October 2015 Letter on Rural Life Expectancy

October 20, 2015

The Honorable Sylvia Burwell, Secretary
U.S. Department of Health and Human Services
200 Independence Avenue SW
Washington, DC 20201

Dear Secretary Burwell,

On behalf of the National Advisory Committee on Rural Health and Human Services, I am sending you a Policy Brief and accompanying recommendations. This brief is a result of our May 2015 Committee meeting and examines rural mortality and life expectancy.

In recent years some articles have appeared in the popular press regarding a decline in life expectancy in rural areas of the country. The Committee wanted to examine this issue, determine if it was a real phenomenon and, if so, why this decline was occurring. We met in Eastern Kentucky, part of the Appalachian region, which has indeed seen increased mortality and a resulting decline in life expectancy.

This problem has been somewhat concealed because overall life expectancy in rural America has gone up, albeit not as greatly as in urban areas. However, there has been an alarming decrease in life expectancy in Appalachia and in some other rural areas of the country. The data included in the attached Policy Brief shows some of the factors causing the decline. Heart disease, cancer and unintentional injuries are cited as accounting for much of the urban-rural differential in mortality and life expectancy. However, data alone can’t convey the emotional impact of what we heard in Kentucky. We heard from researchers and academics but we also heard directly from people who have lived and worked in the Appalachians all their lives.

When we visited the Center of Excellence in Rural Health in Hazard and Marcum and Wallace Hospital in Irvine, it became apparent to us that the disparity between Appalachian and non-Appalachian statistics was not the result of a lack of health care resources.

Perry County, where Hazard is located, has health care facilities available and yet its health status indicators are very poor. What we saw and heard about was a lack of economic development and of a sense of helplessness in the face of extended, generational poverty. This is truly a topic that cuts across the Advisory Committee’s charge to advise you on both health and human services. We hope that this Policy Brief and the accompanying recommendations offer HHS options for how to improve population health and well-being in rural communities.

Our next meeting will be in Beaufort, South Carolina, and will be held from April 18th -20th, 2016. We would welcome participation by you or your representative in the meeting where we will be taking on two important topics. The first will examine HHS’ Delivery System Reform initiative and its implications for rural areas. The second will look at the implications of opioid abuse and its destabilizing impact on rural communities.

Thank you for your attention to rural America.


The Honorable Ronnie Musgrove

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