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Rural Health Information Hub

Facilitators and Barriers to Advancing Health Equity in Rural Areas

Rural communities can leverage multiple strengths to advance health equity in their communities. The NORC Walsh Center for Rural Health Analysis' Exploring Strategies to Improve Health and Equity in Rural Communities report lists individual, organizational, community, and cultural assets that can contribute to positive change. These include:

  • Rural residents who offer a range of skills, knowledge, and experiences
  • Rural organizations, including small businesses, anchor institutions, nonprofits, and community development financial institutions
  • Rural land-grant institutions
  • Rural natural resources that affect economic and community development, including food systems
  • Rural culture and history

To advance health equity, rural communities will also need to address critical barriers that affect the health and well-being of rural residents. In July 2020, the Committee on Ways and Means of the U.S. House of Representatives released the report, Left Out: Barriers to Health Equity for Rural and Underserved Communities. The report identified several rural challenges, including:

  • Low patient volume in rural communities, which creates difficulties for sustaining health system operations when insurance reimbursements are based on fee-for-service
  • Primary and mental healthcare workforce shortages, which limit opportunities for rural residents to access the care they need at the appropriate time
  • Systemic and institutionalized racism that contributes to disenfranchisement and underinvestment in communities that experience inequities
  • A range of non-healthcare factors, including food deserts, limited housing, poverty, structural racism, xenophobia, classism, and lack of transportation options
  • Lack of data to accurately assess disparities in rural communities, which can make it difficult to make a case for investing in programs that advance health equity

Other barriers to advancing health equity may include:

  • A lack of shared understanding of health equity across sectors that affects inequities, such as transportation, agriculture, housing, and community development.
  • A lack of inclusion of communities experiencing health inequities in decision-making and policy-making, which can lead to ineffective attempts to close gaps in health disparities.
  • A lack of healthcare providers who share the background of community members who experience health inequities, leading to issues like ineffective communication.
  • A lack of resources and infrastructure to address root causes of health inequities. For example, approximately 22% of rural Americans and 28% of people who live on tribal lands lack access to broadband internet. Broadband has been shown to foster economic growth, improve access to education, and facilitate access to telehealth services. The Social Determinants of Health Toolkit provides additional information about resource limitations.

Resources to Learn More

Advancing Health Equity: Addressing the Role of Structural Racism
Describes the effects of structural racism on health equity for communities of color. Provides examples of public policies contributing to residential segregation and restrictive Medicaid work requirements. Discusses the lack of access to health insurance influencing maternal health outcomes for women of color.
Organization(s): National Partnership for Women and Families
Date: 5/2019

Evaluating Telehealth Adoption and Related Barriers Among Hospitals Located in Rural and Urban Areas
Examines the adoption of telehealth in rural, micropolitan, and metropolitan area hospitals. Identifies barriers to adopting telehealth in rural areas when compared to urban areas and includes data to support these findings.
Author(s): Chen, J., Amaize, A., & Barath, D.
Citation: Journal of Rural Health, 37(4), 801-811.
Date: 11/2020

Health Equity Challenges in Rural America
Discusses multiple factors contributing to health inequities in rural communities, including healthcare infrastructure, hospital closures, and workforce shortages.
Author(s): Ziller, E., & Coburn, A.
Citation: Human Rights Magazine, 43(3)
Date: 8/2018