The southern rural health and mortality penalty: A review of regional health inequities in the United States

• Published in: Social science & medicine (1982) Vol. 268; p. 113443
• Main Authors: Miller, Charlotte E., Vasan, Ramachandran S.
• Format: Journal Article
• Language: English
• Published: England Elsevier Ltd 01.01.2021; Pergamon Press Inc
• Subjects: Health behavior; Health disparities; Health research; Health risks; Health status; Humans; Individual differences; Inequality; Macrosocial determinants of health; Morbidity; Mortality; Mortality rates; Race; Race-specific mortality; Regional differences; Regional health disparities; Rural; Rural areas; Rural communities; Rural Health; Rural mortality penalty; Rural Population; Rural urban differences; U.S. south; United States - epidemiology; Urban areas; Urban Population; Wealth; White People; United States; United States > US; Rural; U.S. south; Rural health; Macrosocial determinants of health; Regional health disparities; Rural mortality penalty; Race-specific mortality
• ISSN: 0277-9536; 1873-5347; 1873-5347
• DOI: 10.1016/j.socscimed.2020.113443

Rural-urban differences in morbidity and mortality across the United States have been well documented and termed the “rural mortality penalty”. However, research studies frequently treat rural areas as homogeneous and often do not account for geospatial variability in rural health risks by both county, state, region, race, and sex within the United States. Additionally, people living in the rural South of the US have higher rates of morbidity and mortality compared to both their urban counterparts and other rural areas. Of those living in southern rural communities, people of color experience higher rates of death and disease compared to white populations. Although there is a wealth of research that uses individual-level behaviors to explain rural-urban health disparities, there is less focus on how community and structural factors influence these differences. This review focuses on the “southern rural health penalty”, a term coined by the authors, which refers to the high rate of mortality and morbidity in southern rural areas in the USA compared to both urban areas and non-southern rural places. We use macrosocial determinants of health to explain possible reasons for the “southern rural health penalty”. This review can guide future research on rural health between southern and non-southern populations in the US and examine if macrosocial determinants of health can explain health disparities within southern rural populations. •Rural health disparities are worse in the rural south compared to other rural areas.•Southern rural health inequities may be explained by macrosocial determinants of health.•In the rural south, non-white populations often have worse health than whites.•History of the transition of the urban-rural mortality penalty in the US.•Rural mortality rates are worse in the rural south compared to other rural areas.