Open AccessThe State of Rural Public Health: Enduring Needs in a New Decade
Author(s) -
Jonathon P. Leider,
Michael Meit,
J. Mac McCullough,
Beth Resnick,
Debra Dekker,
Y. Natalia Alfonso,
David Bishai
Publication year - 2020
Publication title -
american journal of public health
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 2.284
H-Index - 264
eISSN - 1541-0048
pISSN - 0090-0036
DOI - 10.2105/ajph.2020.305728
Subject(s) - public health , health equity , life expectancy , economic growth , rural area , population health , population , investment (military) , demographic economics , political science , health care , environmental health , medicine , economics , nursing , politics , law
Public health in the rural United States is a complex and underfunded enterprise. While urban-rural disparities have been a focus for researchers and policymakers alike for decades, inequalities continue to grow. Life expectancy at birth is now 1 to 2 years greater between wealthier urban and rural counties, and is as much as 5 years, on average, between wealthy and poor counties.This article explores the growth in these disparities over the past 40 years, with roots in structural, economic, and social spending differentials that have emerged or persisted over the same time period. Importantly, a focus on place-based disparities recognizes that the rural United States is not a monolith, with important geographic and cultural differences present regionally. We also focus on the challenges the rural governmental public health enterprise faces, the so-called "double disparity" of worse health outcomes and behaviors alongside modest investment in health departments compared with their nonrural peers.Finally, we offer 5 population-based "prescriptions" for supporting rural public health in the United States. These relate to greater investment and supporting rural advocacy to better address the needs of the rural United States in this new decade.