determined by interactions with physical, chemical, biological and social factors in the environment” (WHO, 1986). Thus, environmental health focuses on the quality of life and not simply on the absence of disease, and all the factors that contribute to environmental health, including the environment, are assessed when the environmental health of a population or region is evaluated. The definition of environmental health has evolved with research; therefore, the goals of environmental health should be to establish and maintain a healthy environment, to promote an environment that improves well-being both in function and in structure, and to allow the environment to be sustainable, said Roundtable member Donald Mattison of the National Institutes of Health.

Rural America faces challenges such as poverty and isolation, limited access to health care, increasing prevalence of obesity, exposure to hazardous air and water pollutants, farm injuries, and a shrinking demographic.


Although the definition of “rural” is sometimes subjective, rural areas bring to mind small towns and sparsely populated areas. This definition may vary from one state to another, but in essence it refers to villages, cities, towns, or boroughs and excludes the rural portions of extended cities. According to the U.S. Census Bureau, rural is defined as not being urban, and urban, in turn, is any place incorporated with 2,500 or more individuals. In Iowa, “rural” is exemplified by grain bins, farmland adjacent to housing, small towns, and country roads, said Peter Thorne of the University of Iowa. The percentage of rural dwellers varies greatly by state. For example, Vermont has the highest proportion of rural residents—almost 62 percent—whereas California and Nevada each have less than 10 percent (U.S. Census Bureau, 2000a). However, the percentage for Nevada can be misleading because there are vast areas of open country in Nevada consisting of sagebrush and desert where no people live. In contrast, Iowa’s rural areas have a small town almost every 10 miles. Thus, the meaning of “rural” for Iowa and Nevada is very different, noted Sandra Charvat Burke of Iowa State University.

The demographics of the populations in rural areas of the United States also differ. In Iowa, many counties have had and continue to have declining populations, but other nonmetropolitan areas in the western part of the country are growing rapidly. Burke noted that as the population increases, the health care demands in those areas differ from those in areas experiencing population declines.

Families in rural areas often may not have access to health care because they are self-employed on their farms or in some other business that do not have a health plan provided by an employer.

Other socioeconomic aspects, such as education, differentiate metropolitan and nonmetropolitan areas. Metropolitan areas tend to have more people who have completed high school. The difference is even higher in terms of the pro-

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