Rural health disparities in the United States remain poorly understood, in part due to inconsistent definitions of “rurality” and the failure to integrate both geographic and socially constructed dimensions of place. This commentary draws from insights shared during the panel “Addressing Diversity in Cancer Prevention, Control, and Survivorship Within Rural Communities” at the 2024 Transforming Community and Rural Healthcare (TCRH) conference. Panelists emphasized the limitations of current rural-urban classification systems, which often overlook the intersectional identities, cultural heterogeneity, and lived experiences of rural populations. They advocated for integrating community-based participatory research (CBPR) and identity-based approaches to define rurality more holistically. Such methods prioritize self-identification, social determinants of health (SDOH), and localized knowledge, allowing for a more accurate assessment of cancer disparities and the development of equitable interventions. The commentary outlines how geophysical and census-based metrics, although convenient, can misrepresent rural communities and inadvertently perpetuate disparities in cancer care access, outcomes, and policy. The authors argue for an identity- and community-centered conceptualization of rurality that is dynamic, inclusive, and responsive to the complexity of rural life.

Rural oncologist reflects on 20 years of providing vital cancer care in underserved areas.

Wildland firefighters play a critical role in protecting communities and natural resources, yet comparatively little research has examined the occupational health risks associated with repeated smoke exposure. This narrative review analyzed documented health effects, contributing exposure determinants, and mitigation strategies across 38 studies meeting pre-specified inclusion criteria. Included studies were predominantly quantitative field investigations evaluating pulmonary, cardiovascular, metabolic, and chemical exposure outcomes. Consistent findings documented decreased lung function, elevated oxidative stress, increased carbon monoxide (CO) exposure, and cumulative cardiovascular risk. Wildland firefighters were associated with polycyclic aromatic hydrocarbon (PAH) levels 2.2–26.7 times higher than controls. Prescribed burns produced CO concentrations 233% higher than off-fire-line days. Cardiovascular disease accounts for approximately 45% of annual line-of-duty fatalities among U.S. firefighters. Contributing factors included career duration, fire type, and operational role. Altogether, these findings underscore the severe, multi-system health risks faced by wildland firefighters and highlight a pressing need for modern mitigation strategies and firefighter-specific protective technologies to safeguard long-term health.