Rural Americans – particularly men – are expected to live significantly shorter, less healthy lives than their urban counterparts, according to our research, recently published in the Journal of Rural Health.

We found that a 60-year-old man living in a rural area is expected on average to live two fewer years than an urban man. For women, the rural-urban gap is six months.

A key reason is worse rates among rural people for smoking, obesity and chronic conditions such as high blood pressure and heart disease. These conditions are condemning millions to disability and shortened lives.

What’s more, these same people live in areas where medical care is evaporating. Living in rural areas, with their relatively sparse populations, often means a shortage of doctors, longer travel distances for medical care and inadequate investments in public health, driven partly by declines in economic opportunities.

Our team arrived at these findings by using a simulation called the Future Elderly Model. With that, we were able to simulate the future life course of Americans currently age 60 living in either an urban or rural area.

The model is based on relationships observed in 20 years of data from the Health and Retirement Study, an ongoing survey that follows people from age 51 through the rest of their lives. Specifically, the model showed how long these Americans might live, the expected quality of their future years, and how certain changes in lifestyle would affect the results.

We describe the conditions that drive our results as “diseases of despair,” building off the landmark work of pioneering researchers who coined the now widely used term “deaths of despair.” They documented rising mortality among Americans without a college degree and related these deaths to declines in social and economic prospects.

The main causes of deaths of despair – drug overdoses, liver disease and suicide – have also been called “diseases of despair.” But the conditions we study, such as heart disease, could similarly be influenced by social and economic prospects. And they can profoundly reduce quality of life.

We also found that if rural education levels were as high as in urban areas, this would eliminate almost half of the rural-urban life-expectancy gap. Our data shows 65% of urban 60-year-olds were educated beyond high school, compared with 53% of rural residents the same age.

One possible reason for the difference is that getting a bachelor’s degree may make a person more able or willing to follow scientific recommendations – and more likely to work out for 150 minutes a week or eat their veggies as their doctor advises them to.

Why it matters

The gap between urban and rural health outcomes has widened over recent decades. Yet the problem goes beyond disparities between urban and rural health: It also splits down some of the party lines and social divides that separate U.S. citizens, such as education and lifestyle.

Scholarship on the decline of rural America suggests that people living outside larger cities are resentful of the economic forces that may have eroded their economic power. The interplay between these forces and the health conditions we study are less appreciated.

Economic circumstances can contribute to health outcomes. For example, increased stress and sedentary lifestyle due to joblessness can contribute to chronic health issues such as cardiovascular disease. Declines in economic prospects due to automation and trade liberalization are linked to increases in mortality.

But health can also have a strong influence on economic outcomes. Hospitalizations cause high medical costs, loss of work and earnings, and increases in bankruptcy. The onset of chronic disease and disability can lead to long-lasting declines in income. Even health events experienced early in childhood can have economic consequences decades later.

In tandem, these health and economic trends might reinforce each other and help fuel inequality between rural and urban areas that produces a profoundly different quality of life.

What still isn’t known

It should be noted that our results, like many studies, are describing outcomes on average; the rural population is not a monolith. In fact, some of the most physically active and healthy people we know live in rural areas.

Just how much your location affects your health is an ongoing area of research. But as researchers begin to understand more, we can come up with strategies to promote health among all Americans, regardless of where they live.

The Research Brief is a short take on interesting academic work.

Elizabeth Currid-Halkett, James Irvine Chair in Urban and Regional Planning and Professor of Public Policy, University of Southern California; Bryan Tysinger, Assistant Professor of Health Policy and Management, University of Southern California, and Jack Chapel, Postdoctoral Scholar in Economics, University of Southern California

This article is republished from The Conversation under a Creative Commons license. Read the original article.

Imagine a world in which a hurricane devastates the Gulf Coast, and the U.S. has no federal agency prepared to quickly send supplies, financial aid and temporary housing assistance.

Could the states manage this catastrophic event on their own?

Normally, the Federal Emergency Management Agency, known as FEMA, is prepared to marshal supplies within hours of a disaster and begin distributing financial aid to residents who need help.

However, with President Donald Trump questioning FEMA’s future and suggesting states take over recovery instead, and climate change causing more frequent and severe disasters, it’s worth asking how prepared states are to face these growing challenges without help.

