Rural Health Disparities

Dear Colleagues,

Rural–urban health disparities persist and are growing, with health outcomes significantly poorer among rural populations. Because nearly one in five Americans live in rural areas, disparities among this population have broad impacts on the nation’s health. Chronic disease prevalence and age-adjusted mortality rates (preventable deaths) are significantly higher in rural areas for diabetes, cancer, stroke, and cardiovascular disease, and rates of overweight and obesity as well as of tobacco and opioid use exceed those of urban populations. Comparing two extreme life expectancies in the U.S., poor African-American men in rural areas average a 67.7-year life expectancy, which is 20 years shorter than that of equally poor Asian-Pacific Islander women in urban areas (89.6 years)

Poverty is foremost among the complex social determinants of rural health disparities. High rates of poverty (i.e., ≥ 20%) are common in rural areas and especially in the southeastern US where more than 90% of the region is rural. Nine out of the 10 states with the largest rural populations and the highest levels of poverty are in the southeast. Incomes in rural communities are low, unemployment and isolation are high, and built environments (e.g., access to affordable healthy food and to recreational resources) are poor. In addition to poverty, low access to healthcare contributes significantly to these disparities. Rural areas have fewer health care settings and specialists and incur provider shortages and a burden of travel for care. Although the Affordable Care Act increased insurance coverage, many states with large rural populations did not expand Medicaid, leaving millions without access to health insurance. Telehealth technologies have the potential to enhance access to quality care in rural areas, but their utilization has been extremely low (0.26 % in 2011) because of inadequate broadband connectivity in rural communities. Environmental exposures also contribute to poor health in rural communities. Rural residents face greater exposure to pesticides and carcinogens, and water quality is poor. Water systems have high concentrations of chemical and biological contaminants. Many rural communities do not have access to approved public water systems and instead commonly use wells that are not covered by the Safe Water Drinking Act. More than 50% of all waterborne diseases in the US and Canada occur in rural communities, and lack of adequate water treatment is the major cause of such outbreaks. Climate change is another contributor to poor health and has had its greatest impact in rural communities, especially in the southeastern US.  Increasing temperatures release chemical and biological contaminants previously trapped in water. Flooding overwhelms water treatment facilities and waste lagoons, thereby exposing rural populations to pathogenic microorganisms; flooding also causes increased pesticide run-off.

Although poverty, access to care, environmental exposures, and health behaviors all contribute to rural health disparities, there is a paucity of research that comprehensively addresses these factors for any health outcome. Rural health research has taken a risk factor approach that has yielded low-level interventions that have no or very modest effects. There have been few efforts to capture and investigate the dynamic complexity and interconnectedness of diverse aspects of rural deprivation and disadvantage. Hence, there are no models to guide new efforts to reduce these disparities. Moreover, much research has focused on rural–urban differences in health, with insufficient attention to differences within or between rural communities. Racial-ethnic, age, gender, and other demographic (e.g., segregation) disparities within and between rural communities likewise have received insufficient attention.

This Special Issue invites studies and comprehensive reviews on rural health disparities and interventions to reduce them. Papers that address racial-ethnic, gender, segregation, or other disparities within rural communities, compare rural communities in the US or elsewhere or both, integrate several contributing variables from different levels, compare interventions, or present new interventions or policy approaches are especially welcome.

Prof. Dr. Hope Landrine
Prof. Dr. Ronny A. Bell
Guest Editors

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• Chronic disease prevalence and mortality
• Health Behaviors, Healthcare access
• Environmental exposures
• Interventions