Improving Health and Health Care in Rural Communities: A Position Paper From the American College of Physicians.

Abstract

Rural communities throughout the United States experience disparities in health and access to health care. Low population densities, isolating terrain, and vast geographic distances to other population centers create barriers to attracting and retaining physicians and other health professionals. The characteristics of rural communities also pose barriers to facilitating robust economic activity conducive to the production of health and the presence of health care facilities. As such, rural communities have faced high levels of hospital closures and "diseases of despair," such as opioid misuse and suicide. The heterogeneity of rural geographies and population characteristics produces unique and differing challenges across communities that require tailored policy interventions. Interventions that are culturally appropriate for rural communities must be adopted that address diseases and health conditions that impact rural populations and the related social and economic conditions that create and perpetuate these diseases and health conditions. Policymakers must invest in the economies, social services, and infrastructure of rural communities, especially those programs that provide health coverage and services to them. Ensuring access to telehealth is a critical component of expanding health care access. Medical education institutions and the medical community at large have a responsibility to equip physicians and physicians-in-training to care for rural communities and provide opportunities for trainees to practice in rural settings. These institutions must be supported through public policy that incentivizes the recruitment and retainment of a qualified physician workforce in rural communities.