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Due to universal health care coverage, it is hypothesized that Canada will have less of a rural/urban disparity in health outcomes compared to the United States. It is also hypothesized that Canada's decentralized, executive federalism offers more opportunity for public action to address rural health if the political will is present. The evidence reveals that the rural/urban disparity on many health outcomes is just as significant in Canada as in the United States. Regarding public action, Canada has not had a significant federal presence in rural health issues due to the lack of executive will at the federal level. The United States has more public action at the federal level but the policy is fragmented. Subnational governments play an important role in shaping rural health, but more so in the Canadian provinces. It is concluded that the similarities in rural health outcomes and public reaction between the two countries is largely a function of the rural social and economic environment in which the respective federal systems operate. [ABSTRACT FROM AUTHOR]