Do rural and urban populations define “health” differently?

In analyzing the findings from eight rural and urban focus groups on end-of-life care preferences, we noted that rural and urban participants often discussed concepts such as “good health” and “meaningful survival” differently. Rural participants tended to equate “health” with being able to function, particularly on one's own behalf, and to dismiss the idea of meaningful survival when unable to do so. Urban participants were more likely to describe health and survival as goals independent of function.

We conducted a review of the literature to assess the current understanding of rural and urban definitions of “health.” We found that rural residents characterize good health as being able to “take care of what has to be done” and to avoid dependency. Rural residents tend to assess their health on the basis of their ability to work and to reciprocate in social relationships. Rural concepts of health were found to be closely associated with independence by many investigators. While these findings were consistent in the literature, there were few studies that compared rural and urban definitions of health directly. The literature contains little empirical documentation of differences between rural and urban health-related values.

Rural-urban differences in the definition of “good health” present rich opportunities for research, as concepts of health affect self-description of health status, health behavior, and participation in health maintenance and preventive services. Methodological and conceptual challenges in conducting research regarding rural-urban dwellers' definitions of health include the heterogeneity of rural communities, and the need to use valid measures of health values.