James E. Rohrer, Ph.D., Professor and Chair, Department of Health Services, Research and Management, Texas Tech University Health Sciences Center, Lubbock, Texas

The articles published in the Texas Journal of Rural Health address a variety of topics. Most, however, fall into the four categories we usually associate with the determinants of health: environmental hazards, biology, lifestyle, and health care. For those of us who love order in our lives, this kind of neatness is a joy to behold.

In this issue, David Straus reports on the consequences of mold exposure in buildings. Many homes and workplaces could contain fungi that generate products that negatively affect our health. This is not strictly a biochemical problem, since the decisions people make about the quality of their housing are influenced by socioeconomic circumstances. Certainly, the decisions building owners make about investing in the prevention and cleanup of potential hazards are influenced by economic factors. One might almost say that living or working in housing that is susceptible to hazards is a "lifestyle" issue, but obviously this is something about which many people do not have much choice.

Lifestyle is addressed directly in Josie O'Quinn's article about health-related behaviors. She documents the fact that unhealthy lifestyles are common among the rural health providers whom she studied. This is more than a lifestyle issue affecting the health of rural providers. The behaviors of health care providers set an example for their patients and others in the community. Certainly, advising patients to clean up their acts would be difficult if the provider has the same problems. Therefore, exhibiting unhealthy lifestyles may be an attribute of the rural health care system that contributes negatively to community health. On the other hand, if providers cannot follow lifestyle recommendations, are they perhaps unrealistic for the general public? Here lies food for thought.

Herbal medication usage by Mexican-Americans who have Type 2 diabetes is a biological issue, but also one that is directly relevant to health care delivery. Alternative medicines can interact negatively with prescribed medications, so physicians should be aware of what their patients are taking on the side. Besides, some alternative medicines may be effective. Responsiveness to the rural consumer requires that the doctor "meet them where they live" by at least considering the possibility that active involvement in the patient's use of herbal medications is a rational and respectful way to work in partnership with patients.

Being respectful of patients' tastes and preferences is a place where community health workers and marketing managers in health care organizations can come together. Borders and Rohrer analyze the patterns of service use of an oft-forgotten market segment: adult men. How would rural health care delivery look if some services were organized so as to be responsive to male consumers? This is a health care issue, but it must be addressed in a fashion that is informed by awareness of gender-related differences in lifestyles.

These four manuscripts demonstrate that the four determinants of health (lifestyle, environment, biology, and health care) inevitably are inter-connected. My goal of an orderly world where things fit into boxes is foiled again. Life is not as simple as we sometimes wish. That includes rural health.