Why Rural Brits Outlive Rural Americans

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The motto of Rutland, England is multum in parvo: Much in little. Rutland is England’s smallest county, 16.3 miles from north to south, home to quaint cottages, green hills, and the World Championship of Nurdling (competitors throw pennies into a narrow hole in a wooden bench).

As befits its motto, tiny Rutland has played an outsized role in two significant medical studies, both of which focus on life expectancy. The newest, from the University of Liverpool, compared lifespans in rural Rutland to those in four cities: Liverpool, Manchester, Bolton, and Leeds. Rutlandites live longer than their urban counterparts, the study found. The study is a sequel—175 years later—of a pioneering bit of public health research from the Victorian era: In 1842, social reformer Edwin Chadwick found that laborers in Rutland lived longer than tradesmen in the same quartet of cities.

So if fresher air and a pastoral environment help boost life expectancy in the U.K., why isn’t the same true the United States? In the U.K., rural residents live about two years longer than city dwellers; in the U.S., it’s the opposite: Urbanites live two years longer than their rural counterparts. And the gap is growing—in 1969, just four months separated the two.

In some U.S. counties, life expectancy has even declined—dropping by 13 months since the early 1990s for women in rural Kentucky, according to a 2016 National Rural Health Association (NRHA) report. And rural Americans are also more likely to die from five leading causes—heart disease, cancer, unintentional injuries, chronic lower respiratory disease, and stroke—than those living in urban areas, a 2017 Centers for Disease Control and Prevention study found.