Keeping Rural Infants Alive: Combatting Structural Inequities.

Abstract

Rural infants are less likely than urban infants to celebrate their first birthday. This tragic fact motivated Dr Deborah Ehrenthal et al1 to employ a social ecological framework to assess predictors of rural–urban disparities in infant mortality. Published in this issue of Pediatrics , their analysis revealed a stark reality in rural America. Infants living in rural, micropolitan counties (places where there is a town of at least 10 000 but not more than 50 000 people) had 26% higher chances of death before age 1, and those in noncore counties (less populated, more remote rural areas with no town with a population greater than 10 000) had a 32% higher chance of infant mortality, compared with urban counties. Dr Ehrenthal et al1 examined what explained these differences and found that it was not individual risk behaviors or health systems factors (although both of these differed across the rural–urban continuum) but rather a broad measure of community socioeconomic advantage that best explained these disparities. The structural injustices that shape individual risk and … Address correspondence to Katy Backes Kozhimannil, PhD, MPA, Division of Health Policy and Management, University of Minnesota School of Public Health, 420 Delaware St SE, MMC 729, Minneapolis, MN 55455. E-mail: kbk{at}umn.edu