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Community Health Promotion in Rural Areas

February 14, 2023

A person gets vaccinated at a community health clinic.

Health disparities between rural and urban communities matter. Individuals in rural areas are not only less likely to have health insurance, they’re also more likely to face geographical and technological barriers to care. Consequently, community health promotion in these areas by public health officials — the promotion of health and wellness, disease prevention, and programs designed to help individuals make better and more informed health choices — is extremely important.

The U.S. Food & Drug Administration reports that residents of these communities are at a greater risk of dying from stroke, cancer, unintentional injuries such as drug overdoses or motor vehicle accidents, and chronic lower respiratory disease, among others. They’re also more likely to develop hypertension, arthritis, and diabetes than their urban counterparts.

Additionally, Rural Health Information Hub reports that improving rural residents’ awareness of community health promotion programs — such as those focused on maternity care, postnatal care, smoking cessation, exercise, and injury prevention, among others — and making community mental health programs more accessible can empower individuals to make better health and lifestyle choices. They can also help improve quality of life and reduce health disparities.

What Is Community Health?

The term community health has two separate but related definitions. Some agencies define community health as being the generalized health status of a distinct, defined group of people within a specific area, such as those living in a particular town or geographical region, for example.

Others define community health as the broad scope of programs and interventions that aim to reduce health disparities and prevent disease by addressing various determinants of health in a specific area.

These determinants of health may be compounding and interrelated. Examples include the following:

Behavioral determinants: Behavioral determinants of community health include alcohol and tobacco use, dietary choices, exercise and sleep habits, and other behaviors that impact individuals’ health. Lifestyle and behavioral choices impact the likelihood of developing various diseases, such as lung cancer and diabetes, among others.
Economic determinants: Economic determinants include employment, economic stability, income, access to health care and the likelihood that individuals in a given area have medical insurance. Communities with high numbers of uninsured individuals and/or individuals of lower socioeconomic status are more likely to have large populations who don’t seek regular outpatient care, such as annual physical examinations and dental cleanings.
Biological determinants: Community health biological determinants include genetic factors such as gender, age, ethnicity, body mass index (BMI), and overall physical fitness level. They also include a community’s genetic predisposition for certain diseases, such as cancer or cardiovascular disease, high blood pressure, and high cholesterol, among others. For example, whereas sickle cell disease is more common in people with ancestry in Sub-Saharan Africa, the Mediterranean, Saudi Arabia, India, and western hemisphere Spanish-speaking regions, Tay-Sachs disease is more commonly seen in individuals of French Canadian, Central and Eastern European, and Jewish ancestry.
Social determinants: Social determinants of community health impact quality of life, health, and overall well-being. Examples of social determinants include access to education, access to nutritious food, and access to safe housing and transportation, among others.
Environmental determinants: Environmental determinants include factors such as air quality, proximity to hazardous waste and toxic substances, and the quality of ground and surface water, among others. These determinants can profoundly impact the rates of cancer, cardiovascular disease, pulmonary disease, and premature death within a geographically defined area.

The Role of Community Health Workers in Community Health

Community health workers (CHWs) are frontline, nonmedical public health workers who have a deep understanding of the community or communities they work within. Although CHWs do not provide medical care, they do play a crucial role in connecting healthcare and social services workers with individuals in the communities they serve.

For example, CHWs help individuals navigate and understand health insurance systems, support individuals with chronic diseases, and assist people in establishing and building relationships with social, behavioral, and medical services teams.

They help connect community members with organizations that can help them procure food, water, and immunization services. They also provide information counseling on how certain lifestyle changes, such as quitting smoking or starting an exercise program, can help individuals live longer and healthier lives.

In other instances, CHWs may provide translation services and information about culturally appropriate health education topics to doctors and other healthcare workers. They may also help individuals track their progress toward meeting various health-related goals.

How Community Health Promotion Interacts with Determinants of Community Health

Although the promotion of community health programs — such as healthy eating, healthy lifestyle, and preventative care services, among others — doesn’t eliminate health disparities in rural communities, it does help individuals understand how to access programs and services designed to improve their personal health.

For example, people who lack transportation to grocery stores are less likely to have access to healthy foods and good nutrition, which raises their risk of developing health conditions such as diabetes and obesity. While programs promoting healthy food choices are good, combining them with transportation services or information about transportation services that can help individuals access food stores and farmer’s markets can improve the programs’ success rates.

Examples of Community Health Challenges in Rural Communities

The Centers for Disease Control and Prevention (CDC) estimates that 46 million Americans live in rural areas, and the community health challenges these areas face are significant. For example, the CDC reports that individuals living in rural areas are more likely to have higher rates of cigarette use and are less likely to have medical insurance. All of these factors can have a negative impact on health outcomes. Other community health challenges in rural communities include the following:

Lack of Proximity to Healthcare Practitioners and Preventative Care

Access to primary care practitioners, including pediatricians, family physicians, internists, or nonphysician providers such as nurse practitioners, is directly correlated with positive health outcomes, according to the National Academies of Sciences, Engineering, and Medicine.

