Abstract
Rural communities face more health inequities than urban areas. Social determinants of health are amplified by structural urbanism and contribute to barriers faced by rural communities, like limited transportation, long distances to the closest health organization, limited Internet access, low rates of health literacy, and workforce shortages.
Although these barriers impact all rural residents, communities of color and other marginalized communities experience higher rates of poverty and negative physical and mental health outcomes. Indigenous rural populations have faced historic injustice and report experiencing serious psychological distress 2.5 times more than the general population. Rural immigrant and migrant agricultural workers experience significantly high levels of stress, depression, and substance use. Among rural LGBTQ+ communities, barriers include culturally insensitive health practices, low provider knowledge of LGBTQ+ health issues, and sometimes anti-LGBTQ+ stigma.
Rural areas also face severe healthcare workforce shortages; approximately 65% of rural areas lack a psychiatrist, and primary care physicians often close the mental health and substance use treatment services gaps. Despite such challenges, several potential solutions exist to advance health equity in rural communities, especially through integrated healthcare strategies, telehealth, and other innovative models of care.
This is a preview of subscription content, log in via an institution to check access.
Access this chapter
Tax calculation will be finalised at checkout
Purchases are for personal use only
References
Allness. “NAMI National Program Standards for ACT Teams.” 31 October 2010. A Manual for ACT Start-up. www.nami.org/Template.cfm?Section=ACT-TA_Center.
APA. Getting Paid in the Collaborative Care Model. 20 November 2020. https://www.psychiatry.org/psychiatrists/practice/professional-interests/integrated-care/get-paid.
Arora, S, et al. “Expanding access to hepatitis C virus treatment-Extension for Community Healthcare Outcomes (ECHO) project: Disruptive innovation in specialty care.” Hepatology (2010): 1124–1133.
Bachhuber, M et al. “Primary Care: On the Front Lies of the Opioid Crisis.” 1 June 2017. University of Pennsylvania Lennard Davis Institute of Health Economics. http://Ldi.upenn.edu/brief/primary-care-front-lines-opioid-crisis.
Bailey, MN & Bosworth, BP. “Manufacturing Share of Real GDP Manufacturing Employment Share.” Journal of Economic Perspectives (2010): 3–26.
Bazzi, S et al. “Frontier Culture: The Roots and Persistence of “Rugged Indificualism” in the United States.” 2017.
Beck, A et al. “Estimating the Distribution of the U.S. Psychiatric Subspecialist Workforce Project Team.” 2018.
Bhaskar. “Telemedicine Across the Globe-Position Paper form the COVID-19 Pandemic Health System Resilience PROGRAM (REPROGRAM) International Consortium (Part 1).” 2020.
Bhaskar, et al. “Telemedicine as the New Outpatient Clinic Gone Digital: Position Paper from the Pandemic Health System Resilience Program (REPROGRAM) International Consortium (Part 2).” 2020.
Bohnam, et al. “Training Psychiatrists for Rural Practice: a 20-year Follow-Up.” Academic Psychiatry (2014): 623–626.
Brooklyn, JR et al. “Vermont Hub-and-Spoke Model of Care for Opioid Use Disorder: Development, Implementation, and Impact.” Journal of Addiction Medicine (2017): 11(4).
Bureau, US Census. America Counts: Stories Behind The Numbers. 9 April 2019. https://www.census.gov/library/stories/2019/04/health-insurance-rural-america.html#:~:text=Residents%20of%20rural%20counties%20still,percent%20for%20mostly%20urban%20counties.
Byers, A et al. “Low Use of Mental Health Services among Older Americans with Mood and Anxiety Disorders.” Psychiatric Services (2012): 66–72.
Carver, TN. Principles of Rural Economics. 1911.
Case A & Deaton, A. “Rising morbidity and mortality in midlife amonhg white non-Hispanic Americans in the 21st century.” Proceedings of the National Academy of Sciences of the United States of America. National Academy of Sciences, 2015. 15078–15083.
CCBHC. 14 November 2020. https://www.center4healthandsdc.org/the-ccbhc-program.html.
CCHS. Behavioral Medicine Fellowship in Family Medicine. 12 November 2020. https://fmr.ua.edu/fellowships/behavioral-health/.
CDC. “Alcohol and Public Health: Alcohol-Related Disease Impact (ARDI).” 2020a.
—. “Wide-ranging online data for epidemiological research (WONDER).” 2020b.
Census. American Community Survey. Washington DC: U. S. Department of Commerce, 2011–2015, 2016.
Chartis, The Chartis Center for Rural. 2020.
