An Overview of Public Health Services Among Local Health Departments in Rural Versus Urban Jurisdictions

Rural populations face greater barriers to care and worse health outcomes than urban populations. Local health departments (LHDs) serving rural populations may play a key role in bridging the clinical care gap within their communities.

To assess and describe the differences in services provided by rural and urban LHDs, as well as the contextual factors contributing to those differences.

Data from the 2022 National Profile of Local Health Departments was used to estimate the provision of various clinical and population-based services and types of occupations employed, across urban and rural LHDs. Analyses were descriptive in nature but weighted by jurisdiction size to provide nationally representative estimates.

Rural LHDs were more likely to provide many clinical services, offering care that is often more limited from other providers in the jurisdiction than urban LHDs. Conversely, fewer rural LHDs tend to provide population-based services or programs related to emergent public health issues, such as substance use. While 88% of rural LHDs reported that clinical substance use care was available through other community organizations, this is less than the proportion of urban LHDs (94%). Fewer rural LHDs also provide population-based primary prevention in this area than urban LHDs. Fewer rural LHDs employ occupations that support the provision of population-based services than urban LHDs.

Rural LHDs are a key clinical service provider in their communities. However, they may have challenges prioritizing population-based services and those addressing emergent public health issues. Implications include supporting rural LHDs through formula-based funding, workforce capacity, and partnerships to continue and bolster both clinical and population-based services available for their communities.