New Research Shows How Enhanced Connectivity between Health and Social Service Systems Can Reduce Inequality, Inefficiency

Date: Jul 14 2020

Contact: Systems for Action, 303-724-6145
APHA Media Relations

Residents of rural America have lifespans nearly three years shorter than their city-dwelling peers, and this gap has grown larger in recent decades. New research published this month in the American Journal of Public Health identifies a hidden driver of these differences: fewer working relationships between the health and social service organizations that serve rural areas compared to cities.

A growing body of evidence demonstrates that many health problems are caused and made worse by social problems such as housing instability, food insecurity, lack of transportation, stress, loss of income, occupational risks, social isolation and discrimination. Increasingly, this evidence is leading medical providers, public health agencies, and social service organizations to explore new ways of coordinating their efforts and sharing their resources to tackle community problems.

The new study, conducted by researchers at the Colorado School of Public Health using longitudinal data from more than 600 communities, shows that cross-sector connections have been slower to develop in rural than urban communities, giving rise to a new and growing form of inequality across the U.S. The good news from this study is that targeted efforts to build connectivity can produce outsized benefits for rural areas. Moreover, cross-sector connectivity is likely to be a more feasible and efficient pathway to rural health improvement than purely medical strategies like recruiting more doctors or building new healthcare facilities.

”Cross-sector fragmentation is a powerful determinant of health, because it can lock in inequality and prevent communities from steering available resources to the people and problems that need these resources most,” said Glen Mays, PhD, professor in the Colorado School of Public Health and senior author of the study. “Solutions that are working in urban areas need to be adapted for the unique circumstances facing rural populations.”

These findings are part of a collection of 15 new studies released on July 14 in a special issue of the American Journal of Public Health, all focused on the topic of aligning health and social systems to improve population health. Other studies in this issue examine how enhanced connections between health and social service systems can improve care for pregnant women, reduce obesity risks in children, improve access to mental health and primary care and address the health risks of inadequate housing. The studies explore a broad array of strategies for connecting systems, including innovative staffing models, new alliances and partnerships, data integration and novel financing arrangements.

"The COVID-19 pandemic has shown that fragmented health care and public health systems are fragile because they cannot respond in a global, aligned and synchronous fashion,” said AJPH Editor-in-Chief Alfredo Morabia, MD, PhD. “The failed allocation of community services between public health and police departments leading to unwarranted violence also stems from fragmentation. This supplement to the American Journal of Public Health proposes ideas, experiences, and evidence to defragment our health system and strengthen it."

Although most of the studies were completed prior to the emergence of COVID-19, the findings offer valuable lessons for helping communities survive the social, economic and healthcare disruptions precipitated by the pandemic. Job losses, evictions, food insecurity and isolation are among the social risks that can be addressed through the strategies studied in this issue.

This special journal issue was developed and supported by Systems for Action, a research program of the Robert Wood Johnson Foundation that rigorously tests new ways of connecting the nation’s fragmented medical, social service and public health systems. The national program office for the Systems for Action program is based at the Colorado School of Public Health, in the Department of Health Systems, Management and Policy.


The American Journal of Public Health is the monthly journal of the American Public Health Association. APHA champions the health of all people and all communities. We are the only organization that combines a nearly 150-year perspective, a broad-based member community and the ability to influence policy to improve the public's health. Learn more at

Systems for Action (S4A) is a signature research program of the Robert Wood Johnson Foundation (RWJF) that builds a Culture of Health by rigorously testing new ways of connecting the nation’s fragmented medical, social, and public health systems. The program supports research teams from across the U.S. in conducting scientific studies that evaluate the implementation and impact of novel approaches to systems alignment. The National Program Office for S4A is based in the Colorado School of Public Health, University of Colorado. More information is available at