You'd better think twice about living in a rural area if you are a high-risk mother, a high-risk infant, an AIDS patient, an elderly person with chronic health problems or the victim of an accident.

Two of the nation's leading health groups are warning of the dangers, decrying the state of rural health care and calling for a series of specific solutions for improving the situation.A deteriorating health care system, worsened by a failing rural economy, is described in a new report, "Health Care in Rural America: The Crisis Unfolds."

The report, commissioned by the National Rural Health Association and the National Association of Community Health Centers, highlights the critical need for health services, hospitals, physicians and nurses - problems that have been exacerbated by the steady decrease in their availability.

The findings are also endorsed by a number of other organizations, including the Association for Utah Community Health.

"This state is not adequately serving the health needs of its rural citizens," said Mary Thompson, Utah Community Health executive director. "The result of limited and inadequate care is a rural population that needlessly suffers from chronic disease and conditions that could often have been prevented with improved access, intervention and an adequate number of medical providers."

Thompson said Utah has a list of more than 80 openings statewide of all levels of medical providers, including physicians and nurses. They are especially needed in rural areas.

The crisis, Thompson said, is particularly serious for those with more than the most basic health problems.

The report looks at the high rate of infant mortality as one example of the poor state of health care in rural America. The United States as a nation has declined from sixth to a tie for last place among 20 industrial nations in combating infant mortality, and within this country, rural Americans have rates higher than their white and minority counterparts in urban areas.

The national report concludes that the health care systems of rural America are inadequate to serve the needs of those who depend on them, citing problems such as:

-Three-quarters of the rural poor do not qualify for public assistance.

-Rural residents have a 15 percent higher uninsuredness than the U.S. average, and a 24 percent higher rate than their metropolitan counterparts. This leads to a cash drain on the rural family; rural residents pay, on average, 1 percent more of their income out-of-pocket for health care than their urban counterparts.

-At a time when rural needs for physicians are high, the National Health Service Corps, an important source of physicians for rural areas, is being dismantled. Thompson said this could further cripple health care in rural Utah.

Thompson agrees with these specific recommendations for federal and state policymakers in the report:

-Reform that would make it more efficient to recruit and retain health care providers in rural areas.

-Pursuit of public/private initiatives designed to provide health insurance coverage for the growing number of Americans without health coverage.

-Development of model legislation and strategies to encourage states to address the malpractice insurance crisis and its negative impact on access to obstetrical services and infant mortality.

-Development of programs for rural areas to address public health problems such as AIDS and infant mortality.

The National Rural Health Association is a national membership organization of individuals and organizations with an interest in rural health. Its members include administrators, researchers, doctors, nurses and other health professionals from hospitals, community and migrant health centers, private practices, universities and units of government.