Health and Health Services
Health care services are an essential component of a healthy community. Every individual must confront the problems of illness and death, and in every society collective mechanisms evolve to assist the individual in his attempts to mitigate the impact of illness. In rural America, the health care system is a fundamental social service whose symbolic and emotional impact goes beyond the boundaries of a technological response to disease. A stable, functional, and culturally relevant health care system is a basic underpinning of rural society.
Rural society is characterized by low density of settlement; this sparseness of population is paralleled by a relative paucity of social services. In a culture marked by pluralism and abundance, even a wealthy community usually has only one system of health care. This lack of diversity or redundancy makes the rural dweller vulnerable to sudden unpredictable interruption of basic health services; very often the entire spectrum of health services is dependent on an aging physician or obsolescent hospital.
Rural communities are keenly sensitive to these potential disruptions. All members of local communities can mobilize themselves around the loss of health services; often they are more effective in establishing a new practice than maintaining it once it is in place. As Kane has observed ( 1977: 146), "health care seems to play a somewhat unusual role . . . . Although strongly demanded when absent, its effect on the community when present is hard to assess."
Rurality plays a role in American life that exceeds the relative proportion of the population living there. The comparative isolation of rural America from the artificial environments created by dense aggregations of people serves as a respite for the urban dweller, and a persistent internal frontier for the jaded or discouraged. The demographic resurgence of nonmetro areas is the final common pathway