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In this commentary, I place the maturing field of rural health research and policy in the context of the rural health disparities documented in Health United States, 2001, Urban and Rural Health Chartbook. Because of recent advances in our understanding of the determinants of health, the field must branch out from its traditional focus on access to health care services toward initiatives that are based on models of population health.
In addition to presenting distinct regional differences, the chartbook shows a pattern of risky health behaviors among rural populations that suggest a "rural culture" health determinant. This pattern suggests that there may be environmental and cultural factors unique to towns, regions, or United States Department of Agriculture (USDA) economic types that affect health behavior and health. (Am J Public Health. 2004;94:1675-1678)
IN THIS COMMENTARY, I consider the historical focus of rural health research and policy on access to hospitals, primary care, and other health services, and I call for a shift toward a population health approach to rural health. Over the past decade, empirical studies have presented evidence that medical care contributes relatively little to health when compared with social and societal factors, environmental factors, health behaviors, and genetics. The Health United States 2001, Urban and Rural Health Chartbook1 presents a pattern of risky health behaviors among rural populations that suggests a "rural culture" health determinant. It also presents distinct regional differences. Responding to regionally diverse behavioral risk factors is a challenge for the maturing field of rural health.
HOW FAR WE HAVE COME
Rural health research and policy is an established field, with a history of sentinel publications2,3 and a journal, The Journal of Rural Health. Leading researchers and policy experts in the field have established some traditional areas of inquiry-areas that receive research funding and federal support in the form of policy interventions that include programs and funding (e.g., reimbursement, grants for direct services, loan repayments, and training funds). The field received a significant boost in 1987, when the federal Office of Rural Health Policy was authorized largely in response to the significant number of rural hospitals that closed during the mid-1980s. The health and the preservation of rural hospitals is a cornerstone of the field.
The argument for the preservation of...