Rural Hunger and Access to Healthy Food
Gaining access to healthy and affordable food can be a challenge for rural residents. Many rural areas lack food retailers and are considered food deserts: areas with limited supplies of fresh, affordable foods. Ironically, some of these food deserts are in areas where farming is important to the local economy.
In rural areas, access to food may be limited by financial constraints or other factors, such as transportation challenges. Rural shoppers may rely on more expensive and less nutritious food, such as the types available at gas station convenience stores, or face a long drive to a town with a supermarket or grocery store that stocks fresh produce, milk, eggs, and other staples.
Some rural residents and households are food insecure, meaning they cannot rely on access to sufficient affordable and nutritious food at all times, increasing the risk of poor health outcomes. According to the 2017 United States Department of Agriculture Economic Research Service (USDA-ERS) publication Food Insecurity, Chronic Disease, and Health Among Working-Age Adults, food insecurity is strongly associated with chronic disease and poor health, both of which disproportionately affect rural populations. Long-term food insecurity can affect learning, development, productivity, physical and mental health, and family life.
Food security can also be seen as a community-level issue. A 2002 USDA-ERS publication explains that community food security:
“…concerns the underlying social, economic, and institutional factors within a community that affect the quantity and quality of available food and its affordability or price relative to the sufficiency of financial resources available to acquire it.”
In 2021, 10.2% of U.S. households were food insecure at some time, down from 10.5% in 2020, according to the USDA-ERS report, Household Food Security in the United States in 2021. The same report notes that the rate of food insecurity in rural areas declined, from 11.6% in 2020 to 10.8% in 2021.
The USDA-ERS also reports that households in rural areas accounted for 17.7% of all food-insecure households in 2016.
This topic guide provides information for healthcare providers, human service providers, and organizations concerned with food security in rural communities. The guide covers:
- How to learn about rural food security in your community
- Strategies rural communities and healthcare providers can use to address rural hunger
- Funding and assistance programs to address food access and nutrition
Frequently Asked Questions
- During the COVID pandemic, what are some creative strategies that have been used by rural communities to address hunger and food access issues?
- How can we assess the level of food security and availability of healthy food in our rural community?
- Why do food deserts exist in rural areas?
- What strategies have rural communities used to improve access to healthy and affordable food?
- How can rural healthcare organizations address food and nutrition issues in their community?
- How widely used are federal nutrition programs among rural families?
- What nutrition programs are available for children in rural schools, daycare centers, and other settings?
- What food assistance programs are available for seniors in rural communities?
- How does rural food insecurity affect health outcomes?
- What are some funding opportunities for rural community food pantries?
During the COVID pandemic, what are some creative strategies that have been used by rural communities to address hunger and food access issues?
The following rural communities and organizations have created innovations to help community members during the COVID-19 pandemic:
- The Lakewood Engage initiative, developed and implemented by the rural Minnesota Lakewood Health System, distributed fresh-frozen microwave meals to older adult patients who tested positive for COVID-19, thus enabling them to quarantine immediately after receiving test results.
- Vermont Everyone Eats! uses funds from the CARES Act to pay restaurants in rural Vermont to provide free meals to people in need, and stipulates that 10% of the food must come from local farms.
- Charlevoix County Transit in northern Michigan began home delivery of groceries, food pantry packages, and meals provided by senior centers, to older adults and at-risk people who needed to remain at home during the pandemic.
How can we assess the level of food security and availability of healthy food in our rural community?
The Community Food Security Assessment Toolkit was developed by the USDA-ERS to help local government officials, local organizations, and community planners promote food security in all households. The toolkit examines 6 components of community food security:
- Community socioeconomic and demographic characteristics
- Community food resources
- Household food security
- Access to food
- Food availability and affordability
- Community food production resources
Feeding America conducts Map the Meal Gap, a research study represented through an interactive map outlining overall and child hunger down to the county level. Food insecurity data can be viewed by state, county, food bank service area, and congressional district.
