The 131st Annual Meeting (November 15-19, 2003) of APHA

Abstract #64167

Marion K. Slack, PhD, Pharmacy Practice and Science, College of Pharmacy, University of Arizona, P.O. Box 210207, The University of Arizona, Tucson, AZ 85721-0207, 520/626-1099, slack@pharmacy.arizona.edu

The theory of epidemic disease describing the relationship between geography and population size and density was used as a model to describe the characteristics of sparse populations and their relationship to the health status of rural residents. Four characteristics of sparse populations were identified: critical community size, relative isolation, limited range, and a proportional effect. Critical community size describes the size of a population required for an infectious disease to become endemic or for a service to remain economically viable. Below the critical community size, fixed costs per client served are higher and economies of scale are not available. Hence subsidization is required for economic viability and lower wages for providers are a typical subsidization strategy. The second characteristic is relative isolation; that is, rural residents lack easy geographic access to services. Third, sparse populations are characterized by a limited range of goods and services which results in homogeneity within a community but diversity between communities. Fourth is the proportional effect in which small changes have a large effect on the community. Before the twentieth century, small populations and relative isolation protected residents from infectious disease so that rural residents were healthier than urban residents. Improvements in sanitation, treatment of water supplies, and treatment of infections have erased the advantage and created a disadvantage for rural residents who are less likely to have access to public services. Sparse populations also result in higher costs for services so that rural residents are less likely to have access to fluoridated water, timely high quality trauma care, and education. Rural residents are more likely to be employed in the high risk occupations of farming, logging, and mining. Sparse populations also result in underemployment and increased poverty; factors associated with lower health status. Finally geographic isolation may contribute to increased levels of suicide mortality for rural men. However factors such as absolute distance, economic factors, and miscellaneous factors, for example, the availability of public health services, influence the impact of sparse populations on health status so that effects are evident in some communities and absent in others. Conclusions from the above analysis indicate that rural residents in the United States no longer have a health advantage over urban residents and that they are at risk for conditions dependent on access to services or related to occupation or residence in sparsely populated areas.

Learning Objectives:

• Identify four charactersitics of sparse populations.
• Recognize the relationship between at least two characteristics of sparse populations and the health status of rural residents.
• Identify two factors that moderate the impact of a sparse population on the health status of a rural community.

Keywords: Research, Rural Health

Presenting author's disclosure statement:
I do not have any significant financial interest/arrangement or affiliation with any organization/institution whose products or services are being discussed in this session.