Cole, Megan, et al. “Medicaid Expansion and Community Health Centers: Care Quality and Service Use Increased for Rural Patients.” Health Affairs (2018): 900–907.
Cosby, AG et al. “Growth and persistence of place-based mortality in the United States: The rural mortality penalty.” American Journal of Public Health (2019): 155–162.
Cosby, AG. “Preliminary evidence for an emerging nonmetropolitan mortality penalty in the United States.” American Journal of Public Health (2008): 1470–1472.
Cromartie, J. “Rural America at a Glance, 2018 Edition.” November 2018. USDA Economic Research Service. https://www.ers.usda.gov/publications/pub-details/?pubid=90555.
Cunningham, RM. “The Major Causes of Death in Children and Adolescents in the United States.” New England Journal of Medicine (2018): 2468–2475.
DEA. “National Drug Threat Assessment.” 2019. www.dea.gov/documents/2020/01/30/2019-national-drug-threat-assessment.
Dillon, M and Henley, M. “Religion, Politics, and the Environment in Rural America.” 2008.
Economist, The. “America’s urban-rural partisan gap is widening.” 2020. The Economist Daily Chart. https://www.economist.com/graphic-detail/2020/11/10/americas-urban-rural-partisan-gap-is-widening.
FORHP. “Rural Behavioral Health.” 2017.
Glasner-Edwards, S & Mooney LJ. “Methamphetamine Psychosis: Epidemiology and Management.” CNS Drugs (2016): 1115–1126.
Grady, Brian. “Promises and limitations in telepsychiatry in rural mental health care.” World Psychiatry (2012): 199–201.
Gurewich, D, et al. “Managing care for patients with substance abuse disorders at community health centers.” Journal of Substance Abuse Treatment (2014): 277–31.
HAC. Rural Research Brief. August 2020. http://www.ruralhome.org/sct-information/publications/68-rural-rn.
Haley, Jennifer, et al. Adults’ Uninsurance Rates Increased By 2018 Especially in States that did not Expand Medicaid – Leaving Gaps in Coverage, Access and Affordability. 26 September 2018. https://www.healthaffairs.org/do/10.1377/hblog20180924.928969/full/
Han, Xinxin, et al. “Medicaid Expansion and Grant Funding Increases Helped Improve Community Health Center Capacity.” Health Affairs (2017): 49–56.
Hirsch, JK et al. “Suicide in rural areas: An updated review of the literature.” Journal of Rural Health (2014): 65–78.
Holmes, C, et al. “Project ECHO and Opioid Education: a Systematic Review.” Current Treatment Options in Psychiatry (2020): 9–22.
Joo, JY, et al. “Community-based case management effectiveness in populkations that abuse substances.” International Nursing Review (2015): 536–46.
Katzman, JG, et al. “Army and Navy ECHO PAin Telementoring Improves Clinician Opioid Prescribing for Military Patients: an Observational Cohort Study.” Journal of General Internal Medicine (2018): 387–395.
Letourneau, LM, et al. “Supporting Physicians and Practice Teams in Efforts to Address the Opioid Epidemic.” The Annals of Family Medicine (2019): Supplement 1.
Mangrum, M. Suicide rate nearly tripled in children ages 10–14 from 2007–2017. 27 October 2019.
MAP. Movement Advancement Project. April 2019. https://www.lgbtmap.org/rural-lgbt.
MAPAC. Medicaid and CHIP Payment and Access Commission . 12 November 2020. https://www.macpac.gov/subtopic/overview-of-the-affordable-care-act-and-medicaid/.
Mattson, J. “NDSU Upper Great Plains Transportation Institute.” 2015. Small Urban and Rural Center on Mobility. https://www.ugpti.org/surcom/resources/transitfactbook/.
McCarthy, JF et al. “Suicide Among Patients in the Veteran Affairs Health System: Rurl-Urban Differences in Rates, Risks, and Methods.” American Journal of Public Health Supplement (2012): 111–117.
Medicaid. Status of State Medicaid Expansion Decisions: Interactive Map. 2 November 2020. https://www.kff.org/medicaid/issue-brief/status-of-state-medicaid-expansion-decisions-interactive-map/.
Miller, CE & Vasan, RS. “The southern rural health and mortality penalty: A review of regional health inequities in the United States.” Social Science and Medicine (2020): 113443.
Moody, KC. “Prevalence of Dyslexia among Texas prison inmates.” Texas Medicine (2000): 69–75.
Musgrove, R. “National Advisory Committee on Rural Health and Human Services Understanding the Impact of Suicide in Rural America.” 2017.