What FEMA does

FEMA was created in 1979 with the job of coordinating national responses to disasters, but the federal government has played important roles in disaster relief since the 1800s.

During a disaster, FEMA’s assistance can begin only after a state requests an emergency declaration and the U.S. president approves it. The request has to show that the disaster is so severe that the state can’t handle the response on its own.

FEMA’s role is to support state and local governments by coordinating federal agencies and providing financial aid and recovery assistance that states would otherwise struggle to supply on their own. FEMA doesn’t “take over,” as a misinformation campaign launched during Hurricane Helene claimed. Instead, it pools federal resources to allow states to recover faster from expensive disasters.

During a disaster, FEMA:

• Coordinates federal resources. For example, during Hurricane Ian in 2022, FEMA coordinated with the U.S. Coast Guard, the Department of Defense and search-and-rescue teams to conduct rescue operations, organized utility crews to begin restoring power and also delivered water and millions of meals.

• Provides financial assistance. FEMA distributes billions of dollars in disaster relief funds to help individuals, businesses and local governments recover. As of Feb. 3, 2025, FEMA aid from 2024 storms included US$1.04 billion related to Hurricane Milton, $416.1 million for Hurricane Helene and $112.6 million for Hurricane Debby.

• Provides logistical support. FEMA coordinates with state and local governments, nonprofits such as the American Red Cross and federal agencies to supply cots, blankets and hygiene supplies for emergency shelters. It also works with state and local partners to distribute critical supplies such as food, water and medical aid.

The agency also manages the National Flood Insurance Program, offers disaster preparedness training and helps states develop response plans to improve their overall responses systems.

What FEMA aid looks like in a disaster

When wildfires swept through Maui, Hawaii, in August 2023, FEMA provided emergency grants to cover immediate needs such as food, clothing and essential supplies for survivors.

The agency arranged hotel rooms, rental assistance and financial aid for residents who lost homes or belongings. Its Direct Housing Program has spent $295 million to lease homes for more than 1,200 households. This comprehensive support helped thousands of people begin rebuilding their lives after losing almost everything.

FEMA also helped fund construction of a temporary school to ensure that students whose schools burned could continue their classes. Hawaii, with its relatively small population and limited emergency funds, would have struggled to mount a comparable response on its own.

Larger states often need help, too. When a 2021 winter storm overwhelmed Texas’ power grid and water infrastructure, FEMA coordinated the delivery of essential supplies, including water, fuel, generators and blankets, following the disaster declaration on Feb. 19, 2021. Within days, it awarded more than $2.8 million in grants to help people with temporary housing and home repairs.

Which states would suffer most without FEMA?

Without FEMA or other federal support, states would have to manage the disaster response and recovery on their own.

States prone to frequent disasters, such as Louisiana and Florida, would face expensive recurring challenges that would likely exacerbate recovery delays and reduce their overall resilience.

Smaller, more rural and less wealthy states that lack the financial resources and logistical capabilities to respond effectively would be disproportionately affected.

“States don’t have that capability built to handle a disaster every single year,” Lynn Budd, director of the Wyoming Office of Homeland Security, told Stateline in an interview. Access to FEMA avoids the need for expensive disaster response infrastructure in each state.

States might be able to arrange regional cooperation. But state-led responses and regional models have limitations. The National Guard could assist with supply distribution, but it isn’t designed to provide fast financial aid, housing or long-term recovery options, and the supplies and the recovery effort still come at a cost.

Wealthier states might be better equipped to manage on their own, but poorer states would likely struggle. States with less funding and infrastructure would be left relying on nonprofits and community-based efforts. But these organizations are not capable of providing the scope of services FEMA can.

Any federal funding would also be slow if Congress had to approve aid after each disaster, rather than having FEMA already prepared to respond. States would be at the mercy of congressional infighting.

In the absence of a federal response and coordinating role, recovery would be uneven, with wealthier areas recovering faster and poorer areas likely seeing more prolonged hardships.

What does this mean?

Coordinating disaster response is complex, the paperwork for federal assistance can be frustrating, and the agency does draw criticism. However, it also fills an important role.

As the frequency of natural disasters continues to rise due to climate change, ask yourself: How prepared is your state for a disaster, and could it get by without federal aid?

Ming Xie, Assistant Professor of Emergency Management and Public Health, University of Maryland, Baltimore County

This article is republished from The Conversation under a Creative Commons license. Read the original article.