ABSTRACT

Rurality as a concept was originated within the framework of the migration phenomena of the nineteenth century. During the post-war period, a dichotomic approach was established for this concept, along with the emerging notion of growth, which influenced the economic models of multiple countries worldwide. However, during the last 50 years, the rurality concept acquired a polysemic nature. Thus, the main objective of this article is analyzing several definitions of rurality from the perspective of some subdisciplines of the social sciences and their lines of thought to evaluate their implications for public health within different contexts.

Key Words:
Rural health; rural population; public health; sociocultural territory; rural economy (source: MeSH, NLM)

RESUMEN

El concepto de ruralidad surgió en el marco de los fenómenos migratorios ocurridos durante el siglo XIX. Para el periodo posguerra, con la emergente noción de desarrollo, se configuró una aproximación dicotómica al concepto, que influyó en los modelos económicos de distintos países del mundo. No obstante, durante los últimos 50 años la ruralidad adquirió un carácter polisémico. En consecuencia, el objetivo del artículo es analizar las definiciones de ruralidad desde algunas disciplinas de las ciencias sociales y sus corrientes de pensamiento, con el fin de inferir sus implicaciones para la salud pública en distintos contextos.

Palabras Clave:
Población rural; salud rural; salud pública; territorio sociocultural; economía rural (fuente: DeCS BIREME)

Concepts are historical constructs, modelled by disputes, tensions and perspectives. Rurality has been also conditioned in this way, and it is possible to recognize the following characteristics, which have arisen at different moments of contemporary history:

A. This concept was created within the framework of rural-urban migratory phenomena resulting from the industrialization of societies during the nineteenth century and the beginning of the twentieth century.

B. During the interwar period and the post-World War II period (1930-1950), the rural-urban dichotomic view was consolidated; this contributed to the specialization and differentiation of rurality functions. Theoretical approaches adopted the most structuralist and functionalist trends of economy, geography, and sociology. At the end of the war, the notion of growth became dominant, which influenced the concept of rurality in the following decades.

During the 60s and 70s, with the adoption of an interrelational perspective from the urban-rural continuum ¹1. Sorokin PA, Zimmerman CC. Principes of rural-urban sociology. New York: Henry Holt; 1929., that emerged in 1929, from a proposal by Sorokin and Zimmerman ²2. Vargas RL. El espacio rural. Concepto y realidad geográfica. BAETICA Estud Hist Mod Contemp. 1998; (20). DOI: 10.24310/BAETICA.1998.v0i20.509.
https://doi.org/10.24310/BAETICA.1998.v0... . The concept of rurality became diffuse, which made necessary its adaptation to the category of territory.

C. Between 1980 and 1990, more "non-spatial definitions" emerged, associated to identities ³3. Comíns JS, Moreno DR. La delimitación del ámbito rural: una cuestión clave en los programas de desarrollo rural. Estud Geográficos. 2012; 73(273):599 624. DOI:10.3989/estgeogr.201221.
https://doi.org/10.3989/estgeogr.201221... .

D. In the early years of the twentieth century, the concept of hybridization of knowledge was adopted to describe spaces of tension, conflict relations and social forces of change ⁴4. Sandoval-Godoy SA. Hibridación social: un modelo conceptual para el análisis de la región y el territorio. Región Soc [Internet]. 2003 [cited 2020 Apr 11]; 15(28):47-80. https://bit.ly/3bJQpKq.
https://bit.ly/3bJQpKq... ^,55. Vessuri H. La Hibridización del Conocimiento. La tecnociencia y los conocimientos locales a la búsqueda del desarrollo sustentable. Converg Rev Cienc Soc [Internet]. 2004 [cited 2020 Apr 12]; (35). https://bit.ly/35M47bF.
https://bit.ly/35M47bF... . Within the context of a globalized society, it was oriented towards sustainable development, leading to a transdisciplinary approach.

