Health outcomes in rural America: A prevention-to-crisis view on determinants of health, chronic diseases, and economic consequences
Health Access & Equity Health Care Industry Health Care Policy Public Health
健康获取与公平 医疗保健行业 医疗保健政策 公共卫生
This research summary draws on insights generated by America’s Rural Future: Brookings-AEI Commission on U.S. Rural Prosperity .
本研究摘要借鉴了美国农村的未来：布鲁金斯-AEI 美国农村繁荣委员会的见解。
Rural health outcomes reflect a complex continuum of conditions influenced by upstream social determinants, extending through chronic burdens, and ultimately affecting community vitality, workforce, and local economies.
农村健康结果反映了一系列复杂的条件，这些条件受到上游社会决定因素的影响，通过长期负担延伸，并最终影响社区活力、劳动力和当地经济。
Life expectancy in rural areas is lower than in other parts of the U.S., a gap that has widened over the past two decades amid rising health care costs, increasingly uneven access to care, and constraints on system capacity.
农村地区的预期寿命低于美国其他地区，在过去二十年中，由于医疗保健成本不断上升、获得医疗服务的机会日益不均以及系统能力受到限制，这一差距不断扩大。
Many rural communities bear disproportionate burdens of chronic disease, substance use disorders, and mental health challenges, while provider shortages, hospital closures, and weakened health and social infrastructure add to the challenges of preventing, treating, managing, and reversing these conditions.
许多农村社区承受着不成比例的慢性病、药物滥用障碍和心理健康挑战的负担，而提供者短缺、医院关闭以及卫生和社会基础设施薄弱增加了预防、治疗、管理和扭转这些状况的挑战。
This symposium was the second on health-related issues convened by the Brookings-AEI Commission on U.S. Rural Prosperity .
本次研讨会是布鲁金斯-AEI美国农村繁荣委员会召开的第二次健康相关问题研讨会。
While the first examined the pressures on the rural health care system, its workforce and financing, this discussion focused on health outcomes and the broader implications for rural residents, workers, families, employers, and communities.
第一个讨论探讨了农村医疗保健系统、劳动力和融资面临的压力，而这次讨论的重点是健康结果以及对农村居民、工人、家庭、雇主和社区的更广泛影响。
The symposium examined rural health through a prevention-to-crisis framework, moving from the social and behavioral determinants that shape long-term well-being, through the chronic disease pathways that affect rural morbidity, to the economic and community consequences that emerge when the health of rural populations declines.
研讨会通过预防危机框架审查了农村健康，从影响长期福祉的社会和行为决定因素，到影响农村发病率的慢性病途径，再到农村人口健康状况下降时出现的经济和社区后果。
The first panel examined how rural health is influenced by the social determinants of health as well as isolation, loneliness, and social infrastructure: the formal and informal places outside of home and work where people gather, interact, build relationships, and maintain civic and community life.
第一个小组研究了农村健康如何受到健康的社会决定因素以及隔离、孤独和社会基础设施的影响：家庭和工作之外的正式和非正式场所，人们聚集、互动、建立关系以及维持公民和社区生活的地方。
Panelists emphasized that rural health disparities are not explained by access to clinical care alone.
小组成员强调，农村健康差异不能仅用获得临床护理的机会来解释。
Housing quality, transportation, food insecurity, poverty, educational attainment, employment benefits, and social infrastructure all shape health outcomes.
住房质量、交通、粮食不安全、贫困、教育程度、就业福利和社会基础设施都会影响健康结果。
While the meaningful use of these spaces—not simply their presence—was framed as an important but difficult-to-measure contributor to mental health, civic connection, trust, and preventive well-being, transportation emerged as one of the clearest examples of how rural barriers differ in both scale and kind from urban challenges.
虽然这些空间的有意义的使用——不仅仅是它们的存在——被认为是对心理健康、公民联系、信任和预防性福祉的重要但难以衡量的贡献者，但交通成为农村障碍在规模和种类上与城市挑战有何不同的最明显例子之一。
The second panel focused on chronic disease in rural areas, including obesity, diabetes, cardiovascular disease, substance use disorders, tobacco-related illness, and infectious diseases that can accompany addiction.
