The Double Disparity Facing Rural Local Health Departments

Jenine K. Harris, Kate Beatty, J. P. Leider, Alana Knudson, Britta L. Anderson, Michael Meit

Research output: Contribution to journalReview articlepeer-review

40 Scopus citations


Residents of rural jurisdictions face significant health challenges, including some of the highest rates of risky health behaviors and worst health outcomes of any group in the country. Rural communities are served by smaller local health departments (LHDs) that are more understaffed and underfunded than their suburban and urban peers. As a result of history and current need, rural LHDs are more likely than their urban peers to be providers of direct health services, leading to relatively lower levels of population-focused activities. This review examines the double disparity faced by rural LHDs and their constituents: pervasively poorer health behaviors and outcomes and a historical lack of investment by local, state, and federal public health entities.

Original languageEnglish (US)
Pages (from-to)167-184
Number of pages18
JournalAnnual Review of Public Health
StatePublished - Mar 18 2016
Externally publishedYes


  • Health services
  • Health systems
  • Poverty

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