We’ve known for a long time that there is a cost to Maine’s spread out development patterns when it comes time to transportation and school construction.

But a recent report by the Center for Active Living and Healthy Communities at Plymouth State University points to another rarely counted cost — our health.

Rural New Englanders are at a greater risk for obesity than their counterparts in cities and suburbs. Along with the extra weight comes higher instances of heart disease, stroke and diabetes that are not only devastating to a person’s well-being, but major cost drivers of our health care system.

High rates of those chronic and — in many cases — preventable diseases, along with Maine’s status as the state with the oldest population, are the major factors in Maine having among the highest health insurance rates in the country. The best way to reduce those costs is to help people live healthier lives.

You would think that there could be no healthier place than rural Maine, where people from all over the world come to ski and hike. But it isn’t vacationland for the people who live here. Dispersed development means that people routinely travel long distances by car to work, shop and go to school.

Rural highways, often without shoulders and sidewalks, are dangerous places to walk or ride a bike, especially for children. That means that rural Mainers are not getting the opportunities for exercise they need to live a healthy lifestyle.

There is a reason that city dwellers and suburbanites are more healthy than their rural counterparts. It’s not that they are smarter or more virtuous.

It could be that, as a group, they spend less of their time sitting in cars, traveling long distances. And they live in places that give them more opportunities to exercise.

Along with a healthy diet, exercise is the best way to prevent many chronic diseases. That should be part of the equation when we make land-use decisions, and it should be factored into the cost of building amenities like hiking trails, parks and sidewalks in rural communities.

These are not just nice-to-have extras. They are major cost savers and our health depends on them.