第二个小组重点关注农村地区的慢性病，包括肥胖、糖尿病、心血管疾病、物质使用障碍、与烟草相关的疾病以及可能伴随成瘾的传染病。
The discussion added nuance to what is often a narrow focus on deaths of despair, emphasizing that rural mortality burdens are broader, more uneven, and more geographically varied than any single explanation can capture.
这次讨论为通常狭隘地关注绝望死亡的问题增添了细微差别，强调农村死亡负担比任何单一解释所能描述的更广泛、更不平衡、在地理上也更加多样化。
Participants also underscored that successful interventions depend heavily on trust, local networks, and acceptable entry points: services do not improve outcomes simply because they exist, but because residents can reach them, have trust in them, and see them as responsive to their needs.
与会者还强调，成功的干预措施在很大程度上取决于信任、当地网络和可接受的切入点：服务并不仅仅因为它们的存在而改善结果，而是因为居民可以接触到它们，信任它们，并认为它们能够满足他们的需求。
A third session widened the lens, examining how declining rural health outcomes affect workforce development, community stability, and long-term economic vitality.
第三次会议扩大了视角，研究了农村健康状况下降如何影响劳动力发展、社区稳定和长期经济活力。
Poor health is not just an individual or clinical concern, but an issue with overlapping labor market, community, and economic consequences.
健康状况不佳不仅仅是个人或临床问题，而且是一个与劳动力市场、社区和经济后果重叠的问题。
It can constrain workforce participation, reduce productivity, and burden employer recruitment.
它会限制劳动力参与、降低生产率并给雇主招聘带来负担。
At the community level, it strains household stability and social support systems.
在社区层面，它给家庭稳定和社会支持系统带来压力。
Economically, it weakens local tax bases, reduces fiscal capacity, and eventually slows broader local development.
在经济上，它削弱了地方税基，降低了财政能力，并最终减缓了更广泛的地方发展。
Participants’ discussions on aging and associated caregiver responsibilities; farmer mental health; and workforce development models—which integrate employment, behavioral health, recovery, transportation, and civic support—illustrated how these effects intersect in rural communities.
参与者关于老龄化和相关护理人员责任的讨论；农民心理健康；劳动力发展模型——整合了就业、行为健康、康复、交通和公民支持——说明了这些影响如何在农村社区相互交叉。
These examples suggested that health policy and economic development are interdependent, especially where formal health systems and social infrastructure are less accessible or have become more limited.
这些例子表明，卫生政策和经济发展是相互依存的，特别是在正规卫生系统和社会基础设施不易获得或变得更加有限的情况下。
Across the symposium, participants returned to a central theme: Rural health outcomes are both a cause and a consequence of economic disadvantage.
在整个研讨会上，与会者回到了一个中心主题：农村健康结果既是经济劣势的原因，也是经济劣势的结果。
Poor health, chronic disease, social isolation, and limited care access can weaken workforce participation and local economies; in turn, weaker local economies can reduce tax revenue, erode institutions, accelerate outmigration, and leave communities with fewer tools to improve health.
健康状况不佳、慢性病、社会孤立和有限的医疗服务可能会削弱劳动力参与度和当地经济；反过来，地方经济疲软可能会减少税收、削弱机构、加速人口外流，并使社区改善健康的工具减少。
This cycle, however, does not play out uniformly across rural America: Participants cautioned against treating rural America as a monolith.
然而，这个循环在美国农村地区的表现并不统一：参与者警告不要将美国农村地区视为一个整体。
Health disparities vary significantly within rural America by region, race, age, occupation, local economy, and institutional capacity—both in health and governance systems.
美国农村地区的健康差距因地区、种族、年龄、职业、当地经济和卫生和治理系统的机构能力而存在显着差异。
Understanding rural health outcomes therefore requires attention both to the structural constraints of distance and scale and to the unique place-based policy, institutional, and community conditions that may be changed over time.
因此，了解农村健康结果需要关注距离和规模的结构性限制，以及可能随时间变化的独特的地方政策、机构和社区条件。
Deepening that understanding also surfaces opportunities for improvement and innovation, especially via community-led and holistic interventions.
