“Despite the challenges rural America may face to addressing and improving health, it is possible through Public Health 3.0 and the collective impact of local, committed people.”
There are a wealth of activities happening across rural American working to address and improve health outcomes, including community gardens to increase access to healthy foods, economic development to invest in healthy community design, and utilization of local wellness coalitions to take action to address local health. However, increasing globalization and the growing impact of social, economic, and environmental factors on global health, calls for expansion of the scope and reach of population health approaches to improve health outcomes across rural America.
National Public Health Week 2019, an initiative of the American Public Health Association, calls for a focus on rural health to highlight the health disparities rural communities face and opportunities to address them for science, for action, and for health.
Rural-urban disparities in life expectancy and death continue to rise, with rural life expectancy at 76.8 year of age compared to urban life expectancy at 78.8 years of age.[1] With chronic disease as the leading cause of death and illness in the United States, rural communities are left disproportionately affected, with four of the five leading causes of death associated with chronic disease.[2] Rural American is also increasingly impacted by the opioid epidemic. Many of these poor health outcomes are heightened by social, economic, and environmental factors that impact health outcomes, including poverty, access to health care and/or healthy foods, or community infrastructure.[3]
Public Health 3.0 emboldens communities to serve as leaders in charge of expanding approaches to improve population health, including generate collective impact through engagement of multi-sector partners and to improve the social determinants of health (SDOH). Public Health 3.0 builds on Public Health 1.0 and 2.0, focused on the growth of the knowledge and tools for medicine and public health, addressing access to care and public health, as well as building government agency capacity.[4] Where health care was once considered the primary approach to addressing health, death and illness; collaboration is key to collectively address SDOH that affect where people live, work, learn, and play.
Collective Impact is a collaborative approach that helps reduce isolated population health efforts and convenes people to achieve social change.[5] Collective impact centers on a common agenda, shared measurement, mutually reinforcing activities, ongoing communication, and backbone support.6 Considering the lack of resources that rural communities are often challenged by, implementation of collective impact to address SDOH could provide challenging. However, rural communities can effectively adopt Public Health 3.0 approaches and collective impact by capitalizing on the strength of rural communities and leverage existing relationships to work collectively to influence local policy, get creative on how to address SDOH using limited resources, utilize available technology to connect and communicate with partners and arguably one of most important recommendations and often undervalued, is to know what resources are available in your community.[6]
Opportunities to develop the rural public health landscape through Public Health 3.0 will require enhanced leadership to affect SDOH beyond governmental agencies or health systems, including community champions; broadening of strategic partnerships across multiple sectors; utilization of technology and data that matter, using locally relevant data as well as sharing that data; sustainable and flexible funding, including local investment in health important to support rural communities; and above all realize the vision for improving the health of rural communities will require a breadth of thought leaders to collectively address and improve the health of communities.4
Despite the challenges rural America may face to addressing and improving health, it is possible through Public Health 3.0 and the collective impact of local, committed people. Learn more and join the discussion at #ThisisRuralHealthSD to highlight the work happening where you, live, work, learn, and play.
[1] Singh, G.K., Siahpush, M. 2014. Widening Rural-Urban Disparities in Life Expectancy, U.S., 1969-2009. American Journal of Preventive Medicine, 46(2), 19-29. Retrieved from DOI: 10.1016/j.amepre.2013.10.017.
[2] Moy E, Garcia MC, Bastian B, et al. Leading Causes of Death in Nonmetropolitan and Metropolitan Areas — United States, 1999–2014. MMWR Surveill Summ 2017;66(No. SS-1):1–8. DOI:http://dx.doi.org/10.15585/mmwr.ss6601a1.
[3] Health Resources and Services Administration. (2019, January 23). Social determinants of health for rural people. In Rural Health Information Hub. Retrieved from https://www.ruralhealthinfo.org/topics/social-determinants-of-health
[4] DeSavlo, Wang, Harris, Auerbach, Koo, & O’Carroll. (2017, September). Public health 3.0: a call to action for public health to meet the challenges of the 21st century. Preventing Chronic Disease, 14(E78), 1-9. DOI: https://doi.org/10.5888/pcd14.170017
[5] Collective Impact Forum. (2014). Retrieved from https://www.collectiveimpactforum.org/
[6] Iyer, L. (2015, November 2). How do rural communities in the U.S. implement collective impact? In FSG. Retrieved from https://www.fsg.org/blog/how-do-rural-communities-us-implement-collective-impact