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.
Related Guides
Frequently Asked Questions
Tools
Health and Well-Being of Children in Rural Areas: 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.
Healthcare Communities
Web site
Provides a forum for the healthcare quality improvement community to share and contribute to each others' work. Includes a resource center with documents and tools related to community-based quality improvement initiatives.
IHS Fact Sheets
Web site
Offers 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.
Model-based Small Area Income & Poverty Estimates (SAIPE) for School Districts, Counties, and States
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.
National Healthcare Quality Report State Snapshots
Web site
Provides state-specific health care quality information, including strengths, weaknesses, and opportunities for improvement. Information is based on the National Healthcare Quality Report and National Healthcare Disparities Report and is updated annually.
NIH Loan Repayment Programs
Database
Provides competitive programs that offer repayment of up to $35,000 per year of educational loan debt for scientists conducting biomedical and behavioral 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.
Rural Training Track Technical Assistance Program (RTT-TA)
Technical assistance
A demonstration program that seeks to improve fill rates of rural training track (RTT) family medicine residency programs, increase the sustainability of existing RTT programs, and help new RTT programs get started.
South Carolina Rural Health Research Center Publications
Web site
Focuses on health disparities.
State and County QuickFacts
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).
Veterans Rural Health Resource Centers: Central Region
Web site
Located in Iowa City, this center focuses on evaluating rural health programs and piloting new strategies to help Veterans overcome barriers to access and quality.
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
Affordable Care Act: What It Means for Rural Americans
Sponsoring organization: U.S. Department of Health and Human Services
Brochure providing information about the Affordable Care Act and how it will apply to rural Americans.
Date: 12 / 2010
Causes and Consequences of the Rural Uninsured and Underinsured
Author(s): Joe Blankenau, Jon M. Bailey, Julia Hudson
Sponsoring organization: Center for Rural Affairs
Details health insurance coverage in rural America. Includes how rural citizens get insurance coverage and how it differs from urban America, reviews research that explores obstacles in attaining health insurance, addresses the problem of underinsurance, and explores the impact of inadequate financing for health care and its effects on the community.
Date: 04 / 2009
CDC Health Disparities and Inequalities Report: United States, 2011
Sponsoring organization: Centers for Disease Control and Prevention
Presents national data on disparities in mortality, morbidity, behavioral risk factors, health-care access, preventive health services, and social determinants of critical health problems in the United States by using selected indicators.
Date: 2011
Challenges and Successes in Reducing Health Disparities: Workshop Summary
Sponsoring organization: Institute of Medicine
Examines the importance of disparities in differences in life expectancy within the United States, the reasons for those differences, and the implications of this information for programs and policy makers.
Date: 2008
Changes in Emergency Department Access Between 2001 and 2005 Among General and Vulnerable Populations
Author(s): Yu-Chu Shen, Renee Hsia
Sponsoring organization: AcademyHealth
Examines how geographic access to emergency departments, measured by driving time, changed from 2001 to 2005. Results showed that rural communities and vulnerable populations, such as Hispanics, have poorest access.
Journal citation: Changes in Health Care Financing and Organization Volume 13 Issue 6 Pages: 1-3
Date: 11 / 2010
Characteristics of Practice Among Rural and Urban General Surgeons in North Carolina
Author(s): Jennifer King, Erin P. Fraher, Thomas C. Ricketts, Anthony Charles, George F. Sheldon, Anthony A. Meyer
Sponsoring organization: American College of Surgeons Health Policy Research Institute
Study examines variation in the practice patterns of individual general surgeons and how they differ between rural and urban areas of North Carolina.
Journal citation: Annals of Family Medicine
Date: 06 / 2009
Child Health and Well-Being Differ for Metro and Nonmetro Low-Income Households
Author(s): Tracey Farrigan
Sponsoring organization: USDA Economic Research Service
Provides a comparison of the data and statistics regarding the health and well-being of children associated with low levels of household income in both metro and non-metro area.
Date: 11 / 2008
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
Handling the Handoff: Rural and Race-Based Disparities in Post Hospitalization Follow-up Care Among Medicare Beneficiaries with Diabetes
Author(s): Kevin J. Bennett, Robert Chen, Medha Vyavaharkar, Saundra H. Glover, Janice C. Probst
Sponsoring organization: South Carolina Rural Health Research Center
Provides estimates of hospital admission rates for rural Medicare beneficiaries with diabetes, tracks the proportion of patients who receive adequate outpatient care post discharge, and assesses subsequent readmissions to the hospital. It also explores the potential for race-based disparities in care for diabetes.
