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Introduction

To explore issues related to population health in rural America, the public virtual workshop Population Health in Rural America in 2020 was convened on June 24–25, 2020, by the Roundtable on Population Health Improvement of the Board on Population Health and Public Health Practice of the National Academies of Sciences, Engineering, and Medicine. The workshop was planned by a workshop planning committee composed of rural health experts representing public health, health care, and tribal health.¹ Rural America is economically, socially, culturally, geographically, and demographically diverse. This multidimensional diversity presents complex challenges and unique opportunities related to delivering health care and improving health outcomes in rural communities.

In her welcoming remarks, Sanne Magnan, Roundtable on Population Health Improvement co-chair and senior fellow from the HealthPartners Institute, explained that since 2013 the Roundtable on Population Health Improvement has provided a trusted venue for leaders from the public and private sectors to meet and discuss the leverage points and opportunities for achieving better population health. The roundtable’s vision is to help create a strong, healthy, and productive society that cultivates

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¹ The planning committee’s role was limited to planning the workshop, and the Proceedings of a Workshop was prepared by the workshop rapporteur as a factual summary of what occurred at the workshop. Statements, recommendations, and opinions expressed are those of individual presenters and participants, and are not necessarily endorsed or verified by the National Academies of Sciences, Engineering, and Medicine, and they should not be construed as reflecting any group consensus.

human capital and equal opportunity. This vision rests on the recognition that improved health outcomes are shaped by interdependent social, economic, environmental, genetic, behavioral, and health care factors and will require robust national and community-based policies and dependable resources to achieve that vision. The roundtable recognizes that rural health is part of the population health narrative and aims to explore and better understand rural health issues.

WORKSHOP OBJECTIVES

The workshop was structured to follow the institutionally approved Statement of Task (see Box 1-1). Divided into five sessions held over 2 days, the workshop featured invited presentations and discussion that focused on:

• rural America in context,
• rural health vital signs,
• rural health care in action,
• assessment and implementation strategies for improving the health of rural populations, and
• rural health policy.

The workshop began with setting the context and assessing current measures of rural health, and then the scope was expanded to discuss rural health care assessment, strategy, and implementation along with rural health policy. In accordance with the policies of the National Academies, the workshop did not attempt to establish any conclusions or develop recommendations about needs and future directions, focusing instead on issues identified by the speakers and workshop participants.

The proceedings of the presentations and discussions held at the workshop was prepared by a designated rapporteur in accordance with institutional guidelines.

ORGANIZATION OF THE PROCEEDINGS

The proceedings of this workshop is organized into six chapters. Chapter 2, Rural America in Context, provides an overview of rural demographics and a framework for discussing the infrastructure challenges in rural areas. Chapter 3, Rural Health Vital Signs, offers insights into public health in rural settings, including key measures of mortality and morbidity in rural areas, tribal public health activities, and rural health indicators. Chapter 4, Rural Health Care in Action, explores the landscape of rural health, the state of tribal health care in rural settings, the implications of wraparound services for rural America, and the role of community health workers in rural health. Chapter 5, Assessment and Implementation Strategies for Improving the Health of Rural Populations, examines assessment and implementation strategies for rural population health. Chapter 6, Rural Health Policy, presents the current state of rural health policy and explores the opportunities for improving rural health through policy. The speaker and planning committee members biosketches are in Appendix A, the workshop agenda is in Appendix B, and the references are in Appendix C.

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