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The call for articles for this AJPH special section on rural health began with these words: "Rural health in America is at a crossroads." When that call was issued in late 2019, we had no idea how our world would change, and the impact of COVID-19 on the rural United States has caused a seismic shift, buckling that crossroad. COVID-19 aside, the crossroads still exist: predominately a declining and aging population, with a steadily eroding health infrastructure and shrinking economic base. For many, the road out is the only viable path. What vision of rural public health in the 21st century evokes the possibility of a reinvented and reinvigorated rural landscape?
CELEBRATE THE GOOD AND IDENTIFY DISPARITIES
Meit and Knudson (p. 1281) begin the special section by noting that the prevailing narrative about rural America is a dystopic one, often driven by the very attempts to identify opportunities to improve rural health by focusing on inequities. Their work instead sheds light on the good in rural America: pride ofplace, resilience, social cohesion, cross-sector engagement, and innovation. Ever present in assembling this special section was their appeal to create a better balance in the narrative about the rural United States while still providing new perspectives on rural disparities.
Probst et al. (p. 1325) focus on rural-urban mortality gaps in their examination of mortality differentials across geography, race, and ethnicity for 2013 through 2017. The rural Black population experienced the highest mortality from cardiovascular disease, cancer, and stroke, whereas rural American Indians/Alaska Natives experienced the highest unintentional injury mortality. The authors surmise that failing to consider race and ethnicity while investigating overall rural-urban health disparities risks leaving minority health disparities unaddressed.
Jensen et al. (p. 1328) provide additional perspectives on rural-urban disparities, focusing on depopulation and increasing diversity. Population loss attributable to youth out-migration leaves an older rural population, which will ultimately overwhelm the remaining, aging health workforce and infrastructure. They also call for future research on the impacts...