Abstract
In the US, rural communities face challenges to meet the community health needs of older adults and children. Meanwhile, rural areas lag in age-friendly built environment and services. AARP, a US based organization promoting livability for all ages, has developed a Livability Index based on the World Health Organization’s (WHO) domains of age-friendly communities: health, housing, neighborhood, transportation, environment, engagement, and opportunity. This study links the 2018 AARP Livability Index categories with demographic structure and socio-economic factors from the American Community Survey at the county level in the US to examine if the physical, built and social environment differentiate communities with better community health across the rural–urban divide. Results show that the neighborhood built environment has the largest impact on community health for all county types. Although rural areas lag in community health, those which give more attention to engagement and opportunity rank higher. Rural communities with more African Americans, children, and poor Whites, rank lower on community health. While neighborhood characteristics have the strongest link to community health, a broader approach with attention to age, race, poverty and engagement and opportunity is needed for rural areas.
Highlights
Health disparities are related to race, gender, income, and education at the individual level, and are a place-based issue related to geographic location, neighborhood, built environment, and community service delivery [1,2,3]
Three research questions are addressed: (1) How do community health, physical and built environment, and social environment differ across the rural–urban divide? (2) Is the relationship between community health and social and built environment differentiated by metro status? (3) Do differences in community age and race composition differentiate community health across urban and rural areas?
Health shows a clear gradient with the highest value in metro, lower in suburbs, lower in micro core and lowest in remote rural. This confirms the expectation that rural areas lag on community health
Summary
Health disparities are related to race, gender, income, and education at the individual level, and are a place-based issue related to geographic location, neighborhood, built environment, and community service delivery [1,2,3]. WHO’s age-friendly domains, based on extensive research, include the physical and built environment, social environment and services, and civic engagement [4]. WHO’s domains are consistent with the child-friendly recommendations promoted by the United Nations Children’s Fund (UNICEF) [5]. This overlap illustrates the potential for attention to age-friendly domains to increase community health for both older adults and children [6]. In the US, the AARP [7] and the American Planning Association [8] are leading efforts to promote child and age friendy communities, based on the dimensions set out by WHO [4] and UNICEF [5]
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