Is rural America hazardous to your health?


This article was contributed by Jon M. Bailey, former Rural Policy Program Director at the Center for Rural Affairs. You can reach him at

Those of us who live in rural America often proclaim its positive attributes and its extraordinary quality-of-life.

However, a recent article in HealthLeaders Media raises an interesting question based on extensive data and surveys of rural health care providers. Is rural America hazardous to your health?

The question is based on a finding that many of the health issues that plagued rural America a decade ago are still prevalent, and in many cases getting worse. Over the past several years the Center for Rural Affairs has documented these issues in a series of reports.

The most acute health issues vary by region of the country. But as the HealthLeaders Media article asserts, all important health concerns in rural America have an underlying issue of access. There simply are not enough rural health care providers and not enough economic wherewithal in rural America to adequately address the health care issues facing rural people.

This challenge is highlighted in the new Rural Healthy People 2020 report from the Texas A & M School of Public Health. The report is a follow-up to Rural Healthy People 2010.

Jane Bolin, senior editor of Rural Healthy People 2020, says the report finds that “many of the issues remain the same (from the Rural Healthy People 2010 report); many of the goals have not been met.” This is all despite the heroic efforts of many to improve health status in rural America.

The most important rural health care issues found in Rural Healthy People 2020 are:

  • Closure and potential closure of rural hospitals. The failure of many states with large rural populations to expand their Medicaid programs pursuant to the Affordable Care Act has hastened the financial difficulties experienced by many rural hospitals.
  • Nutrition and weight status of rural people. This issue was rated only #10 in the 2010 report.
  • Diabetes
  • Mental health and access to mental health services.
  • Substance abuse

All these health issues play out in an environment also containing a host of economic and social issues – generally higher poverty rates, older population, lower educational attainment, and a lack of well-paying jobs. All of these economic and social conditions – the so-called social determinants of health – have a direct influence on health and health status.

The health challenges facing rural America are not new and have not just recently been revealed. The same issues have existed for years, for decades. Based on data like that in Rural Health People 2020, many of these health challenges are getting worse rather than better.

This trend is not fair or just to rural Americans in a nation with the financial resources of the United States. Rural policymakers – state and federal – need to do better and place people above politics. As importantly, rural people need to advocate for themselves and their health.

At the end of the day, health policy issues are the most important issues we all face. Without a well-functioning health system working to make people healthier – no matter where one lives – everything else pales in comparison.