The agency also notes that primary care services are crucial for preventative care, such as annual physicals and exams, early detection and treatment of diseases and illnesses, and the management of chronic diseases such as diabetes.

Whereas patients with access to primary care services are more likely to receive regular blood pressure, cholesterol, and cancer screenings, immunizations, and other preventative care services, individuals who face geographical barriers to care have an increased risk of poor health outcomes. Shortages of primary care providers in rural areas further restrict access to these and other types of preventative care and disease management services.

Rural residents are more likely to need to travel significant distances to access care, especially to see specialized doctors with training in areas such as cardiovascular health, pulmonary health, and oncology, among others.

Local Healthcare Workforce Shortages and Lack of Telehealth

As of September 2022, it’s estimated that more than 65 percent of Primary Care Health Professional Shortage Areas were located within rural communities. This can be especially challenging for older adults, who often require more care.

Additionally, Rural Health Info Hub reports that limited access to broadband services, coupled with regulatory barriers to insurance reimbursement for individuals seeking telehealth care, have hindered the adoption of telehealth services in some of these communities. In turn, this has increased workloads for many rural healthcare practitioners, which can lead to lessened flexibility in scheduling patient appointments, longer work shifts, and in some cases, higher levels of medical professional burnout.

Lack of Health Privacy and Social Stigma

Rural areas are usually made up of smaller social communities than urban areas, which means there is less personal anonymity. This may also mean a lack of privacy around health care and treatment, especially when residents have personal relationships with their healthcare providers. Because of this, rural residents may not seek out care in a variety of areas, including substance abuse, disease prevention, chronic diseases, sexual health, mental health, pregnancy, and more.

Patients may not want to disclose certain health-related issues to their providers, or they may worry that other members of their community may find out they are seeking treatment for a condition that isn’t openly discussed. Community health promotion can help combat this stigma, increase health literacy, and encourage open dialogue about health and health care.

Lower Rates of Health Insurance Coverage

The National Conference of State Legislatures reports that health insurance plans in rural areas, including plans sold on the Affordable Care Act and Patient Protection marketplaces, typically cost more than plans offered to urban residents, and fewer insurers offer plans in rural communities compared to urban areas.

This is underscored by reporting in a May 2022 article published on HealthPayerIntelligence.com, which found that rural premiums in California were 26 percent higher than urban benchmark premiums within that state. Similar patterns were seen in Arizona and Illinois, where the premium differentials were recorded at 32 percent and 58 percent, respectively.

Individuals in rural communities also have higher poverty rates. Consequently, even when healthcare staffing rates are adequate and access to healthcare services exists, the inability to pay for medical and dental services creates barriers to care.

Lower Rates of Health Literacy

An October 2020 research article published in the Journal of Patient Education and Counseling titled “Health Literacy in Rural and Urban Populations: A Systematic Review,” found that rural populations had lower health literacy than their rural counterparts.

Health literacy is defined by the CDC as the degree to which individuals have the ability to locate, understand, and use information when making health-related actions and decisions for themselves and others. Examples of health literacy include the ability to navigate the healthcare and healthcare insurance systems and understand medical consent forms, instructions from care providers, and instructions for the use of prescription drugs.

Studies have shown that patients’ health literacy correlates with their healthcare outcomes. For example, a 2022 research study published by BMC Health Services Research found that individuals with inadequate health literacy are less able to follow medical recommendations, less likely to attend follow-up appointments, less likely to understand prescription label instructions, and less likely to participate in their healthcare and medical decisions.

Persons lacking in health literacy are also less likely to engage in self-care behaviors, such as flossing, getting adequate sleep, nutrition, and exercise, and have higher mortality rates compared to health-literate populations.

How to Promote Health in the Community: Resources for Health Promotion

Opportunities for hospitals, community health organizations, and public health officials to promote health in rural communities are plentiful. The following are just a few of the most commonly used community resources for health promotion.

Nutrition Promotion Programs

Obesity rates in the United States are on the rise. For example, Trust for America’s Health reports that while 16 states had obesity rates of more than 35 percent in 2021, three additional states had joined that classification in 2022. According to the State of Obesity 2022: Better Policies for a Healthy America report, roughly 4 in 10 American adults are obese, and obesity rates in rural parts of the county are higher than rates seen in suburban and urban communities.

Factors that contribute to higher obesity rates in rural America include numerous social and economic factors, such as limited access to affordable and healthy foods and expansive access to inexpensive fast-food options.

Nutritional promotion programs designed to educate the public about food assistance programs, such as SNAP, WIC, and D-SNAP, and programs that teach people how to read and understand labels on processed foods, can help individuals learn to make better food choices.

Educational Programs About the Prevention of Sudden Infant Death Syndrome

The Mayo Clinic reports that there are several physical, environmental, and behavioral risk factors associated with Sudden Infant Death Syndrome (SIDS), such as recent respiratory infections; infants’ sleeping position; low birth weight; co-sleeping with parents, siblings, or pets; overheating; and exposure to secondhand smoke, among others. Maternal risk factors during pregnancy, such as inadequate prenatal care, cigarette and alcohol use, and being below the age of 20, also affect infants’ risk of SIDS.

