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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.

Resource Limitations

Rural communities often experience limited availability of resources and limited capacity to implement programs. According to the Association of State and Territorial Health Officials (ASTHO), rural health departments rely more heavily on clinical revenues and federal resources than do urban health departments. 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 to 2,500.

Rural Culture

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 Issue
Document
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
Date: 1/2004