These characteristics have promoted the coexistence of rurality in the permeable limits between the disciplines that have included it as an object of study. This concept is particularly conflictive and heterogeneous for public health as an area of knowledge where several sciences and disciplines confluence, since there is no consensus, resulting in different approaches that depend on different epis-temological and theoretical perspectives ⁶6. Racher FE, Vollman AR, Annis RC. Conceptualizations of 'Rural': Challenges and Implications for Nursing Research. Online J Rural Nurs Health Care [Internet]. 2005 [cited 2019 Oct 19]; 4(2):61 77. https://bit.ly/35G8kh2.
https://bit.ly/35G8kh2...

7. Muula A. How do we define 'rurality' in the teaching on medical demography? Rural Remote Health. 2007; 7(1):653.^-88. Rourke J. In search of a definition of 'rural'. Can J Rural Med [Internet]. 1997 [cited 2019 Jul 20]; 2(3). https://bit.ly/3ij19QQ.
https://bit.ly/3ij19QQ... . Likewise, institutional technical criteria have been integrated to its definition. An evidence of this is the indistinctive use of dissimilar concepts such as rural, farmer, agriculture, population or rural community, and rurality observed in studies by Restrepo and Acuña ⁹9. Suárez-Restrepo N del C, Tobasura-Acuña I. Lo rural. Un campo inacabado. Rev Fac Nac Agron Medellin [Internet]. 2008 [cited 2018 Sep 29]; 61(2):4480-95. https://bit.ly/3bJu2o3.
https://bit.ly/3bJu2o3... , Dirven, et.al. ¹⁰10. Dirven M, Echeverri-Perico R, Sabalain C, Rodríguez A, Candia-Baeza D, Peña C, et al. Hacia una nueva definición de "rural" con fines estadísticos en América Latina [Internet]. Naciones Unidas; 2011 [cited 2019 Sep 23]. https://bit.ly/3sBBdFd.
https://bit.ly/3sBBdFd... , Pineda-Restrepo ¹¹11. Pineda-Restrepo B del C. Desarrollo humano y desigualdades en salud en la población rural en Colombia. Univ Odontol [Internet]. 2012 [cited 2019 Nov 11]; 31(66):97-102. https://bit.ly/2LCmBo3.
https://bit.ly/2LCmBo3... and Chung ¹²12. Chung H. Rural transformation and the persistence of rurality in China. Eurasian Geogr Econ. 2013; 54(5 6):594 610. DOI:10.1080/15387216.2014.902751.
https://doi.org/10.1080/15387216.2014.90... .

As for the Colombian context, in order to understand rurality, it is necessary to acknowledge that this is a complex concept that extends beyond population aggregates or administrative structures because it constitutes the axis for identity establishment, reflecting the imposition of growth models and the diversity of conflicts that the country experiences as a nation. Consequently, for understanding rurality, public health needs to broaden the descriptive frameworks of the health-disease process; define dimensions for the interactions among environment, health and work; rebuild social protection policies and reformulate curricula and practices for the disciplines that are part of public health regarded as a field of knowledge and as a field of action; and determine its integration with socio-sanitary services.

Considering the previous rationale, this paper aims at analyzing several definitions of rurality from the point of view of some social sciences subdisciplines and their lines of thought, to determine their implications for public health. The scope was focused on: 1) identifying the conceptual elements guiding the making of governmental health policies and the adoption of strategies and models that are fundamental for the praxis of public health; and 2) promoting debate around the conceptual constructs of rurality which influence public health as a field of knowledge.

Rurality as an analytical category: tensions among geography, sociology, economy and demography

I. Geography: Between the classical view and the critical view

Geography's object of study is spaces, but it considers as essential concepts territories, places, and landscapes, among others. Rojas-Salazar ¹³13. Rojas-Salazar T. Epistemología de la geografía... una aproximación para entender esta disciplina. Terra Caracas [Internet]. 2005 [cited 2020 Apr 12]; 21(30):141 62. https://bit.ly/2LQVhCy.
https://bit.ly/2LQVhCy... identified three lines of thought that move through the historic, quantitative, radical, systemic, social, ecological and landscape traditions:

