Urban Wire Addressing Rural Health Disparities Requires Trust, Data, and a Focus on Equity
Anna Morgan
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Rural communities face increased health challenges, with residents in rural areas more likely to die from cancer, stroke, heart disease, unintentional injury, and chronic respiratory disease compared with urban areas, and they face more barriers to accessing high-quality health care. Lack of transportation options, distant or limited providers, hospital closures (PDF), unreliable internet, and a lack of culturally appropriate services can all prevent rural communities from receiving necessary care. But not all rural areas experience these health disparities in the same way. People in rural Appalachia tend to have higher rates of obesity, drug use and overdoses, and smoking, whereas people along the US-Mexico border are less likely to have health insurance.

Despite these challenges, rural communities across the country are creating innovative solutions to meet their local health needs. The Urban Institute, in partnership with the Partners for Rural Transformation (PRT), recently created a guidebook and hosted a hybrid event to help rural practitioners collaborate, use data, and access financing to advance rural health equity. Event speakers discussed the challenges and solutions for strengthening rural health care access and addressing health disparities, highlighting community-driven innovations with a particular focus on persistent poverty counties.

Throughout the event, a few guiding principles arose for communities embarking on this work. In addition to identifying partners, choosing service models, measuring progress, and finding the right data to promote rural health equity (which are all featured in the guidebook), the speakers raised four key takeaways for implementing community-focused programs to meet rural health needs.

1. Ground rural health equity work in the historical context of structural racism.

To frame the convening, Rekha Balu from the Urban Institute shared:

Some of these rural communities have been systematically denied these investments via structurally racist systems and practices that allowed poverty to persist. If we think of areas in the Black Belt, Appalachia, tribal lands, immigrant and refugee communities—poverty, health, and overall quality of life outcomes tend to reflect this systemic disinvestment and limited opportunities for change.

Many panelists emphasized that the history of rural places is crucial to the work and that persistent poverty areas were not created accidentally. Alex Lawson of Hope Enterprise, which serves many states in the Deep South, highlighted the geographic overlap between concentrated areas of enslaved Africans at the beginning of the Civil War and areas with low rates of economic mobility and wide health disparities. For communities embarking on projects regarding equity in rural areas, understanding and addressing these legacies of structural racism is crucial.

2. Creating effective rural health solutions and partnerships requires community trust.

Without partnerships with community members and organizations, it can be challenging to create meaningful change. Trust is a crucial part of creating these relationships. Past experiences and historical context may impede building trust if communities have seen a lack of follow-through or exploitation at the hands of other organizations.

Elaine Crutchfield of Communities Unlimited recommended being honest and authentic with the communities and organizations as the way forward. Lawson shared that his organization moves “at the speed of trust.” Those engaged in rural health equity work can deepen partnerships by being a reliable partner others can call on for support. Working with known and trusted organizations can also encourage community trust.

For organizations with resources to support rural health equity work, it’s important to listen to the community members and provide the tools to pursue the work they deem important. Progress and success need to be defined by the local community and not driven solely by funders. Organizations can also acknowledge the resources already within rural communities using an asset-based approach, instead of bringing in new folks and organizations, to build trust and honor the community.

3. Culturally appropriate and community relevant services should be part of rural health equity work.

Rural communities are not homogeneous and require unique solutions and culturally appropriate services to address unmet needs. Services that honor and are informed by local culture can ensure community members feel comfortable receiving the health care services they need. Community health workers (CHWs)—trusted community members who provide medical information and connect residents to services in a culturally competent manner—are one successful model because they understand the community they’re serving.

Patty Molina, senior director of community health services at Mariposa Community Health Center, shared that CHWs have been quite successful in meeting the health needs of her community, which is primarily a Mexican-American immigrant community along the US-Mexico border. Communities may consider implementing the CHW model if they’re looking to increase community trust, provide culturally competent health information, and create a bridge between health care providers and community members.

4. Communicating data to a broad audience can increase impact and inclusion.

Sharing data with the broader community can allow for many benefits, such as using data to raise funding and support for programs. Legislators need the most relevant data to weigh specific policies. Sydney Howard, data research analyst with the Center of Excellence in Rural Health at the University of Kentucky, shared that the center presented their data on health care worker shortages to the Kentucky legislature, which resulted in $2 billion in a health care worker student loan relief plan for eastern Kentucky.

Data can also be accessibly, inclusively shared back to the community through mediums such as data interactives, where community stakeholders can respond to and interpret the findings. Interactive online dashboards are another possibility for sharing data with a much broader audience in an accessible format, such as this dashboard on disrupting food insecurity. When sharing out data, it’s important to tailor the information to the target audience.

If practitioners apply these principles, we may see an increase in health-focused programs in rural areas that have strong community buy-in and improved engagement. Because these programs will be better tailored to their specific community and address their unique health challenges, individual and community-level health outcomes could improve and lead to the narrowing of the urban-rural health disparities.


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The Urban Institute podcast, Evidence in Action, inspires changemakers to lead with evidence and act with equity. Cohosted by Urban President Sarah Rosen Wartell and Executive Vice President Kimberlyn Leary, every episode features in-depth discussions with experts and leaders on topics ranging from how to advance equity, to designing innovative solutions that achieve community impact, to what it means to practice evidence-based leadership.


Research Areas Health and health care
Tags Community data use Community engagement Health care delivery and payment Health equity Immigrant communities and racial equity Public health Rural people and places State health care reform
Policy Centers Metropolitan Housing and Communities Policy Center
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