Need for Addressing Social Determinants of Health in Rural Communities

Social determinants of health (SDOH) are closely linked with health outcomes. Research shows that factors like unemployment, poverty, and food insecurity are associated with higher mortality rates in the United States. In addition, SDOH can influence and contribute to chronic health conditions such as obesity, diabetes, and heart disease. For example, people who have low incomes may be more likely to lack access to nutritious foods and experience higher rates of obesity. People with low incomes may also face several barriers to accessing healthcare, including a lack of health insurance.

SDOH contribute to rural health disparities, or differences in health status or outcomes when compared to the overall population, often related to social and economic factors that negatively impact health. Examples of SDOH in rural communities include:

Access to Healthcare

Healthcare workforce shortages and long distances to provider offices, specialists, and emergency services limit access to care in many rural communities. Rural residents are also more likely to lack health insurance, which poses barriers to accessing needed care.

Access to High-Quality Education

Access to high-quality education from early childhood to adulthood has a significant positive impact on health and well-being later in life. For rural communities, addressing education outcomes presents unique considerations. These include approaches for ensuring access to early childhood programs, improving the quality of K-12 programs, and strategies for increasing college graduation rates. A key consideration, however, is that rural residents who leave their communities for four-year colleges often do not return to work locally, potentially limiting the community-wide benefits tied to higher education levels. Another issue in rural areas is limited broadband access, which can limit opportunities for online learning.

Broadband and Technology Access

In 2022, approximately 28% of people in rural areas lacked access to fixed broadband services. Lack of access to high-speed internet can limit opportunities for work, education, healthcare, and other services. For more information, see the Telehealth and Health Information Technology in Rural Healthcare topic guide.

Environmental Exposures

Rural communities can face specific environmental health challenges, including unsafe drinking water and exposure to potentially dangerous substances unique to rural environments and occupations.

Healthy Food Options

In rural and frontier areas of the country and on reservations, residents are more likely to live in areas with low access to food and may have to travel many miles to access healthy food. In 2023, the United States Department of Agriculture Economic Research Service reported that 15.4% of rural households were food insecure, indicating limited or inconsistent access to adequate and nutritious food.

Poverty

The USDA Economic Research Service's Rural Poverty & Well-Being topic page classifies a county as having persistent poverty if 20% or more of the population in that county has lived in poverty since 1980. Of the 353 persistent-poverty counties in the United States, 85% (301 counties) were rural. The rural counties with persistently high poverty rates account for over 15% of all rural counties in the U.S. While poverty rates in rural areas have historically been higher than in urban areas, the disparity between rural and urban poverty is decreasing. In 2022, the rural poverty rate was 15.5%, compared to the urban rate of 12.1%.

Social Connectedness and Civic Engagement

Social connection is a key factor in individual health and community well-being. Low levels of social connection are associated with an increased risk for disease, poor mental health, and premature death. Social connection may also impact educational attainment, workplace satisfaction, and economic status. Higher levels of social connection are associated with greater health, resilience to natural disasters, safety, economic prosperity, and civic engagement. Rural areas have unique barriers to social connection and civic engagement, including limited transportation, internet access, and civic infrastructure.

Transportation

Rural communities face greater transportation barriers when compared to non-rural populations. These barriers include greater travel distances to access healthcare, fewer public transit options, and greater reliance on personally owned vehicles for transportation. However, for individuals who do not have access to a vehicle, transportation can be a major barrier to obtaining healthcare, nutritious food, and other important resources. For more information about transportation as a rural social determinant of health, see the Rural Transportation Toolkit.

Resources to Learn More

Rural Data Explorer
Map/Mapping System
Interactive map providing state- and county-level data on various health indicators, including demographics, healthcare workforce, healthcare access, SDOH, and more. Allows users to compare data from metro and nonmetro counties across the U.S. and within a state.
Organization(s): Rural Health Information Hub

Social Determinants of Health
Document
Explores the SDOH in rural communities and discusses challenges rural communities face when planning and implementing programs and policies to address issues related to the rural SDOH. Covers strategies and offers policy recommendations to help address rural needs.
Organization(s): National Advisory Committee on Rural Health and Human Services
Date: 1/2017