Jonathon P. Leider is with the School of Public Health, University of Minnesota, Minneapolis. Michael Meit is with NORC at the University of Chicago, Bethesda, MD. J. Mac McCullough is with Arizona State University College of Health Solutions, Phoenix. Beth Resnick, Y. Natalia Alfonso, and David Bishai are with Johns Hopkins Bloomberg School of Public Health, Baltimore, MD. Debra Dekker is with National Association of County and City Health Officials (NACCHO), Washington, DC.
Am J Public Health. 2020 Sep;110(9):1283-1290. doi: 10.2105/AJPH.2020.305728. Epub 2020 Jul 16.
Public health in the rural United States is a complex and underfunded enterprise. While urban-rural disparities have been a focus for researchers and policymakers alike for decades, inequalities continue to grow. Life expectancy at birth is now 1 to 2 years greater between wealthier urban and rural counties, and is as much as 5 years, on average, between wealthy and poor counties.This article explores the growth in these disparities over the past 40 years, with roots in structural, economic, and social spending differentials that have emerged or persisted over the same time period. Importantly, a focus on place-based disparities recognizes that the rural United States is not a monolith, with important geographic and cultural differences present regionally. We also focus on the challenges the rural governmental public health enterprise faces, the so-called "double disparity" of worse health outcomes and behaviors alongside modest investment in health departments compared with their nonrural peers.Finally, we offer 5 population-based "prescriptions" for supporting rural public health in the United States. These relate to greater investment and supporting rural advocacy to better address the needs of the rural United States in this new decade.
美国农村的公共卫生是一项复杂且资金不足的事业。尽管几十年来，城乡差距一直是研究人员和政策制定者关注的焦点，但不平等现象仍在继续扩大。现在，出生时的预期寿命在富裕的城市和县与农村县之间相差 1 到 2 年，而在富裕县和贫困县之间相差多达 5 年。本文探讨了过去 40 年来这些差距的增长，其根源在于过去同一时期出现或持续存在的结构性、经济和社会支出差异。重要的是，关注基于地点的差异意味着认识到美国农村并非铁板一块，在地区上存在重要的地理和文化差异。我们还关注农村政府公共卫生企业面临的挑战，即与非农村同行相比，农村地区的卫生部门面临着更糟糕的健康结果和行为以及对其投资不足的“双重差距”。最后，我们为支持美国农村公共卫生提供了 5 项基于人口的“处方”。这些涉及到更多的投资和支持农村宣传，以更好地满足美国农村在这一新十年的需求。
