Related Guides on this Topic
For specific racial and ethnic health disparities you may want to see these guides: Minority Health, Migrant Health, and Tribal Health.
Introduction
Health disparities, most often associated with urban ethnic and racial populations, persist in rural America as well. Geographic isolation, socio-economic status, health risk behaviors, and limited job opportunities contribute to health disparities in rural communities. While 20% of the United States population lives in rural areas higher rates of chronic illness and poor overall health are found in those communities when compared to urban populations. Rural residents are older, poorer, and have fewer physicians to care for them. This inequality is intensified as rural residents are less likely to have employer-provided health care coverage; and if they are poor, often not covered by Medicaid. Federal and state agencies, and membership organizations are working to diminish these disparities and keep rural America healthy and strong. Some provide funding, information, and technical assistance to be used at the state, regional and local level and others inform state and federal legislators to help them recognize the issues affecting health care in rural America.
Frequently Asked Questions
Tools
2007 State Snapshots
Web site
Provides State-specific health care quality information, including strengths, weaknesses, and opportunities for improvement.
Factline: Tracking Health in Underserved Communities
Web site
Information and resources on health disparities in underserved communities. Includes sections on women's health, mental health, minority health, and health care access.
Health and Well-Being of Rural Children: A Portrait of the Nation, 2005
Web site
Chartbook of data on children's health status, health care access, safety, child care and other issues related to children's well-being. Compares the health status, health care use, and risk factors experienced by children in rural and urban communities.
Health Disparities Projects and Interventions Database
Database
Public health projects and interventions submitted by the public health community. Search by topic, keyword, race/ethnicity, age group, and state. See the category "Reducing geographic challenges" for rural-specific projects. Includes detailed project descriptions and project contacts.
HRSA Health Disparities Collaborative
Web site
A centralized portal for communication as well as a forum for sharing the challenges, successes, tools, and lessons learned to improve access to high quality, culturally and linguistically competent primary and preventive healthcare for underserved, uninsured, and underinsured Americans.
IHS Fact Sheets
Web site
Information on specific healthcare topics concerning American Indian and Alaska Natives. Covers health disparities, treaties and laws, statistics and more.
Key Health and Health Care Indicators by Race/Ethnicity and State
Web site
Shows variation across states and racial and ethnic groups for key health and health care indicators. Data update looks at disparities in infant mortality, diabetes-related mortality and AIDS cases among African Americans and Hispanics in all 50 states and the District of Columbia, and the percentages of each group that is uninsured, enrolled in Medicaid and living in poverty.
National Healthcare Quality Report State Snapshots
Web site
Health care quality report for each state, based on the National Healthcare Quality Report and National Healthcare Disparities Report.
NIH Loan Repayment Programs
Database
Provides competitive programs that offer repayment of up to $35,000 per year of educational loan debt for health professionals pursuing careers in clinical, pediatric, contraception and infertility, or health disparities research.
Rural Health Research: Health disparities
Web site
Provides summaries of current and completed rural health research projects and related publications addressing the topic of health disparities, produced by the Office of Rural Health Policy's funded rural health research centers.
Rural Healthy People 2010: Models for Practice
Database
Lists rural health model programs, browseable by focus area, state, and program name.
Small Area Income & Poverty Estimates
Web site
Provides more current estimates of selected income and poverty statistics than the most recent decennial census. Created for states, counties, and school districts, and intended for the administration of federal programs and the allocation of federal funds to local jurisdictions.
South Carolina Rural Health Research Center Findings & Reports
Web site
Publications from one of eight federally funded Rural Health Research Centers. Lists research and reports. Focuses on health disparities.
Southwest Rural Health Research Center Publications
Web site
Lists publications, presentations, and final reports. Focuses on rural underserved and special populations, reducing health disparities, and maintaining rural health systems.
State and County Quick Facts
Web site
Facts and data about the people, business and geography of each state and county.
