That health inequalities exist across countries was well known before the Covid pandemic, but as in so many areas, these discrepancies were exacerbated over the past 18 months. Research from Iowa State University illustrates the scale of the problem, especially for vulnerable populations within small towns.
The researchers focused their attention on the Iowa towns of Perry, Marshalltown, and Ottumwa to act as a proxy for rural towns across America. They were interested in understanding how vulnerable populations in these towns were affected by their built environment, and the various environmental risks they faced.
Environmental exposure
The analysis found a significantly higher rate of environmental exposure to toxins in the air, to lead paint in their homes, and even to potentially dangerous chemical accidents than is the national average.
The researchers argue that these risks exacerbate the problems already faced by vulnerable populations in these towns, across both mental and physical domains, which are already significantly higher than the national average.
As industrialized agriculture has expanded in recent decades, the paper argues that the populations of these small towns have suffered from what environmental justice campaigners refer to as “double jeopardy” of injustice, which sees people with the fewest resources who are already living in low-income communities, and are faced with higher levels of environmental and social risks.
The paper reveals that it is widely known that urban areas benefit from green spaces, so one would assume that rural areas’ cup runneth over, but that isn’t always the case, as pesticides, fertilizers, and so on often render such spaces inhospitable.
“There is a rural health paradox: These small towns may appear on the outside that they’re healthier and safer, but the reality is that the metrics cities use are not really compatible,” the researchers say.
Environmental risk
This knowledge gap is important, as there is far more research on environmental risk in urban areas, but this study highlights how this doesn’t translate well to smaller towns.
The authors explain that these towns often have parallel communities that rarely interact with each other, whether due to the nature of their work, language barriers, or geography.
“When we think about public health these days, we think about viruses and epidemics,” the researchers say. “What’s increasingly being supported through research is that the neighborhoods we live in have huge impacts on our mental and physical health.”
Population change
The rate of population change has also exacerbated the problems small towns face, with longstanding residents moving to bigger towns and cities for work, and new people, who are often foreign-born, moving in.
“Although the influx of foreign-born workers and their families to small towns has enabled economic growth in the hands of a local few, the stability of small towns is fragile,” the researchers say. “A decline in local investment coupled with aging infrastructure is likely to impact the built environments in small towns, potentially compounding deleterious effects as vulnerable populations bring families and become established.”
Rural towns have a wide range of issues to face, many of which are exacerbated by a decline in the built environment. The authors conclude by urging policymakers to renew their focus on this, even if it means investing in relatively low-cost interventions on things such as sidewalks, street trees, or crosswalks, all of which can make a fundamental difference in counteracting the looming public health crisis.