Possibilism is framed within rural geography as a branch describing the human and socio-economic aspects of this discipline, which highlights the importance of multiple factor analysis of geographic facts. García-Ramón ¹⁷17. García-Ramón MaD. Desarrollo y tendencias actuales de la geografía rural (1980-1990), una perspectiva internacional y una agenda para el futuro. Agric Soc [Internet]. 1992 [cited 2020 Apr 12];(62):167-94. https://bit.ly/2N4cKaZ.
https://bit.ly/2N4cKaZ... and Ávila-Sánchez ¹⁸18. Ávila-Sánchez H. Tendencias recientes en los estudios de Geografía rural. Desarrollos teóricos y líneas de investigación en países de América Latina. Investig Geográficas Bol Inst Geogr UNAM [Internet]. 2015 [cited 2019 Sep 24]; (88):75-90. https://bit.ly/3p1lug4.
https://bit.ly/3p1lug4... acknowledged Vidal de la Blache school as the precursor of rural geography. Within this setting, we must acknowledge the influence that English-speaking countries postulates had, which proposed spatial modelling (thus, getting closer to positivism).

In contrast with possibilism, the concept of rural metabolism has a wide resonance today, understood as a notion emerging from the Marxist category of capitalism analysis, which is related to the appropriation of nature observed from a deterministic position. At the same time, the appropriation of nature consists of an internalization or assimilation of natural elements by the social "organism" ¹⁹19. Toledo VM. Metabolismos rurales: hacia una teoría económico-ecológica de la apropiación de la naturaleza. Revibec [internet]. 2008 [cited 2019 Sep 24]; 7:1-26. https://bit.ly/35FZUGz.
https://bit.ly/35FZUGz... .

On the other hand, rising from the theory of interdependences, descriptive approaches of the concept of rural have emerged, based on the urban-rural continuum (grounded on Sorokin and Zimmerman's empiricist postulates), which highlight the benefits of adopting an integrated rural-urban approach for regional growth by focusing on interdependencies and common features, rather than differences ²⁰20. Caffyn A, Dahlström M. Urban-rural interdependencies: Joining up policy in practice. Reg Stud. 2005; 39(3):283-96. DOI:10.1080/0034340050086580.
https://doi.org/10.1080/0034340050086580... . Additionally, and coming from the perspective of peri-urban territories, Ávila-Sánchez has proposed to incorporate to the analysis:

II. Rural sociology: Between Europe and America

Rural sociology started its development in the late nineteenth century, in Europe. However, its dissemination overseas was materialized in the United States until the second half of the twentieth century. We may differentiate three traditions around agricultural questions: the German, the Marxist, and the American traditions.

One of the most prominent authors in the German tradition was Ferdinand Tönnies, who proposed an important sociological distinction between community (Gemeinschaft) and society (Gesellschaft). This distinction contributed to shape the classical view of rurality, associated to a dichotomic vision (rural-urban; backwardness-progress). It is important to note that German sociology has closer links to Husserl's phenomenology and Neo-Kantianism regarding the inclusive and transcendental relation of agricultural matters to capitalism. Consequently, it seeks to place, within the wider context of society, the forms adopted by the economic, political, and cultural transformations experienced by rural areas due to the globalization of the capitalist organization of labor and production. The influence of the first works by Max Weber at the end of the nineteenth century should be highlighted, when the ideals of the German Nation-State materialized in the agrarian reform at the east of the country, through lands concession to German peasants ²⁴24. Duek MC. Max Weber: posición política, posición teórica y relación con el marxismo en la primera etapa de su producción. Convergencia [Internet]. 2009 Aug [cited 2020 Apr 13]; 16(50):249-80. https://bit.ly/3qtZV8z.
https://bit.ly/3qtZV8z... .

The Marxist tradition emerged from questionings about land, before, during and after the social revolution. As a response, the Worker-Peasant Alliance was established during the nineteenth century, a common element of emancipation for Marx, Engels, Lenin, Trotsky, Mao Zedong and Rosa Luxemburg, who studied the conditions of the peasant class in countries such as England, France, Russia, China and Egypt. Meanwhile, Kautsky ²⁵25. Kaustky K. La cuestión agraria. Estudio de las tendencias de la agricultura moderna y de la política agraria de la socialdemocracia. Tercera. Barcelona: Laia; 1974. analyzed the future of rural social sectors from the perspective of social actors, within the framework of the capitalist process and its laws, applied to the rural setting.

