rurality AND RURAL HEALTH 101

 

What are we talking about when we talk about rurality and rural health? 

Rural area: A rural area is characterized by low population density and low housing unit density (United States Census Bureau, 2023). Rural areas often have less access to health care facilities, transportation hubs, and shopping centers, in contrast to the more densely populated urban areas. Forty-six million people in the United States–15% of the population–live in rural areas (U.S. Food and Drug Administration, 2021).

Rural health: Rural health refers to the health of people who live in rural areas. Rural health may be impacted by limited access to health care services, specialists, and transportation, as well as by socioeconomic factors impacting rural communities (U.S. Food and Drug Administration, 2021).

Telemedicine: Telemedicine refers to the remote delivery of health care services through the use of electronic communication technology (American Telemedicine Association, 2023).

Why does rurality matter in healthcare?

Rural communities face unique challenges compared to urban communities. Factors such as increased poverty, lower education rates, larger elderly populations, and limited access to health services all impact rural health. As a result, rural communities face elevated morbidity and mortality rates from common causes of death. For instance, rates of chronic diseases like coronary heart disease and diabetes are higher in rural areas than in urban areas, and outcomes for diseases like lung cancer are worse due to less access to prevention and delays in receiving care. Delayed or limited care also impacts people with neurodevelopmental challenges and mental illnesses, leading to large disparities in suicide rates between urban and rural areas (Coughlin et al., 2019). To address some of these health disparities, many people point to telehealth. A narrative review of studies on telehealth in rural settings found the use of telehealth produced positive results, and was a feasible strategy for making health care more effective and convenient in rural areas (Butzner & Cuffee, 2021). 

Still, additional challenges remain. Rural populations often face stigma from their providers. One study showed that providers had more negative stereotypes about patients with opioid use disorder who came from rural areas compared to those from urban areas (Franz, Dhanani, & Miller, 2021). Health care disparities also exist within rural areas between members of racial and ethnic minorities versus non-Hispanic whites. Patients who experience stigma–including racial and ethnic minorities and gender minorities–may be less likely to seek medical care, contributing to the health disparities that exist among rural populations (Morales, Barksdale, & Beckel-Mitchener, 2020). 

What do we know about rurality and rural health in medical and health professions education?

Health professions education must do more to prepare students to treat patients in rural settings and to encourage these students to practice in rural areas in the future. Medical schools have taken many steps to increase rural health education and interest in rural health care, such as offering rural electives, rural tracks, and loan forgiveness programs for providers who will practice in rural areas (Curran & Rourke, 2004). As medical schools incorporate rural-specific training and provide opportunities for students to engage with rural communities, students may better understand rural communities, and may choose to practice in them (Curran & Rourke, 2004).

Another way to help recruit students to rural communities is to increase representation of rural students in medical schools. Rural students are underrepresented in medical schools and are becoming more underrepresented, reaching only 5% of all incoming medical students in 2017 (Shipman, 2019). Given that rural students are more likely to practice in a rural area in the future, it is important to explore new recruitment strategies. For example, one study from the UNC School of Medicine discusses effective efforts to recruit rural students by creating pipeline programs (Beck Dallaghan, 2021). 

How does the Bias Checklist address rurality and rural health in health professions education content?

The Bias Checklist first asks: 

  • “Does the content include any mention of any discussion of patients from or of healthcare provision in rural areas?”

If you answer no, you will be prompted to consider whether your content should discuss rural health.

Below are some examples of common ways in which bias, shame, stereotype and stigma toward rurality and rural health can manifest in health professions education content:

  • Assuming that people living in rural areas are less educated than those in urban areas

  • Assuming that people living in rural areas are less likely to have a healthy lifestyle or to adhere to healthcare recommendations

  • Assuming that people living in rural areas are white, Christian and/or Republican

Last, the Checklist asks: 

  • “Could the content be perceived as promoting stereotypes, bias, shame or stigma?”

What can we do to address this problem?

Content examples are coming soon!

Where can I go to learn more? 

I learn best by…

Reading

  • Mental Health in Rural America: A Field Guide by Ellen Greene Stewart

  • Out in the Rural: A Mississippi Health Center and Its War on Poverty by Thomas J. Ward

  • The Hospital: Life, Death, and Dollars in a Small American Town by Brian Alexander

Watching

Listening

Need a consultation?

The following people have identified themselves as experts in rural health and are willing to be contacted with questions regarding your content.

  • Contact list coming soon!

Have something to add? 

Email us at biaschecklist@gmail.com with any of the following:

  • Recommendations for additional important content to include above, or suggested corrections or clarifications → use the subject header “Rurality and Rural Health 101 - Correction”

  • Suggestions for additional questions to add to the Bias Checklist → use the subject header “Rurality and Rural Health 101 - Checklist Question”

  • Suggestions for additional resources for learning more → use the subject header “Rurality and Rural Health 101 - Learn More”

  • Examples of curricular bias, including before and after versions of content → use the subject header “Rurality and Rural Health 101 - Example”

  • Your name, credentials, affiliation, area(s) of expertise, and brief biography or summary of qualifications if you are willing to serve as an expert consultant → use the subject header “Rurality and Rural Health 101 - Consultant”

References

contributing writer(s)

Jacqueline Hogan, MD Candidate

Sophie Pollack-Milgate, BA

last updated October 4, 2023