Healthcare Disparities Between Rural and Urban America

by Max Kanuk


What you can do:

  • If you live in a rural area, be familiar with your nearest hospitals, emergency services, and any other healthcare services so that if needed you can receive high-quality care in a timely and efficient manner.
  • Call your local representative and urge them to fight to delegate a more proportional amount of funding to rural areas that need and deserve it, and importantly to more efficiently allocate funding to the areas in rural zones that need it. 
  • Donate or volunteer (or support in other ways) to charities devoted to developing and improving rural healthcare such as the Main Health Access Foundation (MeHAF), the Health Georgia Foundation, the Episcopal Health Foundation (EHF), the Sunflower Foundation, and many more! [19]
  • If you know people who might be suffering from rural healthcare disparities, talk to them and teach them what you’ve learned. Helping even just one person makes a world of difference!

In 1960, approximately 30% of the United States population lived in rural areas while 70% lived in urban centers. Today, urbanization across the country (and the world) has resulted in a significant decrease in rural populations with approximately 20% of the US population living in rural areas, and 80% living in urban centers [1][2]. At first appearance, this may suggest a shrinking rural population, but the reality is in fact the opposite: many rural communities around America significantly thrive and prosper to the point in which their population and development no longer classify them as rural, and thus they begin to be considered a part of the urban population. There are significant differences between urban and rural life in the United States, particularly when it comes to healthcare. Urban zones have developed systems and infrastructure to the point of providing for massive populations of people, and by very definition, they are centers of business, supply, and commerce. This gives city-dwellers a unique advantage over their rural counterparts since rural zones have a much smaller supply due to smaller populations, the lack of significant commercial and business opportunities compared to city-commerce, and distances and transport costs to deliver supplies to more remote areas. Furthermore, unfortunately, government funding seems to be quite inefficient in the management of rural development such that money invested in rural communities has a significantly smaller yield than funding to urban zones. These factors all contribute to a serious healthcare disparity between rural and urban populations. Quality and access to healthcare including preventative care and emergency services, mental health services, and cultural impacts on chronic conditions are all examples of imbalances between rural and urban communities.

Almost 20% of the United States population live in rural areas, but unfortunately, rural populations often have significantly lower access to healthcare professionals and healthcare services (and even less when particular services are required in a timely manner such as emergency services). In fact, while almost 20% of the United States population live in rural areas, only 11% of healthcare providers in the country practice in rural zones [3]. This creates a serious shortage of access to healthcare for rural populations, and leads to serious negative healthcare consequences. Reasons for this serious lack of healthcare professionals in rural areas include ‘lower salaries, geographic isolation from peers and education opportunities, and fewer amenities such as schools and recreations’ [4]. Unfortunately, rural areas receive proportionally less government funding that benefits community development than more populated urban areas do. Chuck Fluharty, the founder, president, and CEO of the Rural Policy Research Institute (RUPRI) [5] stated that this disparity is such that a large proportion of federal ‘rural funding primarily goes to individuals, where in urban areas, “The majority of the money goes to economic and community development.”’ [6]. The consequence of this is that ‘tens of billions of dollars’ [6] are inadequately invested in rural community development, a serious failure and inefficiency in government spending leaving millions of rural Americans without many benefits that urban populations enjoy. This disparity and lack of funding for community development in rural areas results in serious resource deficits which have devastating long-lasting impacts on these communities. While urban government funding is largely adequately invested into education, infrastructure, access to supplies around the country, and domestic commercial support, rural areas unfortunately do not receive the same gains. Without adequate educational opportunities, schools, infrastructure, emergency services, and other necessary factors contributing to a healthy community, many rural zones lacking in these areas are at a major disadvantage, as this seriously discourages workers to migrate to rural zones for job opportunities; i.e., healthcare providers are unlikely to move into the country if there is not adequate government funding to mould a healthy community; healthcare professionals are often turned off by job prospects in communities without the appropriate government support to provide adequate educational opportunities for their children, sufficient access to medical supplies from interstate and international healthcare manufacturers and suppliers, and acceptable developed infrastructure to provider for larger populations of people. The ramifications of these developmental lags are significant:

The Department of Health and Human Services recommends a provider-to-patient ratio of one primary care physician to every 2,000 individuals. Over 20 million rural Americans live in areas that have a provider-to-patient ratio of 1 to 3,500 or less and are federally designated as health professional shortage areas (HPSAs). More than 2,200 physicians are needed to remove the HPSA designation from all rural areas, but more than twice that number is needed to achieve the recommended ratio of 1 to 2,000 in these areas.’ [7].

