Evidence Demonstrates Rural Public Health
Departments Struggle to Meet Demands
Rural populations experience higher rates of
mortality, especially rural minorities. 1, 2
• Comparing urban whites to rural whites, and urban blacks to
rural blacks, there are disparities in life expectancy that are
based on geography alone, and a dual disparity that exists
when you combine race with geography. For example, the
average life expectancy of an affluent white person in an
urban setting exceeds the average life expectancy of a poor
black person in a rural setting by 8.3 years.2
• Poverty and unemployment, lower levels of educational
achievement, and the lack of access to affordable health
care contribute to poor health outcomes, all factors more
common in rural communities than in urban areas.3
• Expanded insurance coverage does not address rural
provider shortages. In fact, expansion exacerbates existing
access challenges so that local health departments in rural
areas find themselves providing more direct preventive
clinical services than do their urban counterparts.6
The average life expectancy of an affluent white person
in an urban setting exceeds the average life expectancy
of a poor black person in a rural setting by 8.3 years.2
Affluent white (urban)
Despite health insurance coverage expansion,
the public health system provides needed
services.
Poor white (urban)
• Even if health care coverage expands, researchers find that
deaths due to preventable disease will continue to increase
when public health funding is cut.4
• Communities that invest more in public health delivery see
slower growth in medical care spending and reductions in
infant mortality and deaths due to cardiovascular disease,
diabetes, and cancer.5
8.3 years
Affluent black
(urban)
7.2 years
4.5 years
Poor black (rural)
0
2
4
6
8
10
Resources are needed to bolster the rural
public health system.
• Local health departments (LHDs) in rural communities function
with lower staffing levels and rely more heavily on part-time
public health workers than do their urban counterparts.7, 8
• LHDs in rural communities are proportionally more reliant
on state and federal resources; an additional $10 of public
health spending per person saves approximately 9.1 lives
per 100,000 people—resulting in an annual savings of
$2.95 billion.9
• A very small proportion of the evidence focuses on rural
health departments—which comprise approximately 60
percent of all LHDs.10
Rural Health in the Numbers11
•Rates of Chronic Obstructive Pulmonary Disease
(COPD) are 31 percent higher among our most rural
citizens, as compared to our most urban citizens—and
it has grown by 25 percent over the past decade,
compared to 6% amongst urbanites.
• Smoking rates among our most rural youth (age 1217) are double those of our most urban youth; while
smoking rates among our most urban adults have
decreased 30% over the past decade, rates among
rural adults have remained constant.
• Mortality rates for heart disease are 80 percent higher
for women in the South and more than double the U.S.
rate for men in the South.
• Mortality rates for suicide are 80 percent higher for men
and women in the West.
• Mortality rates for cancers are 40 percent higher for men
and women in Appalachia.
• Mortality rates from unintentional injury are nearly
double for men in Appalachia and 2.3 times higher
for women in Appalachia.
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Endnotes
1. Singh GK, Siahpush M. Widening rural-urban disparities in all-cause mortality
and mortality from major causes of death in the USA, 1969–2009. J Urban Heal.
2013;91(2):272-292. doi:10.1007/s11524-013-9847-2.
2. Singh GK, Siahpush M. Widening rural-urban disparities in life expectancy, U.S.,
1969–2009. Am J Prev Med. 2014;46(2):19-29). doi:10.1016/j.amepre.2013.10.017.
3. Crosby R, Monica ML, Vanderpool RC, Casey B. Rural Populations and Health: Determinants, Disparities, and Solutions. San Francisco, CA: John Wiley and Sons; 2012.
4. Mays GP. Does Medicaid crowd out other public health spending? Projecting ACA’s
health & economic effects. AcademyHealth Annual Research Meeting. San Diego,
CA. Jun. 2014.
5. Mays GP and Smith SA. Evidence links increases in public health spending to
declines in preventable deaths. Health Affairs. 2011; 30(8): 1585-93. doi: 10.1377/
hlthaff.2011.0196
6. Beatty KE, Meit M, Hale N, Khoury A, Masters P. Clinical Service Delivery Disparities
along the Urban/Rural Continuum. Paper presented at AcademyHealth PHSR Interest Group Meeting; 2015 June 16-17; Minneapolis, Minnesota.
7. Leep CJ. 2008 national profile of local health departments. J Public Health Manag
Pract. 2008;12(5):496-498. http://www.ncbi.nlm.nih.gov/pubmed/22286289.
8. Leider JP, Shah GH, Castrucci BC, Leep CJ, Sellers KSJ. Changes in public health
workforce composition: Proportion of part-time workforce and its correlates, 2008–2013.
Am J Prev Med. 2014;5 Suppl 3(Nov):S331-S336. doi:10.1016/j.amepre.2014.07.017
9. Brown TT. How effective are public health departments at preventing mortality?.
Econ Hum Biol. 2013; 13(1): 34-45. doi: 10.1016/j.ehb.2013.10.001
10.Hale NL. Rural public health systems: challenges and opportunities for improving
population health. AcademyHealth. October 2015.
11.Centers for Disease Control and Prevention, National Center for Health Statistics,
National Health Interview Survey.