Can Age-Friendly Planning Promote Equity in Community Health Across the Rural-Urban Divide in the US?

Abstract

In the US, rural communities face challenges to meet the community health needs of older adults and children. Meanwhile, rural areas lag in age-friendly built environment and services. AARP, a US based organization promoting livability for all ages, has developed a Livability Index based on the World Health Organization’s (WHO) domains of age-friendly communities: health, housing, neighborhood, transportation, environment, engagement, and opportunity. This study links the 2018 AARP Livability Index categories with demographic structure and socio-economic factors from the American Community Survey at the county level in the US to examine if the physical, built and social environment differentiate communities with better community health across the rural–urban divide. Results show that the neighborhood built environment has the largest impact on community health for all county types. Although rural areas lag in community health, those which give more attention to engagement and opportunity rank higher. Rural communities with more African Americans, children, and poor Whites, rank lower on community health. While neighborhood characteristics have the strongest link to community health, a broader approach with attention to age, race, poverty and engagement and opportunity is needed for rural areas.

Healthy Places for Children: The Critical Role of Engagement, Common Vision, and Collaboration

“…Our second research question explores the role of planning and social inclusion on child-friendly zoning codes and services. While prior studies have identified the critical role of engagement of families with children and youth in promoting community health [ 3 , 19 , 39 , 42 , 49 ], our results show that a common vision across generations, race, and ethnicity is as important as engagement in building healthy communities for children. Positive attitudes toward families with children are not enough.…”

“…Public health agencies such as the Robert Wood Johnson Foundation and the National Institutes for Health Disparities recognize the importance of engagement and inclusion in meeting the needs of children [ 10 , 11 ]. Cross-agency collaboration, local government policy and social inclusion are recognized as key community level factors determining public health outcomes [ 39 , 41 ]. Planners have an especially important role in promoting child health in both rural and urban settings [ 45 , 46 , 47 ].…”

“…Engagement matters. Community attitudes, vision, and opportunities for engagement are key to building more age-friendly communities to support public health [39]. Healthy cities for children create opportunities for participation and community inclusion [8,35,40].…”

COVID-19 Policy Differences across US States: Shutdowns, Reopening, and Mask Mandates

“…However, up to September 2020, 14 out of 50 states in the US still did not mandate mask wearing in public [ 31 ]. The lifting of shutdown orders and the rapid move to reopening disproportionally affected the minority population, as a higher percentage of minorities work in low-paid essential occupations [ 2 , 32 ], and minority communities have less access to health care and prevention, and a low quality of health care generally [ 33 , 34 ]. Due to inequities in the social determinants of health among minority groups, the infection rate among minorities is almost three times the infection rate of whites [ 35 ].…”

Which states and cities protect residents from water shutoffs in the COVID-19 pandemic?

“…In the city model, we control for community health, using the health category in the AARP livability index (2018). This is measured at the county level and has been used in other studies of public health ( Zhang et al, 2020 ). The health category is an index on a scale of 0–100, which captures prevention, access, and quality at the county level.…”