Background:  Providing health care that considers environmental determinants of health, environmental impact on health, and outcomes attributed to environmental issues is complex due to the need for providers to be competent not only in social and health sciences, but also in environmental health concepts.

Purpose:  The purpose of this study was to develop a set of basic environmental health competencies that are needed by all rural primary care providers.

Methods:  Using established discipline specific competencies, as well as expert stakeholder knowledge, a competency guide was developed during a consensus conference. The competencies were rigorously evaluated in phase two of the study by additional clinicians, academics and experts in the areas of clarity, content validity and applicability to the rural primary care provider. The guide was further refined through consensus of the original developers.

Results:  The final competency guide delineates key environmental health competencies for rural primary care providers. A primary care framework of assessment, diagnosis, management and evaluation organizes the competencies by levels of care and influence for the rural primary care provider; the individual, the family and community, and the health care system. Key definitions of terms are provided.

Policy and Future Implications:  The integration of the key environmental health competencies into current and future entry level and professional continuing education programs for rural primary care providers will be an essential policy direction. Environmental health competencies should be included in accreditation standards for all programs preparing primary care providers. Future research should test the relationship of competency development in environmental health in primary care providers to health outcomes in rural communities.