The American tradition originated after the end of the Civil War (1861-1865), that evidenced the rural poverty in the country. It emerged from a modernization process that was maintained until the Great Crash of 1929 and generated a mobilization of groups of farmers, such as The Grange, and the National Farmers Alliance, who sought grants from the government to solve their economic problems, caused by the Great Depression ²⁶26. Boyer PS, Clark CEJ, Halttunen K, Kett J, Salisbury N, Harvard Sitkoff, et al. The Enduring Vision: A History of the American People. Ninth Edition. Boston: CENGAGE Leaning; 2016..

The decades of 1930 and 1950 saw the rise of rural sociology, which disseminated throughout Latin America, promoted by the progressive vision of the Organization of American States and based on Parsons and Merton's contributions to Structural-Functionalism, which were then transferred to Orlando Fals Borda's first works, who would subsequently move towards historical materialism, through the Participatory Action Research ²⁷27. Ribero-Balaguera D. Un rastreo desde la ruptura de Orlando Fals Borda con el paradigma funcionalista en 1962 hasta la aparición de la categoría de formación económico-social en el primer capítulo de la Historia Doble de la Costa: Mompox y Loba en 1979 (trabajo de grado) [Internet]. Bogotá: Universidad Nacional de Colombia; 2018 [cited 2019 Oct 24]. https://bit.ly/38NRTBd.
https://bit.ly/38NRTBd... .

As constructs originated in the United Kingdom and France during the second half of the twentieth century and the first decades of the twenty-first century, the approaches from ethnography and symbolic interactionism were characterized as a criticism against American rural sociology ²⁸28. Hillyard S. The Rising Salience of the Absent: An Interactionist Analysis. Qual Sociol Rev [Internet]. 2019 [cited 2019 Oct 24]; 15(2):56-72. DOI:10.18778/1733-8077.15.2.05.
https://doi.org/10.18778/1733-8077.15.2.... . These approaches addressed topics such as the new geographies of the peasant agriculture; studies on rural youth population; the conceptualization of space through social representations of the rural ⁶6. Racher FE, Vollman AR, Annis RC. Conceptualizations of 'Rural': Challenges and Implications for Nursing Research. Online J Rural Nurs Health Care [Internet]. 2005 [cited 2019 Oct 19]; 4(2):61 77. https://bit.ly/35G8kh2.
https://bit.ly/35G8kh2... ^,2929. Anjos FS dos, Caldas NV. From measuring the rural to the rural made to measure: social representations in perspective. História Ciênc Saúde-Manguinhos. 2014; 21(2):385-402. DOI: 10.1590/S0104-59702014000200002.
https://doi.org/10.1590/S0104-5970201400... ; the "associations of age, the geography of diseases, gay and lesbian ghettos; the itinerant lifestyles of some communities (elder travellers, gypsies, etc.); social conflicts between non-agricultural populations within the rural setting; the division of public and private spaces in rural areas" ¹⁸18. Ávila-Sánchez H. Tendencias recientes en los estudios de Geografía rural. Desarrollos teóricos y líneas de investigación en países de América Latina. Investig Geográficas Bol Inst Geogr UNAM [Internet]. 2015 [cited 2019 Sep 24]; (88):75-90. https://bit.ly/3p1lug4.
https://bit.ly/3p1lug4... and gender constructs ³⁰30. Gomes R de CM, Nogueira C, Toneli MJF, Gomes R de CM, Nogueira C, Toneli MJF. Mulheres em contextos rurais: um mapeamen-to sobre gènero e ruralidade. Psicol Amp Soc. 2016; 28(1):115-24. DOI:10.1590/1807-03102015v28n1p115.
https://doi.org/10.1590/1807-03102015v28... . With regards to gender constructs, works are focused on agricultural labor roles, post-colonialist forms of politic ecology and community forms of resistance, reflected through movements such as La Vía Campesina or Anti-GMOs Movements ¹⁸18. Ávila-Sánchez H. Tendencias recientes en los estudios de Geografía rural. Desarrollos teóricos y líneas de investigación en países de América Latina. Investig Geográficas Bol Inst Geogr UNAM [Internet]. 2015 [cited 2019 Sep 24]; (88):75-90. https://bit.ly/3p1lug4.
https://bit.ly/3p1lug4... .

