Rural counties make up about 80 percent of the land area of the United States, but they contain less than 20 percent of the U.S. population (Ingram and Franco, 2012). The relative sparseness of the population in rural areas is one of many factors that influence the health and well-being of rural Americans. Rural areas have histories, economies, and cultures that differ from those of cities and from one rural area to another. Understanding these differences is critical to taking steps to improve health and well-being in rural areas and to reduce health disparities among rural populations.
To explore the impacts of economic, demographic, and social issues in rural communities and to learn about asset-based approaches to addressing the associated challenges, the Roundtable on Population Health Improvement and the Roundtable on the Promotion of Health Equity of the National Academies of Sciences, Engineering, and Medicine held a workshop titled “Achieving Rural Health Equity and Well-Being: Challenges and Opportunities” on June 13, 2017, in Prattville, Alabama, outside the city of Montgomery. The two roundtables brought complementary but distinct perspectives and expertise on the topic.
1 The planning committee’s role was limited to planning the workshop, and the Proceedings of a Workshop was prepared by the rapporteurs as a factual account of what occurred at the workshop. Statements, recommendations, and opinions expressed are those of individual presenters and participants and are not necessarily endorsed or verified by the National Academies of Sciences, Engineering, and Medicine. They should not be construed as reflecting any group consensus.
Since February 2013, the Roundtable on Population Health Improvement has been providing a trusted venue for leaders from the public and private sectors to meet and discuss the leverage points and opportunities arising from challenges and changes in the social and political environment for achieving better population health. The roundtable’s vision is of a strong, healthful, and productive society that cultivates human capital and equal opportunity. This vision rests on the recognition that outcomes such as improved life expectancy, quality of life, and health for all are shaped by interdependent social, economic, environmental, genetic, behavioral, and health care factors, and that robust national and community-based policies and dependable resources are needed to achieve that vision.
The Roundtable on the Promotion of Health Equity serves as the conveners of the nation’s experts in health disparities and health equity, with the goal of raising awareness and driving change. The roundtable was created in 2007 to promote health equity and reduce health disparities by advancing the visibility of and understanding about the inequities in health and health care among racial and ethnic populations, amplifying research, policy, and community-centered programs, and catalyzing the emergence of new leaders, partners, and stakeholders.
An important activity of the roundtables is to hold workshops for their members, stakeholders, and the public to discuss issues that contribute to eliminating disparities and improving the nation’s health. An independent planning committee, comprising Julie Baldwin, Marthe Gold, Jeffrey Henderson, Dennis Johnson, Octavio Martinez, Phyllis Meadows, Alan Morgan, and Tim Size, was charged with developing a workshop to explore how rural communities in different parts of the United States handle the challenges and opportunities of advancing health equity and well-being (see Box 1-1). The workshop was designed to do the following:
- Explore impacts of economic issues, immigration, and racial inequities in U.S. rural communities
- Learn about asset-based approaches to addressing these challenges
To achieve these objectives, the planning committee organized panels that revolved around how regional philanthropic organizations leverage resources to help address unique local and regional needs, how local finance and community advocacy organizations work to create the conditions for economic prosperity, and how health sector institutions work to ensure access to quality health care services for rural communities.
This Proceedings of a Workshop synthesizes the discussions held at the workshop, highlights the speakers’ perspectives on rural health equity and well-being, and provides an overview of showcased initiatives and approaches to meeting the particular challenges and opportunities in improving health in rural communities. Chapter 2 summarizes two keynote presentations that provided an overview of differences between rural and urban communities and the challenges and opportunities rural communities face. Chapter 3 summarizes presentations on the strengths and resources that rural communities have and the ways in which local and regional foundations can build on those strengths. Chapter 4 examines in greater detail some of the factors that contribute to health disparities in rural areas, including economic, historical, and cultural forces. The presentations outlined in Chapter 5 focus on a range of communities, including rural Alabamians, people living along the U.S.–Mexico border, and people living near rural hospitals that close, and consider different ways to overcome the unique challenges in rural communities. Chapter 6 provides the final comments and reflections on the day’s presentations (see Box 1-2 for highlights).
In accordance with the policies of the National Academies, workshop participants did not attempt to establish any conclusions or recommendations about needs and future directions, focusing instead on issues discussed by the speakers and workshop participants. In addition, the
planning committee’s role was limited to planning the workshop. The Proceedings of a Workshop was prepared by the workshop rapporteurs Steve Olson and Karen Anderson as a factual summary of what occurred at the workshop.