These healthcare deficits have serious impacts on rural healthcare. Rural populations are more prone to conditions such as ‘heart disease, cancer, unintentional injury, chronic lower respiratory disease, and stroke than their urban counterparts’ [8]. Furthermore, ‘unintentional injury deaths are approximately 50 percent higher in rural areas than in urban areas, partly due to greater risk of death from motor vehicle crashes and opioid overdoses’ [8]. 

Access to healthcare is a particularly significant discrepancy and impacts the health of rural Americans. Due to larger travel distances, environmental and geographical obstacles, greater impact of weather on travel, and a lack of resources (both man-power and supplies), emergency services in rural areas are significantly disadvantaged in their ability to provide the best possible care in emergency situations. Furthermore, patients with more severe conditions often experience much longer travel times due to local hospitals not being adequately equipped to deal with particular types of emergencies [9]. 

Chronic health conditions, and cultural impacts that cause greater numbers of ‘risky health-related behaviours’ [10] such as smoking and drinking are also unproportionally higher in rural populations. Rural populations are additionally more likely to be uninsured for longer periods of times than their urban counterparts, and as a result are less likely to get tested for chronic conditions [11], seriously hindering preventative healthcare. Almost 20% of rural residents in the United States are uninsured, compared to approximately 16% of their urban counterparts being uninsured [12]. As a consequence, conditions such as substance abuse and addiction, alcoholism, chronic obstructive pulmonary disease (COPD), cardiac issues, diabetes, and mental disorders, are not addressed as often as they are in urban centers, which results in a greater number of individuals suffering from untreated or ignored illnesses.

https://hpi.georgetown.edu/rural/ (Source: Center on an Aging Society analysis of data from the 1998 Medical Expenditure panel Survey.)

(Bold: Higher percentage for that category)

https://hpi.georgetown.edu/rural/ (Source: Center on an Aging Society analysis of data from the 1998 Medical Expenditure panel Survey.)

*Refers to those who have consumed alcohol in the past year.

In light of these serious adverse health deficits that plague rural America, there are some potential benefits to rural-living. Growing up in areas with more natural scenery and more of a natural environment proves to be a huge influence on the mental health of Americans. Compared to their rural counterparts, urban residents have approximately a ‘40% higher risk of depression, [have] over 20% more anxiety [cases], and double the risk of schizophrenia’ [13]. 

A study done by a group of psychological and neuroscience experts [14] analysed the neurobiological impact of stimuli on the brain comparing natural versus artificial stimuli. Humanity – as all species do – retains physiological elements from our evolutionary ancestors. Our brains are largely suited for a hunter-gatherer lifestyle, and ever since the agricultural revolution we have been continuously changing the environment around us to suit ourselves. Today, crowded urban centers have a profound impact on our neurobiology and psychological health. This study showed that natural stimuli/environments have significantly more positive influences as opposed to artificial stimuli/environments. The study suggested that long-term separation from natural environments can significantly impact neurological function and mental health. One conclusion states that as ‘modern human environments stray from our ancestral roots, a close examination of how these modifications impact neural responses and functions may illustrate causal factors for various mental illnesses, especially those that are expressed at increased rates in urban settings’, i.e., drastic urbanisation and lack of access to more natural environments can have underlying impacts on mental and psychological health.

