Throughout the 2016 campaign President-elect Donald Trump reached out to voters who felt the system didn’t work for them. They were crucial to his November victory.

But the challenges those voters face is about more than just economics and government policy, it cuts all the way to the physical health of their communities.

People who live in Trump’s most supportive communities feel they are not as healthy as the nation as a whole and people in their communities are more likely to die from a drug or alcohol overdose, according to data from the Gallup and the Centers for Disease Control analyzed by the American Communities Project.

Meet The Press merged data from three groups of counties that Trump won by more than 20 points – Graying America, Evangelical Hubs and Working Class Country. Those counties carry some common traits. They are more rural than the other places and tend to have lower incomes and lower college education rates.

There are 1024 counties in that merged group. Trump won 986 of them. And they look very different from the country on some key health measures.

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More than 28% of the people in those counties said they have health problems that prevent them from doing things people their age normally can do. In some of those places that was much higher, well over 30%. That’s compared to a national average figure of roughly 22%, according to Gallup surveys conducted in the 3rd quarter of 2016.

Those are self-diagnoses, of course, and respondents could be referring to anything from hard knee or back pain to diabetes. But the “health problems” question is fairly consistent across the counties Trump won. The counties Clinton won tended to have fewer than average people citing “health problems” that affected their lives.

Maybe more surprising, those 1024 Trump-heavy counties also scored well above the national average in death induced by drugs or alcohol, according to 1999-2014 data from the CDC. The rate for drug or alcohol induced death was 24.2 per 100,000 people compared to less than 20 per 100,000 nationally.

In fact, contrary to what many might expect, the numbers for drug and alcohol induced deaths were higher in those rural counties than they were big cities (20.9 per 100,000 people) or dense urban suburbs (18.4). That’s despite the fact that drug and alcohol abuse is often seen as a bigger problem in urban areas.

In many ways these health numbers are more crucial to understanding the frustration that drove parts of the Trump coalition than other political or economic indicators. In a very real sense, these data are not revealing attitudes, they are reporting outcomes — the impact of what it means to live in some of the nation’s more rural, less wealthy areas.

The health numbers further expose the depth of the urban/rural divide running through the country. They suggest that divide is increasingly connected to politics. And they indicate Donald Trump is inheriting a very nation that may be very difficult to bring together.