Public Health Rural Health in the United States
Ryung Suh, Hilda R. Heady
  • LAST REVIEWED: 28 May 2013
  • LAST MODIFIED: 28 May 2013
  • DOI: 10.1093/obo/9780199756797-0089


“Rural health in the United States” refers to the health status of rural people and the policies that guide the health-care delivery system that serves them. As populations in US rural areas decline, resources to address their health status also decline, which exacerbates the challenge of accessing health care and compromises efforts to improve health status. In general, rural populations are older, poorer, and often have more limited insurance coverage than their urban counterparts. People in rural communities suffer from high rates of chronic conditions, and there is a persistent shortage of health professionals practicing in rural communities. When accessing care, rural populations face challenges, such as distance, weather, transportation, and time, which can make it difficult to receive timely care. The rural health landscape consists of systems of care similar to those in urban areas, yet there are fewer resources for specialty care and services. Throughout US history, rural people have made significant contributions to the nation’s social and economic structures. Generations of urban dwellers can trace their roots to the early agrarian culture and values that dominated the founding of the United States. Rural people are known for their hard work; their commitment to family, community, and service to others; and their independence, self-modesty, patriotism, and faith. Economies of many rural communities are based on extractive industries associated with raw natural resources and other risky occupations such as farming, fishing, timbering, gas and oil production, and mining. As these industries decline, public sector employment in local and county government, education, and in health care rises. The purpose of this review is to offer a selection of relevant literature of the most current and prominent issues that impact US rural communities. The collections below demonstrate the need for greater community and provider practice involvement in the unique health needs of rural communities, such as prevention and wellness, quality of care, workforce, veterans care, health systems delivery, and technology. The criteria used for this search was based on the most prevalent health issues present in US society, as determined by Healthy People 2010. In addition, direct experience and collaborations with rural health leaders resulted in many of the selected articles. The focus of this collection is on US rural health, which could be considered a limitation. While there is a great deal of literature on international rural health perspectives, they are not the focus of this commentary and literature review.

General Overviews

According to Coburn, et al. 2007, there is no single definition for rural and rural communities. Executive government departments that write and implement policies for rural communities each have their own definition that relies on a variety of data sources. Even though the defining characteristics of rural communities vary by geographic regions, there are common notable disparities among America’s rural communities with regard to their health, income, education, and quality of life. Slama 2004 describes general rural characteristics and rural culture, while taking into account the great diversity within the US rural population. Mohatt, et al. 2006 provides an excellent overview of rural America today by examining the definition of rural and analyzing the demographics and economies of rural America, before focusing the remainder of the report on the state of rural mental health care in the United States. The annotated bibliography is an extensive resource for publications. In Gamm, et al. 2003, rural community stakeholders describe and offer solutions for fifteen of the HHS Healthy People 2010 focus areas that particularly pertain to rural health care. Geyman, et al. 2001 takes a decidedly more clinical approach to rural health care by creating recommendations targeting rural clinicians, clinician teachers, residents, and medical students. Cardiovascular health is of particular concern in rural America. Zuniga, et al. 2003 is a literature review about the prevalence of heart disease and stroke in rural America and the particular challenges of this problem. Appel, et al. 2002 examines the cardiovascular health of southern rural women, and finds that when controlling for BMI, women who have the least education are at the greatest risk of developing cardiovascular disease, regardless of race. In the economics of many rural communities, the health-care delivery system is often among the largest employers. The Economic Research Service website examines the economy of rural communities throughout the United States, and explores how investments in rural people, businesses, and communities could affect the capacity of rural economies.

  • Appel, S. J., J. S. Harrell, and S. Deng. 2002. Racial and socioeconomic differences in risk factors for cardiovascular disease among southern rural women. Nursing Research 51.3 (May–June): 140–147.

    DOI: 10.1097/00006199-200205000-00002

    This study used questionnaires mailed to 1,110 women in rural North Carolina to determine disparities in cardiovascular health between rural African American and white women. Results indicated that African American women had lower education, lower income, higher BMI, and higher prevalence of hypertension, angina, and diabetes. However, the only significant predictors of CV risk were BMI and education level.

  • Coburn, A. F., A. C. MacKinney, T. D. McBride, K. J. Mueller, R. T. Slifkin, and M. K. Wakefield. 2007. Choosing rural definitions: Implications for health policy. Issue Brief 2. Omaha, NE: Rural Policy Research Institute Health Panel.

    This issue brief explains that there is no universal definition of rural that serves all policy purposes. As a result, this produces significant policy implications for rural populations. Different government entities create their own definitions based on chosen geographic characteristics and available data. The way an organization chooses its definition of rural and rural populations has a significant impact on the creation and execution of policies.

  • Economic Research Service.

    Website for USDA’s Economic Research Service. Provides useful publications on the topic of rural economics, trends, and policy issues in the United States.

  • Gamm, Larry D., Linnae L. Hutchison, Betty J. Babney, and Alicia M. Dorsey, eds. 2003. Rural Healthy People 2010: A companion document to Healthy People 2010. Vol. 1. College Station: Texas A&M Univ. System Health Science Center, School of Rural Public Health, Southwest Rural Health Research Center.

    Provides an overview of top rural health concerns and objectives associated with Healthy People 2010 focus areas, references to key literature regarding these concerns, and descriptions of promising community-based interventions and approaches in rural communities. First volume in a series of three. See also Volume 2 and Volume 3.

  • Geyman, John P., Tom E. Norris, and L. Gary Hart, eds. 2001. Textbook of rural medicine. New York: McGraw-Hill Professional.

    Textbook written by three members of the Department of Family Medicine at the University of Washington School of Medicine. Focuses on special clinical problems and approaches common to rural care, augmented by practical information on management and organization issues, as well as rural and family medicine education.

  • Mohatt, Dennis F., Scott J. Adams, Mimi M. Bradley, and Chad D. Morris, eds. 2006. Mental health and rural America, 1994–2005: An overview and annotated bibliography. 3d ed. Rockville, MD: Health Resources and Services Administration, Office of Rural Health Policy.

    Report and annotated bibliography that provides a summary of the current knowledge base surrounding mental health issues in America’s rural and frontier areas and an overview of the environment of mental health in rural areas over three decades. Available online only.

  • Slama, Kay. 2004. Rural culture is a diversity issue. Minnesota Psychologist 53.1: 9–13.

    Article that provides a detailed overview of characteristics particular to rural people and communities and describes how these differences influence mental health care provision. The article’s examples focus on rural Minnesota but speak broadly to rural populations across the United States.

  • Zuniga, M., D. Anderson, and K. Alexander. 2003. Heart disease and stroke in rural America: A literature review. In Rural Healthy People 2010: A companion document to Healthy People 2010. Vol. 2. Edited by Larry D. Gamm, Linnae L. Hutchison, Betty J. Babney, and Alicia M. Dorsey, 73–84. College Station: The Texas A&M Univ. System Health Science Center, School of Rural Public Health, Southwest Rural Health Research Center.

    This is a literature review examining the issues of heart disease and stroke in rural areas, including a discussion of the impacts of these conditions and the barriers to prevention and treatment.

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