It is Time to Tackle Rural Health Disparities

Alan Morgan, MPA

Rural America represents a large geographic area, a place where more than 60 million people currently reside. How large? As much as 75%of the nation’s geography is considered to be “rural and frontier.” The public health challenges of this vast area and population are significant, and often under appreciated.

Rural Americans face a unique combination of factors that create significant disparities in health care including economic factors, cultural and social differences, educational limitations, and the sheer isolation of living in remote areas. These challenges are compounded by the fact that many policymakers do not understand or recognize that rural communities have unique challenges comparative to urban communities. This distinctive health care environment requires a unique approach to delivering care.

The National Rural Health Association is concerned that many rural and frontier areas lack necessary public health infrastructure in the form of district, county, or city public health departments. For rural communities that lack public health departments, many are understaffed or employ staff with little formal public health training. 

While rural America has long faced health care challenges, now is a time of particular concern for policymakers. In the face of chronic health care workforce shortages, rural America is also now experiencing a rural hospital closure crisis. More than 80 rural hospitals have closed since 2010. One in three is in financial risk, and 25% of all rural hospitals will close in less than a decade without federal or state intervention.

A January 2017 Centers for Disease Control and Prevention report found that life expectancies in rural America have actually declined and the top five chronic diseases are far worse in rural America.  As a result, we have an emerging definition of what “rural” actually represents: Rural America is the place where those most in need of health care services have the fewest options available to seek care.

It is now time to work together on behalf of rural America. Recognition of the role that public health workers play in the rural areas that have departments of public health and advocacy for improved access to the complete range of public health services for rural residents is vital for a paradigm shift. Local rural public health services are an integral component of comprehensive rural health services access.  Rural public health services hold particular value amidst our current era when preventable health behavior risks continue to function as the most important determinant of future health status and overall wellbeing for rural Americans.  

Alan Morgan, MPA, is Chief Executive Officer of the National Rural Health Association.

This blog post is part of a series focusing on different aspects of public health in recognition of Public Health Thank You Day, held each year on the Monday before Thanksgiving. Visit is external) for more information, and join us on social media using the hashtag #PHTYD

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