COVID-19 and Unique Challenges in Rural Communities

05 June, 2024

Health Inequities and COVID-19

While many health inequities are historically well documented, the COVID-19 pandemic sparked a deeper conversation, ultimately challenging us to expand our understanding of inequities across many different populations, including rural communities.

A Medical Picture of Rural Communities

Approximately 80% of rural counties in America can be defined as a “medically underserved” — lacking access to several different kinds of care. This includes a shortage of medical personnel, poor distributions of facilities, lack of culturally competent providers and other barriers to access specialty care. Less than 8% of all providers choose to practice in rural areas, and those who do often have less education or training. Since 2005, 181 rural hospitals have closed across the country with more than 453 at risk of closure. As a result, residents of rural communities face cumbersome or impossible transportation required to see specialists or receive trauma care — effectively creating medical deserts around the United States. These communities often have limited access to public health services already, with few underfunded clinics serving vast areas.

On top of structural barriers to health care, rural residents also face a unique combination of health challenges. Rural residents are more likely to die from each of the 10 leading causes of death when compared to their urban counterparts. They are more likely to smoke, consume more than five alcoholic drinks per day, be overweight or obese, and avoid regular exercise. They also report fair to poor mental health more frequently than urban residents and often lack access to mental health resources (Georgetown University). However, it is underappreciated that these communities also have the highest rates of uninsured, underinsured and publicly insured residents (Census, 2019).

Demographically, rural areas continue to diversify. While nearly 76% of these areas are White, this number is down from 79.8% just 10 years ago. According to the 2020 census, the racial minority has grown at nearly the same pace as the decline in the non-Hispanic White majority. As of 2020, about 24% (11 million individuals) of residents living in rural areas were not White:

  • Hispanic: 9%
  • Black: 7.7%
  • Indigenous/Other: 2.5%
  • Asian: 1% 

Multiracial residents are also growing, making up 3.5% of the rural population, especially among those under 18. Incorrect assumptions about the demographic makeup of people in rural communities limit our ability to implement culturally competent care. The consequences of these assumptions lead to exacerbated negative health outcomes among several demographic groups.

Minoritized groups face further marginalization in terms of language barriers, basic health literacy and fear of abuse and deportation. Aging residents may experience delayed care for chronic diseases as well as have poor adherence to diagnostic procedure recommendations such as mammograms and colonoscopies. Additionally, children who are taught at home or in rural co-ops may not be current on vaccines due to inaccessible clinics and/or a lack of vaccine confidence among some rural communities.

Because people in rural communities are more likely to have lower incomes and lower educational attainment, expanding access to high-quality care via Federally Qualified Health Centers and prescription delivery services is imperative to achieving better health outcomes. Brick-and-mortar clinics are not always the answer for communities in remote regions. We must also support other tangential initiatives, such as the expansion and subsidization of rural broadband, which provides critical internet access to communities who are underutilizing telemedicine and mobile health clinics to fill gaps left by the dissolution of local and regional rural hospitals.

Rural Communities and COVID-19

These structural and demographic challenges compounded worse outcomes for rural communities during the COVID-19 pandemic. Most notably, a lack of confidence in vaccines soared in rural communities. In early 2022, rural residents were the least likely to vaccinate against COVID-19 and 15% less likely to follow other prevention measures such as masking or refraining from large public gatherings. Only 49.4% of adults in rural counties were fully vaccinated, compared to urban communities. As of September 2021, 1 in every 434 rural Americans died of COVID-19, compared to 1 in 513 rural Americans. Hesitancy, fear and distrust were exacerbated by a lack of access to care. In rural areas, there are 1.7 ICU beds per 10,000 people, compared to 2.8 beds per 10,000 people in urban areas.

Taking Action Beyond COVID-19

Health disparities can be examined along many lines, but the rural-urban divide is often overlooked. The first step is raising awareness of the unique challenges rural residents face, then addressing the structural and social barriers that limit their care. Increasing access to quality care for rural residents could mean embracing telemedicine, workforce programs for skilled workers, innovative solutions to transportation services and fostering relationships with community health care partners long term. Showing our support for other state and federal initiatives — such as subsidizing rural broadband, expanding mental health services and reinforcing infrastructure to allow mobile health centers to take critical care on the road — is crucial to connecting rural communities with the care and education needed to enhance their lives.

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