The Social Determinants Accelerator Act of 2021: An Opportunity for Reducing the Burden of Chronic Disease in Rural Health

In the Surgeon General’s first report on Community Health and Economic Prosperity, seven vital conditions for good health are described: 1) a thriving natural world, 2) basic needs for health and safety, 3) lifelong learning, 4) meaningful work and health, 5) humane housing, 6) reliable transportation, and 7) belonging and civic muscle (i.e., opportunities to participate in civic activities). We know these factors as the social determinants of health or well-being, and addressing them can be a powerful way to prevent chronic diseases.

Chronic diseases disproportionately impact the rural United States, where people are older and sicker on average than their urban counterparts. Populations in rural areas are more likely to have multiple chronic conditions, such as high blood pressure and depression. They also are more likely to die from preventable conditions such as cancer, heart disease, tooth decay or loss, and stroke. The Social Determinants Accelerator Act of 2021 and the President’s Federal Fiscal Year 2022 Budget, both under consideration in the U.S. Congress, propose for the first time that the federal government accelerate its work to address the social determinants by enabling the creation of cross-sector plans for the implementation of approaches.  However, for the Act to be implemented effectively in rural, tribal, and territorial communities, training and technical assistance specifically for those areas will be needed.

For example, we know that, while most urban populations have access to fluoridated water, this is not true in rural areas. Fluoridation of municipal water supplies is a highly effective approach to reducing tooth decay, a cause of multiple other chronic conditions, and the periodic application of fluoride varnish in home and school settings is effective for children where community water supplies cannot be fluoridated. We also know that transportation, or lack of transportation, is a greater problem in rural areas, and that rates of motor vehicle fatalities area higher in those areas. Programs that use modeling to identify and prioritize roads for safety improvements—and that help coordinate transportation to health services for individuals with chronic conditions—can be effective. A final example: we also know that residents of rural areas are more likely to use tobacco than urban populations. Smoke-free zones and tobacco taxes are universally effective in reducing use of—and exposure to—tobacco products. However, rural populations may need added phone or text-based support to quit tobacco, may be more receptive to radio advertisements than television, and may benefit from supplemental services like receiving nicotine replacement therapies by mail to make attempts to quit more successful. .

The approaches outlined in the Social Determinants Accelerator Act have tremendous potential to rapidly address the social factors that contribute to chronic disease in rural, tribal and territorial areas. But intentional approaches and technical assistance specifically designed to support these communities will be needed if we want to quickly and comprehensively reduce the burden of chronic disease in these harder-hit areas.