ASTHO Policy Watch: Health Equity and Rural Health

January 10, 2022|11:33 a.m.| ASTHO Staff

Girl and her mother with produce from an urban farmEach year, ASTHO notes the top public health policy issues to watch in the upcoming year. ASTHO has published a prospectus on several issues, with more coming later this month. ASTHO kicked off its top 10 public health state policy issues to watch in 2022 with Immunization the first week in January. This week, we are focusing on health equity and rural health.

Health Equity

Public health officials work to improve the health of all people, regardless of race, ethnicity, gender, sexual orientation, or social status. Discrimination based on a person’s physical characteristics of perceived social grouping is a psychosocial stressor linked to negative health outcomes such as high blood pressure and sleep disturbances. The COVID-19 pandemic magnified existing health inequities, with Black, Indigenous, and Latino communities disproportionately impacted.

To achieve optimal health for all, public health agencies are working with governmental and nongovernmental partners to dismantle structural racism and other forms of structural discrimination. This work, commonly referred to as health equity, include strategies such as investing additional resources in historically under-resourced or disinvested communities, addressing inequities in social determinants of health, and supporting community-led solutions.

Advancing health equity requires a multimodal approach, including legislative action. Recent actions by state legislatures include:

  • Declaring racism as a public health crisis.
  • Advancing efforts to improve collecting data on health disparities.
  • Implementing legislative processes to promote health equity.

Read the Health Equity Policy Prospectus.

Rural Health

According to CDC, rural Americans are more likely to die from heart disease, cancer, unintentional injury, chronic lower respiratory disease, and stroke than urban Americans. Characteristics of rural living contribute to some of these poor health outcomes, such as longer distances to travel to access emergency or specialty care, as well as higher rates of poverty and lower rates of health insurance. Difficulty accessing healthcare in rural areas is also a result of workforce shortages within rural care centers. Recent studies show a lower number of physicians (both in primary care and specialties) per 100,000 people in rural areas than in urban areas. The COVID-19 pandemic also forced hospitals to suspend elective procedures and reduce non-urgent services, which resulted in revenue loss and furloughed healthcare staff.

While there are a multitude of issues facing rural hospitals, states and territories have used policy to improve access to rural health services by:

  • Incentivizing providers to practice in rural areas through loan repayment.
  • Improving behavioral health services.
  • Expanding telehealth options.
  • Supporting broadband infrastructure.

Read the Rural Health Policy Prospectus.


Maggie Davis, JD, MA, is the director of state health policy at ASTHO
Beth Giambrone, MPP is a senior analyst of state health policy at ASTHO