Telemedicine uses telecommunications technologies to deliver health care to populations located at some distance from health care providers. Telehealth is a somewhat broader term that includes non-clinical applications (such as education). This article draws on data from a nationwide survey of telehealth networks that assesses the extent and character of telemedicine activity. Although statistics point to increased utilization, the distribution of growth has been skewed toward a few applications and it is not clear that rural areas would derive substantial benefit in the absence of federal subsidy. Reported barriers to building sustainable programs often seem to reflect concerns of large hospitals and health care systems rather than constraints faced by rural organizational and individual network members. The potential role of government in addressing barriers is discussed.

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In agrarian societies living in marginally productive environments, the primacy of subsistence production can shape customary rights to land and resources. In the Senegalese villages that participated in this field research, the subsistence imperative means land not being cultivated should be made available to those who would clear and farm it, regardless of who claims the land. Men consider women's contributions to the subsistence enterprise as secondary to their own responsibilities for organizing communal grain production. Women can use land, but not control it or manage its resources, and are subject to eviction and=or relegated to less fertile areas. Further, women's access to important commons resources may be more a function of prevailing land use than any structure of tenure rights.

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