Research indicates that the United States lags behind other high-income countries in public health. This lag relates directly to variable health system quality across U.S. communities, which have different resource bases, different healthcare needs, and different institutional structures to support those needs. In contrast to urban sites, rural communities tend to have fewer available resources for public health, weaker political institutions, and different public health challenges. Understanding variation across urban and rural public health delivery systems is crucial to improving health.
This study examines local health systems in both urban and rural communities to better understand how and why differences across communities exist. Using a retrospective design based on a national sample of communities from the 2016 National Longitudinal Survey of Public Health Systems (NLSPHS), the researchers formed a three-tiered measure of public health system quality: comprehensive, conventional, and limited. Initial findings indicate thatdifferences between rural and urban systems persist even when accounting for variables known to drive system quality.