The USDA-ERS Food Access Research Atlas provides information on food access by census tract. This mapping tool uses the following indicators:
- Distance to a store with healthy food or the number of stores in an area
- Low vehicle access areas
- Low-income areas
- Areas in which 67% or more of the population live in group quarters, such as correctional facilities or skilled nursing facilities.
The USDA-ERS Food Environment Atlas provides county-level data on a wider set of statistics regarding food choices, health, and community characteristics. The Food Environment Atlas has maps showing the following factors, all of which influence the diet quality of individuals and communities:
- Access and proximity to a grocery store
- Store availability
- Restaurant availability
- Food assistance
- State food insecurity
- Food prices and taxes
- Local foods
- Health and physical activity
- Socioeconomic characteristics
Why do food deserts exist in rural areas?
Characteristics and Influential Factors of Food Deserts, from the USDA-ERS, reports that food deserts tend to have smaller populations, higher numbers of vacant homes, higher rates of unemployment, and more residents with less education and lower incomes.
Many rural areas lack a population base large enough to support a grocery store that stocks a variety of affordable and healthy food, particularly if some residents bypass the local store to shop at distant supermarkets offering lower prices or order groceries online. A 2009 article in the American Journal of Preventive Medicine discusses the economics of rural food access:
“…small town food stores, with limited floor space, economies of scale, and distance from distribution centers, continue to provide limited food selection at higher prices and face the persistent challenge to remain profitable… As a result, rural families with only convenience or small stores from which to choose experience higher prices and lower selection and quality of foods than those shopping in larger supermarkets.”
What strategies have rural communities used to improve access to healthy and affordable food?
Many different approaches have been used to address this issue. The Healthy Food Access Portal can help communities find funding and resources related to retail projects and policy efforts. Strategies include:
Special Financing for Food Retailers
Some rural communities offer subsidized financing for food retailers by participating in state programs. Examples include the Michigan Good Food Fund and the California FreshWorks Fund, which offer financing to enterprises that benefit underserved communities in those states.
Cooperative Grocery Stores
Some rural grocery stores are community-owned or use the cooperative model. Co-ops have long existed in rural communities to provide key services such as electricity and phone service, where distance and low volumes make providing that service unattractive and unsustainable for traditional businesses.
Cooperatives are composed of members who are both customers and owners. The community-owned model closely resembles the cooperative model, although it is typically organized as a corporation, in which community members can buy shares.
Farmers markets can be established in rural areas to help small local farmers financially, while also increasing access to fresh fruits and vegetables for local residents. However, it can be a challenge to establish a rural farmers market, due to large geographic distances and the small number of potential shoppers. Farmers’ Market Challenges in a Rural Setting: A Case Study of the Elaney Wood Heritage Farmers Market explores a rural North Carolina farmers market's strategies for attracting and retaining vendors and customers. Rural Farmers Market Promotes Food Security highlights how one farmers market in rural Michigan has promoted programs to help disadvantaged residents access fresh produce more easily.
The Supplemental Nutrition Assistance Program (SNAP) and the Special Supplemental Nutrition Program for Women, Infants and Children (WIC) encourage farmers markets to accept their program benefits.
Community Supported Agriculture Programs
In community supported agriculture programs (CSAs), local residents commit to purchasing part of a local farmer’s crop at the beginning of the year. Farmers receive a cash investment to operate their farm and residents receive a supply of fresh produce. This program allows farmers and consumers to share the risks and benefits of local farming.
Farm to School Initiatives
Farm to school initiatives help local farmers sell fresh fruits and vegetables directly to public schools or incorporate school gardens in meal programs so that nutritious meals and snacks can be served to students and teachers, as well as educating children about nutrition and local farming. The Center for Integrated Agricultural Systems offers toolkits and other resources related to farm to school initiatives. RHIhub’s Rural Schools and Health topic guide has more information about how schools can provide access to nutritious meals for students.
