor. Last Doctor I did see told me they
| would not do a sweat salinity test because I couldn't afford a
| diagnosis.
|
| Can't buy Sudafed; pharmacies treat the request like you asked
| them for their virgin daughter.
|
| Can't buy anitbiotics at the feed stores no more; FDA took care
| of that.
|
| I've got my own individual reasons to doubt the medical industry;
| I see my neighbors finding many of their own. We're going to need
| witch doctors and other unlicensed caregivers before long.
|
| Of course, it could be a question of metrics vs incentives, too.
| Who gets promoted when they juke the stats to say there _isn 't_
| a problem? "Rural Healthcare" is one of those lovely nebulous
| goals that can soak up nearly infinite amounts of grant money
| without ever having to show real results.
| jonhohle wrote:
| I'm sure you've run down a lot of options already but in case
| you haven't come across these (or to anyone else with similar
| issues):
|
| > Can't buy Sudafed; pharmacies treat the request like you
| asked them for their virgin daughter.
|
| If you have a Costco when you go into town, you can get 24
| generic for about $3 and can buy 3 boxes at a time from the
| pharmacy. 6 if you are there with someone else on the card.
| I've never been given a funny look about it and stock up
| whenever our family seems like they might be getting sick. I'm
| not sure what the limit is beyond single visit, but for a
| family of 6 we've never had an issue having enough on hand.
|
| > Can't buy anitbiotics at the feed stores no more; FDA took
| care of that.
|
| JASE seems expensive, but then and others will give you
| prescriptions via telemedicine.
|
| I used a teledoc during COVID to get the verboten prescription
| and it wasn't any more expensive than a pharmacy clinic or
| urgent care.
| nunez wrote:
| > Costco
|
| Even when the nearest Costco is an hour away at best?
| ad2k wrote:
| Having grown up and lived in the country, something being
| only an hour away is not unusual or a big deal. Our grocery
| store was 45 mins away, it isn't a big deal when that has
| been your life.
| jjk166 wrote:
| Presumably buying 3 boxes of sudafed isn't something you do
| frequently.
| spamizbad wrote:
| > Can't buy Sudafed; pharmacies treat the request like you
| asked them for their virgin daughter.
|
| Do they really make it that hard in rural counties to buy that
| stuff? Here in the city you just need to ask for it at the
| pharmacy counter and they scan your ID and you're good.
| indymike wrote:
| Depends on where you live. I live in Indiana, and you can buy
| Sudafed in limited quantites, but you are reported to law
| enforcement. Most people don't want law enforcement even
| knowing they bought Sudafed, so they go without. I had a
| chance to sit in a policy briefing where they shed a little
| light on what's going on in rural Indiana with mortality
| rates:
|
| * Opioid epidemic really hit rural communities hard and high
| suicide rates are pretty common among addicts. This led to an
| increase in suicide in older people.
|
| * Meth epidemic was fueled by cooking meth in the country,
| and it hit younger people.
| ericd wrote:
| There's a lot that has to go wrong before those two things
| become a major risk, though. Happy people don't generally
| decide that doing meth is a great idea. So what's driving
| the high rates?
|
| Is it high rates of bad overall health? Bad economic
| prospects and high expenses leading to hopelessness?
| Something else?
| indymike wrote:
| > Bad economic prospects and high expenses leading to
| hopelessness?
|
| Debt + Meth is a bitch..
| h2odragon wrote:
| my wife wont even ask anymore. our state law is one box per
| adult, per month, with ID. you dare not mention "family",
| they can't sell to anyone who says they're buying for others.
|
| When i ask, its a wait while thy call the other pharmacies to
| see if ive bought there, and then they copy my info down and
| post it on a bulletin board. That's assuming they've got the
| time to deal with me: if they're rushed they just say no.
| wolverine876 wrote:
| > Who gets promoted when they juke the stats to say there isn't
| a problem?
|
| Who says there isn't a problem? IME many people says there is a
| major one, that the US needs to revamp its healthcare system,
| and rural voters vote against it.
| HPsquared wrote:
| I'm a bit skeptical of the age grouping. 25-54 is a very wide
| range, and I would assume cities have more 25-year-olds, whereas
| the countryside will have more 54-year-olds.
| 082349872349872 wrote:
| I think that's part of the point: US agricultural policy since
| at least the 1970s has been "get big or get out", so you'd
| expect remaining rural populations to be more marginal.
|
| https://en.wikipedia.org/wiki/Earl_Butz#Secretary_of_Agricul...
|
| (It's possible to still have viable family farms in 2024, but
| it requires a willingness to have both (a) economic
| inefficiencies, and (b) legislative restrictions; although the
| Home of the Brave might be willing to implement a similar
| program, the Land of the Free is certainly not)
| coldtea wrote:
| > _I would assume cities have more 25-year-olds, whereas the
| countryside will have more 54-year-olds._
|
| Would that be true?
|
| For the same total population on each (say, 1M in cities vs 1M
| in the countryside) I'd expect the countryside to have higher
| birth rates and younger marrying couples, so younger
| demographics. Whereas cities have more career focused people,
| who marry later (if ever), have less kids, and have them at a
| greater age.
| inanutshellus wrote:
| Regardless of where you're born, high-paying jobs and the
| promise of professional growth are in the city.
