The rural determinants of health: using critical realism as a theoretical framework

Rural health needs to be based on robust theory that guides efforts in practice, teaching and research. This could make the sets of assumptions that are inevitably brought to bear on prioritization and decision-making more explicit. It has not yet been described in theoretical terms because to insiders such as health practitioners it seems to be more of a practical endeavour than an academic one. The rural determinants of health, as a more specific expression of the social determinants of health, include issues of geography and topography in addition to the social, economic and political factors that result in the persistent disadvantage in health access and outcomes of rural populations. The philosophical approach of critical realism provides a theoretical framework that is inclusive of subjective, objective and abstract realities. Using a case study from South Africa to illustrate these notions, a conceptual model is proposed that displays the geographical and historical foundations of rural health alongside the political, economic, social and health system factors influencing patterns of disease and wellness in rural areas.