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Resource Considerations for Rural Programs Addressing Social Determinants of Health

Rural areas often experience additional barriers to addressing social determinants of health (SDOH). In particular, rural areas face challenges providing resources, such as transportation, and other social services, such as afterschool programs. Addressing SDOH in rural areas may therefore require more thoughtful planning and the development of innovative funding solutions.


Lack of sufficient funds to address SDOH is a common issue among rural communities. Recent research has focused on how flexible funding strategies, such as braiding and blending, have the capacity to improve both community health and economic mobility. Blending refers to the pooling of two or more funding sources to fund a program or initiative, while braiding protects each funding stream's connection to its original source.

Many healthcare programs that aim to address SDOH operate and are funded in silos, which can be a challenge. Funding opportunities for programs looking to address SDOH often focus on one type of social determinant and prevent resource allocation for competing problems. Additionally, funding may come with varying requirements, creating barriers to data integration and program coordination efforts.

Another funding challenge that programs may experience relates to reimbursement for certain healthcare services. Community health workers (CHWs), patient navigators, and other healthcare providers are essential in connecting people to services to help address SDOH. However, reimbursement structures typically do not allow for CHW payment codes. Identifying alternative funding sources is crucial to maintain CHW and patient navigator services. The Rural Community Health Workers Toolkit compiles funding considerations to sustain these types of programs.


In many rural areas, providing sufficient transportation is important to fostering community health. However, transportation comes at a large cost for many small, remote areas. For example, some remote areas may only be accessible by a boat or plane — potentially large expenses for programs that include transportation services. Securing funds for transportation may improve program success and outcomes. Because transportation is often the largest operating cost for SDOH programs, it is very important that programs carefully calculate expected transportation costs and allocate sufficient funds in their annual budgets.

For more information about transportation-related implementation considerations, see the Rural Transportation Toolkit.


In some rural areas, especially in designated provider shortage areas, it can be challenging to find staff with the appropriate skills and credentials to run healthcare programs that address SDOH. The specific staff experience and credentials required by programs may vary depending on the SDOH focus area. For example, programs that focus on addressing SDOH through individual asset building and other approaches targeting economic stability may want to hire staff with a background in finance, specifically a background in providing financial literacy counseling and education. Organizations may want to hire candidates who have specialized financial literacy certifications from accredited programs. Staff with other types of financial backgrounds and degrees in business and accounting may also be appealing. Similarly, for programs focused on improving transportation access to address SDOH, programs may consider hiring people with a background in customer service, human resources, as well as staff trained to drive and operate different types of vehicles for the public.