It is important to note that peasant movements, analyzed from the point of view of class conflicts in rural areas, are permeated by confrontations of several actors, which range from everyday forms of resistance to conflicts at a large scale, such as land conflicts. Also, there is a convergence of some movements that emerged due to problematics of land leasing, taxes, the deterioration of life conditions, social injustice and/or war. They often are part of greater movements for national liberation and social revolution, taking some evident historical and local specificities under consideration. As for counter-movements involved in agricultural matters, Bernstein ³¹31. Bernstein H. Dinámicas de clase y transformación agraria. Primera. Ciudad de México D.F.: Universidad Autónoma de Zacatecas. Red Internacional de Migración y Desarrollo; 2012. identifies them as an emergent field of analysis.

Regarding socio-cultural definitions, Halfacree ³²32. Halfacree K. Locality and social representation: Space, discourse and alternative definitions of the rural. J Rural Stud. 1993 Jan 1; 9(1):23-37. DOI: 10.1016/0743-0167(93)90003-3.
https://doi.org/10.1016/0743-0167(93)900... states that they vary according to the type of environment where people live; therefore, there is a correlation between the social and spatial features that influence studies on rural matters.

III. Economic thinking: From peasant economy to the notion of growth

An epistemological approach of economic thinking was born in the nineteenth and twentieth centuries. According to García & Montiel ³³33. García EVB, Montiel AGC. La teoría económica y la epistemología. ECONÓMICAS CUC [Internet]. 2016 Jul 1 [cited 2020 Apr 13]; 37(1):9-42. DOI: 10.17981/econcuc.37.1.2016.01.
https://doi.org/10.17981/econcuc.37.1.20... , this discipline moves through approaches from realism to constructivism. On economy branches, particularly peasant economy, Alexander Chayanov was one of the first authors to mention this concept in the first half of the twentieth century, since he stated that the farmer's system of production is an independent system of production, with a different rationality to that of the capitalist system ³⁴34. Chayanov A. Chayanov y la teoría de la economía campesina. México D. F.: Siglo XXI editores S.A.; 1987.. Currently, Ber-nestein's ³¹31. Bernstein H. Dinámicas de clase y transformación agraria. Primera. Ciudad de México D.F.: Universidad Autónoma de Zacatecas. Red Internacional de Migración y Desarrollo; 2012. postulates, which establish the concept of peasant class, and Van der Ploeg's ³⁵35. Ploeg JD van der. Nuevos campesinos. Campesinos e Imperios alimentarios. 1a ed. Barcelona: Icaria editorial; 2010. notion of food empires are the most widespread alternatives for the analysis of globalization at localized ruralities in Latin America.

Another alternative with an empirical and descriptive character is the index of rurality, aimed at creating gradients by using the contrast of two or more indicators, such as the place of residence, and the level of income or the economic activities, as well as the number of inhabitants, among others ³⁶36. Gaudin Y. Nuevas narrativas para una transformación rural en América Latina y el Caribe. La nueva ruralidad: conceptos y medición [Internet]. Ciudad de México D.F.: Comisión Económica para América Latina y el Caribe (CEPAL); 2019 [cited 2019 Oct 19]. (Documentos de Proyectos). Report No.: (LC/TS.2019/45-LC/MEX/TS.2019/9). https://bit.ly/3nWTc5r.
https://bit.ly/3nWTc5r... ; it becomes a comparative or relative measure of a community ³⁷37. Minore B, Hill ME, Pugliese I, Gauld T. Rurality literature review. Centre for Rural and Northern Health Research; 2008.. In Colombia, the recommendation of the Organization for Economic Co-operation and Development (OECD) was adopted; the National Planning Department, through the mission for rural transformation, directed by Jose Antonio Ocampo, established the index of rurality, based on the rurality criteria of urban systems, population density and population relations ³⁸38. Programa de las Naciones Unidas para el Desarrollo (PNUD). Colombia rural. Razones para la esperanza. Informe Nacional de Desarrollo humano 2011 [Internet]. Bogotá: INDH/ PNUD; 2011 [cited 2018 Jul 3]. https://bit.ly/3bJQDkE.
https://bit.ly/3bJQDkE... ^,3939. Departamento Nacional de Planeación [DNP]. El campo colombiano: Un camino hacia el bienestar y la paz. Informe detallado de la misión para la transformación del campo [ Internet]. Nuevas Ediciones S.A. Bogotá: Departamento Nacional de Planeación; 2015 [cited 2019 Jun 16]. https://bit.ly/2LvuFqW.
https://bit.ly/2LvuFqW... .

