Rural Healthy People 2010:
A Companion Document to Healthy People 2010
VOLUME 2:
Introduction, Literature Reviews
Introduction to Rural Healthy People 2010 (Volume 2)*
Rural Healthy People 2010 (RHP2010) is comprised of two volumes. Volume 1 contains brief overviews of the top rural health concerns and objectives associated with Healthy People 2010 focus areas, references to key literature about these concerns, and descriptions of models for practice that rural communities can draw upon to achieve key Healthy People 2010 (HP2010) objectives. Volume 2 is an appendix that presents more detailed literature reviews and associated references for the top rural health concerns.
One of the objectives of RHP2010 is to review the research literature on a number of HP2010-related rural health issues. Each chapter in Volume 2 corresponds to the Overview and Models for Practice chapter that deals with the same topic in Volume 1. Most of the rural health priorities examined here are Healthy People 2010 focus areas and/or objectives associated with health conditions and/or access to care conditions. The focus in the following literature reviews is on summarizing research findings that outline important factors related to the rural health conditions being explored by professionals and other interested parties in states and rural communities. The reviews do not address methodological issues in the conduct of rural health research. Also, authors may use the terms urban and rural interchangeably with metropolitan and non-metropolitan counties during discussion. More precise labels are applied when the research being summarized employs more exacting classifications of counties that are central to the points being presented in these reviews. For a discussion of the various urban-rural classification schemes, see Ricketts.1
Frequently, studies that examine rural-urban differences in health-related conditions across the nation attend, also, to the impact of other factors such as population age, poverty, education, employment, health insurance status, and race/ethnicity on differences in health-related conditions. In some statistical analyses, one or more of the latter factors appear to be more powerful factors than rural location in accounting for poorer access or poorer health in a population. It is important, of course, to be cognizant of the importance of addressing any of these factors in urban or rural settings that contribute to significant disparities in access to health or health status. It is the case that in many rural areas, the population is disadvantaged on several, if not all, of these factors. This provides an additional reason to be attentive to these other social and economic factors that are often associated with poorer health and that must be attended to in strategies to improve the health of populations in these rural areas.
Although some policies are mentioned in the treatment of these topics, this document does not formally evaluate or advocate particular policies. Researchers at the Southwest Rural Health Research Center and researchers at other Rural Health Research Centers with funding from the Office of Rural Health Policy are continually engaged in projects that are more directly related to policy options. These centers are identified at the website of the Office of Rural Health Policy (http://ruralhealth.hrsa.gov). The advocacy dimension here is directed largely at encouraging health organizations, professionals, and communities to consider what some communities or other organized efforts have accomplished to address rural health priority issues.
In a number of rural health priority areas, of course, one cannot ignore the contribution of a number of health policies to increase the supply of physicians and other health providers in rural areas or the role of Medicare and Medicaid in supporting health care for large numbers of rural residents. We intend this work to be helpful to policymakers, as well as to state and local rural health leaders, and rural residents. It will hopefully add to our collective understanding of rural health conditions, knowledge of some of the unique challenges facing delivery of health services in rural areas, and an appreciation of the innovativeness and commitment of many rural health leaders and communities to make the most of available resources to advance the health of rural residents.
1. Ricketts, T.C.; Johnson-Webb, K.D.; and Randolph, R.K. Populations and places in rural America. In: Ricketts, T.C., ed. Rural Health in the United States. New York, NY: Oxford University Press, 1999.
*Reference numbering in Volume 2 reflects the order in which references were introduced in the corresponding overviews in Volume 1.