State Offices of Rural Health Directory
Web site
Directory of the State Offices of Rural Health with contact information for key SORH staff. Maintained by the National Organization of State Offices of Rural Health (NOSORH).
Your State's Health
Web site
State-based health information, including adult and child health indicators, health disparities, bioterrorism preparedness, and federal funding to the state for health.
Funding
Inactive Funding
Inactive Funding Opportunities -
Lists additional funding programs for this topic that are not currently accepting applications. Programs that are inactive may be offered again in the future.
Regulations, Forms & Other Useful Documents
Analysis of Disparities in Health Status and Access to Health Care in the Appalachian Region
Author(s): Joel Halverson
Sponsoring organization: Appalachian Regional Commission
Examines health disparities in the Appalachian region, with information on geographic and demographic disparities. Provides data for specific conditions, including cancer, diabetes, stroke and more. Includes maps showing the availability of medical resources throughout the region.
Date: 09 / 2004
Bridging the Health Divide: The Rural Public Health Research Agenda
Sponsoring organization: University of Pittsburgh Center for Rural Health Practice
Reports the results of a meeting rural public health experts held September 22-23, 2003, in Pittsburgh, PA. Describes the state of the rural public health infrastructure. Lists priority research questions for rural public health topics such as health care access, health disparities, preparedness, and environmental issues.
Date: 04 / 2004
Demographic Trends in Rural and Small Town America
Author(s): Kenneth Johnson
Sponsoring organization: Carsey Institute
Summarizes population redistribution trends in the rural and small town communities that are an important part of the social, economic and political fabric of the country.
Date: 2006
Diabetes & Hypertension among Rural Hispanics: Disparities in Diagnostics and Disease Management (Executive Summary)
Sponsoring organization: South Carolina Rural Health Research Center
Modest disparities in health were found among rural Hispanics when examining diabetes.
Undiagnosed hypertension was higher for rural residents, both Hispanic and White, than for urban
residents. A large proportion of persons diagnosed with either disease had poor control of their condition, as indicated by elevated glucose levels or high blood pressure.
Date: 2004
Does Economic Vulnerability Depend On Place Of Residence? Asset Poverty Across the Rural-Urban Continuum
Author(s): Monica G. Fisher, Bruce A. Weber
Sponsoring organization: RUPRI Rural Poverty Research Center
Describes the concept of asset poverty, a state in which households cannot invest in the future or weather economic disruptions, and compares asset poverty levels among urban and rural residents.
Date: 03 / 2004
Education and Health
Sponsoring organization: National Poverty Center
Discusses the complicated relationship between education and health that cannot be fully explained by income, the labor market, and family background.
Date: 03 / 2007
Health and Well-Being of Children in Rural Areas: A Portrait of the Nation 2005
Sponsoring organization: Maternal and Child Health Bureau
Provides information on the health and well-being of rural children and their use of health services. Includes information on rural children's families and neighborhoods, as well as data on health status, health insurance coverage, and other aspects of child well-being. Includes comparisons of children in rural and urban communities.
Date: 2005
Health Care Disparities in Rural Areas: Selected Findings from the 2004 National Healthcare Disparities Report
Sponsoring organization: Agency for Healthcare Research and Quality
Presents findings related to rural health care from the 2004 disparities report by describing the quality of care for diabetes and heart attack, access to health insurance coverage, and utilization of dental services. Examines socioeconomic and racial disparities and tracks progress in eliminating them.
Date: 05 / 2005
Health Disparities Experienced by American Indians and Alaska Natives
Sponsoring organization: Centers for Disease Control and Prevention
Issue describes disparities in health
for certain preventable health conditions (diabetes, cancer, bronchiolitis, and injuries) among American Indians and Alaska Natives (AI/ANs).
Journal citation: MMWR (Morbidity and Mortality Weekly Report) Volume 52 Issue 30
Date: 08 / 2003
Health, United States, 2001 With Urban and Rural Health Chartbook
Sponsoring organization: National Center for Health Statistics
Includes a chartbook that highlights rural-urban differences and presents information on population characteristics, health-related behaviors, health status, and health care access and use for five levels of urbanization and four regions of the United States.