Additionally, the analysis of social capital and the configuration of social networks and relationships contribute to the evaluation of rurality dynamics ⁴⁰40. Lee J, Árnason A, Nightingale A, Shucksmith M. Networking: Social Capital and Identities in European Rural Development. Sociol Rural. 2005; 45(4):269-83. DOI: 10.1111/j.1467-9523.2005.00305.x.
https://doi.org/10.1111/j.1467-9523.2005... , as well as its political processes and identities ⁴¹41. Cruickshank J. Protest against centralisation in Norway: The evolvement of the goal for maintaining a dispersed settlement pattern. Nor Geogr Tidsskr. 2006; 60(3):179-88. DOI:10.1080/00291950600889954.
10.1080/00291950600889954... . Likewise, rurality is integrated to the analysis of economic relations: political economy, the Actor-Networks theory and the theories of innovation and learning processes ⁴²42. Murdoch J. Networks: a new paradigm of rural development? J Rural Stud. 2000; 16(4):407-19. DOI: 10.1016/S0743-0167(00)00022-X.
https://doi.org/10.1016/S0743-0167(00)00... .

In view of the above, the economic thinking generated the idea of rural growth, which emerged after the end of World War II and reached its peak in the first decade of the twentieth century. According to Pachón, et. al. ⁴³43. Pachón Ariza F, Bokelmann W, Ramírez-M C. Rural development thinking, moving from the green revolution to food sovereignty. Agron Colomb [Internet]. 2016 [cited 2019 Oct 26]; 34(2):267 76. https://bit.ly/35IajSc.
https://bit.ly/35IajSc... , two approaches are involved in the debate about rural growth: a technocratic one (focused on food production through the Green Revolution) and a contemporary one (centered on people and the social inclusion of the rural population). For the latter, particularly in Latin America, a perspective of new rurality was proposed, which constitutes a new conception on the multidimensionality of globalization from the point of view of sustainability ⁴⁴44. Llambí-Insua L, Perez-Correa E. Nuevas ruralidades y viejos campesinismos. Agenda para una nueva sociología rural latinoamericana. Cuad Desarro Rural [Internet]. 2007 [cited 2020 Apr 12]; 4(59):37-61. https://bit.ly/2KpFFpe.
https://bit.ly/2KpFFpe... . Additionally, it is important to highlight the debate about land distribution and the agrarian structure and reform that has taken place during the twentieth century in Colombia, which has been promoted by authors such as Absalón Machado, Jesús Antonio Bejarano, Orlando Fals Borda and Darío Fajardo. This debate has discussed issues on rural poverty and land tenure within the complex Colombian context, in relation with social inequalities and conflicts.

