If this election made anything clear, it may be that there’s a very large divide between rural America and urban America.

Most rural voters cast their votes for President Donald Trump, while the vast majority of people living in major cities — especially on either coast — voted for Democrat Hillary Clinton.

But that divide goes beyond the ballot box. A new study by the Centers for Disease Control and Prevention shows a striking gap in health between rural and urban Americans.

According to the CDC, about 46 million Americans, or about 15 percent of the population, live in rural areas. And they are at higher risk of death from heart disease, cancer, unintentional injuries and stroke.

So, what’s behind this? According to the CDC, rural Americans tend to be older and sicker than people who live in cities. There are higher rates of poverty in rural areas of the country, and fewer people have access to health care or health insurance.

And, according to Dan Derksen, director for the Center for Rural Health at the University of Arizona, poverty has a lot to do with this.

“In rural areas, there’s often not the job opportunities that there may be in other areas,” he said. “The jobs that tend to be available may not pay as well as other jobs that might be available in a more urbanized setting, and there may not be, if you are employed, the employer may not offer health insurance.”

And, he said, the effect of poverty has ripple effects on the health-care network in rural communities.

In Arizona, he said, we have cut the number of uninsured people in half since the Affordable Care Act went into effect.

“And that really helped these safety net, rural health providers and clinics and hospitals because it dramatically reduced their uncompensated care, what also called charity care,” he said. “When you have more people covered and there’s a payment source, it tends to help keep a healthy bottom line for these facilities and the health providers in these rural communities to continue to take care of people.”

Derksen also says the opioid epidemic has hit rural communities hard, but he thinks Arizona is taking a proactive approach to try to stop the rising numbers of heroin-related deaths. 

Another big challenge facing rural communities is that there just aren’t enough health-care providers, according to Dr. Carlos Gonzales, assistant dean at the University of Arizona, where he runs the Rural Health Professions Program.

He spent much of his career, before coming to UA, working as what he calls a “frontier doc” in Patagonia, a small town south of Tucson.

And, he said the problem for patients in rural communities is simple: they’re rural. “Often, it takes them half-hour, 45 minutes to get to my office,” he said. Then, after an evaluation and waiting for an ambulance or helicopter, they’ll make it to a hospital to be taken care of.

"So, that golden hour that they often speak about for these acute problems, is long gone,” he said.

The other problems, Gonzales says, is the cost of health care. Even after the Affordable Care Act meant that more low-income people could get health insurance, he said that many people couldn’t afford expensive deductibles on their plans.

The physician shortage in Arizona is another important factor. Since he left his clinic in Patagonia in 2006, they have not been able to find another full-time provider to fill his role.

The Rural Health Professions Program at UA, which Gonzales is in charge of, works to get medical students into rural areas for training with the hope they’ll stay and work in those areas.

But, he said, “We need them in all fields. We need family physicians, we need pediatricians, we need internal medicine specialists, we need Ob-gyns, we need surgeons,” he said.