Rural health

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Village elders participate in a training for rural health care workers in Ethiopia.

In medicine, rural health or rural medicine is the interdisciplinary study of health and health care delivery in rural environments. The fields of study comprising rural health include: geography, midwifery, nursing, sociology, economics, and telehealth or telemedicine.

The term "rural" can be defined in many ways, such as by population density, by geographic location or other factors. Due to the large number of choices in the definition parties may often disagree with one another on which definition to use.

Most rural communities have a large proportion of elderly people and children, with relatively few people of working age (20–50 years), resulting in a higher dependency ratio. Compared to their urban counterparts, rural individuals have poorer socio-economic conditions, less education, higher rates of tobacco and alcohol use, higher mortality rates.[1]

Many countries have made it a priority to increase funds for rural health research.[2][3] Several have also developed research institutes with rural health mandates (e.g. the Centre for Rural and Northern Health Research in Canada, Countryside Agency in the United Kingdom, the Institute of Rural Health in Australia, and the New Zealand Institute of Rural Health). While research plays a fundamental role in speaking for rural dwellers, it also provides decision makers with evidence based information. With that said, ‘rural proofing’ practices have been implemented to ensure rural needs are not overlooked in policy making.[4]


Definitions of "rural" differ greatly, varying among and sometimes within countries.[5] Depending on which set of standards is applied, Canada’s rural population can be anywhere from 22% to 38%,[6] while the United States' can be from 17% to 63%.[7]

Most rural definitions have been based on geographic parameters, such as population size, population density, and distance from an urban centre, settlement patterns, labor market influences, and postal codes.[8]

Life expectancy[edit]

Life expectancy rates are higher in urban areas than in rural areas.[1] Life expectancy in men ranged from 74 years in the most remote areas of Canada to 76.8 years its urban centers. For women, life expectancy was also lowest in rural areas, with an average of 81.3 years. Those living in rural areas adjacent to urban centers experience higher life expectancies (with men at 77.4 years and women at 81.5 years).

Australian life expectancies ranged from 78 years in major cities to 72 years in remote locations.[9] In China, the life expectancy of females is 73.59 years in urban areas and 72.46 in rural areas. Male life expectancy varies from 69.73 years in urban areas and 58.99 in rural areas.[10]

Health determinants[edit]

Access to healthcare[edit]

Telemedicine consult: Dr. Juan Manuel Romero, a cardiologist in Sonora, Mexico, engages in a pre-op consultation with Alma Guadalupe Xoletxilva, who is 640 km (400 mi) away in La Paz, Baja California. Telemedicine helps deliver care to patients in rural and remote areas.

People in rural areas have less access to healthcare: in 1993, only 10% of the rural population of China had medical insurance, compared with 50% of urban residents.[11] In the 1990s, only 20% of the government's public health spending went to the rural health system, which served 70% of the Chinese population.[11] In the United States, between 1990 and 2000, 228 rural hospitals closed, leading to a reduction of 8,228 hospital beds.[12] Canadian rural and small town dwellers have half as many physicians (1 per 1000) as their urban counterparts, and on average, have to travel five times the distance (an average of 10 km [6.2 mi])to access these services.[13] They have fewer specialized health care services such as dentists, dental surgeons, and social workers.[14] In addition, ambulance service was available in only 40% of the selected sites, blood and Urine testing services in one third of the sites, and only one of the 19 sites had neonatal services. Nursing service had reduced from 26.3% in 1998 to 21.1% in 2005. In 2009, patients living in rural areas of the United States were transferred to other facilities for care at a rate three times higher than that of patients in large central metropolitan areas.[15]