IV. Demography

Demography describes the distribution of populations with statistical purposes. It is generally used as a criterion to evaluate rurality by entities such as the National Center for Health Statistics in the United States (NCHS) ⁴⁵45. Smith ML, Dickerson JB, Wendel ML, Ahn S, Pulczinski JC, Drake KN, et al. The Utility of Rural and Underserved Designations in Geospatial Assessments of Distance Traveled to Healthcare Services: Implications for Public Health Research and Practice. J Environ Public Health. 2013; 11(2013). DOI:10.1155/2013/960157.
https://doi.org/10.1155/2013/960157... , the Canadian Statistical Agency ⁶6. Racher FE, Vollman AR, Annis RC. Conceptualizations of 'Rural': Challenges and Implications for Nursing Research. Online J Rural Nurs Health Care [Internet]. 2005 [cited 2019 Oct 19]; 4(2):61 77. https://bit.ly/35G8kh2.
https://bit.ly/35G8kh2... , or the Rural Urban Classification of rural settlements in the United Kingdom ³⁷37. Minore B, Hill ME, Pugliese I, Gauld T. Rurality literature review. Centre for Rural and Northern Health Research; 2008.. In Colombia, the National Department of Statistics adopted census distributions and established the categories of major municipality, center of population and dispersed rural settlements ⁴⁶46. Departamento Nacional de Estadística (DANE). Conceptos Básicos [Internet]. 2011 [cited 2019 Jun 14]. https://bit.ly/3qhMfgK.
https://bit.ly/3qhMfgK... .

Some authors identify as main limitations ⁴⁵45. Smith ML, Dickerson JB, Wendel ML, Ahn S, Pulczinski JC, Drake KN, et al. The Utility of Rural and Underserved Designations in Geospatial Assessments of Distance Traveled to Healthcare Services: Implications for Public Health Research and Practice. J Environ Public Health. 2013; 11(2013). DOI:10.1155/2013/960157.
https://doi.org/10.1155/2013/960157... ^,4747. Johansen PH, Nielsen NC. Bridging between the regional degree and the community approaches to rurality-A suggestion for a definition of rurality for everyday use. Land Use Policy. 2012; 29(4):781-8. DOI: 10.1016/j.landusepol.2011.12.003.
https://doi.org/10.1016/j.landusepol.201... ^,4848. Hermi-Zaar M. El análisis del territorio desde una 'totalidad dialéctica'. Más allá de la dicotomía ciudad-campo, de un 'par dialéctico' o de una 'urbanidad rural'. Rev Bras Geogr Económica [Internet]. 2017 [cited 2019 Sep 15]; V(10). https://bit.ly/3qqs5Bb.
https://bit.ly/3qqs5Bb... the assumption of a false dichotomy between urban and rural areas that underlies population distribution classifications, which makes them insufficient. Additionally, this ignores the variability in important characteristics of the communities who live outside large urban centers or in what could be called the commuting factor, which defines territories that can be regarded as urban, but that may include extremely rural regions lacking the services available in the metropolitan region ⁶6. Racher FE, Vollman AR, Annis RC. Conceptualizations of 'Rural': Challenges and Implications for Nursing Research. Online J Rural Nurs Health Care [Internet]. 2005 [cited 2019 Oct 19]; 4(2):61 77. https://bit.ly/35G8kh2.
https://bit.ly/35G8kh2... . Also, Burawoy, as cited by Johansen and Nielsen ⁴⁷47. Johansen PH, Nielsen NC. Bridging between the regional degree and the community approaches to rurality-A suggestion for a definition of rurality for everyday use. Land Use Policy. 2012; 29(4):781-8. DOI: 10.1016/j.landusepol.2011.12.003.
https://doi.org/10.1016/j.landusepol.201... identifies three contextual fallacies (ignoring, reifying and homogenizing the world beyond the field site) and three dynamic fallacies (viewing the field site as eternal, treating the present as a point of arrival rather than a point of departure and, wishful).

Contributions from the Colombian context

There are two epistemological concepts that are transverse to the study of ruralities: time and space. Therefore, the multiple theoretical approaches allow us to elucidate the relevance of rurality as a historical, social, economic, political, and cultural phenomenon that goes beyond territorial or population disaggregation.

The identification of the terms rural, agrarian, and agricultural was a result of the industrial revolution, due to the functional specialization of the rural setting for supplying food within the urban-industrial society. Among our complex and globalized societies, the terms rural, agrarian and agricultural need to be clearly distinguished, as rurality refers to a wider lens, based on the construction of identities, representations, imaginaries, territories and lifestyles that are geopolitically localized; it is precisely in this last setting where the term agrarian is established, meaning the economic production model that seeks to change surplus value to a lifestyle that is closely related to production and sustainability. Therefore, at the heart of rural societies, as Van der Ploeg proposes, there are different agrarian classes that depend on the economic model that has been established: the peasant classes and the industrial or capitalist classes. It is in these types of settings where we should consider the interconnections with the environment, culture, and society. Finally, the term agricultural refers to the associations with land use and, more precisely, to the activities that are specific of cultivation, which are not linked to forestry.