Date: 2001
Indian Health Service Facts on Indian Health Disparities
Sponsoring organization: Indian Health Service
Provides statistics on Indian health disparities and mortality disparities.
Date: 01 / 2006
National Health Plan Collaborative, Phase One Summary Report: Reducing Racial and Ethnic Disparities & Improving Quality of Health Care
Sponsoring organization: Robert Wood Johnson Foundation
Summarizes and shares what those companies know about disparities in health care delivery. The authors propose key steps to build on that knowledge - collecting additional data, enhancing access for non-English speakers, supporting investment in disparities reduction, and disseminating what member plans have learned.
Date: 11 / 2006
National Healthcare Disparities Report, 2006
Sponsoring organization: Agency for Healthcare Research and Quality
Comprehensive national overview of disparities in health care. Covers health care quality and health care access issues. Includes a section on health disparities experienced in rural areas.
Date: 12 / 2006
Person and Place: The Compounding Effects of Race/Ethnicity and Rurality on Health
Author(s): Janice Probst, Charity Moore, Saundra Glover, Michael Samuels
Sponsoring organization: American Public Health Association
Discusses how the research addressing rural Black, Hispanic, and American Indian/Alaska Native populations suggests that disparities in health and in health care access found among rural racial/ethnic minority populations are generally more severe than those among urban racial/ethnic minorities.
Journal citation: American Journal of Public Health Volume 94 Issue 10
Date: 10 / 2004
Rural Health Disparities
Sponsoring organization: University of Arizona Mel and Enid Zuckerman College of Public Health
Provides a brief overview of rural health disparities in the United States.
Date: 2006
Rural Health Disparities, Population Health, and Rural Culture
Author(s): David Hartley
Sponsoring organization: American Public Health Association
Discusses the rural health disparities documented in Health United States, 2001, Urban and Rural Health Chartbook and endorses branching from the traditional focus on access to health care services toward initiatives that are based on models of population health. Identifies the risky health behaviors among rural populations that suggest a "rural culture" health determinant and suggests that there may be environmental and cultural factors unique to towns or regions that affect health behavior and health.
Journal citation: American Journal of Public Health Volume 94 Issue 10
Date: 2004
Rural Health Disparities: Innovative Programs Offer Health Care Coverage to the Rural Uninsured
Author(s): Candi Helseth
Sponsoring organization: Rural Assistance Center
Features the Farmers’ Health Cooperative of Wisconsin and Franklin Community Health Network’s Contract for Care, who are attempting to meet the special needs of farmers and other self-employed rural people.
Journal citation: Rural Monitor
Date: 02 / 2008
Rural Health Disparities: Providers Overcome Disparities by Improving Health of Rural People
Author(s): Candi Helseth
Sponsoring organization: Rural Assistance Center
Highlights three rural providers in New Mexico, Texas and Maine who are working to decrease health care disparities through innovative programs that offer medical and preventative care to their local populations.
Journal citation: Rural Monitor
Date: 02 / 2008
Rural Healthy People 2010: A Companion Document to Healthy People 2010. Volume 1
Author(s): Larry D. Gamm, Linnae L. Hutchison, Betty J. Dabney, Alicia M. Dorsey, eds.
Sponsoring organization: Southwest Rural Health Research Center
Brief overviews of the top rural health concerns and objectives associated with Healthy People 2010 focus areas, references to key literature about these concerns, and descriptions of models for practice that rural communities can draw upon to achieve key Healthy People 2010 objectives.
Date: 2003
Rural Healthy People 2010: A Companion Document to Healthy People 2010. Volume 2
Author(s): Larry D. Gamm, Linnae L. Hutchison, Betty J. Dabney, Alicia M. Dorsey, eds.
Sponsoring organization: Southwest Rural Health Research Center
Detailed literature reviews and associated references for the top rural health concerns addressed in Vol. 1 of Rural Healthy People 2010.
