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Food Access and Unique Populations in Rural Communities

Food insecurity is associated with a wide array of negative health outcomes, particularly in specific populations that are at increased risk of adverse outcomes. This module will highlight four such groups: children, seniors, people with disabilities, and immigrants and refugees.

In 2013, the Rural Monitor highlighted existing programs providing food assistance to adults and children in the article Food Programs Aim to Help Specific Populations: Rural Elderly and Children Often the Most Vulnerable to Hunger.


While hunger has negative health consequences unacceptable in any population, the effects are particularly devastating among children. Lack of adequate nutrition can cause delays in children's physical, intellectual, and emotional development. These impairments can result in consequences to their health, education, and in the long-run, earning potential.

Households with children are more likely to report being food insecure than households without children. Although the average median income is slightly higher in households with children, they may experience greater financial limitations resulting from larger household sizes and the expense of childcare. The USDA found that 3.1 million households (8%) had children who experienced low or very low food security at some time in 2016, and 15% of food insecure households were located in rural communities.

Models of school-based programs targeting children can be found in Module 2. Examples of other food assistance programs targeting children are listed on RHIhub’s Rural Hunger and Access to Healthy Food topic guide.


1.2 million (9%) American households headed by seniors living independently faced food insecurity in 2015. Rural communities are largely comprised of seniors who are 65 years or older. This trend is projected to continue as the number of older Americans continues to rise over the next four decades.

Seniors are particularly vulnerable to severe health implications resulting from food insecurity. Most seniors have at least one chronic health condition and more than 25% are simultaneously caring for multiple conditions. Some of the most common diagnoses are diet-influenced, such as cardiovascular and cerebrovascular disease, diabetes, osteoporosis, and cancer. Proper nutrition is an important aspect of appropriately treating these and other ailments. Therefore, while the overall quantity of nutritional intake may generally decline with age, an increase in specific essential nutrients found in healthy foods may be necessary.

For both ailing and strong seniors, good nutrition and food security are critical to support healthy aging. Adequate food is associated with optimal nutrition intake and better health outcomes. Many seniors qualify for the Supplemental Nutrition Assistance Program (SNAP, formerly known as food stamps) benefits that can help with food costs, but SNAP is substantially underutilized by this population. Please visit Food Assistance Programs in Module 2 for more information on SNAP.

Examples of other food assistance programs that target seniors are listed on RHIhub’s Rural Hunger and Access to Healthy Food topic guide.

People with Disabilities

Over 9 million people living in rural America have disabilities, and this number is growing. Working-age adults with disabilities are about twice as likely to live below the poverty line as adults with no disabilities, increasing the likelihood that they are not only food insecure, but suffer from very low food security. The issue is cyclical; not having access to healthy food can lead to physical and mental deficiencies, particularly in childhood. Having a disability, however, can lead to limitations in accessing and affording healthy food, which can lead to further maladies.

Additionally, having a disability is expensive and there are many competing demands on the budget, such as high medical costs, necessary adaptive devices, and the frequent concern about cutbacks in assistance. Social determinants also contribute to poverty levels, such as access to necessary services, social infrastructure, and structural ableism that restricts opportunities and livelihoods of disabled persons.

Immigrants and Refugees

The past several decades have shown a steady increase of immigrants and refugees in rural communities. This can be traced back to agriculture, meat packing plants, timber harvesting, and other industries that attract immigrant and migrant laborers relocating from urban to rural communities, and continues today. Immigrants living in rural communities are more likely to be Hispanic (54%) and non-Hispanic white (26%). Despite having comparatively high rates of employment, immigrants residing in rural communities are more likely to live in poverty (24%) than native-born rural residents (18%) in their communities.

New immigrants typically have lower rates of obesity and diabetes than the general U.S. population, but there is evidence that associates acculturation to the U.S. with poor diet and increased prevalence of obesity and diabetes, particularly among Latinos, who comprise the bulk of rural immigrants. This increased prevalence is largely attributable to changes in healthcare, physical activity, and diet.

Immigrants living in rural communities are less likely to be naturalized citizens, more likely to be working-age, and largely belong to the working poor economic class. In addition to geographic distribution of food retailers and lack of transportation, immigrant communities face additional hardships that contribute to household food security, including:

  • Language barriers
  • Lack of culturally appropriate foods
  • Minimal participation rates in federal assistance programs

The National Immigration Law Center has provided a detailed breakdown of federal programs that includes requirements to qualify for a variety of federal and state assistance programs.

Resources to Learn More

Elder Health in Rural America Policy Brief
Overview and analysis of the current state of rural communities and rural elder health. Makes policy recommendations based on a systems approach, incorporating elements such as sustainability, quality, and efficiency to create a functional and responsive system of care for rural elders.
Author(s): Hartman, R., & Weierbach, F.
Organization(s): National Rural Health Association
Date: 2/2013

Food Assistance Programs
Provides links to food and nutrition assistance programs funded by the federal government and administered by the Food and Nutrition Service (FNS).
Organization(s): U.S. Department of Agriculture

Map the Meal Gap 2016: Highlights of Findings for Overall and Child Food Insecurity
Reports findings on food insecurity, food banks, and food prices across the U.S. Includes discussions on county-level food insecurity, and breaks down data based on geography, income, homeownership, congressional district, and more. Maps and charts help visualize the data for easy comparison.
Organization(s): Feeding America
Date: 2016

Rural Childhood Obesity Prevention Toolkit
Collection of resources and programs designed to help policymakers, advocates, and community leaders advance ideas that will result in healthier rural children. Solutions focus on creating healthier rural communities through sound public policy and collaboration.
Author(s): Rockeymoore, M., Moscetti, C., & Fountain, A.
Organization(s): Leadership for Healthy Communities
Date: 9/2014