The most common cause of death in America is rarely what you expect

If you live in New York City, chances are you live in a high-rise building with elevator access. If you live in the rural middle of nowhere, chances are you don’t.

If you’re listening, I suppose it’s possible that this statement is slightly creepy: It’s no wonder that 1,286 Americans died in American homes with no elevator last year.

But that’s also the No. 1 most common cause of death in the United States. Something tells me if the government cut funding to hard-to-access communities — especially if you live in Kingston, New York — you’d see a jump in the death rate. The truth is, the basic infrastructure of the average home is decaying in America.

The main character in John Green’s incredibly popular (and Netflix series) “The Fault in Our Stars” is a character named Augustus Waters, who has Hodgkin’s lymphoma. Kingon Green’s story explores how Augustus spends the time he spends in the hospital, worrying about how his mom, Tammy and his father are doing. In his eyes, the story is heartbreaking but it’s also inspirational. But the important lesson is one he recognizes in the end — success is a matter of being comfortable in your own skin. Gus talks to his best friend, Charlie King, during chemotherapy and after he’s been diagnosed with cancer, Augustus and Charlie spend time together. They go in the same tub. Charlie describes Gus to Gus as “strong as a rock”.

A few months after Gus gets his book deal and his life looks pretty good, he has a relapse. And Charlie, who probably doesn’t even know Augustus, endures one hell of a process that sounds a lot like chemotherapy. Gus comes back, trying to figure out what he needs to do in order to survive. Gus says, in a quote I learned in a 45 minute podcast from the library, that “every single day is something different.” Charlie is forced to face the time when, in a beautiful landscape, he thinks he has strength. And Gus, at the end of the story, has moved on to be strong again, in a place where he has something to where he’s comfortable.

I wrote about this story and why it was so important last month. Now, in the interest of full disclosure, I’m still very grateful that I live outside Washington, D.C. This isn’t just a story about hard-to-access communities — it’s a story about hard-to-access opportunities. What I find so interesting about the film is the beauty of a tough journey. Gus doesn’t just cross a metaphorical line and get another life — he gets an actual one. He doesn’t just make a new friend, or make a couple of money jokes, or get diagnosed. Gus has a life.

In a place like Kingston, upstate New York, access to something as simple as a bright, pink-trimmed tub (or a day camp) is about all Gus has. For a really good story on how this story occurs, check out Scott Prather’s fine essay in the Atlantic on how homelessness isn’t a matter of dwelling. Scott explains how Green’s novel has many great and nuanced things to say about poverty and life, but the ending, just as Gus himself, is about comfortable, beautiful life. Gus is ready for it. Where else is he going to find it?

The median income in Kingston is $69,400, per the 2000 Census. Over the course of last year, 3,441 people died in the city without an elevator. That represents less than 2 percent of the population. It is not more or less severe than any other place in the U.S. Where people are dying in suits, firefighters, cops and soldiers are probably dying in more places than towns with public housing. But for now, money isn’t the dividing line. As you can see in the infographic above, high-rise buildings are cleaner than rural homes. New York City pays more than Kingston does to build housing and landlords pay more for housing in New York than Kingston does to keep the line between farmers and Hollywood actors straight.

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