The home page of the National Rural Health Association1 asks a question that is a perfect introduction to the articles in this issue of Family & Community Health "What's different about rural health care?" Some of the articles describe a variety of programs and projects that have been implemented in rural areas aimed to improve health. Other articles discuss structural and policy issues that affect rural people.
What is different about rural people compared with those who live in urban areas? First, it is important to remind ourselves that a sizable portion of our population in the United States lives in rural areas. To be specific, one-fourth of America's population lives in a rural area. As you will read in the articles in this issue, rural people have higher levels of poverty, a larger percentage of older adults tend to be in poorer health and have fewer physicians and other health care professionals to provide care, and they are less likely to have insurance than people who live in urban areas. Because their locale is typically sparsely populated getting to health care facilities is often a challenge. The residents may not have an automobile and it is unlikely that they could walk, bike, or use public transportation to seek health care. There is also a higher rate of alcohol abuse and the use of smokeless tobacco among rural youth and the suicide rate is already high among rural men and increasing in rural women. Given these different indices of health in rural versus urban areas, the articles in this issue offer some insights into ways to help rural people.
I recently returned to the United States, after living and working for more than a year in Hong Kong. I now live in a rural area in Tennessee. Even though I exercise nearly every day, I am finding it more difficult to keep my weight under control. Why is that? First, in Hong Kong, I did not have a car so I had to walk to work, to shop, and to go to many other venues. If I did not walk to my destination, I had to walk to ride the bus and then walk some more when I reached my destination. So, although I engaged in about the same kind of planned exercise in both Hong Kong and Tennessee and eat more or less the same way, I have gained weight. The key is in much less activity. To go anywhere outside my neighborhood, I must drive because the distance is too great to walk to work or to shop and, to other places of business is not an option now. Consider how the environment in which you live influences your level of fitness and health.
I think you will find that the range of articles in this issue is impressive. To focus on as many innovative programs as possible, we have chosen to have shorter articles and more articles. You will read about 4 programs in Appalachia, programs to engage children and youth in activities and healthy eating, telehealth mental health counseling and other system issues such as the need for Rural Healthy People 2010, what the effect on the Patient Protection and Affordable Care Act of 2010 will have on rural people, and what factors contribute to the effectiveness and efficiency of rural health clinics.
REFERENCE