Toward Sustainable and Equitable Rural Health - Recommendations for Multisector Action.

Abstract

Rural communities face widening mortality gaps driven less by geography than by policy choices shaping care delivery, workforce distribution, and investment. Informed by the 2025 Dartmouth Rural Health Symposium, this article synthesizes evidence and field experience to outline a practical reform agenda. The authors propose redefining rural hospitals around essential, financially viable services; scaling team-based and artificial intelligence-supported care; modernizing payment models; and rebuilding trust through community partnership. A phased implementation plan proposes near- and long-term actions and highlights responsibilities across sectors. Durable progress will depend on aligning incentives with prevention and local relevance, allowing proven innovations to move from isolated pilots to routine practice nationwide.