Micropolitan communities are defined as mid-sized rural communities. They are in non-metro places with populations from 2,500-50,000 people. Micropolitan communities are home to about 61% of rural residents, and 10% of the overall population. These communities provide a source of work, health care, and shopping for rural people.
There are 15 micropolitan communities in the state of Iowa. Many University of Iowa Prevention Research Center for Rural Health (PRC-RH) projects focus on these communities because they are unique places with different needs for interventions that make health better for many rural people. Two PRC-RH programs working toward better health of micropolitan residents are Active Iowa and the Healthy Coping projects.
Americans living in rural communities experience health challenges, and people living in micropolitan communities have unique health needs. People in rural America often have higher rates of poverty, less access to health care, and are less likely to have health insurance. These factors can lead to poor health, including:
Compared to urban places, people in rural places are at a greater risk of death from the top 5 causes: heart disease, cancer, unintentional injury, long-term lower respiratory disease, and stroke. Rural and micropolitan communities often have higher rates of cigarette smoking, high blood pressure, and obesity. Iowa is fourth in the nation for obesity, with 24% of Iowans reporting no physical activity in their free time. In these communities specifically, physical activity may be harder because of the way they are built, which sometimes leads to higher usage of cars.
People living in rural and micropolitan places also experience mental health challenges. While mental illness can be found in rural and urban America, mental health services are not as available in rural communities. In Iowa, there is major need for mental health services; 92 out of 99 counties in the state are considered places where there are too few (a shortage of) mental health professionals. Every micropolitan community was considered a mental health shortage place as of March 2020. Even when mental health services are available, individuals living in rural and micropolitan communities may struggle to access services because of longer travel distances. Using mental health services may be hard for individuals living in rural and micropolitan places as they may experience more judgment for using mental health care.
Micropolitan communities are typically isolated from other bigger cities. People in these communities might travel longer distances between homes and places where they work or run errands. Public transportation services, like public buses, are often limited in micropolitan communities. Walking in micropolitan communities might be harder depending on things like the number and quality of sidewalks in town. This can make simple physical activity more challenging.
These communities often have older populations; many younger people move away for school or jobs. Older people living in micropolitan communities often have chronic (long-term) health conditions as they age. Additionally, micropolitan communities have been experiencing more cultural diversity because of an increase of immigrant populations who are looking for jobs in agriculture (farming) and manufacturing. However, health and language translation services for these immigrant groups may not be easy to access or they might not be widely available.
Many jobs in micropolitan communities are in agriculture or manufacturing. These types of jobs can require hard labor for workers with long hours worked. Workers in these jobs have a greater risk of on-site injuries from things like repeated movements and heavy lifting.
Consistent or regular access to the internet may vary in micropolitan communities, especially on the outskirts of towns where it becomes more rural. Some internet service providers won’t cover certain places, and even when access is available some people may not be able to afford the necessary devices needed to use it. This “digital divide” can stop community members from accessing telehealth services (things like having a doctor’s appointment through video chat) and can make it hard for community members to look for information about their health concerns.
Being farther away from more metro or urban places can mean less access to health care. Not having health care close by can negatively affect community member health because it might be harder to get the care they need on a regular basis. While micropolitan communities typically have smaller hospitals that serve more rural residents, these communities often don’t have services, such as mental health providers, dieticians, and occupational therapists.
Things like sidewalks, roads, buildings, parks, and community centers that are not built, or need a lot of fixing or up-keep, may make it harder for micropolitan community members to participate in social activities in their community. It is often harder to walk in these communities, which means they have lower “walkability scores”, (meaning that outdoor physical activity may not be easy to do).
People in rural communities many times have strong social connections to other members of their community. The social environment that is created by social connection is defined as the mutual benefit, cooperation, and trust that exists between community members. A positive social environment can encourage people to be active in their community and try for positive change.
A strong sense of political voice in a community can affect voter turnout and political decision making. When rural community members feel like they have a strong political voice to ask for change in their community, they can influence the decisions and policies or rules set out to promote health.
While there may be health disparities, or negative differences in health that don’t need happen, in micropolitan communities, these communities also have special strengths that can be used to make health conditions better.