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Toward Sustainable and Equitable Rural Health - Recommendations for Multisector Action

Amber E Barnato1,2,3,4, Sally A Kraft5,6,7, Mark A Creager8,9,10

  • 1John E. Wennberg Distinguished Professor of Health Policy and Clinical Practice, Professor of Medicine, and Chair of Health Policy and Clinical Practice, Geisel School of Medicine at Dartmouth, Lebanon, NH, USA.

NEJM Catalyst Innovations in Care Delivery
|July 15, 2026
PubMed

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Primary Healthcare Services01:30

Primary Healthcare Services

Primary care promotes wellness and prevents disease. This care includes health promotion, education, protection (such as immunizations), early disease screening, and environmental considerations. Settings providing this type of healthcare include physician offices, public health clinics, school nursing, and community health nursing.
In 1978, international leaders convened in Alma-Ata, Kazakhstan, for what would be a pivotal event in global health. The Alma-Ata Declaration was the first to call...
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Methods Of Healthcare Delivery System

At the different levels of the healthcare system, we see varying methods of healthcare used. These methods include managed care systems, case management, and primary healthcare.
Managed Care System:
The managed care system is designed to control the cost while maintaining the quality of care. The patient's care from admission to discharge is planned by the primary care provider or the case manager, also known as the gatekeeper. In a managed care system, the number of care providers is limited...
Sustainable Development01:43

Sustainable Development

As the human population continues to grow and use resources, we must be mindful of our planet’s natural limits. Sustainable development provides a pathway to maintain and improve human life now while also ensuring that future generations will have the resources that they need. The long-term success of sustainability efforts rests on understanding the interplay between human actions and ecological systems.
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International Nursing Organizations II

The World Health Organization (WHO) is a specialized agency of the United Nations based in Geneva. The WHO has many initiatives that center around health. Primarily, they lead global efforts to expand universal health coverage using science-based policies and programs. They are also responsible for shaping health research agendas and developing norms and standards.
The WHO provides expert team support, including funding, vaccines, testing, and treatment tools at the country level to fight...
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Levels of Health Promotion and Illness Prevention

Health promotion allows a person to control the determinants of health, resulting in an improved health status. It enhances the quality of life and reduces premature deaths. Health promotion and illness prevention programs help people make beneficial choices to reduce the risk of disease and disabilities. There are three health promotion and illness prevention levels: primary, secondary, and tertiary prevention.
In primary prevention, actions taken before disease onset prevent the disease from...
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Community Based Intervention

Community-based interventions in mental health represent a paradigm shift from institution-centered care to treatments embedded within the fabric of local communities. By prioritizing inclusion and leveraging existing societal structures, this approach fosters a supportive environment conducive to addressing mental health challenges while promoting individual dignity and agency.
Foundations of Community Mental Health Programs
Central to the success of community-based interventions is the...