加深这种理解也带来了改进和创新的机会，特别是通过社区主导的整体干预措施。
Participants highlighted the following as foundational elements for evaluating and improving rural health care outcomes:
与会者强调以下是评估和改善农村医疗保健成果的基本要素：
Symposium participants reached broad agreement on the insights above, but several tensions remain unresolved.
研讨会参与者就上述见解达成了广泛共识，但仍有一些紧张局势尚未解决。
Issue.
问题。
A recurring tension was whether rural transportation barriers are unavoidable features of distance, density, and scale, or whether they are created, reinforced, or exacerbated by policy and program designs with a structural urban bias.
一个反复出现的紧张局势是，农村交通障碍是否是距离、密度和规模不可避免的特征，或者它们是否是由具有结构性城市偏见的政策和项目设计造成、强化或加剧的。
Distance, density, and scale create real constraints, but policy and programs that take urban conditions as their starting point can result in designs that exacerbate those constraints or even create new barriers, making limitations mutually reinforcing rather than strictly one-directional.
距离、密度和规模造成了真正的限制，但以城市条件为出发点的政策和计划可能会导致设计加剧这些限制，甚至产生新的障碍，使限制相互加强，而不是严格单向的。
Transportation was the clearest example: Rural residents rely more heavily on private vehicles, have less access to comprehensive public transportation, and face road, bridge, weather, and distance barriers that make access difficult even when the services they need technically exist.
交通是最明显的例子：农村居民更加依赖私家车，获得综合公共交通的机会较少，并且面临道路、桥梁、天气和距离的障碍，即使技术上存在他们所需的服务，也使他们的出行变得困难。
The unresolved question is whether rural transportation can be “solved,” or whether policy should instead prioritize linked-service models that reduce the need for repeated long-distance travel.
尚未解决的问题是，农村交通能否得到“解决”，或者政策是否应该优先考虑减少重复长途旅行需求的联动服务模式。
Research needed.
需要研究。
Which infrastructure and transportation barriers are inherent to rural distance, density, and scale, and which are reinforced or made more difficult to address by policy and program design?
哪些基础设施和交通障碍是农村距离、密度和规模所固有的，哪些通过政策和计划设计得到加强或变得更加难以解决？
Which models reduce travel burdens most effectively—transportation services, mobile delivery, community health workers, school-based care, telehealth, pharmacy access, or multipurpose service hubs?
哪些模式最有效地减轻旅行负担——交通服务、移动交付、社区卫生工作者、学校护理、远程医疗、药房服务还是多功能服务中心？
How do these answers vary across different kinds of rural communities and geographies?
这些答案在不同类型的农村社区和地区之间有何不同？
2.
2.
Poor rural versus poor urban communities, and variation within rural America
贫困农村社区与贫困城市社区以及美国农村地区的差异
Issue.
问题。
A key assumption tested in the first panel was whether social determinants of health have a greater effect in rural places, or whether they operate differently because rural communities have different infrastructure, labor markets, housing conditions, transportation systems, and social networks.
第一个小组测试的一个关键假设是健康的社会决定因素是否在农村地区产生更大的影响，或者它们的运作方式是否因为农村社区有不同的基础设施、劳动力市场、住房条件、交通系统和社交网络而有所不同。
The discussion suggested that poverty matters in both rural and urban settings, but the pathways through which poverty shapes health may differ.
讨论表明，贫困对农村和城市都很重要，但贫困影响健康的途径可能不同。
It also reinforced that rural America itself is highly varied by region, race, ethnicity, age, occupation, local economy, and state policy context.
它还强调了美国农村本身因地区、种族、民族、年龄、职业、当地经济和国家政策背景而存在很大差异。
Research needed.
需要研究。
How do social determinants of health operate differently by type of geography, and how does that inform the variation that exists within rural America by region, race, ethnicity, age, occupation, local economy, and state policy?
健康的社会决定因素如何因地理类型的不同而产生不同的作用？这如何影响美国农村地区、种族、民族、年龄、职业、地方经济和国家政策方面存在的差异？
How do we determine what makes a rural community “wealthy,” or well-resourced?