Food pantries and other forms of direct food assistance, such as backpack food programs for children, can fill an important need for rural residents experiencing food insecurity. Food pantries can distribute nutritious food to low-income families and work with the local social services staff to give families information on nutrition, the Supplemental Nutrition Assistance Program (SNAP), and other social services in the community. Mobile food pantry trucks may be an option in rural communities without a suitable place to store and distribute food. For example, the Care and Share Food Bank provides mobile food pantry services to rural communities across Southern Colorado.
Community Education and Outreach
Community programs to improve access to food may also include education and outreach activities. Approaches to assist low-income residents include education on food assistance programs, social services, and training related to home economics, such as cooking from scratch and shopping wisely. The SNAP Ed program and Expanded Food and Nutrition Education Program (EFNEP) are federally-funded programs that provide peer education. In addition, community organizations can plant community gardens and teach people how to grow their own food.
How can rural healthcare organizations address food and nutrition issues in their community?
Rural healthcare organizations can work with human services providers to ensure that low-income patients are able to access healthy food options. Human services organizations may be able to offer training and tools to primary care providers so that they can screen patients for food insecurity. Addressing Food Insecurity in Health Care Settings provides tips for screening patients for food insecurity and providing interventions, such as referrals. Healthcare providers can refer patients to:
- Local food pantries
- Human services agencies for food assistance programs
- Women, Infants, and Children (WIC) offices
- Meal programs for seniors
In addition, rural healthcare providers can provide counseling and nutrition education for patients, to promote wellness and help manage chronic disease. Facilities may partner with other community organizations and businesses to provide or refer patients to cooking classes, meal programs, and other nutrition-related services and education.
Healthcare providers can also prescribe healthy foods. Providing Patients with Access to Nutritious Food describes programs in which medical facilities actively promote consumption of healthy foods among patients and local residents. The Lakewood Health System, in rural Minnesota, created Lakewood Engage, a program designed to improve access to safe, nutritious, and affordable food for positive health impact. See the Models and Innovations section of this topic guide for other examples of projects conducted in rural communities.
How widely used are federal nutrition programs among rural families?
The USDA Food and Nutrition Service’s Supplemental Nutrition Assistance Program (SNAP) helps low-income individuals and families buy nutritious food. According to the USDA-ERS report, Alleviating Poverty in the United States: The Critical Role of SNAP Benefits, rural areas have higher rates of poverty and higher use of SNAP benefits than metropolitan areas. Furthermore, child poverty is higher in rural areas. One of the report’s key findings is that SNAP benefits are particularly effective in reducing poverty for people in nonmetropolitan areas.
The December 2022 document Trends in Supplemental Nutrition Assistance Program Participation Rates: Fiscal Year 2016 to Fiscal Year 2020 reports that in pre-pandemic FY 2020 there was a 75% participation rate among SNAP-eligible people in rural areas, and a 79% rate among their urban counterparts. According to Characteristics of Supplemental Nutrition Assistance Program Households: Fiscal Year 2019, 15.9% of all SNAP households are in micropolitan or non-core rural areas.
The USDA Food and Nutrition Service’s Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) serves low-income women, infants, and children up to age five who are at nutritional risk. WIC provides nutritious food, information on healthy eating, education on breastfeeding, and referrals to healthcare. According to the Food Research & Action Center’s 2018 document Rural Hunger in America, the percentage of income-eligible families with young children participating in the WIC program is higher in rural areas (46%) than in metropolitan areas (42%).
What nutrition programs are available for children in rural schools, daycare centers, and other settings?
In addition to SNAP, nutrition programs available for rural children include:
- School Breakfast Program
- National School Lunch Program
- Special Milk Program
- Child and Adult Care Food Program: Afterschool Program
- Summer Food Service Program
For more information, see RHIhub's Rural Schools and Health topic guide.
