People living in rural America have a life expectancy three years shorter than those living in urban areas, and they have a 20 percent higher death rate for cardiovascular disease and stroke.

These sad and sobering statistics have led to two significant advisories to be published recently by the American Heart Association in the journal Circulation with a call to action for both the association and other stakeholders to make rural populations a priority in programing, research and policy initiatives.

The association recently announced its new 10-year goal to equitably increase healthy life expectancy from 66 to at least 68 years in the U.S. by 2030.

The research shows that, generally, rural populations also have higher rates of tobacco use, physical inactivity and obesity, which have given rise to higher rates of diabetes and high blood pressure.

These populations face unique challenges that create these barriers to health including:

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Income: The median household income in mostly rural counties is as much as $10,000 less than the median household income nationally.

Housing: Rental options are limited in rural areas.

Food insecurity: Rural populations disproportionately live without reliable access to grocery stores that sell affordable, fresh foods, and are frequently left to rely on corner stores with processed foods.

Underinsured: Rural populations are more likely to be uninsured than people in urban areas.

Transportation: Rural populations face limited public transportation options, high costs, and long travel distances, which can lead to delays in treatment, inadequate access to medical treatment and unmet health care needs.

Adding to these challenges, rural hospitals are under enormous financial strain and face shortages of health care providers. Long distances between facilities and lack of access to transportation make it difficult for rural populations to access preventive and emergency care.

Improving rural health requires innovative policy and community health approaches.

What does this mean for Minnesota?

Here in Minnesota, there are many stakeholders already invested in improving health outcomes for everyone in the state.

Previously the American Heart Association worked with hospitals and EMS around the state to build one of the best stroke systems of care in the country. Last year we worked to get a $300,000 sustained annual investment to maintain the state’s Good Food Access Program which has already granted nearly $1 million to 50 local enterprises around Minnesota for unique food insecurity solutions.

We are currently working to keep youth healthy by reducing consumption of sugary drinks, pushing for policies that stop the targeting of youth with flavored nicotine products, and reinvesting at least $6 million in Minnesota’s Safe Routes To School Program for local infrastructure improvements that which would reach 24,000 Minnesota youth.

We are also working with numerous health care systems and clinics to implement clinical programs that help reduce cholesterol, high blood pressure and diabetes rates in their communities.

Funding research will continue to be our major focus including the nearly $5 million we grant each year to Minnesota institutions, including the University of Minnesota and Mayo Clinic, but to close the gap, we will need to apply a "rural lens" to all of our research, education, quality improvement, programs and policies.

The American Heart Association is steadfast in working with strategic partners on the development of unique local solutions. Improving health in rural America will require the sustained commitment of all stakeholders.