Rural Public Health

The public health needs of rural Americans are unique and challenging. Disparities in chronic disease prevalence and related health behaviors, issues of diversity and shifting population demographics, and assuring access to health care services are complicated in rural areas.

Rural health departments, in addressing these issues, face challenges regarding workforce recruitment, retention and training, epidemiologic investigation, information technology and telecommunications. Investments over the past decade related to emergency preparedness planning, pandemic influenza, and implementation of the Affordable Care Act have highlighted deficits in infrastructure and capacities faced by many rural health departments. To the extent that areas without sufficient infrastructure may not have the capacity to utilize these resources, gaps in public health capacities between rural and non-rural health departments are likely to increase.


Michael Meit, NORC Walsh Center for Rural Health Analysis

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Frequently Asked Questions

What health disparities exist between urban and rural areas?

Analysis of National Health Interview Survey (NHIS) and Medical Expenditure Panel Survey (MEPS) data conducted for the 2008 report of the National Advisory Committee for Rural Health and Human Services showed that, “health status is generally worse among rural residents compared to urban residents and that this situation has persisted for the past two decades.” Even after adjusting for the older age distribution of rural populations, data showed that respondents living in non-metropolitan counties were more likely to rate their health as fair or poor, and most chronic diseases were reported to be more prevalent in rural areas. Information from the Centers for Disease Control and Prevention (CDC), which produced a report on rural health disparities in 2001, also demonstrated disparities among rural residents including higher rates of obesity, cigarette smoking, and total tooth loss.

Many community health partnerships have formed in rural areas to help strengthen the public health and health care delivery systems and social structures needed for effective prevention of disease and death. Recent investments, such as CDC’s Community Transformation Grants, have the potential to stimulate partnership activities directed at rural health disparities. The Community Transformation Grants program is noteworthy in that 20% of funding is required to be directed at addressing the needs of rural communities.

The National Rural Health Association is a strong advocate for rural communities facing these issues. The National Indian Health Board provides resources on tribal public health, a rural population with additional unique health concerns and needs.

What are underlying issues that impact the public's health in rural communities?

Many social and economic challenges unique to rural areas impact health status. Some examples include:

  • Lower wages
  • Disproportionately high housing costs (relative to wages)
  • Psychological impacts associated with increased isolation
  • Fewer jobs
  • High numbers of underinsured or uninsured
  • Increased risk of poverty
  • Lack of educational opportunities

The average age of people in rural communities is rising as a result of youth migration, which leaves behind an older population with limited support systems. Taken together, these factors contribute to increased inequities in the health status of rural residents.

What federal agency focuses on public health in rural areas?

The Federal Office of Rural Health Policy (FORHP) promotes better health care service in rural America. Established in August 1987 by the Administration, the Office was subsequently authorized by Congress in December 1987 and located in the Health Resources and Services Administration. Congress charged the Office with informing and advising the Department of Health and Human Services on matters affecting rural hospitals and health care, coordinating activities within the department that relate to rural health care, and maintaining a national information clearinghouse, which is the Rural Assistance Center.

While the Centers for Disease Control and Prevention (CDC) do not have a similar office directed to address rural issues, some CDC programs have targeted resources addressing rural health outcomes linked to particular disease conditions and risk factors.

Is there any funding for public health programs in rural communities?

We maintain a list of federal, state and foundation funding opportunities for public health. You can also contact us at 1.800.270.1898 or to request a list of funding opportunities specific to your project and location.

What is the public health infrastructure in rural areas?

This is a difficult question to answer because the local public health infrastructure varies from state to state and community to community.

The National Association of County and City Health Officials (NACCHO) conducts a survey of local public health agencies to find out about their infrastructure, which is available on the NACCHO website. While useful, this resource only provides information for jurisdictions served by local health departments (LHDs). Less is known about areas without LHDs and how essential public health services are provided in these jurisdictions.

State public health agencies may provide some services to these communities, and other services may be provided by a patch work of agencies and service providers. Rural hospitals, private practice physicians, and community groups often play a role in providing the needed services for areas without an LHD.

Other options to learn about the local public health infrastructure in a given state include searching the state's Department of Public Health website or contacting the local public health agency that serves a specific community.

What public health services are provided in rural areas?

Local health departments in rural areas of the United States provide a variety of services to their communities. These services may include direct clinical services, immunizations, chronic disease prevention, emergency response planning and environmental health. Each locality is different.

Rural communities that do not have a local health department are likely to have fewer public health services available. Communities each adapt in their own way, with other agencies, local hospitals and providers stepping forward to address some or all of the public health needs.

Some services may also be provided on a regional basis, either by the state health department, multiple local governments, or by independent local health departments sharing resources between jurisdictions. Strategies to regionalize services have been explored by many jurisdictions.

How can I locate my local governmental public health agency?

Check your local phonebook for a listing of your local governmental public health agency or contact your town or city government offices. The agency may serve the city and/or the county and be listed as a health department, board of health, health district, or public health agency. If your community does not have a local public health agency, contact your state Department of Public Health to learn about other agencies that may be providing public health services in your community.

I am interested in pursuing a higher degree related to rural public health. Where should I start, and how can I find out about training and educational opportunities?

For information on rural public health education possibilities, please see the Association of Schools of Public Health and the Council on Education for Public Health, which are the two accrediting bodies for schools of public health. From there you can contact accredited schools to learn more about their programs and focus areas.

For more information on training, the Public Health Foundation coordinates TRAIN, an online learning resource to find and register for public health training.

What issues are facing public health workers in rural communities?

There are many issues facing public health workers including financial constraints, limited infrastructure, and access to workforce development opportunities. Yet, rural public health workers may also have opportunities to implement innovative public health solutions by leveraging their extensive relationships with community partners and lead the way in enhancing the health of the communities they serve.

What other topics are related to public health?

Other topics related to rural public health include:

Where can I find information particular to my region or state?

There are several good sources for finding information on a particular region or state. The National Association of State Offices of Rural Health maintains a list of rural health contacts for each state. The Rural Assistance Center has a list of State Rural Health Associations and the American Public Health Association has a list of State Public Health Associations.

The Centers for Disease Control and Prevention’s (CDC) Behavioral Risk Factor Surveillance System (BRFSS) offers data from a national telephone survey, which can be used to identify emerging health problems and track health trends in a particular state. CDC’s National Center for Health Statistics also provides state and territorial-specific data.

How can I connect to peers interested in rural public health issues?

To connect to peers interested in rural public health issues, you could join the National Rural Health Association (NRHA) Community Health Status Constituency Group, which represents members interested in community-level policy development and advocacy in order to promote access to health care services and tangible improvements in the community's overall health status. Membership in NRHA is required.  If you are interested in joining the interest group, contact Michael Meit, Co-Director, NORC Walsh Center for Rural Health Analysis.