The Child and Adult Care Food Program (CACFP) provides financial assistance to childcare centers for nutritious meals and snacks. The program helps in-home daycare providers, daycare centers, afterschool programs, and emergency shelters improve access to healthy food. Their website also provides nutrition education, healthy recipes, and wellness resources.
One barrier for eligible rural families to participate in the Child and Adult Care Food Program is that rural children are more likely to receive care in a relative's home than in a daycare center or afterschool program which qualifies for the Child and Adult Care Food Program. Other challenges to increasing enrollment in child nutrition programs for eligible rural families include a lack of awareness about existing programs as well as a stigma related to receiving government assistance. Rural families may also have a more difficult time utilizing the Summer Food Service Program because of the distance needed to travel to a participating site.
What food assistance programs are available for seniors in rural communities?
Nutrition Services programs funded through the Administration on Aging provide access to nutritious meals, education, and nutrition counseling for adults age 60 and above, particularly those who have social and economic need. Programs vary depending on the needs and the resources available in each community.
Congregate meal programs offer meals in a central setting, such as a senior center. Home-delivered meal programs, such as Meals on Wheels, bring meals to the homes of frail, homebound, or isolated older adults. Providing hot home-delivered meals to older adults living in remote rural communities can be a challenge due to travel distance and time required for delivery. In some locations, frozen meals or sack lunches can be delivered on a less frequent basis or picked up from a designated location. Often there is a suggested donation or sliding fee schedule to defray the cost of meals.
The Child and Adult Care Food Program (CACFP) is a federal program that provides healthy meals and snacks to adults receiving day care. Adult day care centers receive payments for serving healthy meals to adults who are 60 or older, or who are physically or mentally impaired to a degree that limits their independence.
The Senior Farmers’ Market Nutrition Program (SFMNP) is offered through the USDA Food and Nutrition Service to provide low-income seniors with coupons that can be used at farmers markets, roadside food stands, and community-supported agriculture programs to promote the consumption of fresh fruits and vegetables among seniors.
The Commodity Supplemental Food Program works to improve the health of low-income people at least 60 years of age by distributing shelf-stable food and administrative funds to participating states and tribal organizations.
USAging has more information about home and community-based services available to seniors.
How does rural food insecurity affect health outcomes?
Research shows that access to nutritious and affordable food for rural residents is important for improving health behaviors and status. Chapter 8 of the National Research Council’s Research Opportunities Concerning the Causes and Consequences of Child Food Insecurity and Hunger: Workshop Summary discusses the literature related to the health of children and pregnant women. It shows that food insecurity and hunger adversely affect child development and academic performance, and may contribute to behavioral health disorders, compromised immune systems, and other health issues.
According to the report Patterns of Food Insecurity, Food Availability, and Health Outcomes among Rural and Urban Counties, the risk of food insecurity increases as counties become more rural. The highest food insecurity was found in rural areas of the East South Central census division. Results of the study show significant associations between food insecurity risk and the following:
- No leisure time physical activity
- Consuming fewer than five servings per day of fruits and vegetables
What are some funding opportunities for rural community food pantries?
To set up a food pantry in a rural community, it is helpful to start by contacting your local Feeding America food bank. Food banks provide a range of supports and expertise for launching and maintaining an effective food pantry, and collectively, the Feeding America network serves every county in the United States allowing for a culture of learning and sharing best practices for rural, urban, and suburban communities alike.
Rural food pantries may receive donations from many sources. The Rural Monitor article, Food Pantries Serving More and More of the Rural Poor, highlights rural food pantries that receive funding and donations from federal programs, their state government, foundations, corporations, churches, and individuals.
The Emergency Food Assistance Program (TEFAP) is a federal program that makes food available to State Distributing Agencies such as food banks, which then provide food to local pantries and other organizations.
The Rural Health Information Hub has a list of funding opportunities regarding food and hunger. You can also contact us at firstname.lastname@example.org or 800.270.1898 for a customized funding search.
Last Reviewed: 1/18/2022