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More efforts needed to better understand rural public health.

In August 2001, the National Center for Health Statistics at the Centers for Disease Control and Prevention (CDC) released the 25th annual statistical report on the nation’s health. A special focus of this report was an investigation of the nation’s health status relative to community urbanization level, making this the first effort to articulate rural health disparities in the United States. This is a significant publication as it brought a needed focus to rural health issues and concerns. The report’s findings demonstrated a number of disparities in health status between rural and nonrural citizens including the following: teenagers and adults in rural counties were the most likely to smoke; residents of rural communities had the fewest visits for dental care; death rates for working-age adults were the highest in the most rural and most urban areas; and rural areas had a high percentage of residents without health insurance, and residents of rural areas had the highest death rates for unintentional injuries, in general, and for motor-vehicle injuries specifically.1 Even before the CDC report, the Health Resources and Services Administration (HRSA) Office of Rural Health Policy and the National Advisory Committee on Rural Health were recognizing the need to address public health issues within rural communities and sought to learn more about the role of rural governmental public health systems in this regard. In 1999, the National Advisory Committee issued a report to the Secretary of the US Department of Health and Human Services assessing rural public health needs and decrying the lack of any data or analysis of the challenges faced by rural public health providers. That report led to a partnership between our office and the National Association of County and City Health Officials (NACCHO) to analyze existing survey data by geographic location. In many ways, the findings of the NACCHO survey were not that surprising. Rural health departments tended