Reimagining Rural: Shifting Paradigms About Health and Well-Being in the Rural United States

Abstract

Rural health disparities have attracted increased national attention, compelling an expanded focus on rural health research. In this manuscript, we deconstruct the definitions and narratives of “rural” communities and suggest that a paradigm shift is needed that centers the complexity and strength of rural places. We discuss the relevance of health equity frameworks, implementation science, and community-engaged approaches to promote rural well-being. Focusing on rural in its own right will lead to intervention innovations and reinvention with implications beyond rural areas. We conclude with suggestions for research and practice to inspire renewed interest in partnering with rural communities to promote health equity. Expected final online publication date for the Annual Review of Public Health, Volume 43 is April 2022. Please see http://www.annualreviews.org/page/journal/pubdates for revised estimates.

Facilitators of Multisector Collaboration for Delivering Cancer Control Interventions in Rural Communities: A Descriptive Qualitative Study

“…Partly as a result of long-standing underinvestment and systematic disinvestment, rural US counties experience an excess burden of risk factors for cancer and cancer mortality but have limited resources for addressing these issues ( 5 – 7 ). Poverty ( 7 ), physical inactivity ( 6 ), obesity ( 6 , 7 ), tobacco use ( 6 , 7 ), heavy alcohol use ( 6 ), and food insecurity ( 7 ) are higher in US nonmetro areas than in metro areas. Furthermore, rural residents often have poorer health care access and are less likely to use preventive services than urban residents ( 7 , 8 ).…”

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Inequities in Physical Activity Environments and Leisure-Time Physical Activity in Rural Communities

“…Although rural communities vary, they typically have lower levels of educational attainment, higher levels of poverty, less investment in infrastructure, and distance and/or terrain that decreases access to healthpromoting resources (4,5). Scholars have urged the consideration of rurality in intersectionality approaches that examine how overlapping social categories produce inequalities based on disadvantaged social position (6)(7)(8)(9). Knowledge about intersections of rurality, race, and socioeconomic status (SES) help to illuminate disparities in PA (1,2,10).…”

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