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Rural Health Information Hub

Need for Addressing Social Determinants of Health in Rural Communities

Compared to their non-rural counterparts, people living in rural areas have higher rates of unemployment, lower educational attainment, and less access to healthcare and social services. These factors directly affect an individual's health and well-being. Rural residents face several documented health disparities. For example, rural residents are more likely to have chronic diseases such as heart disease, obesity, and diabetes, in comparison to non-rural residents. Social and environmental factors have contributed to decreased life expectancy in rural areas, with the gap between rural and urban life expectancy widening since the 1990s. In addition, children's health outcomes are worse in rural areas, with higher infant and child mortality.

Several social, environmental, economic, and physical factors in rural communities affect the conditions in which rural residents grow up, live, work, and age.

Access to Healthcare

The closure of rural hospitals 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 live without health insurance, which poses barriers to accessing needed care.

Transportation Barriers

People in rural communities often have to travel farther to healthcare appointments and to access health and social services. Furthermore, they face greater transportation barriers when compared to non-rural populations. For more information about transportation as a rural social determinant of health, see the Rural Transportation Toolkit.

Limited Healthy Food Options

Recent estimates suggest that 2.3 million rural residents live in food deserts. In frontier areas of the country and on reservations, residents are more likely to live in food deserts and may have to travel many miles to access healthy foods. In many rural locations, local grocery or convenience stores have limited food options.

Lack of Access to Broadband and Other Technology

Approximately 40% of rural communities lack access to broadband. Lack of access to high-speed internet can limit opportunities for work, education, healthcare, and other services.

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.


As of 2010, 64% of counties designated as noncore counties (meaning they have a population of less than 10,000 people) were also classified as:

persistent poverty counties, or counties in which 20% or more of the population was living in poverty over the last thirty years.”

Historical Trauma

In many tribal communities, the impact of historical trauma, such as the loss of land and policies of segregation and discrimination, have had a lasting influence on community health and well-being, and have limited the ability of families to accrue assets.

For more information on how the social determinants of health impact rural residents, see the Social Determinants of Health for Rural People topic guide.

Resources to Learn More

Health Equity in Rural Communities
Describes health equity, and discusses the challenges and opportunities for improving health equity and how experiences in New Mexico, Colorado, and nationally can be applied to other rural communities.
Organization(s): The Colorado Trust, Con Alma Health Foundation, National Center for Frontier Communities
Date: 7/2015

Rural Healthy People 2020, Volume 1 and Volume 2
Explores the rural context for goals and objectives put forth in Healthy People 2020. Outlines research identifying priority health issues in rural areas, and provides suggestions for addressing these health disparities.
Organization(s): Southwest Rural Health Research Center, Texas A&M University

Social Determinants of Health
Provides an overview of the social determinants of health in rural communities and offers policy recommendations to help address rural needs.
Organization(s): National Advisory Committee on Rural Health and Human Services
Date: 1/2017

Understanding Rural Communities
Describes an initiative to improve mental health and well-being by addressing SDOH in parts of rural Texas. Emphasizes the elements of rural culture and the differences inherent in rural communities that can be challenging for implementing mental health programs.
Author(s): Galante, E.
Organization(s): Hogg Foundation for Mental Health
Date: 7/2018

Understanding the Social Determinants of Health: A Self-Guided Learning Module for Rural Health Care Teams
Helps rural providers and care teams learn more about the impact of SDOH on patient care, and enables them to improve health outcomes by identifying and addressing the social and root factors in their communities contributing to SDOH.
Organization(s): Rural Policy Research Institute, Stratis Health
Date: 3/2016