Rural areas, especially in Africa, have greater difficulties in recruiting and retaining qualified and skilled professionals in the health care field.[16] In Sub-Saharan Africa, urban and more prosperous areas have disproportionately more of the countries’ skilled health care workers.[16] For example, urban Zambia has 20 times more doctors and over five times more nurses and midwives than the rural areas. In Malawi, 87% of its population lives in rural areas, but 96.6% of doctors are found in urban health facilities. Burkina Faso has one midwife per 8,000 inhabitants in richer zones, and one per nearly 430,000 inhabitants in the poorest zone.[16] In South Africa alone, half of their population lives in rural areas, but only 12% of doctors actually practice there.[17] The lack of healthcare workers has resulted in unconventional ways of delivering health care to rural dwellers, including medical consultations by phone, travel grants, as well as mobile preventative and treatment programs. There have been increased efforts to attract health professionals to these isolated locations, such as increasing the number of medical students from rural areas and improving financial incentives for rural practice.[18] There are now programs in Africa designed to train women to perform home-based health care for patients in Rural Africa. One of the programs is African Solutions to African Problems (ASAP).[19]

Working conditions[edit]

Those living in rural areas experience higher rates of unemployment. Unemployment rates in Canada were consistently higher in rural and small towns from 1976 through 1989, fluctuating between 7% and 12%. Jobs in forestry, farming and fishing, manufacturing, and mining are prevalent,[20][21] often accompanied by greater health and safety hazards due to the use of complex machinery, exposure to chemicals, working hours, noise pollution, harsher climates, and physical labor. Rural work forces thus report higher rates of life-threatening injuries.[22][23]

Personal health[edit]

Persons from rural areas report higher rates of smoking, exposure to second-hand smoke, obesity, and lower rates of fruits and vegetable consumption.[1] Suicide rates, injury, and poisoning are also more prevalent rural areas, and the Australian Institute of Health and Welfare reports higher rates of interpersonal violence.[9]

Physical environment[edit]

The Australian Institute of Health and Welfare[9] reports lower water quality and increased crowding of households as factors affecting disease control in rural and remote locations. As well, insufficient wastewater treatment, lack of paved roads, and exposure to agricultural chemicals has been identified as additional environmental concerns for those living in rural locations.[24]

Efforts to increase health[edit]

In the United States, the Health Resources and Services Administration funds the Rural Hospital Performance Improvement Project to improve the quality of care for hospitals with fewer than 200 beds.[25] Research centers (such as the Center for Rural and Northern Health Research at Laurentian University, the Center for Rural Health at the University of North Dakota, and the RUPRI Center) and rural health advocacy groups (such as the National Rural Health Association, National Organization of State Offices of Rural Health, National Rural Health Alliance) are relatively new in comparison to other research centers.[26] In Canada, many provinces have started to decentralize primary care and move towards a more regional approach. Recently,[when?] in Ontario, Canada, "Local Health Integration Networks" have been established in order to address the needs of the many Ontarians living in rural, northern, and remote areas.[27]

In China, a US$50 million pilot project has been approved in order to improve public health in rural areas.[28] China is also planning to introduce a national health care system. Australia has also recognized its issues with rural healthcare.[29]

The 2010 United States federal budget included $73 million to improve both access to and quality of health care in rural areas.[30]


In developing nations such India, non-profit organizations often partner with corporate houses to execute rural health projects such as TeleDoc, carried out by the Jiva Institute of Faridabad, India. In the United States, the Extension for Community Healthcare Outcomes project uses a telehealth platform to help urban medical center specialists train primary care doctors in rural settings.[31] Eula Hall founded the Mud Creek Clinic in Grethel, Kentucky to provide free and reduced-priced healthcare to residents of Appalachia. In Indiana, St. Vincent Health implemented the Rural and Urban Access to Health to enhance access to care for under-served populations, including Hispanic migrant workers. As of December 2012, the program had facilitated more than 78,000 referrals to care and enabled the distribution of US$43.7 million worth of free or reduced-cost prescription drugs.[32]

Mental Health[edit]