我们如何确定是什么让农村社区“富裕”或资源充足？
Which rural-specific assets contribute the most to improved health outcomes, and how should these findings change program design, targeting, eligibility, delivery models, and evaluation?
哪些农村特有资产对改善健康结果贡献最大，这些发现应如何改变计划设计、目标、资格、实施模式和评估？
Issue.
问题。
There was broad agreement that social infrastructure matters, but less clarity on what should count as social infrastructure in rural places.
人们普遍认为社会基础设施很重要，但对于农村地区的社会基础设施应算作什么还不太明确。
“ Third places ” such as libraries, parks, coffee shops, religious organizations, grocery stores, and community centers are part of the picture, but informal spaces such as homes, porches, schools, faith networks, and multipurpose gathering places may play similar roles.
图书馆、公园、咖啡店、宗教组织、杂货店和社区中心等“第三场所”是其中的一部分，但家庭、门廊、学校、信仰网络和多功能聚会场所等非正式空间也可能发挥类似的作用。
The deeper tension is that availability alone may not matter unless people meaningfully use those spaces for interaction, trust-building, and support.
更深层次的紧张是，除非人们有意义地利用这些空间进行互动、建立信任和支持，否则仅可用性可能并不重要。
Research needed.
需要研究。
What is the full picture of social infrastructure in rural America?
美国农村社会基础设施的全貌是怎样的？
How can researchers measure not only availability but also meaningful use?
研究人员如何不仅衡量可用性，而且衡量有意义的使用？
What facilitates or prevents the use of third places in rural communities?
是什么促进或阻碍了农村社区第三场所的使用？
What evidence is needed to link investments in third places, informal gathering places, and multipurpose community spaces to public health outcomes including loneliness, mental health, preventive care, chronic disease management, and civic participation?
需要什么证据才能将第三地、非正式聚会场所和多功能社区空间的投资与公共卫生成果（包括孤独感、心理健康、预防保健、慢性病管理和公民参与）联系起来？
Issue.
问题。
Technology was discussed as a possible way to reduce rural distance barriers, including drone delivery, telehealth, and remote treatment models.
人们讨论了技术作为减少农村距离障碍的一种可能方法，包括无人机送货、远程医疗和远程治疗模式。
But the discussion repeatedly qualified that technology does not succeed on its own.
但讨论一再强调技术本身不会成功。
In several examples, technology appeared most promising when it acted as an extension of trusted local relationships, rather than replacing them.
在几个例子中，当技术充当可信本地关系的延伸而不是取代它们时，它似乎最有前途。
Research needed.
需要研究。
When and how can technology reduce rural health barriers?
技术何时以及如何减少农村健康障碍？
What conditions are necessary for it to succeed rather than fail, particularly related to local trust, human relationships, broadband access, pharmacy access, and community-based implementation capacity?
它要成功而不是失败需要哪些条件，特别是与当地信任、人际关系、宽带接入、药房接入和基于社区的实施能力有关？
Which services can be meaningfully and effectively delivered through technology, and which require in-person or peer-supported models?
哪些服务可以通过技术有意义且有效地提供，哪些服务需要面对面或同行支持的模型？
Issue.
问题。
Low uptake of rural health interventions can be interpreted in several ways: low demand, poor design, lack of trust, stigma, transportation barriers, cost, limited anonymity, or the wrong entry point.
农村卫生干预措施采用率低的原因有多种：需求低、设计不良、缺乏信任、耻辱、交通障碍、成本、匿名性有限或切入点错误。
There is also the challenge of who in the community knows about the intervention, how active a role they play in promoting it, and to whom.
还有一个挑战是，社区中谁了解干预措施，他们在促进干预措施方面发挥了多大的积极作用，以及了解的对象是谁。
The discussion complicated the assumption that making a service available is enough.
讨论使“提供服务就足够了”这一假设变得更加复杂。
Examples from addiction treatment, hepatitis C treatment, GLP-1 medications, telehealth, and peer recovery support suggested that uptake often depends on whether an intervention begins from a need residents already recognize, whether the messenger is trusted, and whether the service is socially and financially accessible.
