Health Disparities in Rural America

November 16th, 2022 | Viewpoint


Health care in rural communities is affected by great distances and demographic, economic, and structural characteristics that impede access and challenge quality and sustainability. November 17 is National Rural Health Day, a moment to reflect on the equity issues that affect the health of those who live in rural areas.  

Working with rural communities across the country, JSI is talking with specialists and using information in medical claims data to provide a detailed view of access to medical, dental, and mental health services.

Did you know?

  • While 97% of the total landmass of the United States is classified as rural, only 15% of the population lives in a rural area. (US Census)
  • Maine is considered to be the most rural state in the nation, with 61% of the population living in a rural area. (MPR)
  • The proportion of the population over age 65 is growing in all counties in the U.S., but that increase is most pronounced in rural counties where, on average, 18% of the population is age 65 or older compared to 13% in urban areas.
  • Rural residents are poorer than urban residents. The per capita income in rural areas in 2020 was $45,917, compared to national per capita income of $59,510.
  • Minority populations living in rural areas experience particularly high rates of poverty. In fact, the poverty rate is as high as 31% for African Americans in some rural areas of the country.

Rural Health Care Access

  • Access to medical care is more limited in rural areas. For example, the primary care provider to patient ratio in rural areas is 40/100,000, compared to 53/100,000 in urban areas.
  • Between 2010 and 2021,136 rural hospitals closed their doors, reducing access to care for people in rural communities. (AHA)
  • Fewer than 50% of rural counties have a health care facility with an obstetrical unit.
  • Rural residents on average travel 2-to-3 times farther to see medical and surgical specialists than those living in urban areas. (Journal of Rural Health)
  • While 90% of the U.S. population had high-speed internet access in 2019, only 72% of rural areas did. (US Census)

People living in rural areas experience significant health disparities due to limited access to health care providers and social services, transportation, employment opportunities, and healthy foods and activities.
Improving access to health care in rural communities:

  • Offer geriatrics training and build age-friendly health systems. Because population aging is more pronounced in rural areas than in urban communities, it is important to expand geriatric/gerontology training for rural primary care providers and support the development of “age-friendly health systems.” This will strengthen local systems and allow older rural residents to have their health needs met within their own communities.
  • Use rural networks to promote healthy living while strengthening social bonds. An asset in rural communities is the strength of social bonds. People know each other and often reach out in personal ways to help their neighbors. Those community networks can be used to increase awareness about healthy eating and physical activity and engage people in exercise programs, cooking classes, and other events that rely on strong social bonds.
  • Develop strong rural telehealth systems that partner with acute care systems. If you can’t get the rural patient to the provider, why not bring the provider to the patient…using telehealth? Rural primary care providers can develop partnerships with urban-based specialists and host telehealth visits with them. Telehealth partnerships support sophisticated care in rural places and engage all providers in a partnership for patient care.
  • Support health care providers by offering ECHO opportunities. Developed by the University of New Mexico, the ECHO Model® is an education and support framework where participants engage in a virtual learning community with peers outside their own geography. The “all teach, all learn” format facilitates sharing of best practices and builds a virtual support and education network for participants.
  • Grow your own health care workforce. Data has shown that health profession students who have lived and trained in rural areas are more likely to practice in them. Rural practices should be prioritized for funding to provide internships, fellowships, and residencies in multiple health care roles to engage local youth and provide real-world training opportunities.
  • Expand high-speed internet throughout the nation. This will connect rural residents and health care providers to medical information and services remotely and improve their overall health care.

By Margaret Frankhauser

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