Authored by Finley Allen
Art by Nava Lippman
The southern United States is defined by more than its geographical location. These states share a unique mystique characterized by long syllables, cowboy boots, and country music, but there’s another commonality unique to the south—southern residents have shorter lives than the rest of America [1].
In southern states like Mississippi, Louisiana, Alabama, South Carolina, Kentucky, Arkansas, and Tennessee, the life expectancy is approximately five to ten years lower than in other American regions [1]. Although the specific cause remains hotly contested and undefined, different studies and sources pose various theories regarding this discrepancy and endemic mortality rate.
In a longitudinal study spanning 49 years, Nathan T. Dollar, et al. examined specific disadvantages Southerners face and the impact they have on life expectancy. Dollar found that young people, ages one to 24, who live in the south experience high mortality rates due to gun violence and motor vehicle crashes [2]. It is widely known that southern states have few firearm regulations. The prevalence of guns, paired with a lack of proper training, will invariably contribute to more deaths, but it's not likely that motor vehicle crashes contribute significantly to the disparity in life expectancy across all ages. According to the Insurance Institute for Highway Safety (IIHS), driving at higher speeds is directly proportional to more motor vehicle deaths [3]. However, speed limits are not significantly higher in Southern states [3]. Furthermore, the South does not appear to have a higher total traffic fatality rate when compared to other American regions [4]. This does not negate Dollar’s conclusion; it does, however, mean that the life expectancy in the South is influenced by more variables.
An article published by Texas A&M University asserts that Southern state residents are subject to a slew of health-related challenges due to a lack of public smoking bans, limited walkability, and a shortage of primary care physicians [5]. It stands to reason that these factors will also cause higher mortality rates. After all, cigarettes are carcinogens, sedentary lifestyles cause obesity, and, according to an article published in 2019 by Stanford Medicine, the availability of primary care physicians is inversely proportional to mortality rates [6].
Fortunately, new legislative acts are starting to address these problems. For example, in August 2021, the Biden-Harris Administration passed the Emergency Rural Healthcare Grants to provide funds to rural healthcare facilities to expand and serve more people in these regions [7]. Unfortunately, legislation can be slow and is often subjected to arduous bureaucracy, so some non-governmental organizations are creatively addressing these problems.
The Association of American Medical Colleges noticed that physicians from rural areas are the most likely to practice in these communities. In 2016 and 2017, however, aspiring physicians from rural areas made up less than 4.3% of the national matriculating class. By incentivizing students with automatic admissions and recruiting directly from rural communities, medical schools are seeing an increase in this demographic, a trend that is expected to continue rising [8]. This is a good start, but more should be done to solve this systemic problem. However, there are very limited financial resources to incentivize physicians to practice rurally.
Passing multifaceted legislation to combat these fundamental causes is also imperative for raising southern mortality rates. Simple policy action can eliminate public smoking, legislatures can fund public parks to build trails for walking, and additional government initiatives like the Emergency Rural Healthcare Grants, can help bring primary care physicians to these regions.
Additionally, as in any “boots on the ground” work, equity must always be at the forefront–do these programs reach all rural communities equally? Or is there still a disparity between socioeconomic statuses, genders, and ethnicities? If so, rectifying this will take federal legislation and intentional work by the program directors and intentional action by these medical schools.
Do lower life expectancies in the south stem from gun violence? Sedentary habits? Healthcare accessibility? The simple and sad fact is that the answer is complex and multifaceted. Legislation must be improved to provide better education and stricter regulations on firearms, public infrastructure needs to improve to make cities more walkable, and physicians need to move to the south to help treat those in need. Though it is certainly an intimidating task, it is not insurmountable; average people, when coalescing, have great power to make change! Write a congressperson demanding action, listen to Southerners about their experiences, sign petitions, donate to southern organizations, and, above all, proceed with compassion. As human beings, it is our responsibility to ensure that all people have equitable access to health resources. Fixing this daunting task begins here and now.
References
[1] CDC. (2021, March 15). Life Expectancy at Birth by State, 2018. Www.cdc.gov. https://www.cdc.gov/nchs/pressroom/sosmap/life_expectancy/life_expectancy.htm
[2] Dollar, N., Gutin, I., Lawrence, E. M., Braudt, D. B., Fishman, S. H., Rogers, R. G., & Hummer, R. A. (2020). The persistent southern disadvantage in US early life mortality, 1965‒2014. Demographic Research, 42, 343–382. https://doi.org/10.4054/demres.2020.42.11
[3] Speed: Maximum posted speed limits by state. (n.d.). IIHS-HLDI Crash Testing and Highway Safety. https://www.iihs.org/topics/speed/speed-limit-laws
[4] Dollar, N., Gutin, I., Lawrence, E. M., Braudt, D. B., Fishman, S. H., Rogers, R. G., & Hummer, R. A. (2020). The persistent southern disadvantage in US early life mortality, 1965‒2014. Demographic Research, 42, 343–382. https://doi.org/10.4054/demres.2020.42.11
[5] Maddock, J. (2018, February 5). 5 Charts Show Why The South Is The Least Healthy Region In The US. Texas A&M Today. https://today.tamu.edu/2018/02/05/5-charts-show-why-the-south-is-the-least-healthy-region-in-the-us/
[6] Policy, B. D.-B. B. D.-B. is the communications manager for S. H. (2019, February 18). More primary care physicians leads to longer life spans. News Center. https://med.stanford.edu/news/all-news/2019/02/more-primary-care-physicians-lead-to-longer-life-spans.html#:~:text=
[7] USDA Press. (2023, July 25). Biden-Harris Administration Helps Expand Access to Rural Health Care Through Investing in America Agenda. Www.usda.gov. https://www.usda.gov/media/press-releases/2023/07/25/biden-harris-administration-helps-expand-access-rural-health-care#:~:text=In%20August%202021%2C%20USDA%20made
[8] Jaret, P. (2020, February 3). Attracting the next generation of physicians to rural medicine. AAMC. https://www.aamc.org/news/attracting-next-generation-physicians-rural-medicine