Rural Health

Geographic and socioeconomic challenges have resulted in the closure of many rural hospitals nationwide. In the last decade, more than 130 rural hospitals have closed. Tennessee accounts for 16 of the hospital closures and ranks second for the most hospital closures since 2005. Over a quarter of rural Tennessee counties lack a hospital, and 22 out of the 48 rural hospitals left in Tennessee are currently at risk of closing. Many already struggle to get care because of the time required or the costs of care; however, the divide in care has only continued to grow. 630 hospital beds have been lost, emergency care services are inaccessible, and patients are losing their primary care. [4]

Much of our wellbeing dependends on investments in health in our communities. Urban areas often have surpluses of medical care and increased rates of access to employee sponsored insurance. On the other hand, rural Americans have lower rates of insurance coverage and when covered are relying on public options that do not provide the same accessibility to care. In rural areas, geographic isolation not only limits availability and accessibility to care, but it can discourage utilizing preventative care services such as routine cancer screenings and annual checkups. One reason is because of the increased cost, which includes the time and money required to travel to care as transportation options are limited. As a result, patients may only seek healthcare when an illness has advanced.

Areas where the rural hospitals have closed have experienced economic losses which also affect food. Food insecurity often affects those experiencing poverty and can compound health disparities, including associated risk of obesity. The southern region of the United States faces the greatest food insecurity nationally and within that, rural regions experience a greater rate of food insecurity. Many rural places are considered food deserts, as healthy options can be inaccessible and more expensive. New establishments in these areas are likely to be fast food restaurants that target lower income areas. The Tennessee Health Care Campaign within their Rural Equity Project stated that owners of fast-food restaurants in areas affected by a hospital closure saw a greater increase in dollar menu sales after the closure. Even when there is access to limited food options, there are still concerns of high food costs. A possible alternative is frozen and canned foods, which can provide greater security and tend to be less expensive than fresh food and healthier than fast food.

Active living begins with a culture and environment that supports health. It is currently recommended that individuals engage in 150 min of moderate-intensity or 75 min of vigorous-intensity physical activity a week. However, almost a third of rural populations do not engage in physical activity beyond work (Jones et. al. 2021). While the geographic isolation characteristic of rural regions may bring cleaner air, water, or land for some, this can result in losses to an individual’s ability to sustain a healthy lifestyle. For example, if road designs do not allow for safe biking or walking, an individual may need to rely on a personal car for transportation.  This increases the amount of time they spend sedentary during the day.  In these areas, there may not be public transportation, leading to further disparities between those who can afford and car and cannot.  Furthermore, a reduced number of active living facilities and perceptions of an unsafe or inaccessible park result in even less opportunities to pursue physical activity. Rural areas also lack a “third location,” a place for someone to exist outside of their home or work. These places foster social connectivity and healthy minds. However, when nonresidential establishments do exist, they are unlikely to be free to the public, limiting accessibility.

While rural Americans have access to broadband now more than ever, they still may not enjoy the same technological advantages of their urban counterparts. Whether due to the local government or outside investors, rural regions do not have the same economic capacity to invest in faster and greater internet capabilities. As a result, rural populations have reduced access to job opportunities, such as remote jobs, and kids have less access to educational resources. This lack of access affects health in numerous ways. The internet is a powerful resource for individuals to understand and take authority over their own health. Access to the internet increases health literacy and understanding of diagnosis and medication. Furthermore, rural populations have less access to telehealth, which served a very important role during the COVID-19 pandemic. Telehealth is also an important resource to increase access to mental health services. Mental health resources must be as barrier-free as possible to be helpful, especially since rural populations face greater rates of mental illnesses and stigmatization.  

Rural Americans have been experiencing a mental health crisis at higher rates with limited access to mental health resources. Social isolation, low socioeconomic status, and chronic health conditions are risks factors that many individuals in rural America face, especially within older populations. Day to day stressors from the family to economic instability, the workplace, or longer commutes can result in physical concerns such as higher risk of cardiovascular disease, weight gain, and immune suppression. However, an even greater concern is mental health that is left unaddressed because of social stigma, cost, or lack of available treatment. Living in a state of constant stress is living in constant survival mode. When mental health crises are left untreated, the effects of it continue to harm the individual. The National Alliance on Mental Illness states, “untreated mental health conditions can result in unnecessary disability, unemployment, substance abuse, homelessness, inappropriate incarceration, and suicide, and poor quality of life.” In fact, half of all people that have had mental illnesses have also experience substance misuse.  When treatment is unavailable, people will look to other means to cope or self-medicate.