Furthermore, some similar recent research points towards the concept of neural ‘overload’ [15a]. Cities contain constant sensory stimuli such as ‘density, crowding, noise, smells, sights, disarray, pollution and intensity of other inputs’ [15] such that every ‘part of the urban environment is deliberately designed to assert meanings and messages’ [15]. This constant input of neural stimuli causes an ‘overload’ as the brain begins to struggle to manage this constant influx. The impacts of ‘overload’ can cause an increase of ‘the body’s baseline levels of arousal, stress, and preparedness, [while] also driving people to seek relief: quiet, private spaces; over time this urge may evolve into social isolation associated with depression and anxiety, and also forms the basis of the ecological hypothesis of schizophrenia’ [16]. These indications suggest serious mental health risks of prolonged urban life.

Now while this information suggests an advantage of rural living for a mental health perspective, previously mentioned disparities between rural and urban access to health care ‘cancel out’ the mental health benefits of living in areas with greater natural environments. Unfortunately, ‘[c]ompared with their urban counterparts, rural Americans have higher depression and suicide rates, but are less likely to access mental health care services’ [17]. There are significantly fewer psychiatric and mental health professionals in rural areas compared to urban areas, and furthermore, rural residents are ‘less likely to seek mental health services [and] are less likely to be able to afford mental health services because of financial constraints and lack of health insurance’ [18]. Additionally, higher rates of poverty, homelessness, and substance abuse also contribute to greater mental health and psychiatric illnesses in rural communities.

Ultimately, there are huge differences between rural and urban life in the United States, with particular emphasis on major healthcare imbalances. Unfortunately, there is a serious disparity in healthcare between rural and urban Americans impacting millions of people every year. While 20% of the US population live in rural areas, there is disproportionally significantly less government funding for rural community development than there is for urban centers. Rural residents have much less access to healthcare resources including healthcare providers, emergency services, and other healthcare services. Studies show that modern urban life can seriously impact our neurological behaviour, and could possibly be a significant factor to rising mental health issues in the United States. However, other research has shown that rural residents suffer from mental health and psychiatric conditions more than urban residents, due to a variety of health factors including a lack of healthcare resources for mental and psychiatric health and higher rates of poverty, homelessness, substance abuse, and chronic illnesses that often go untreated. As Americans, we should be striving towards policies that aim to help our countrymen and women have access to adequate healthcare services and resources in the attempt to bridge the healthcare gap between rural and urban America. Hopefully in the future this country can work towards narrowing these disparities and bring Americans from all walks of life together, united.


Works Cited:

[1] https://www.statista.com/statistics/985183/size-urban-rural-population-us/

[2] https://www.statista.com/statistics/985183/size-urban-rural-population-us/

[3] https://hpi.georgetown.edu/rural/

[4] https://hpi.georgetown.edu/rural/

[5] https://www.public-health.uiowa.edu/people/charles-fluharty/

[6] https://www.agri-pulse.com/articles/12386-why-rural-areas-need-more-not-less-federal-funding

[7] https://hpi.georgetown.edu/rural/

[8] https://www.cdc.gov/ruralhealth/about.html

[9] https://www.ruralhealthinfo.org/topics/emergency-medical-services

[10] https://hpi.georgetown.edu/rural/

[11] https://hpi.georgetown.edu/rural/

[12] https://hpi.georgetown.edu/rural/

[13] https://www.urbandesignmentalhealth.com/how-the-city-affects-mental-health.html

[14] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4774049/

[15a] https://www.urbandesignmentalhealth.com/blog/overload-and-the-city

[15] https://www.urbandesignmentalhealth.com/how-the-city-affects-mental-health.html

[16] https://www.urbandesignmentalhealth.com/how-the-city-affects-mental-health.html

[17] https://www.psychiatryadvisor.com/home/practice-management/health-disparities-in-rural-america-current-challenges-and-future-solutions/3/

[18] https://www.psychiatryadvisor.com/home/practice-management/health-disparities-in-rural-america-current-challenges-and-future-solutions/3/

[19] https://www.healthaffairs.org/doi/full/10.1377/hlthaff.2017.1220