And most of the people for whom life is better... did things just improve, or did they MAKE life get better? In part because they had the resources to move someplace else or tap into help (help which isn't available everywhere)?

I mean, I know people who grew up in judgmental shitty religious towns and still live there as adults because there is no realistic way for them to leave. They're dead broke & have no transportation, they have health issues, they have dependent family, whatever.