Unincorporated Health: Understanding Residents’ Perspectives on Factors Impacting Their Health and Emergent Place-Based Solutions

ABSTRACT

Increased mortality rates and decreased life expectancy in the United States are associated with rurality, even after adjusting for poverty. In unincorporated rural communities, high population density may compound the negative health impact of the upstream factors associated with rurality, yet little is known about how this context contributes to residents’ health. We conducted nine focus groups with youth and adults from March–July 2017 in two Texas unincorporated rural communities. Using ecosocial theory and applied thematic analysis for focus groups, we investigated social, political, and historical factors that affect health. We identified two primary themes: upstream barriers to community health and K-12 schools as facilitators of community health. K-12 schools, and full-service community schools, in particular, may have an important role in closing the rural-urban health gap, even in the context of structural constraints associated with unincorporated rural status.

KEYWORDS:

• Social determinants of health
• rural
• place
• health promotion
• community schools

Acknowledgments

We would like to acknowledge the area residents, community leaders, County Commissioner, and public health Department director and staff, who welcomed us to their community, and generously shared with us their experiences and insights. We would also like to thank the reviewers whose thoughtful feedback improved the quality of the manuscript.

Disclosure statement

No potential conflict of interest was reported by the authors.

Additional information

Funding

This project received funding from the Victoria County Public Health Department.