Introduction to the special section: rural health issues in pediatric psychology.

The difficulties of meeting the medical and psychological needs of individuals living in rural areas have long been recognized. In Pre-Colonial days, a network of native healers attempted to meet the needs of rural populations, and when the Colonists arrived from England, the first formally trained physicians arrived in America as well. As the colonists moved westward, physicians followed, facing difficulties and hardships they had not encountered previously. In 1910, the Flexner report was released, which suggested revamping medical education and moving toward a formalized 4-year medical education system. Less than 20 years after this report was implemented, publications started to appear in the literature discussing the lack of healthcare providers in rural areas—an unintended consequence of the Flexner report. Recognizing this problem, in the 1960s and 1970s, the federal government established Area Health Education Centers (AHECs) primarily to directly serve the medical and behavioral needs of rural individuals. Although the office of Rural Health Policy at the U.S. Department of Health and Human Services was not formally established until 1987, it was seen as a final major step forward in improving the health of rural Americans. Data indicate, however, that even with all of these impressive steps forward, the health of rural populations is still lacking when compared to urban populations. Recent data released by the National Center for Health Statistics (2010) indicate that 14.8% of individuals in urban areas ‘‘did not get medical care due to cost,’’ and yet this rate is even higher (17.1%) among rural residents. The same is true for the items querying ‘‘did not get prescription drugs due to cost’’ (10.8% urban, 13.6% rural) and ‘‘did not get dental care due to cost’’ (16.4% urban, 19.2% rural). Specific to children, 10.2% of the children aged <18 years who live in urban areas had no visit to a physician in the past 12 months; the rate for rural children was higher at 12.0%. Finally, the percentage of children aged 18 years with one or more visits to an emergency room was higher for rural children (24.2%) than for urban children (20.2%). Though these differences may seem small, they equate to tens of thousands of rural children not receiving adequate medical care. Looking at specific diseases, data from the National Survey of Children’s Health (U.S. Department of Health and Human Services, 2005) indicate that rural children are more likely to be overweight (17.1% large rural, 17.4% small rural) than urban children (14.2%). Unintentional injury rates are also higher among rural children (9.4% large rural, 10.0% small rural) compared to urban children (9.3%). Chronic physical or mental health problems are also more prevalent among rural children (9.0% large rural, 8.1% small rural) than among urban children (7.7%). Our nation has long recognized the problems faced in meeting the medical and behavioral needs of rural populations, and has taken dramatic and positive steps to ameliorate these differences. Despite this, taken together, data overwhelmingly indicate that children and adults living in rural areas still experience greater medical and behavioral issues and are less likely to receive treatment for these issues relative to their nonrural counterparts.