Monday, Sep. 10, 2001 Bad news for city slickers and country folk alike: The suburbs are the healthiest place to live in America. According to a new report from the Centers for Disease Control and Prevention, residents of the American suburb rank highest in terms of overall health, access to care and medical treatments. The study, which examined the state of American health care, also concluded that U.S. residents are healthier and living longer than ever before. Unfortunately for those living outside the reach of major metropolitan health systems, the good news does not hold: Residents of rural areas fared the worst in terms of overall indicators of health, with urbanites coming in a close second. Researchers found that rural residents tended to smoke more, lose their teeth more often and die sooner than their more citified peers. They also suffered from a lack of preventative and palliative care. These numbers extend across economic lines: In 1997 and 1998, for example, 10.6 percent of wealthiest residents in rural areas lacked health insurance, compared to 10 percent of all urban residents and 6.6 percent of suburbanites. Dental care was also a serious problem for rural dwellers; 37.6 percent of rural residents over 65 have suffered total tooth loss, compared with 25.7 percent of suburbanites and 26.8 percent of folks in cities. So what gives? Are rural residents suffering from a lack of access to healthcare providers, or are they simply less apt to follow the edicts of a health-crazed media? The answer is probably a little bit of both, says Mark Eberhardt, epidemiologist at CDC뭩 national center for health statistics, and an author of the study. "On the one hand," Eberhardt says, "you have the issue of educating people about health issues: Some high-risk behaviors, like smoking, remain higher in rural areas than in cities and suburbs. On the other hand, we did see a lower access to physicians, dentists, and health insurance coverage in rural areas." Of course, even if you manage to convince a doctor to move to the country, you have the challenge of getting erstwhile patients to darken his door, says Professor Janet Hardy Boettcher, a registered nurse and the director of the school of nursing at Radford University in southwestern Virginia. "Rural people believe, for the most part, that you뭨e well until you can뭪 move around," she says. "That뭩 certainly true in this area." That cultural aversion to doctors?offices may also be fueled by the fact that as a rule, country doctors are not as up-to-date in procedures as city physicians. There may be other perception problems as well, adds Boettcher. "While there are certainly good doctors in rural areas, you can often find doctors here who are not at the peak of their careers — possibly just starting out, or nearing retirement, or perhaps trying to escape from problems elsewhere." What뭩 to be done? Boettcher believes the solution to rural health care뭩 crisis will not come from outside forces, but from within the communities themselves. "Politically, of course, the impact of rural areas is so small — politicians can be elected whether we뭨e here or not," she says. That뭩 why schools like Radford have begun their own programs aimed at sending new nurses and doctors into nearby rural communities. At Radford, Boettcher adds, they뭭e seen great reactions. "We뭭e seen some of these new graduates really taken into these under-served communities," she says. "You really feel needed, and that뭩 especially important when you뭨e just starting out."