Rural life hardly healthier
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* Michael Monette

It’s tempting to conclude that suburbs rule as it seems the classic notions that country life is healthy and idyllic, and city life toxic and schizophrenic, are both wrong. And right.

According to experts, the health perils of country and city life are different, but probably a wash when it comes to the question of whether rural or urban living is healthier.

There’s certainly little validity to the proposition that country life, replete with all that fresh air, is a guarantor of good health, says Raymond Pong, a senior research fellow at the Centre for Rural and Northern Health Research, and a professor in the School of Rural and Northern Health at Laurentian University in Sudbury, Ontario.

“It’s not that the whole of the rural population is in jeopardy, but generally speaking, the more remote, the more northern, the smaller the community, the poorer the health status,” says Pong, principal investigator on a Canadian Institute for Health Information study which found that people living in rural Canada have higher mortality rates and shorter life expectancies than those in urban regions ([www.phac-aspc.gc.ca/publicat/rural06/pdf/rural\_canadians\_2006\_report\_e.pdf](http://www.phac-aspc.gc.ca/publicat/rural06/pdf/rural\_canadians_2006_report_e.pdf)). It also found that life expectancy in 2001 for men born in remote, rural areas was 74 years compared to 76.8 years in urban Canada. The difference was statistically negligible in woman, with life expectancies ranging from 81.3 to 81.5 years.

Obesity, smoking and less physical activity contributes to a higher incidence of chronic diseases like diabetes and cardiovascular disease among country dwellers, who also suffered more deaths from motor vehicle collisions and occupational hazards such as injuries and poisoning, the study found.

But the news wasn’t all bad for rural residents. They have lower cancer death rates, experience less stress, suffer less respiratory disease and report a greater “sense of community belonging,” it added.

![Figure1](http://www.cmaj.ca/https://www.cmaj.ca/content/cmaj/184/17/E889/F1.medium.gif)

[Figure1](http://www.cmaj.ca/content/184/17/E889/F1)

Among the health challenges faced by those who live in rural areas is that their remoteness often requires them to travel longer distances to obtain care.

Image courtesy of © 2012 Thinkstock

Pong says that rural Canadians also face a health challenge in terms of access to health services in comparison with their city counterparts. Their remoteness often requires them to travel longer distances to obtain care, which leads to a higher rate of traffic collisions. There’s also the fact that they often hold more dangerous jobs in the farming, mining, fishing and logging industries, he adds.

The disparity in access to health services is typical of rural and urban environments throughout the world, according to a World Health Organization study (*Fam Pract* 2003;20:457–63). “Even in countries where the majority of the population lives in rural areas, the resources are concentrated in the cities. All countries have difficulties with transport, communication, services and resources, and they all face the challenge of shortages of health-care providers in rural and remote areas,” it states.

But if country living isn’t all that it’s cracked up to be, health-wise, it isn’t as if city living constitutes any manner of Shangri-La, as studies have repeatedly shown that city-dwellers suffer a high incidence of mental health problems, including depression, psychosis and schizophrenia, as well as a greater incidence of drug and alcohol dependence.

It’s not clear, though, what aspect of city life is responsible for that higher incidence of mental health problems, says Jens Pruessner, associate professor of psychiatry, neurology and neurosurgery at McGill University in Montréal, Quebec.

“It could be the noise, the traffic. … There might be a greater social pressure in the city compared to the rural environment because of the greater number of people you are exposed to,” says Pruessner, coauthor of a study which surmised that there might be differences in the way in which the brains of urban dwellers and rural residents process social stress, which could contribute to more schizophrenia and mood or anxiety disorders among city dwellers (*Nature* 2011;474:498–501).

But there may be other factors at play in the lower incidence of mental health problems among rural Canadians, says Judith Kulig, professor of health sciences at the University of Lethbridge in Alberta. A strong sense of community belonging and “connection to the landscape” can contribute to positive health among rural Canadians, she says. “When people live in a physical environment that they feel an attachment to and that gives them not just a sense of belonging, but a sense of peacefulness, that actually assists with lack of stress.”

As well, greater social cohesion in rural areas also means that country dwellers can more readily rely on friends and neighbours for help in the event of injury or illness, Kulig adds. “There are many, many stories of farmers who have some kind of accident or something and aren’t able to finish their harvest, and their neighbours come out and finish their harvest for them.”

But others say no safe conclusions can be drawn about the respective health merits of country or city life.

There are some cities, or pockets of some cities, and some rural areas, or pockets of some rural areas, that are healthier to live in than others, says Judith Guernsey, associate professor of community health and epidemiology in the Faculty of Medicine at Dalhousie University in Halifax, Nova Scotia.

Not all rural communities are plagued with poor health and difficulties accessing services, Guernsey says. “Some rural communities are absolutely beautiful, pristine and healthy and very well-resourced, whereas other rural and remote locations are completely challenged, impoverished.”

But city life is no less variable, she adds, citing a study that found an 11-year difference in life expectancy between two areas of Montréal ([http://publications.santemontreal.qc.ca/uploads/tx_asssmpublications/978-2-89673-119-0.pdf](http://publications.santemontreal.qc.ca/uploads/tx_asssmpublications/978-2-89673-119-0.pdf)). “Some urban communities are thriving. You go to the downtown core and they’re thriving areas, but there are other urban settings that are very challenged,” she says. “From a research perspective, we really have to look at the local context … to understand why some people are healthier than others.”