The meaning of ‘rural’ in rural health: A review and case study from Brazil

Abstract

Health disparities between rural and urban populations are an important global health concern, although ascertaining what constitutes a rural context is a complicated undertaking. This article summarises theoretical contributions that help to explain how uncritical use of rural classifications may interfere with epidemiological data and health policies. Bonfim, a community located in Rio de Janeiro state, Brazil, illustrates the discussion. Bonfim is classified as urban by the Brazilian census, although the community contains farmland, parkland and rural social groups such as family farmers and ecotourism employees. The (mis)classification of Bonfim as urban further complicates the meaning of rural, and thus also what is meant by rural health. Researchers have developed some new rurality indexes to overcome the rural–urban dichotomy and to help understand local scale health determinants. But the obstacles for large-scale studies and government decision-making are still many. ‘Rural’ is an epidemiological variable that unites in a single indicator diverse life aspects relevant for health purposes. Therefore, to facilitate allocation of health resources based on objective criteria, governments and policy makers must acknowledge the difficulty of defining what rural is and work to improve the definitions they use.

Keywords:

• public health
• rural health
• health policy
• measurement
• nutrition

Acknowledgements

I thank Dr Andrea Wiley for her careful review and stimulating discussions of this paper. My thanks also to Dr James Trostle for his help framing this argument and reviewing the manuscript. Dr Eduardo Stotz, Dr Luiz dos Anjos and Dr Maria José Carneiro helped developing the research in Bonfim. The Brazilian Federal Agency for Support and Evaluation of Graduate Education, the Carlos Chagas Filho Research Support Foundation and the Brazilian National Research Council provided graduate fellowships.