Sosin and Carpenter-Song: Reimagining Rural Health Equity
In Reimagining Rural Health Equity: Understanding Disparities and Orienting Policy, Practice, and Research in Rural America, Anne N. Sosin and Elizabeth A. Carpenter-Song (both Anthropology, Dartmouth College) argue that advancing rural health equity after the pandemic requires both understanding the underlying problems that create rural health disparities and redesigning the policies and practices that encourage rural disadvantage.
The COVID-19 pandemic revealed stark disparities between rural and urban health care. During the pandemic, rural regions experienced higher rates of deaths than urban areas. Many blame this disparity on the public health system failing the US. The authors, however, contend that the US has failed public health.
Sosin and Carpenter-Song propose five principles to reimagine rural health equality. The first principle is that rural health equity is health equity. During the pandemic, many assumed that the lower population density and geographic isolation of rural communities would prevent the spread of COVID-19. This assumption ignored rural economic realities—for example, rural workers are more likely to be employed as essential workers and unable to work remotely.
The next three principles extend on the first: the second focuses on centering rural disadvantage; the third on considering rural disadvantage across one’s lifespan; and the fourth on expanding methods to address rural disadvantage. The article notes that rural disadvantage reflects how the interactions of historic, economic, environmental, social, and institutional arrangements negatively shape health dynamics in rural communities. Advancing rural health equity requires addressing rural disadvantage in analysis, policy, and practice. Mentioning rural communities is not enough; rather, active efforts must be made to improve rural health. Additionally, addressing rural communities only through the needs of older adults is insufficient.
The final, fifth principle is centering rural leadership and assets. The authors argue for applying diverse research methods to help identify rural strengths in public health. Rural leaders know their communities, and giving these leaders a voice in policy decisions can help improve public health. Sosin and Carpenter-Song recognize that rural public health is in a period of decline and argue that reversing this trend requires new policy, practice, and research. The authors hope this commentary will help give direction to future research in rural America.
