Consequences of differential residence designations for rural health policy research: the case of infant mortality.
In 1991, members of the rural caucus proposed numerous bills designed to attenuate the rural-urban differences in health care delivery and health status. Implicit in the legislative process is the assumption that "rural America" differs systematically from "urban America." However, research has consistently demonstrated that there is not a single rural America but rather, those areas outside of the major metropolitan areas represent a complex mosaic of varying social and environmental settings. Rural communities differ in meaningful ways along a number of socioenvironmental parameters, and accordingly, health status indicators also differ across rural communities. Thus, health outcome statistics averaged across rural communities will often mask important disparities experienced by certain population groups. Policies based on these aggregate indicators may overlook the needs of the most disadvantaged. While a number of measures of rurality have emerged in the last decade, much of the information presented to policy-makers is either too aggregated (i.e., metropolitan-nonmetropolitan) to identify important differences across the range of communities, or it is gathered in agency-specific categories that are not comparable. The central question under examination in the current context is the possibility of distorting the picture of infant health status by aggregating the diverse rural locales of the United States. Empirical results indicate that when considering infant mortality, any rural disadvantage is contingent upon how 'rural' and 'urban' have been defined. Further, the results indicate that conclusions must be conditioned on other important sociodemographic parameters such as region of the country and race.
Farmer
F L
FL
Department of Agricultural Economics and Rural Sociology, University of Arkansas, Fayetteville 72701.
Clarke
L L
LL
Miller
M K
MK
D001741:Black or African American / Q000706:statistics & numerical data; D001131:Arkansas; D003625:Data Collection; D005431:Florida; D005843:Geography; D006291:Health Policy; D006302:Health Services Research / Q000592:standards*; D006801:Humans; D007226:Infant Mortality; D007231:Infant, Newborn; D012111:Residence Characteristics; D012423:Rural Health / Q000706:statistics & numerical data*; D014481:United States; D014504:Urban Health / Q000706:statistics & numerical data; D044465:White People / Q000706:statistics & numerical data