Challenges and Barriers to Addressing Social Determinants of Health in Rural Areas
Social determinants of health (SDOH) are especially complex to address in rural communities due to resource
limitations, cultural factors, and a lack of awareness about the ways social determinants affect health.
Rural communities often experience limited availability of resources and limited capacity to implement programs.
Due to low
population density, rural programs may also struggle to obtain philanthropic
funding to support programs. Resource challenges in rural areas also include healthcare staffing shortages. While approximately
one-fifth of Americans live in rural areas, the ratio of physicians to patients in rural regions is 1
Across the U.S., there is an assumption that personal
health choices — such as diet and exercise — and access to healthcare are the most important
contributors to a person's health. This belief may be more common in rural areas where independence and
self-determination are strong cultural values. However, this assumption does not take into account the social,
cultural, and environmental factors that contribute to health outcomes, such as access to healthy food options
in a community or a person's race and ethnicity. Therefore, cultural views toward personal health choices may
pose challenges when developing programs that focus on SDOH.
Some rural programs that focus on SDOH seek to connect residents to social services, such as food, housing, and
transportation assistance. However, rural residents may experience stigma or social pressures around seeking
certain services. For example, rural residents may feel concerned about stigma when seeking mental health services due to a lack of
anonymity in the community. Some populations, such as older adults, may be reluctant to ask for help with
transportation to a medical appointment for fear of being a burden, or appearing dependent on others.
Understanding rural cultural values can help to facilitate programs that focus on SDOH. For example, a focus
group of rural healthcare providers organized by the University of
Kansas found that rural residents are
more likely to reach out to a pastor or family member for
assistance with a health issue than a healthcare provider.
For additional information, see How does Rural
America differ from the nation as a whole, regarding the social determinants of health? on the Social
Determinants of Health for Rural People topic guide.
Resources to Learn More
Rural Culture is a Diversity
Describes the unique culture and context of rural communities. Suggests cultural considerations for mental
health providers who work in rural communities.
Author(s): Slama, K.
Organization(s): Minnesota Psychological Association