A Portrait of Rural Health in America (2012)

Rural America is home to more than 59 million people (USBC 2012). Health and health care issues affect the lives of these many millions of people. While rural residents confront many of the same health issues and health care challenges that their urban counterparts experience, they are often considered a more vulnerable population due to their economic disadvantages, poorer health, and limited health care access. Congress in the Healthcare Research and Quality Act of 1999 (Public Law 106-129) specified rural residents as one of the Agency for Healthcare Research and Quality's (AHRQ) priority populations (U.S. Department of Health and Human Services 2012). To promote the health of rural residents and communities, the top ten rural-specific health priorities were identified in Rural Healthy People 2020 (Bolin and Bellamy 2012): access to quality health services; diabetes; mental health and mental disorders; nutrition and weight status; heart disease and stroke; substance abuse; physical activity and health; older adults; cancer; and maternal, infant, and child health.Rural America has experienced notable minority population growth that has important health policy implications (Johnson 2012). Coupled with the persistent economic disadvantages and structural barriers in the health care system, the recent economic recession places more challenges on rural residents to obtain needed health care. Moreover, the recent health care reform that enacted health coverage expansions is likely to have substantial impacts on residents, health care providers, and health care systems in rural communities.This special issue of the Journal of'Rural Social Sciences presents studies focusing on the current rural health and health care issues that reflect the impacts of demographic changes and some of the top public health priorities for Rural Healthy People 2020. These studies employ varied theoretical and methodological approaches to examine rural health issues at various levels (e.g., individual, neighborhood, and community). Before introducing each paper in this special issue, I provide some brief descriptions regarding American rural health focusing on the following five aspects: population characteristics, the current health issue, health insurance, health care access and services, and the potential changes in health care that may take place with the enacted coverage expansions under the Patient Protection and Affordable Care Act (ACA). The relevant statistics and information are drawn from various studies and recent reports on rural communities and rural health issues.POPULATION CHARACTERISTICSHealth and health care issues in rural areas are closely related to the population characteristics. Overall rural residents are often older and poorer than urban residents. More than 17 percent of rural residents are aged 65 or older, compared with 13 percent of the total U.S. population (U.S. Census Bureau 2011). Per capita income is much lower in rural than urban areas ($28,781 versus $40,570 annually), and the income disparity is even greater for rural minorities (United States Department of Agriculture 2007). Poverty rates, particularly the child poverty rate, have been disproportionately high in rural areas. According to Mattingly, Johnson, and Schaefer (2011), 81 percent of counties with persistent child poverty are designated as rural areas. This persistent child poverty is not limited to areas with a high proportion of minorities, but is also widespread in white-dominant areas such as Appalachia and the Ozarks. The rural economic disadvantages could be even worse due to the recent economic recession.Rural America has experienced notable demographic changes. According to Johnson (2012), rural areas have become more racially and ethnically diversified, while non-Hispanic whites are still a dominant group (about 79 percent) in those areas. Between 2000 and 2010, minorities contributed roughly 83 percent of rural population growth. …