Date: 2003
Rural Healthy People 2010: A Companion Document to Healthy People 2010. Volume 3
Author(s): Larry D. Gamm, Linnae L. Hutchison, eds.
Sponsoring organization: Southwest Rural Health Research Center
Addresses several rural health concerns and objectives not covered in Volumes 1 and 2 of Rural Healthy People 2010. Includes overviews, literature reviews, and accompanying models for practice for four rural health topics.
Date: 02 / 2005
Rural-Urban Difference in Health Care Benefits of Community-Based Sample of At-Risk Drinkers
Author(s): John C. Fortney, Brenda M. Booth, JoAnn E. Kirchner, Xiaotong Han
Sponsoring organization: WICHE Center for Rural Mental Health Research
Compares the cost-containment strategies used by health plans of insured at-risk drinkers residing in rural and urban areas.
Journal citation: Journal of Rural Health Volume 19 Issue 2
Date: 2003
Rural-Urban Differences In Nursing Home And Skilled Nursing Supply
Author(s): Kathleen Dalton, Rebecca Slifkin, Joan Walsh
Sponsoring organization: North Carolina Rural Health Research and Policy Analysis Center (Cecil G. Sheps Center)
Findings brief of statistics on urban and rural nursing facilities. Includes maps.
Date: 02 / 2003
Use of Preventive Services Among Hispanic Sub-Groups: Does One Size Fit All?
Sponsoring organization: South Carolina Rural Health Research Center
Provides key facts on preventive health services provided to rural Hispanics.
Date: 2007
Why are Health Care Expenditures Increasing and is There a Rural Differential?
Author(s): Timothy D. McBride
Sponsoring organization: RUPRI Center for Rural Health Policy Analysis
Focuses on the factors that account for the rise in health care expenditures, empirical evidence showing whether there are differences between rural and urban areas in health care expenditure increases, and a framework for considering future changes in rural health care systems.
Date: 11 / 2005
Organizations
Agency for Healthcare Research and Quality (AHRQ)
Federal government
Sponsors and conducts research that provides evidence-based information on health care outcomes; quality; and cost, use, and access. The information helps health care decisionmakers - patients and clinicians, health system leaders, purchasers, and policymakers - make more informed decisions and improve the quality of health care services.
American Academy of Family Physicians (AAFP)
National organization
Works to improve the health of patients, families, and communities by serving the needs of members with professionalism and creativity.
American Public Health Association (APHA)
National organization
Works to influence policies and set priorities in public health.
Association of Clinicians for the Underserved (ACU)
National organization
A nonprofit, transdisciplinary organization of clinicians, advocates, and health care organizations united in a common mission to improve the health of America's underserved populations and to enhance the development and support of the health care clinicians serving these populations.
CDC's Office of Minority Health & Health Disparities (OMHH)
Federal government
Aims to accelerate CDC’s health impact in the U.S population and to eliminate health disparities for vulnerable populations as defined by race/ethnicity, socio-economic status, geography, gender, age, disability status, risk status related to sex and gender, and among other populations identified to be at-risk for health disparities.
National Association of Rural Health Clinics (NARHC)
National organization
Works to improve the delivery of quality, cost-effective health care in rural underserved areas through the Rural Health Clinics (RHC) Program.
National Center on Minority Health and Health Disparities (NCMHD)
Federal government
The mission is to promote minority health and to lead, coordinate, support, and assess the NIH effort to reduce and eliminate health disparities. NCMHD will conduct and support basic, clinical, social, and behavioral research, promote research infrastructure and training, foster emerging programs, disseminate information, and reach out to minority and other health disparity communities.
National Organization of State Offices of Rural Health (NOSORH)
National organization
Works to foster and promote legislation, information exchange, education, and liaison activities with all State Offices of Rural Health, the federal Office of Rural Health Policy, the National Rural Health Association, and other organizations.