成瘾治疗、丙型肝炎治疗、GLP-1 药物、远程医疗和同伴康复支持的例子表明，干预措施的采用通常取决于干预措施是否从居民已经认识到的需求开始，信息传递者是否值得信任，以及该服务是否在社会和经济上可以获取。
Research needed.
需要研究。
How should policymakers interpret low uptake of rural health interventions?
政策制定者应如何解释农村卫生干预措施采用率低的现象？
What would it take to identify which barrier is operating in a given community?
如何确定特定社区中正在运作的障碍？
How can programs test whether different entry points, messengers, or delivery models improve participation?
项目如何测试不同的切入点、信使或交付模式是否可以提高参与度？
Issue.
问题。
Conventional metrics may miss the conditions that shape rural health outcomes.
传统的衡量标准可能会忽略影响农村健康结果的条件。
Standard measures of access, utilization, or cost may not fully capture transportation burdens, housing quality, social isolation, trust, informal caregiving, implementation capacity, or whether a program is reaching the people it was designed to serve.
准入、利用或成本的标准衡量标准可能无法完全反映交通负担、住房质量、社会隔离、信任、非正式护理、实施能力或项目是否惠及其旨在服务的人群。
The measurement problem is especially acute when county-level data obscure local variation, or when the most important outcomes are long-term changes in health, social connection, and community stability.
当县级数据掩盖了当地差异时，或者当最重要的结果是健康、社会联系和社区稳定性的长期变化时，测量问题尤其严重。
Research needed.
需要研究。
What metrics are effective in evaluating rural health programs when standard measures may miss underlying social determinants and long-term health outcomes?
当标准措施可能错过潜在的社会决定因素和长期健康结果时，哪些指标可以有效评估农村卫生计划？
At what geographic scale should rural need be measured?
应在什么地理范围内衡量农村需求？
How should programs account for differences in access to, and familiarity with, technologies that are important for successful program implementation?
项目应如何考虑对成功实施项目至关重要的技术的获取和熟悉程度的差异？
How can evaluation frameworks account for transportation, social infrastructure, implementation capacity, meaningful uptake, and local variation across rural America?
评估框架如何考虑美国农村地区的交通、社会基础设施、实施能力、有意义的吸收和当地差异？
Issue.
问题。
Workforce development becomes more complicated when health barriers are a major reason people cannot enter or remain in the labor force.
当健康障碍成为人们无法进入或留在劳动力队伍的主要原因时，劳动力发展变得更加复杂。
The discussion suggested that employment programs may need to connect participants to behavioral health, recovery, transportation, primary care, caregiving support, and civic infrastructure.
讨论表明，就业计划可能需要将参与者与行为健康、康复、交通、初级保健、护理支持和市政基础设施联系起来。
The unresolved boundary is how far workforce development programs should go in addressing health-related barriers without being treated as substitutes for broader health care access.
尚未解决的边界是，劳动力发展计划在解决与健康相关的障碍方面应走多远，而不被视为更广泛的医疗保健服务的替代品。
At the same time, policymakers should ensure that workforce development programs do not negatively affect health care access programs in the community.
与此同时，政策制定者应确保劳动力发展计划不会对社区的医疗保健获取计划产生负面影响。
Research needed.
需要研究。
How can workforce development programs be integrated with health care, behavioral health, and recovery support in ways that strengthen participation and stability without becoming a substitute for care itself?
如何将劳动力发展计划与医疗保健、行为健康和康复支持相结合，以加强参与和稳定性而不取代护理本身？
Which partnerships between employers, providers, community organizations, and training programs show measurable results?
雇主、提供者、社区组织和培训计划之间的哪些伙伴关系显示出可衡量的成果？
How can different but linked outcomes be tracked in a meaningful way: employment, retention, health stability, recovery, and civic participation?
如何以有意义的方式跟踪不同但相关的结果：就业、保留、健康稳定、恢复和公民参与？
How can workforce development programs address the needs of sandwich-generation participants who are caring for both children and parents?
劳动力发展计划如何满足同时照顾孩子和父母的三明治一代参与者的需求？