The Hidden Costs of Decline: Health Disparities in America's Diminishing Micropolitan Areas

Todd Gardner, George Washington University

In the mid-20th century, a significant portion of the U.S. population resided in small towns. This study retrospectively identifies over 600 areas that would have been categorized as micropolitan statistical areas had that classification existed at that time. By analyzing their population trajectories, this study reveals a strong correlation between population change and health outcomes. Four categories are examined: areas that experienced substantial growth and transitioned to metropolitan status, those absorbed by the expansion of nearby cities and became outlying metropolitan counties, areas with moderate growth, and areas experiencing long-term population decline. Generally, population growth correlates with more positive health outcomes, while decline is associated with negative outcomes. This disparity is partly attributed to lifestyle choices and constraints imposed by the built environment. Declining areas exhibit higher rates of smoking, obesity, and physical inactivity, which are closely linked to elevated rates of diabetes and cancer mortality. Notably, life expectancy reveals a widening gap: while all of the micropolitan categories clustered around the national average in 1980, the disparity in life expectancy between growing and declining areas widened considerably in the years that followed. Life expectancies in declining areas were more than three years below the national average by the COVID-19 pandemic. These findings underscore the need for targeted interventions to address the growing health inequities between thriving and declining communities.

No extended abstract or paper available

 Presented in Session 209. Drivers and Consequences of Advantage and Disadvantage