I grew up in southern Michigan near a small town with only a thousand people. I lived in the “country.” That’s what we called anything outside of the one-square-mile town where I went to church and school. There was (and still is) one bank, one bar, a library, and a few ever-changing shops. Growing up there, everyone knew everyone. While this made for steady gossip, these close ties were invaluable in times of need. Neighbors often helped each other with snow or tree removal after storms, car or tractor repairs, and rides to the doctor’s office. I always felt safe. I spent a lot of time outside, ate food fresh from our garden, and was surrounded by caring adults. I thought this charming childhood was typical.
While adverse childhood experiences (ACEs) like abuse, neglect, and household dysfunction are unfortunately common across the country (as measured by an ACE score), children in rural areas are more likely to have at least one ACE. And according to the CDC, the five leading causes of death in the United States are higher in rural areas than in urban ones. Rural communities experience higher rates of isolation, poverty, unemployment, obesity, chronic disease and disability, pain and suffering, and lower life expectancies across all demographics. These challenges undoubtedly lead to stress on families and compound the long-term impacts of ACEs on children: risky health behaviors later in life, chronic health conditions, and early death. As the number of ACEs increase, so does the risk for these outcomes. ACE scores also tend to increase as household income decreases.
No matter where you live, these statistics should concern you. Perhaps it’s my rural upbringing, but I believe that we all do better when we ensure that everyone experiences health and well-being. When our neighbors are sick or struggling, we are struggling. Whether we live in the same neighborhood or not, we experience the effects of others’ well-being. Or lack thereof.
First, we need to acknowledge that community context is critically important in rural America, where opportunities for employment, education, active living, healthy and affordable food, and access to healthcare are different than for suburban and urban communities. County Health Rankings & Roadmaps shares potential strategies for rural areas, ranging from strengthening the local workforce to improving access to health care. And honoring a community’s context means that the strategies to improve health and well-being are selected by the residents who are most impacted by these challenges, and in alignment with their needs.
We also need to address the root causes of rural health disparities. At a recent Public–Private Collaborations for Rural Health Care meeting, Erika Ziller of the Maine Rural Health Research Center recommended that we support rural economic development and build community resilience. Similarly, the Centers for Disease Control (CDC) recommends a needs-based allocation of resources: “Although rural communities are at higher risk for death from the five leading causes of death, funding to address risk factors is allocated on a population basis, often resulting in underfunded rural programs.” An increased emphasis on need might help bridge the mortality gap.
Finally, funders and allies should support collaborative partnerships. Ziller aptly noted that rural communities are multi-sector collaborators by necessity. I’ve seen how rural residents wear many hats and play various roles to keep things working, but it’s hard to make sustained progress without resources. Ziller also noted that faith-based and service organizations can be strong allies with buy-in and training, and that health systems, like hospitals and primary care providers, are seen as leaders who can bring other stakeholders to the table.
I am grateful for the happy, healthy childhood I had in rural America. I wish every child in rural communities could have a similar experience. To make that possible, we all must see each other as neighbors and lend a hand.