Date: 09 / 2011
Hard Times in the Heartland: Health Care in Rural America
Author(s): Meena Seshamani, Joan Van Nostrand, Jenna Kennedy, Carrie Cochran
Sponsoring organization: U.S. Department of Health and Human Services
Discusses the current state of health care in rural areas and the need for health care reform. Covers the use and cost of insurance and health care for farm and ranch operators, poverty and unemployment rates, health disparities, and the state of health care provider workforce in rural America.
Date: 03 / 2009
Health Care in Urban and Rural Areas, Combined Years 2004-2006: Requests for Assistance on Health Initiatives: Update of Content in MEPS Chartbook No. 13
Sponsoring organization: Agency for Healthcare Research and Quality
Examines the differences in health care access, use, and expenses between urban and rural areas.
Date: 04 / 2009
Health Disparities: A Rural-Urban Chartbook (Executive Summary)
Author(s): Kevin J. Bennett, Bankole Olatosi, Janice C. Probst
Sponsoring organization: South Carolina Rural Health Research Center
Examines potential disparities among rural populations in health, health behaviors, preventive services and diabetes care.
Date: 06 / 2008
Health Disparities: A Rural-Urban Chartbook (Full-Report)
Author(s): Kevin J. Bennett, Bankole Olatosi, Janice C. Probst
Sponsoring organization: South Carolina Rural Health Research Center
Presents data on health disparities experience by people living in rural America. Some disparities are poorer health status, higher prevalence of obesity, lesser options for activity, and higher mortality rates.
Date: 06 / 2008
Health Status and Health Care Access of Farm and Rural Populations
Author(s): Carol Adaire Jones, Timothy S. Parker, Mary Ahearn, Ashok K. Mishra, Jayachandran N. Variyam
Sponsoring organization: USDA Economic Research Service
Discusses health care access and health status in
rural areas, where the population is older, has lower education and income levels, and is more likely to be living in medically underserved areas.
Date: 08 / 2009
HHS Action Plan to Reduce Racial and Ethnic Health Disparities
Sponsoring organization: HHS Office of Minority Health
Provides a brief overview of racial and ethnic health disparities and unveils the Department
of Health and Human Services Action Plan to Reduce Racial and Ethnic Health Disparities.
Date: 04 / 2011
Indian Health Service Facts on Indian Health Disparities
Sponsoring organization: Indian Health Service
Provides statistics on Indian health disparities and mortality disparities.
Date: 01 / 2011
Medicaid's Role for Black Americans
Sponsoring organization: Kaiser Commission on Medicaid and the Uninsured
Includes data on Medicaid's coverage of black Americans, the program's impact on their access to care, impacts of the recent recession, and the coming expansion of Medicaid under health reform on enrollment in Medicaid among black Americans. Also has a chart showing state-by-state data on health insurance coverage of black Americans.
Date: 05 / 2011
Medicaid's Role for Hispanic Americans
Sponsoring organization: Kaiser Commission on Medicaid and the Uninsured
Includes data on Medicaid's coverage of Hispanic Americans, the program's impact on their access to care, impacts of the recent recession, and the coming expansion of Medicaid under health reform on enrollment in Medicaid among Hispanic Americans. Also has a chart showing state-by-state data on health insurance coverage of Hispanic Americans.
Date: 05 / 2011
National Healthcare Disparities Report, 2010
Sponsoring organization: Agency for Healthcare Research and Quality
Comprehensive national overview of disparities in health care.
Date: 02 / 2011
National Partnership for Action: Toolkit for Community Action
Sponsoring organization: HHS Office of Minority Health
Toolkit for community action in order to support community efforts in the goal of ending health disparities and promoting health equity.
Date: 2011
National Plan for Action
Sponsoring organization: U.S. Department of Health and Human Services
Captures the status of health disparities in our country and proposes 20 strategies for their elimination.
Date: 12 / 2009
National Stakeholder Strategy for Achieving Health Equity
Sponsoring organization: U.S. Department of Health and Human Services
Provides a common set of goals and objectives for public and private sector initiatives and partnerships to help racial and ethnic minorities - and other underserved groups - reach their full health potential.