In view of the above, rurality is not a diaphanous analytic category that can be distilled from a single discipline. Therefore, a transdisciplinary analysis is needed, which can evidence its complexity in our societies nowadays, as rurality has been used as an adjective (rural health, rural economy, rural sociology, rural geography), due to the influence of hegemonic and sectorial factors. Within the Colombian context, the dilemmatic nature of rurality definitions has generated a dramatic impact in agrarian reform processes, a lack of preciseness in approaches to corporate and peasant agriculture, and a poor contribution to governmental policy making for peasantry ³⁵35. Ploeg JD van der. Nuevos campesinos. Campesinos e Imperios alimentarios. 1a ed. Barcelona: Icaria editorial; 2010..

In public health, rurality as an analytic category requires an acknowledgement of the post-conflict scenario ⁴⁹49. García-Balaguera C. La salud como derecho en el postconflicto colombiano. Rev Salud Pública. 2018; 20(6):771-7. Disponible en: https://bit.ly/3pKUulG.
https://bit.ly/3pKUulG... , not only to overcome the barriers to healthcare access in rural areas, but to reconsider the goals of the health system in order to identify individuals' particularities, financing alternatives and the role of both healthcare professionals and non-medical personnel. It is also necessary to formulate new approaches to community participation that eliminate the restrictions imposed by current regulations and incorporate community as an essential element of the health system. Other fundamental aspects involve the mental health of victims and ex-combatants, policies for social protection in rural areas of the country and the conservation of the practices and knowledge of peasant women.

The acknowledgement of the importance or rurality for resources, regulations, political and personal decision-taking, the world vision, and interaction patterns with other people implies that education programs in public health must incorporate the study of ruralities and lore in their curricular plans.

In this view, establishing the euphemism "rural health" within the Colombian context implies persisting in a perspective that denies the vindications of territory and territorialities that are emerging in Latin America and Colombia, and which advocate for the character of social construct that rurality has as an analytical category for public health.

The following points was identified as emergent topics throughout this essay:

A further aspect to integrate is the concept of agrarian structure, which influences the notion of rurality, as it is a synergy of the economic and sociological postulates. Likewise, we still must examine the epistemological view of the relation among ecology, economy and geography ¹⁹19. Toledo VM. Metabolismos rurales: hacia una teoría económico-ecológica de la apropiación de la naturaleza. Revibec [internet]. 2008 [cited 2019 Sep 24]; 7:1-26. https://bit.ly/35FZUGz.
https://bit.ly/35FZUGz... ^,5252. Porto-Gonçalves CW. Lucha por la Tierra. Ruptura metabólica y reapropiación social de la naturaleza. Polis Rev Latinoam [Internet]. 2016 Nov 11 [cited 2020 Apr 12]; (45). https://bit.ly/3soeDQ2.
https://bit.ly/3soeDQ2... , in terms of the positions and ruptures that nature requires.

To conclude, considering rurality as an analytical category within the field of public health requires to understand the new political orders of our society, which originate from the existence of narratives that diverge from those that have been already stablished and demand new dialogs and the recognition of the socio-territorial diversity of rurality ⁵³53. Floriani N, Ríos FT, Floriani D. Territorialidades alternativas e hibridismos no mundo rural: resiliência e reproduçao da sociobiodiversidade em comunidades tradicionais do Brasil e Chile meridionais. Polis Santiago. 2013;12(34):73-94. DOI:10.4067/S0718-65682013000100005.
https://doi.org/10.4067/S0718-6568201300... . The consistent talk about "rural" matters implies a conceptual distortion inherited from the imposition of growth and/or the westernization of territory as a construct ♣

Acknowledgments:

This text constituted the author's qualification exam to opt for the candidacy for doctorate in Public Health of National University of Colombia. The author would like to thank the evaluators of this process.

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