Rural Health Needs a Surgical StrikE
- Irion Pursell
- May 31
- 3 min read
Updated: Jun 26
In public health, we often talk about scale—how to reach the greatest number of people, how to roll out interventions across states or regions, how to shift population-level metrics. But when it comes to rural America, this approach misses the mark. The health crisis unfolding in rural communities isn’t a broad-strokes problem—it’s a precision challenge.
What rural health needs right now is not a blanket strategy. It needs a surgical strike: focused, targeted, community-specific action that addresses the unique needs of small, underserved populations with precision and urgency.
Broad Approaches Leave Rural Communities Behind
Most national health strategies are designed with urban infrastructure in mind. They assume proximity to services, access to transportation, broadband availability, and a sufficient provider workforce. But none of these are guaranteed—or even common—in rural areas.
Worse still, when interventions are designed to benefit the "average American," rural populations often disappear in the data. That’s because they are numerically small, geographically dispersed, and underrepresented in research. Averages mask extremes, and in public health, those extremes are where the crisis lives.
Precision, Not Popularity: Why a Surgical Approach Matters
A surgical strike strategy means identifying specific communities with poor outcomes and designing interventions tailored to their context, not their inclusion in a national framework. This approach has several advantages:
Local relevance. Solutions are built around the actual barriers people face—not theoretical models or data proxies.
Efficient use of resources. Instead of spreading thin across large populations, a focused strategy concentrates effort where the need is most urgent.
Community engagement. Smaller-scale efforts are more conducive to trust-building, relationship development, and long-term partnerships.
Actionable results. Measurable change is more likely when goals are realistic, populations are defined, and outcomes are observed closely.
Case in Point: The Healthy Communities Initiative
Take the Healthy Communities Initiative (HCI) as an example. Rather than applying a county-wide or state-wide intervention, HCI starts with a single U.S. Census Block—a hyper-local, place-based unit of geography where health disparities are most severe. Using Community Health Workers (CHWs), the program enrolls every adult resident in the block, assesses their medical and social needs, and connects them directly to services they may not even know exist.
It’s not fast. It’s not flashy. But it’s precise. And that’s what works.
What the Surgical Strike Looks Like in Practice
A surgical approach to rural health means:
Mapping micro-communities where disparities cluster—not just counties, but census tracts or neighborhoods.
Listening before acting. Engaging residents, local leaders, and civil society organizations to define the problem.
Deploying Community Health Workers or trusted locals—not just clinicians—who know the terrain, culture, and people.
Addressing social barriers as part of the health strategy, including food insecurity, lack of housing, poor broadband, and transportation deserts.
Evaluating continuously so small programs can evolve in real time and scale thoughtfully—not blindly.
This Is Not Inefficient. It’s Effective.
Critics may argue that surgical strategies lack scale. But if your broad strategy fails to move the needle in high-need populations, what have you really accomplished?
National public health depends on local victories. Rural communities may be small in number, but they’re large in need—and in potential. The health of the nation cannot improve if entire regions are left behind by design.
Conclusion: We Know Where the Fire Is—Let’s Put It Out
We don’t need to guess where rural health disparities are. We know which communities are hurting most. We have data. We have lived experience. What we lack is the political and institutional will to act with focus and urgency.
A surgical strike is not about exclusion—it’s about inclusion with intention. It’s about showing up in the places that need help the most, with interventions built specifically for them.
It’s time to stop talking about "rural health" as a checkbox and start treating it as a precision mission—one that requires humility, commitment, and above all, focus.
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