|
| So 18+ (heading-to-college-and-after) leave their rural homes
| and rarely go back. Even if they manage to go to a local
| university, schooling leads to a niche job in some /other/
| city far away from home.
|
| Not only that, but agricultural jobs have been dwindling for
| decades.
|
| Anecdotally, (before my time) my high school used to shut
| down in the middle of spring so all the teenagers could
| harvest tobacco. These days that's just grandpa on a giant
| harvester.
| coldtea wrote:
| > _So 18+ (heading-to-college-and-after) leave their rural
| homes and rarely go back._
|
| One would think so, but then you read things like:
|
| "Do Americans live where they grew up? At 68%, the majority
| polled answered yes, they live in or near the city where
| they grew up. People most often stay in the same town to be
| with their family, while those who move typically move for
| work. The data shows that these two reasons are the biggest
| factors in moving. It's interesting to compare the current
| data to the U.S. Census Bureau's 2016 study results. A few
| years ago, 75% of women stayed in their hometowns, compared
| to 68% of men. Those numbers have flipped, according to our
| 2022 survey."
| Fishkins wrote:
| I'd also guess rural areas have higher birth rates and
| younger marriages. By the time those kids reach 25, though, a
| lot of them will have moved to cities. That could still mean
| HPsquared is correct. I'd need to look up stats to be sure.
| AuryGlenz wrote:
| It's pretty common in my rural area for people to move to a
| city after college and then come back (or go somewhere else
| rural) in their 30s or 40s.
|
| People often want to raise kids in the type of environment
| they grew up in.
| jajko wrote:
| Yes, city people rarely enjoy quiet simpler life near/in
| the nature and wonder WTF folks actually do there, and
| rural folks struggle to find cities appealing enough due to
| all the missing bits, noise, pollution, crowds.
|
| Work or studies overcome this, but as you write, especially
| with kids, getting a bit older folks somehow remember
| positives of their childhood and revert, if work allows it.
| WFH gained wider acceptance due to covid helped massively,
| I still hope self-driving cars/pooled ai taxis will cover
| the rest in few years.
|
| Thats literally a continuous trillion dollar business, and
| compared to many big name corps popular here this would
| tremendously positively help so many people.
|
| IIRC some psychological research found out we humans can
| adapt to almost any situation, positive or negative, and
| over time revert to our original selves and level of
| happiness coming from our own existence (that's why joy
| from ie new toy fizzles away so quickly not only in kids).
| But folks seem to not do that for 2 items even after time
| passes - pets you actually enjoy (consistent positive
| energy) and long daily commutes where life tickles away and
| you are stuck doing nothing worthwhile for your life (the
| opposite).
| hedgehog wrote:
| That is the range of ages for which they found an increase but
| the biggest increase is in the 30-34 age subgroup. The report
| is not hard to skim, the overall picture is rural populations
| particularly in southern states are dying much more of
| "natural" causes like heart disease and cancer, and that
| divergence from urban populations started in the mid 80s.
| There's some speculation in the report as to why.
| panarky wrote:
| Mortality is strongly correlated with wealth and physical
| activity.
|
| Wealth is a proxy for better healthcare, diet and education.
|
| City people are generally richer and walk more.
|
| Rural residents are poorer and drive everywhere.
| ChrisArchitect wrote:
| Avoid syndicated content.
|
| Actual article: https://www.cbsnews.com/news/city-country-
| mortality-gap-wide...
| garciansmith wrote:
| Am I wrong in thinking it's the opposite? CBS notes and links
| back to KFF, and the reporter, Jazmin Orozco Rodriguez, works
| for KFF.
| hereme888 wrote:
| My experience for years living in several very rural areas of the
| US leads me to believe that one big factor is "positive peer
| pressure" and quality food availability.
|
| "Southern" people's rural lives may be calmer and richer in
| nature, but their hobbies and lifestyle are quite unhealthy.
|
| In big cities there is more social pressure for being good-
| looking, mainly a healthy BMI and muscles, both which are
| protective against cancer.
|
| They're also "food deserts" where supermarkets and restaurants
| with healthy food are extremely scarce. I've been to towns where
| you'd be hard-pressed to find any vegetables in their menu
| besides tomato sauce and a pickle. Health literacy is also
| abysmal. I don't see how they can avoid a heart attack with such
| food menus.
| screwturner68 wrote:
| I don't want to live anywhere where I can see my neighbor. These
| people are choosing this lifestyle. These same people are a
| massive tax on society because we have to subsidize this
| lifestyle because it's very expensive to provide services to
| places where nobody lives. Why would you build a hospital where
| only 10,000 live? Why spend $5000 to drag fibre to someone's
| house so that they can pay $50/month for internet access? How can
| you afford to pave a road where one person has 800ft of frontage
| and pays $1500 a year in SALT?
|
| Again, at the end of day this is a choice and their choice costs
| everyone. I can't really feel sorry for these people, it's what
| you get when you want to go it alone.
| trallnag wrote:
| Shouldn't you use "we" instead of "these people"?
| abduhl wrote:
| We need places where nobody lives to produce things. You cannot
| farm acres of land where everybody lives, it has to be done
| where nobody lives. You can't raise cattle where people live
| because the cattle has to live there.
|
| I suppose the converse view is that city dwellers are
| externalizing the cost of their existence and so we should see
| huge increases in prices for staple goods until rural dwellers
| are paid appropriately and we have equitable outcomes with
| respect to mortality between rural and urban populations.
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