The southern rural health and mortality penalty: A review of regional health inequities in the United States

Charlotte E. Miller, Ramachandran S. Vasan

Research output: Contribution to journalReview articlepeer-review

71 Scopus citations


Rural-urban differences in morbidity and mortality across the United States have been well documented and termed the “rural mortality penalty”. However, research studies frequently treat rural areas as homogeneous and often do not account for geospatial variability in rural health risks by both county, state, region, race, and sex within the United States. Additionally, people living in the rural South of the US have higher rates of morbidity and mortality compared to both their urban counterparts and other rural areas. Of those living in southern rural communities, people of color experience higher rates of death and disease compared to white populations. Although there is a wealth of research that uses individual-level behaviors to explain rural-urban health disparities, there is less focus on how community and structural factors influence these differences. This review focuses on the “southern rural health penalty”, a term coined by the authors, which refers to the high rate of mortality and morbidity in southern rural areas in the USA compared to both urban areas and non-southern rural places. We use macrosocial determinants of health to explain possible reasons for the “southern rural health penalty”. This review can guide future research on rural health between southern and non-southern populations in the US and examine if macrosocial determinants of health can explain health disparities within southern rural populations.

Original languageEnglish (US)
Article number113443
JournalSocial Science and Medicine
StatePublished - Jan 2021
Externally publishedYes


  • Macrosocial determinants of health
  • Race-specific mortality
  • Regional health disparities
  • Rural
  • Rural health
  • Rural mortality penalty
  • U.S. south

ASJC Scopus subject areas

  • Health(social science)
  • History and Philosophy of Science


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