Nelso, DE et al. “Alcohol-attributable cancer deaths and years of potential life lost in the United States.” American Journal of Public Health (2013): 641–648.
Nesbitt, Thomas. The Role of Telehealth in an Evolving Health Care Environment: Workshop Summary. Washington DC: National Academies Press, 2012.
Olson, Steve et al. “Achieving Rural Health Equity and Well-Being: Proceedings of a Workshop.” National Academies of Sciences, Engineering. National Academies Press, 2018.
Parker, Kim et al. “What Unites and Divides Urban, Suburban, and Rural Communities: Amid widening gaps in politics and demographics, Americans in urban, suburban, and rural areas share many aspects of community life.” 22 May 2018. Pew Research Center Social & Demographic Trends. https://www.pewsocialtrends.org/2018/05/22/what-unites-and-divides-urban-suburban-and-rural-communities/.
Pender, J. Rural America AT A Glance. 2019. https://www.ers.usda.gov/webdocs/publications/95341/eib-212.pdf?v=7864.9.
Project Horseshoe Farm. 27 November 2020. https://www.projecthsf.org/overview.
Pro, George et al. “The Role of State Medicaid Expansions in Integrating Comprehensive Mental Health Services into Opioid Treatment Programs: Differences Across the Rural/Urban Continuum.” Community Mental Health Journal (2020): Online accessed ahead of print.
Raney, Lori. Integrated Care: Working at the Interface of Primary Care and Behavioral Health. Washington DC: American Psychiatric Association Press, 2015.
Ratcliffe, M, et al. Defining Rural at the US Census Bureau: American community survey and geography brief. 1–8 December 2016. www.census.gov/geo/pdfs/reference/ua/Defining_Rural.pdf.
Ritchie, H. “Urbanization. Our World in Data.” 2018.
SAMHSA. 14 November 2020. https://www.center4healthandsdc.org/the-ccbhc-program.html.
SAMSHA. “National Survey on Drug Use and Health.” 2019.
Secretary, E. “National Advisory Committee on Rural Health and Human Services Exploring the Rural Context for Adverse Childhood Experiences (ACEs).” 2018.
Smalley, K et al. Rural Public Health: Best practices and Preventative Models. Springer Publishing Company, 2014.
Smith, ML et al. “The Utility of Rural and Underserved Designations in Geospatial Assessments of Distance Traveled to Healthcare Services: Implications for Public Health Research and Practice.” Journal of Environmental and Public Health (2013): 960157.
Spencer, M et al. “Rates of Alcohol-induced Deaths Among Adults Aged 25 and Over in Urban and Rural Areas: United States, 2000–2018: NCHS Data Brief.” 2020.
Thomas, KC et al. “County-level estimates of mental health professional shortage in the United States.” Psychiatric Services (2009): 1323–1328.
Tocqueville, A de. Democracy in America. Book II. G Dearborn and Co., 1838.
UC-Davis. Psychiatry and Behavioral Sciences. 20 November 2020. https://health.ucdavis.edu/cht/aboutus/legacy.html.
Uebelacker, LA et al. “Treatment of Depression in a Low-Income Primary Care Setting with Collocated Mental Health Care.” Family Systems Health (2009): 161–171.
Underwood, B. Ohio Department of Health says suicide is the leading cause of death in kids aged 10–14. 20 November 2019.
UNM. Center for Rural and Community Behavioral Health. 12 November 2020a. https://sociology.unm.edu/research/research-affiliates/profile/center-for-rural%2D%2Dcommunity-behavioral-health.html.
—. Project ECHO The University of New Mexico. 14 November 2020b. https://hsc.unm.edu/echo/.
USDA. “Rural Education at a Glance.” 2017.
—. United States Department of Agriculture Facts. 2018. November 2020. Ers.usda.gov.
Author information
Authors and Affiliations
Editor information
Editors and Affiliations
Rights and permissions
Copyright information
© 2022 The Author(s), under exclusive license to Springer Nature Switzerland AG
About this chapter
Cite this chapter
Rekerdres, C.M., Giggie, M.A. (2022). Rural Populations. In: Sowers, W.E., McQuistion, H.L., Ranz, J.M., Feldman, J.M., Runnels, P.S. (eds) Textbook of Community Psychiatry. Springer, Cham. https://doi.org/10.1007/978-3-031-10239-4_48
Download citation
DOI: https://doi.org/10.1007/978-3-031-10239-4_48
Published:
Publisher Name: Springer, Cham
Print ISBN: 978-3-031-10238-7
Online ISBN: 978-3-031-10239-4
eBook Packages: Behavioral Science and PsychologyBehavioral Science and Psychology (R0)