Geographic Variation in the Structure of Kentucky's Population Health Systems: An Urban, Rural, and Appalachian Comparison.

Introduction: Research examining geographic variation in the structure of population health systems is continuing to emerge, and most of the evidence that currently exists divides systems by urban and rural designation. Very little is understood about how being rural and Appalachian impacts population health system structure and strength. Purpose: This study examines geographic differences in key characteristics of population health systems in urban, rural non-Appalachian, and rural Appalachian regions of Kentucky. Methods: Data from a 2018 statewide survey of community networks was used to examine population health system characteristics. Descriptive statistics were generated to examine variation across geographic regions in the availability of 20 population health activities, the range of organizations that contribute to those activities, and system strength. Data were collected in 2018 and analyzed in 2020. Results: Variation in the provision of population health protections and the structure of public health systems across KY exists. Urban communities are more likely than rural to have a comprehensive set of population health protections delivered in collaboration with a diverse set of multisector partners. Rural Appalachian communities face additional limited capacity in the delivery of population health activities, compared to other rural communities in the state. Implications: Understanding the delivery of population health provides further insight into additional system-level factors that may drive persistent health inequities in rural and Appalachian communities. The capacity to improve health happens beyond the clinic, and the strengthening of population health systems will be a critical step in efforts to improve population health.