title: The Double Disparity Facing Rural Local Health Departments.
abstract: Residents of rural jurisdictions face significant health challenges, including some of the highest rates of risky health behaviors and worst health outcomes of any group in the country. Rural communities are served by smaller local health departments (LHDs) that are more understaffed and underfunded than their suburban and urban peers. As a result of history and current need, rural LHDs are more likely than their urban peers to be providers of direct health services, leading to relatively lower levels of population-focused activities. This review examines the double disparity faced by rural LHDs and their constituents: pervasively poorer health behaviors and outcomes and a historical lack of investment by local, state, and federal public health entities.
authors.affiliation: Brown School, Washington University in St. Louis, St. Louis, Missouri 63130; email: harrisj@wustl.edu.
authors.forename: Jenine K
authors.initials: JK
authors.lastname: Harris
authors.affiliation: Department of Health Services Management and Policy, College of Public Health, East Tennessee State University, Johnson City, Tennessee 37614; email: beattyk@etsu.edu.
authors.forename: Kate
authors.initials: K
authors.lastname: Beatty
authors.affiliation: Department of Health Policy and Management, Johns Hopkins University, Baltimore, Maryland 21205; email: jleider2@jhu.edu.
authors.forename: J P
authors.initials: JP
authors.lastname: Leider
authors.affiliation: Public Health Department.|NORC Walsh Center for Rural Health Analysis, University of Chicago, Chicago, Illinois 60637; email: Knudson-alana@norc.org , anderson-britta@norc.org , meit-michael@norc.org.
authors.forename: Alana
authors.initials: A
authors.lastname: Knudson
authors.affiliation: NORC Walsh Center for Rural Health Analysis, University of Chicago, Chicago, Illinois 60637; email: Knudson-alana@norc.org , anderson-britta@norc.org , meit-michael@norc.org.
authors.forename: Britta L
authors.initials: BL
authors.lastname: Anderson
authors.affiliation: Public Health Department.|NORC Walsh Center for Rural Health Analysis, University of Chicago, Chicago, Illinois 60637; email: Knudson-alana@norc.org , anderson-britta@norc.org , meit-michael@norc.org.
authors.forename: Michael
authors.initials: M
authors.lastname: Meit
mesh_terms: D003469:Culture; D006077:Government Agencies / Q000191:economics / Q000458:organization & administration*; D015438:Health Behavior; D006297:Health Services Accessibility; D054624:Health Status Disparities; D006280:Health Workforce; D054625:Healthcare Disparities / Q000458:organization & administration*; D006801:Humans; D057766:Policy; D012111:Residence Characteristics; D012423:Rural Health; D019035:Rural Health Services / Q000191:economics / Q000458:organization & administration*; D012959:Socioeconomic Factors; D014481:United States / Q000453:epidemiology
keywords: health services; health systems; poverty