Health Policy

Health Equity in Midsize Rural Communities: Challenges and Opportunities in a Changing Rural America

Novak, N.L.; Baquero, B.; Askelson, N.M.; Diers, L.; Dunn, B.; Haines, H.; Afifi, R.; Parker, E.A.


Increasing premature mortality in the rural United States has brought new attention to rural health disparities. However, public health research on rural–urban disparities often overlooks the demographic, cultural, and economic heterogeneity of rural America.1 Addressing health inequities between urban and rural areas, as well as within rural areas, requires an approach that considers the heterogeneity of communities across the rural–urban continuum as well as the growing sociodemographic diversity within rural settings. Although discussions of rural areas often conjure images of open space and towns of a few thousand people, most rural residents (59%) live in “micropolitan” communities: nonmetropolitan areas with from 10 000 to 50 000 people. In the past two decades, micropolitan areas (which are distinguished from smaller, “noncore” areas) have experienced economic adversity and demographic changes that present unique challenges and opportunities for public health. We discuss recent changes in the economic conditions and demographic composition of micropolitan communities, evidence about health in micropolitan communities, and obstacles and opportunities for intervention to promote public health and health equity in micropolitan communities. We draw on our work in Iowa to illustrate potential strategies for using community strengths to implement evidenced-based public health interventions in micropolitan settings.