People living in rural areas often have less access to mental health services than do those living in urban areas. Telemedicine offers a method to reduce these disparities by delivering services such as telepsychiatry through video conferencing sessions.[33] In the United States, several programs have been established that use telemedicine to provide mental health services to rural patients. Between 2007 and 2012, the University of Virginia Health System implemented a videoconferencing project that allowed child psychiatry fellows to host approximately 12,000 sessions with children and adolescents living in rural parts of the State.[34] In 2009, the South Carolina Department of Mental Health established a partnership with the University of South Carolina School of Medicine and the South Carolina Hospital Association to form a statewide telepsychiatry program that provides access to psychiatrists sixteen hours a day, seven days a week, to treat patients with mental health issues who present at emergency departments in the network.[35]

See also[edit]


  1. ^ a b c How healthy are Rural Canadians? An Assessment of Their Health Status and Health Determinants. Ottawa: Canadian Institute for Health Information. 2006. ISBN 978-1-55392-881-2. Archived from the original on 2008-06-20. 
  2. ^ Healthy Horizons- Outlook 2003-2007: A Framework for Improving the Health of Rural, Regional, and Remote Australians. Australian Health Ministries’ Advisory Council’s National Rural Health Policy Sub-committee and the National Rural Health Alliance for the Australian Health Minister’s Conference. 2003. ISBN 07308 56844. 
  3. ^ Ministerial Advisory Council on Rural Health (2002). Rural Health in Rural Hands: Strategic Directions for Rural, Remote, Northern and Aboriginal Communities. Ottawa: Health Canada. 
  4. ^ (see Countryside Agency, 2002)
  5. ^ Pong, R. W.; Pitbaldo, R, J (2001). "Don't take "geography" for granted! Some methodological issues in measuring geographic distribution of physicians". Canadian Journal of Rural Medicine 6: 105. 
  6. ^ du Plessis, V.; Beshiri, R.; Bollman, R.; Clemenson, H. (2001). "Definitions of Rural". Rural and Small Town Canada Analysis Bulletin 3 (3). 
  7. ^ "Rural Definitions: Data Documentation and Methods". United-States Department of Agriculture. 2007. Retrieved January 31, 2008. 
  8. ^ Pitblado, JR (March 2005). "So, what do we mean by "rural," "remote" and "northern"?". The Canadian Journal of Nursing Research 37 (1): 163–8. PMID 15887771. 
  9. ^ a b c "Rural, regional, and remote health: Indicators of health". Australian Institute of Health and Welfare. 2005. ISBN 9781740244671. Retrieved February 19, 2008. 
  10. ^ Shen, J (February 1993). "Analysis of urban-rural population dynamics of China: a multiregional life table approach". Environment & Planning 25 (2): 245–53. PMID 12286564. 
  11. ^ a b Brant, S.; Garris, M.; Okeke, E.; Rosenfeld, J. (2006). Access to Care in Rural China: a Policy Discussion. The Gerald R. Ford School of Public Policy, University of Michigan. pp. 1–19. Retrieved February 27, 2009. 
  12. ^ "Trends in rural hospital closure 1990–2000". U.S Department of Health and Human Services. 2003. Retrieved February 19, 2008. 
  13. ^ Ng, E.; Wilkins, R.; Pole, J.; Adams, O. (1999). "How far to the nearest physician". Rural and Small Town Analysis Bulletin 1: 1–7. 
  14. ^ Halseth, G.; Ryser, L. (2006). "Trends in service delivery: Examples from rural and small town Canada, 1998 to 2005". Journal of Rural and Community Development 1: 69–90. 
  15. ^ Kindermann, D; Mutter, R; Pines, JM (February 2006). Emergency Department Transfers to Acute Care Facilities, 2009: Statistical Brief #155. PMID 24006549. 
