Rural health
In medicine, rural health or rural medicine is the interdisciplinary study of health and health care delivery in rural environments. The concept of rural health incorporates many fields, including wilderness medicine, geography, midwifery, nursing, sociology, economics, and telehealth or telemedicine.
Rural populations often experience health disparities and greater barriers in access to healthcare compared to urban populations. Globally, rural populations face increased burdens of noncommunicable diseases such as cardiovascular disease, cancer, diabetes, and chronic obstructive pulmonary disorder, contributing to worse health outcomes and higher mortality rates. Factors contributing to these health disparities include remote geography, increased rates of health risk behaviors, lower population density, decreased health insurance coverage among the population, lack of health infrastructure, and work force demographics. People living in rural areas also tend to have less education, lower socioeconomic status, and higher rates of alcohol and smoking when compared to their urban counterparts. Additionally, the rate of poverty is higher in rural populations globally, contributing to health disparities due to an inability to access healthy foods, healthcare, and housing.
Many countries have made it a priority to increase funding for research on rural health. These research efforts are designed to help identify the healthcare needs of rural communities and provide policy solutions to ensure those needs are met.
Definitions
There is no international standard for defining rural areas, and standards may vary even within an individual country. The most commonly used methodologies fall into two main camps: population-based factors and geography-based factors. The methodologies used for identifying rural areas include population size, population density, distance from an urban centre, settlement patterns, labor market influences, and postal codes.The reported number of individuals living in rural areas can vary greatly depending on which set of standards is applied. Canada's rural population can be identified as anywhere from 22% to 38% of the population. In the United States the variation is greater; between 17% and 63% of the population may be identified as living in rural areas. The lack of consensus makes it difficult to identify the number of individuals who are in need of rural healthcare services.
Life expectancy and mortality
Rural areas within the U.S. have been found to have a lower life expectancy than urban areas by approximately 2.4 years. Rural U.S. populations are at a greater risk of mortality due to non-communicable diseases such as heart disease, cancer, chronic lower respiratory disease, and stroke, as well as unintentional injuries such as automobile accidents and opioid overdoses compared to urban populations. In 1999, the age-adjusted death rate was 7% higher in rural areas compared to urban areas. However, by 2019 this difference had widened, with rural areas experiencing a 20% higher death rate compared to in urban areas. There is some evidence to suggest that the gap may be widening as more public health resources are directed away from rural areas towards densely populated urban areas.These trends are also observed on a global scale, as rural communities are more likely to have lower life expectancies than urban counterparts. Data collected from 174 countries found the maternal mortality rate to be 2.5 times higher in rural areas compared to urban areas. Additionally, the likelihood that a child born in a rural area will die before the age of 5 is 1.7 times higher than a child born in an urban area. Factors contributing to the increased risk of maternal and child mortality include healthcare worker shortages, as well as a lack of health facilities and resources in rural areas.
Health determinants
Access to healthcare
People in rural areas generally have less access to healthcare than their urban counterparts. Fewer medical practitioners, mental health programs, and healthcare facilities in these areas often mean less preventative care and longer response times in emergencies. Geographic isolation also creates longer travel times to healthcare facilities, acting as a barrier to accessing care in rural communities. The lack of resources in rural areas have resulted in utilization of telehealth services to improve access to speciality care, as well as mobile preventative care and treatment programs. Teleheath services have the potential to greatly improve access to providers in remote areas, however, barriers such as lack of stable internet access create disparities to accessing this care. There have also been increased efforts to attract health professionals to isolated locations, such as increasing the number of medical students from rural areas and improving financial incentives for rural practices.Rural communities face healthcare worker shortages that are more than twice as high as urban communities. For example, Canadians living in rural areas have access to half as many physicians and have to travel five times the distance to access these services compared to urban counterparts. There is also a lack of specialist physicians, such as dermatologists or oncologists, in rural communities, resulting in a higher reliance on primary care physicians and emergency rooms for healthcare.
Rural areas, especially in Africa, have greater difficulties in recruiting and retaining qualified and skilled professionals in the healthcare field. In recent years, over 30% physicians from sub-Saharan Africa have left low-income rural areas and moved to higher-income countries due to burnout. This creates further physician shortages and a higher risk of burnout on the physicians that remain in rural communities. In sub-Saharan African countries such as Zambia and Malawi, urban areas have disproportionately more of the countries' skilled physicians, nurses, and midwives despite a majority of the population living in rural areas. In South Africa alone, 43% of the population lives in rural areas, but only 12% of doctors actually practice there. This is similar to the realities in Ghana, which implemented the Community-based Health Planning and Services program, designed to promote community health through preventive and primary care, though the initiative has faced issues due to the uneven distribution of healthcare professionals across all communities.
The gap in services is due, in part, to the focus of funding on higher-population areas. Only 20% of the Chinese government's public health spending went to the rural health system in the 1990s, which served 70% of the Chinese population. In the United States, between 1990 and 2000, 228 rural hospitals closed, leading to a reduction of 8,228 hospital beds. In order to improve health care availability in rural areas, it is important to understand the needs of each community. Each area has unique barriers to accessing care. Local officials, partners, and community members all have a valuable perspective to addressing these issues.
Economic stability and employment status
The median income of rural households is typically lower than urban households. In 2021, the US Census Bureau reported the median rural household income to be approximately $17,000 lower than urban households. Additionally, there are higher rates of poverty in rural areas compared to urban areas, impacting the ability for rural residents to pay for healthcare services and basic living needs. One contributing factor is that rural areas have less availability of jobs that pay a living wage and offer health benefits.Industries such as mining, logging, and farming are prevalent in rural areas, which are associated with special health problem of their own. These professions are associated with health complications due to injuries, exposure to toxic chemicals, and exposure to diseases from animal waste. These industries also impact the environmental health in the surrounding community by contaminating their air and water with toxins.