Although there is currently no way to prevent SIDS, educational outreach programs for expectant and recent mothers can help mitigate these risk factors.

Exercise Promotion Programs

Obesity rates among rural adults and children are significantly higher than the obesity rates of individuals living in more densely populated areas, and a 2019 research paper published in the International Journal of Behavioral Nutrition and Physical Activity found that because of this, rural residents face increased risk of diseases related to inactivity. Rates of heart disease, high cholesterol, high blood pressure, and type-2 diabetes, among others, are all more prevalent within these areas.

Since numerous medical studies have shown that exercise can improve the outcomes of numerous chronic diseases, such as those listed above, public health outreach interventions that encourage physical activity may promote community health and improve outcomes.

Injury and Fatality Prevention Programs

Individuals residing in rural areas are less likely to use seat belts and are thus more likely to experience motor vehicle traffic fatalities than their urban counterparts, according to a 2019 study conducted by the U.S. Department of Transportation.

Additionally, 2021 data from the Children’s Safety Network indicates that injury rates among children and adolescents in rural communities are approximately 55 percent higher compared to children and adolescents in rural areas. The CSN also notes that the unintentional injury death rates within these age groups are nearly twice that of minors in urban areas, and the rates of unintentional drowning deaths are 49 percent higher.

Increasing access to educational programs about farm equipment safety, water and fire safety, and motor vehicle safety may reduce a variety of injuries, such as electrocutions, occupational injuries, and unintentional firearm injuries, among others.

Prenatal and Postnatal Care Programs

Studies have shown that there are geographical disparities in infant mortality rates among rural Americans. For example, a 2020 study published in the American Academy of Pediatrics Journal found that rural counties have the highest infant mortality rates in the country. The study further found that these rates are “best explained by mothers’ greater socioeconomic disadvantages,” such as lessened access to health care, as opposed to individual characteristics, such as food and lifestyle choices.

There are numerous opportunities to promote high quality prenatal and postnatal care services in rural communities. Examples include improving telemedicine platforms to help patients manage high-risk pregnancies; expanding educational opportunities for rural nurses to include urgent situations, such as neonatal resuscitation and cesarean procedure education programs; and expanding rural obstetrics and gynecology residency programs, among others.

Smoking Cessation Programs

Studies have also shown that there are wide-spanning disparities in both tobacco use and tobacco-related diseases, such as cancer, between rural and nonrural communities. The American Psychiatric Association reports that not only are rural individuals more likely to use tobacco, including cigarettes and smokeless tobacco, but they’re also more likely to be exposed to secondhand smoke.

A 2020 study conducted by CounterTobacco.org found that 27.3 percent of rural adults used tobacco products, compared to 17.7 percent in urban areas. The study also found that rural Americans were more likely to start smoking at an earlier age and more likely to smoke greater quantities of tobacco products than their urban counterparts.

Improving access to and promoting smoking cessation programs in rural communities may help reduce risk factors for a variety of conditions, such as chronic obstructive pulmonary disease (COPD) and cardiovascular diseases, and improve reproductive health outcomes.

Other Health Promotion Programs

Health promotion programs include local lectures, classes, courses, workshops, seminars and webinars that offer information on health topics. Community health promotion programs focus on specific populations and tailor their strategies to address health needs and risks associated with those audiences. This may involve a community needs assessment to discern what type of health support certain populations need.

Community health workers may work to support health education interventions. Some examples of health education models for rural communities include:

The Disabled Adults Oral Health Initiative. This Maryland-based program educates adults with disabilities on how to access oral health services. It also educates learners on topics related to oral health, such as tooth brushing, diet, dentist visits, and more.
One Community Health’s Wellness Program. This program, based in rural Oregon and Washington, provides bilingual health education that promotes health wellness through preventative screening, a healthy diet, education, and more.
The Tribal Home Based Kidney Care Project. Based in Laguna, New Mexico, this program provides screenings and health education to learners who either have or may develop kidney disease as a result of diabetes.

Become a Leader in Community Health Promotion

Professionals interested in helping address rural health disparities by promoting health programs in these communities are likely to find that completing an advanced education can help them further their professional goals. Coursework in an Online Master of Public Health degree program often covers topics such as determinants of health, fundamentals of public health, and evaluation of public health programs, among others.

The program prepares graduates to take an evidence-based approach to address the health needs of the populations they serve. Learn more about how an Online Master of Public Health degree, such as the one offered by Tulane University, can provide you with the skills to take an interdisciplinary approach to community health promotion.

Recommended Readings:

How to Become a Public Health Analyst

Guide to a Career in Public Health Research

Strategies for Community Health Advocate: Roles and Responsibilities

Sources

American Academy of Pediatrics Journal, “Infant Mortality In Rural and Nonrural Counties in the United States”

American Hospital Association Center for Health Innovation, Community Health & Well-Being

Azalea Health, 5 Ways to Promote Your Rural Healthcare Clinic

Centers for Disease Control and Prevention, About Rural Health

Centers for Disease Control and Prevention, Data & Statistics on Sickle Cell Disease

Centers for Disease Control and Prevention, Health Disparities

Centers for Disease Control and Prevention, What Is Health Literacy?