Some communities are geographically dispersed—that
is, not clustered together in a particular neighborhood but, instead, spread
across neighborhoods or regions. Such communities, which include rural
populations and urban Indians, are the focus of the studies described in
this section.
When comparing rural and urban areas, researchers find that
rural populations are at increased risk for many health conditions, but
at lesser risk for
others. Access to services in distant rural areas is one critical challenge.
Measurement challenges for rural areas include averaging health outcomes
across many rural communities and masking important differences as a
result, and inaccurate definitions of rural communities.
The authors of the studies of rural communities described in this section
make various recommendations to improve the health of rural residents,
among them improving health insurance coverage, the distribution of
health services, rural economic development policies, and regulation of
pesticide
use, and instituting or expanding community health worker and mobile
health programs, e-health, telemedicine, and job training programs.
Urban American Indians also face many health challenges. They are often
dispersed throughout cities and do not live in neighborhoods with
other American Indians, do not have access to care through the Indian Health
Service, and face high rates of poverty and other health risk factors.
Studies have shown that urban Indians have a higher prevalence of
low
birthweight and neonatal mortality as well as lower rates of use
of early prenatal
care, than do American Indians in rural areas. Urban Indians are
plagued by high rates of tuberculosis, alcoholism, diabetes, and other
diseases
and health conditions.
The authors of these studies recommend that policymakers should target
more resources to improving the health of this population. Few
studies have investigated community factors that affect urban Indian health
beyond health service access.
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