National Rural Health Association (NRHA)
National organization
Promotes leadership, ideas, information, communication, education, research, advocacy, and methods to improve rural health. Composed of individual and organizational members who share a common interest in rural health.
University of Arizona Mel and Enid Zuckerman College of Public Health
Academic/Research
A nationally accredited college of public health. An integral part of their mission is to promote health equality and respond to health disparities.
Terms & Acronyms
Health Care Care, services or supplies related to the health of an individual. Examples of health care are preventive, diagnostic, therapeutic, rehabilitative, maintenance palliative care, counseling, sale or dispensing of a drug or other device in accordance with a prescription.
Health Disparities The differences in the incidence, prevalence, mortality, and burden of diseases and other adverse health conditions that exist among specific population groups in the United States.
Health Professional Shortage Area (HPSA) Geographic regions that have shortages of professionals working in primary medical care, dental or mental health care. HPSAs may be urban or rural areas, population groups or medical or other public facilities. Geographically, HPSAs can be cities or towns, counties or groups of counties. HPSA designations are reviewed and revised annually by the Secretary of Health and Human Services based on criteria set forth in the Public Health Service Act.
Health Professional Shortage Area - Mental Health (HPSA - Mental Health) HPSA designation for a shortage of mental healthcare professionals that requires three criteria are met. First, the area must be a rational area for delivery of mental healthcare services. Second, the ratio of population to existing providers must meet at least one of several criteria detailed in the Health Professional Shortage Area Mental Health Designation Criteria listed on the Bureau of Health Professions website. Also, the area under consideration must have mental health professionals in continuous (nearby/adjoining) areas that are over utilized, excessively distant or inaccessible.
Health Professional Shortage Area - Primary Care (HPSA - Primary Care) HPSA designation for a shortage of primary care health professionals that meets three requirements. First, the area must be a rational area for delivery of primary medical care services. Second, the ratio of population to existing providers must meet or exceed 3,500 people to every single provider or meet or exceed a ratio of 3,000 to 1 and have an unusually high level of need. Lastly, the area under consideration must have primary medical care professionals in continuous (nearby/adjoining) areas that are over utilized, excessively distant or inaccessible.
Health Professional Shortage Area - Dental Care (HPSA - Dental Care) The federal designation for a shortage of dental care health professionals that meets the following three criteria. First, the area must be a rational area for delivery of dental care services. Second, the ratio of population to existing providers must meet or exceed 5,000 people to every single provider or meet or exceed a ratio of 4,000 to 1 and have an unusually high level of need for dental services. Lastly, the area under consideration must have dental care professionals in continuous (nearby/adjoining) areas that are over utilized, excessively distant or inaccessible.
Medically Underserved Area (MUA) Medically Underserved Areas (MUAs) are federal designations derived from the Index of Medical Underservice (IMU). This index ranges from 0 to 100 and is based on four criteria: 1) ratio of primary medical care physicians per 1,000 people, 2) infant mortality rate, 3) percent of the population with incomes below the poverty level and 4) the percent of the population age 65 or older. An IMU of 62.0 or less qualifies an area to be designated a MUA. Geographic areas designated as MUAs can be a whole county or a group of contiguous (adjoining) counties, minor civil divisions (MCD), census county divisions (CCD) or census tracts.
Medically Underserved Population (MUP) A federal designation that is derived by using the Index of Medical Underservice (IMU). This index ranges from 0 to 100 and is based on four criteria: 1) ratio of primary medical care physicians per 1,000 people, 2) infant mortality rate, 3) percent of the population with incomes below the poverty level and 4) the percent of the population age 65 or older.
Quality of Care The degree to which health care services for individuals and populations increases the likelihood of desired health outcomes and are consistent with current professional knowledge.
State Office of Rural Health (SORH) Established by ORHP, each state office serves its rural communities in four ways: by collecting and disseminating information within the state; by improving recruitment and retention
of health professionals into rural areas; by providing technical assistance to attract more federal, state, and foundation funding; and by coordinating rural health interests and activities across a state.
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