Advancing Health Equity in Rural America

A concern for equity leads us to address disparities in health and in opportunities for good health both by place (rural versus urban) and within rural places by race and class.

The health of rural Americans matters for our nation overall. More than one in every seven Americans lives in a rural place, and rural regions play a vital role in the U.S. economy. Rural residents, in general, are disadvantaged by place—facing geographic barriers to services, resources, and opportunities. Within rural areas, low-income people are doubly disadvantaged by place and class, and low-income rural people of color are multiply disadvantaged by place, race, and class.

This report, produced in partnership with the University of California, San Francisco, assists those working to improve health, well-being, and equity in rural America. It is directed not only to those working in public health or healthcare, but also to those working in other fields—such as rural development, community development, housing, and education—that powerfully shape health.

Recommendations to Advance Rural Health Equity

• Make long-term economic and community development the centerpiece of any strategy to advance rural health equity, targeting rural areas with persistent poverty.
• Focus on dismantling systemic racism in rural areas through strategies that increase economic opportunity for and end the disenfranchisement of rural people of color.
• Invest in educational opportunities for rural residents, particularly those living in poverty and people of color.
• Ensure that all rural residents have reliable internet access, which is crucial for education, employment, telemedicine, and full participation in contemporary society.
• End the suppression of Indigenous, African American, and Latino/Hispanic voters by increasing opportunities for voter registration and enacting universal mail-in voting in every state.
• Invest in transportation innovations, such as rural car-sharing.
  Break down other rural barriers to healthcare by constructing and maintaining rural clinics that address social as well as healthcare needs; training and supporting rural community health workers; implementing telehealth; and more.
• Support innovation, testing, and adaptation of interventions that have been effective at advancing equity in health and its determinants in urban settings and appear promising for rural environments.

Key Findings

• Rural communities have many cultural, organizational, and individual assets that can be—and are being—used to promote health equity. Examples include strong civic bonds, community-based organizations and nonprofits, faith-based organizations, and educational institutions.
• As compared to their urban counterparts, rural residents are disproportionately impacted by preventable cancers, severe maternal morbidity, opioid misuse, and they are less likely to receive critical healthcare services such as cancer screenings and childbirth care.
• Within the rural population, there also are wide disparities in health and mortality among socioeconomic groups. Worse health is consistently associated with lower education or income.

While the challenges to achieving health equity in rural America are formidable, it is heartening that so many promising efforts—such as the examples presented in the full report—are now underway in many regions of the country. These examples reflect important assets of rural communities that provide rich soil in which innovations can be conceived and flourish.