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.
One reason for the trans-Atlantic distinction is simple geography: At 94,060 square miles, the U.K. is roughly half the size of California, and quite densely settled. “We don’t have extreme rural areas, just because the distances aren’t as big,” says Andy Jones, professor of environmental sciences at the University of East Anglia’s Centre for Diet and Activity Research. “In the U.K., you’re never a long way away from civilization.” Rural Brits have access to similar healthcare infrastructure,