Environmental Extremes and the Health of the Rural Elderly

This project examines the impacts on mental and physical health of extreme environmental events, nationwide, with a focus on the rural elderly. Most of the research on the public health impacts of events, such as wildfires, hurricanes, or tornadoes, focuses on urban areas or on individual extreme events. Extreme environmental events — such as floods, wildfires, and hurricanes — are increasing in frequency and severity (Hayhoe et al. 2018) and rural residents are especially vulnerable given their lower levels of health insurance coverage (Cohen et al. 2021) and lesser access to health care. Physician density is much lower in rural areas (Machado et al. 2021) and ongoing hospital closures mean longer transport times, including for emergency care (GAO 2021). In fact, rural dwellers are already subject to the “rural mortality penalty” in that they already have lower life expectancies compared to their urban counterparts (Miller and Vasan 2021). In this project, we combine data on physical and mental health from the National Health Interview Survey, historical weather data, FEMA disaster declarations, and background on the scale and scope of extreme environmental events and link these to indicators of ruralness based on the USDA’s rural-urban continuum. We emphasize the connections between extreme environmental events and health for the rural elderly by contrasting the association for this group with that for younger individuals and urban dwellers. Of additional interest is the potential for social support and connection to be protective. In urban areas, social isolation has been found to play a role in mortality in disasters such as the loss of elderly life in the Chicago heat wave of 1995 (Klinenberg 2015). However, rural areas are characterized by relatively stronger social bonds (Henning-Smith et al. 2019), and we therefore examine the possibility of such connections benefiting the rural elderly in times of disaster.