Population Considerations for Advancing Health Equity
Contextual factors — both current and historical — affect opportunities for rural community members to achieve their optimal health. To understand why some populations experience higher rates of chronic disease, illness, and preventable deaths, rural communities must understand how policies, systems, and power have affected access to health-promoting resources like wealth, education, and housing.
The Social Determinants of Health Toolkit describes population considerations to address the social determinants of health, which can advance health equity. The toolkit provides specific information for the following population groups:
- American Indian/Alaska Native Tribal Populations
- Racial and Ethnic Minority Populations
- Immigrant and Migrant Populations
- Populations with Limited English Proficiency
- Populations with Disabilities
- Older Adults
- Lesbian, Gay, Bisexual, Transgender, and Questioning/Queer (LGBTQ+) Populations
- People Experiencing Homelessness
In addition, many rural regions of the United States have experienced policies and social structures that contribute to health inequities on a larger scale.
Border Communities and Colonias
Rural communities along the United States-Mexico border face multiple barriers to achieving health equity. Some of these communities are known as colonias. Many individuals settled in colonias due to a lack of other affordable housing options, and most live in poverty. Colonias are characterized by substandard housing and lack of access to critical infrastructure like potable water and paved roads. Other infrastructure challenges include lack of access to utilities such as electricity and internet, which pose additional barriers to opportunities for education and employment. Most residents of colonias are of Hispanic/Latino descent. As colonias tend to be unincorporated communities, residents may have limited decision-making power over needed infrastructure changes.
Many American Indian and Alaska Native populations live in rural areas and/or near their tribal homelands. On tribal lands, health inequities are rooted in the intersection of rurality and historical discrimination and injustices that have been perpetrated against American Indian and Alaska Native communities. These injustices included violent colonization and forced relocation and cultural assimilation. Historical harms continue to contribute to historical trauma, with long-lasting effects on tribal communities, families, and relationships. Lack of investment in tribal lands has contributed to major infrastructure deficits that pose challenges to health and well-being, including poor road conditions, lack of access to safe drinking water, and limited access to broadband internet service.
In the rural South, the legacy of slavery and systematic racial segregation laws that followed, such as Jim Crow laws, continue to have a profound impact on health inequities among Black communities. These structural factors have segregated Black communities from opportunities to access education, build wealth, and lead healthy lives. Systematic exclusion combined with a lack of economic investment and other factors have resulted in high rates of poverty across multiple generations among Black communities in the rural South. Nearly half of Black people who live in poverty live in persistent poverty counties, or counties that have experienced poverty rates of 20% or greater for 30 years or more.
Counties in Appalachia also have high rates of persistent poverty and economic distress, which is rooted in several social, economic, and political factors. Many Appalachian communities are geographically isolated and have experienced limited investment in infrastructure, such as lack of highway infrastructure. Geographic isolation has contributed to limited opportunities for economic development and barriers to accessing healthcare. In rural Central Appalachia, declining demand for coal has also contributed to loss of employment in the coal industry. Heavy excavation and extraction of Appalachia's natural resources have also exposed residents to pollutants in the air, soil, and water.