The Centers for Disease Control and Prevention reported in 2001 that significant disparities exist between urban and rural areas in regard to risk factors and health outcomes, with rural areas performing less well than urban areas. Some rural areas face additional environmental health challenges from such sources as agriculture-related pollution and unsafe mining and logging practices. Although wide variations in local public health structures exist across the country, problems of infrastructure development are especially pronounced in many rural areas, where access to human and material resources is hampered by low population and isolation. As a consequence, many local health departments in rural areas are called upon to do more to protect the health of the people they serve, relative to urban health departments, but with substantially fewer assets.
With funding from the Health Resources and Services Administration’s (HRSA) Office of Rural Health Policy, we studied the structure of local health departments in rural areas. We conducted site visits to six geographically disparate states (Arizona, Georgia, Kansas, Louisiana, Pennsylvania, and Washington) and 12 rural counties within the states to obtain qualitative information about the structure of local health departments in rural areas.