Rural Prejudice-Urban Bias: The Stories and Structures That Oppress Rural Communities

Abstract

Rural communities account for somewhere between 72% and 97% of the land mass in the United States and approximately 15–20% of the country’s population (United States Census Bureau. New census data show differences between urban and rural populations [Press release]. Retrieved from https://www.census.gov/newsroom/press-releases/2016/cb16-210.html, 2016; United States Department of Agriculture. Rural America at a glance 2016 Edition. Retrieved from https://www.ers.usda.gov/webdocs/publications/80894/eib-162.pdf?v=42684, 2017). Furthermore, rural communities are an important part of the American mythos, representing a population and lifestyle that features heavily in the identity of America (Stamm. Rural behavioral health care: An interdisciplinary guide. American Psychological Association, Washington, DC, 2003). As such, rural communities and people occupy both a large and socially important piece of the United States. Likewise, being only 20% of the population, rural residents are also an often overlooked and underserved minority. The dominant urban culture often portrays rural people in negative stereotypes that can both exacerbate behavioral health problems and impact the quality of care received by rural residents. Further, prejudice against rural people and communities is manifested in the lived realities of rural disadvantage and policy marginalization, which lead to challenges for the delivery of quality behavioral health care in rural communities. Taking a public narrative model for understanding community health outcomes (N. V. Mohatt et al. Soc Sci Med 106, 128–36, 2014; Rappaport. Am J Community Psychol 28(1), 1–24, 2000), we review how stigma and prejudices manifest in rural community life and relate to persistent rural health disparities. The objective of this chapter is to provide rural mental health practitioners with a deeper understanding of the ways in which stigma and prejudice toward rural communities shape the landscape of mental health in rural America. In conclusion, we provide a series of recommendations to reshape the structural and cultural biases and provide effective rural behavioral health treatment and community action.