Date: 2011
Pediatric Surgeons: Subspecialists Increase Faster than Generalists
Author(s): Stephanie Poley, Thomas Ricketts, Daniel Belsky, Katie Gaul
Sponsoring organization: American College of Surgeons Health Policy Research Institute
A fact sheet discussing the expansion of the pediatric surgical workforce with an increase in the number of subspecialists whereas growth in the general pediatric workforce has remained flat. Urban and rural data are compared.
Date: 07 / 2009
Promoting Health Equity: A Resource to Help Communities Address Social Determinants of Health
Author(s): Laura K. Brennan Ramirez, Elizabeth A. Baker, Marilyn Metzler
Sponsoring organization: Centers for Disease Control and Prevention
A workbook for community-based organizations seeking to affect the social determinants of health through community-based participatory approaches and nontraditional partnerships. Includes references to rural.
Date: 2008
Racial, Socioeconomic, and Rural-Urban Disparities in Obesity-Related Bariatric Surgery
Author(s): Amy E. Wallace, Yinong Young-Xu, David Hartley, William B. Weeks
Sponsoring organization: Muskie School of Public Service Institute for Health Policy
Presents research that examines the difference between rural residents receiving bariatric surgery to combat obesity and their urban counterparts. Describes how Medicare and Medicaid play a role in access to care.
Date: 01 / 2010
Rethinking Human Services: Why Does He Want That Job?
Author(s): Tom Corbett
Sponsoring organization: Rural Assistance Center
Summarizes challenges facing the new presidential administration in relation to unemployment rates, financial stability, and rural America.
Journal citation: Rural Monitor Issue Winter
Date: 02 / 2009
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 Health Issues: Implication for Rural Healthy People 2020
Sponsoring organization: National Rural Health Association
Outlines NRHA's main rural health concerns for the next decade as they prepare to draft the Rural Healthy People 2020 companion document to Healthy People 2020.
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 (editors)
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 (editors)
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 (editors)
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 Income, Poverty, and Welfare: Poverty Geography
Sponsoring organization: USDA Economic Research Service
Provides a summary of the conditions and trends in rural income, poverty, and welfare. Includes statistics comparing metro and non-metro poverty rates.
Date: 09 / 2011
Rural Populations Have Higher Rates of Chronic Disease
Author(s): Carol Adaire Jones
Sponsoring organization: USDA Economic Research Service
Discusses the higher rates of mortality, chronic disease, and disability found in rural Americans when compared to urban residents and the special challenges that may impair the health status of rural residents.
Journal citation: Amber Waves
Date: 06 / 2010
Rural-Urban Differences in Health Care Access Vary Across Measures
Author(s): Erika Ziller, Jennifer Lenardson
Sponsoring organization: Maine Rural Health Research Center
Reports that rural residents were more likely than urban residents to have a usual source of health care, particularly among the uninsured. Despite this, rural adults were somewhat less likely to receive certain preventive care services compared to urban adults.
Date: 06 / 2009
Surgical Deserts in the US: Places Without Surgeons
Author(s): Daniel Belsky, Thomas Ricketts, Stephanie Poley, Katie Gaul, Erin Fraher, George Sheldon
Sponsoring organization: American College of Surgeons Health Policy Research Institute
Describes the uneven distribution of surgeons across the United States, with more surgeons located in urban centers and fewer in rural communities.
Date: 07 / 2009
Uneven Cost of Rural Health Care
Author(s): Bill Bishop, Julie Ardery
Reports that the Unites States is spending vastly more on health care in some rural areas than in others without any indication that the increased spending results in better health.
Date: 10 / 2009
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
What's Different about Rural Health Care?
Sponsoring organization: National Rural Health Association
Lists and describes some of the unique factors which Rural Americans face that create disparities in health care not found in urban areas.
Date: 2008
Organizations
Agency for Healthcare Research and Quality (AHRQ)
Federal government
Sponsors and conducts research that provides evidence-based information on health care outcomes, quality, 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. Advocates for the Patient Centered Medical Home, promotes education for physicians and residents, and provides leadership in health promotion.
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 working to improve the health of America's underserved populations and to enhance the development and support of the medical and dental 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 Partnership for Action (NPA)
National organization
Mission is to mobilize and connect individuals and organizations across the country to create a Nation free of health disparities, with quality health outcomes for all people.
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.
Rural Center for AIDS/STD Prevention (RCAP)
National organization
Focuses on the promotion of HIV/STD prevention in rural America, with the goal of reducing HIV/STD incidence.
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 Equity The absence of persistent health differences over time, between racial and ethnic groups. The distribution of disease, disability or death that does not place a disproportionate burden on one population group.
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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