  16. ^ a b c "Health Workers Needed: Poor Left Without Care in Africa’s Rural Areas". The World Bank. 2008. Retrieved February 27, 2009. 
  17. ^ "Bring Health Care Services to Rural Africa". The Atlantic Philanthropies. 2012. Retrieved Dec 13, 2013. 
  18. ^ Rourke, J. (2008). "Increasing the number of rural physicians". Canadian Medical Association Journal 178: 322–325. doi:10.1503/cmaj.070293. PMC 2211345. 
  19. ^ "Health". African Solutions to African Problems. 2013. Retrieved December 2, 2013. 
  20. ^ Bollman, Ray D. (13 Nov 2008). "An Overview of Rural and Small Town Canada". Canadian Journal of Agricultural Economics/Revue canadienne d'agroeconomie 39 (4): 805–817. doi:10.1111/j.1744-7976.1991.tb03642.x. 
  21. ^ U.S Congress, 1991
  22. ^ Gerberich S.G.; Gibson, R.W.; French, L.R.; Lee, T.Y.; Carr, W.P.; Kochevar, L.; Renier, C.M.; Shutske, J. (1998). "Machinery-related injuries: Regional Rural Injury Study-I (RRIS-I)". Accident Analysis and Prevention 30: 93–804. PMID 9805522. 
  23. ^ Pickett, W.; Hartling, L.; Brison, R. J.; Guernsey, J. R.; Program (1999). "Fatal work-related farm injuries in Canada, 1991-1995". Canadian Medical Association Journal 160 (13): 1843–1848. PMC 1230438. PMID 10405669. 
  24. ^ Aday, L. A.; Quill, B. E.; Reyes-Gibby, C. C. (2001). "Equity in rural health and health care". In Loue, Sana; Quill, B.E. Handbook of Rural Health. New York City: Kluwer Academic-Penum Publishers. pp. 45–72. ISBN 9780306464799. 
  25. ^ "Challenges Facing Rural Health Care: A Conversation With Brock Slabach, Senior Vice President for Member Services at the National Rural Health Association". Agency for Healthcare Research and Quality. 2013-04-17. Retrieved 2013-09-29. 
  26. ^ "Ottawa Charter for Health Promotion". First International Conference on Health Promotion. World Health Organization. November 21, 1986. Archived from the original on February 18, 2012. Retrieved February 15, 2009. 
  27. ^ Population health profile: North East LHIN. North Bay, Ontario: North East LHIN: North East Local Health Integration Network. 2006. Retrieved January 20, 2009. 
  28. ^ "China launches rural health project". China Daily. 2008. Retrieved March 2, 2009. 
  29. ^ Humphreys, J; Hegney, D; Lipscombe, J; Gregory, G; Chater, B (February 2002). "Whither rural health? Reviewing a decade of progress in rural health.". The Australian Journal of Rural Health 10 (1): 2–14. PMID 11952516. 
  30. ^ "A New Era of Responsibility". United States Office of Management and Budget. 
  31. ^ "Focusing on Priority Populations: An Interview With Cecilia Rivera Casale, Senior Advisor for Minority Health, AHRQ". Agency for Healthcare Research and Quality. 2013-04-017. Retrieved 2013-08-27. 
  32. ^ "Field-Based Outreach Workers Facilitate Access to Health Care and Social Services for Underserved Individuals in Rural Areas". Agency for Healthcare Research and Quality. 2013-05-01. Retrieved 2013-05-13. 
  33. ^ Ana Maria Lopez, MD, MPH, FACP (2013-12-04). "Academic Telepsychiatry Programs Enhance Access for Rural Populations". Retrieved 2013-12-04. 
  34. ^ "Videoconferencing Enhances Access to Psychiatric Care for Children and Adults With Mental Illness in Rural Settings". Agency for Healthcare Research and Quality u rl= 2013-12-04. 
  35. ^ "Statewide Partnership Provides Mental Health Assessments via Telemedicine to Patients in Rural Emergency Departments, Reducing Wait Times, Hospitalizations, and Costs". Agency for Healthcare Research and Quality url= 2013-12-04. 


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