For folks who live in rural communities — 15% of the United States — it’s harder to access healthcare than in urban spaces. But when you’re also Black or part of another marginalized group, there are often even fewer options.
A recent report published by the Robert Wood Johnson Foundation (RWJF) notes that while the task is large, there are several ways to “advance rural health equity” — or in other words — get folks the health care they need, regardless of where they live.
Katrina Badger, a program officer at RWJF, says “healthy equity” means “everyone has a fair and just opportunity to be as healthy as possible.”
Compared to urban residents, rural Americans suffer from higher rates of depression and suicide. They also have a life expectancy that’s two years shorter than their urban counterparts and suffer from obesity, opioid misuse, and maternal morbidity, RWJF reports.
“Rural counties — primarily those with large populations of color — have higher premature death rates than most urban places and fare worse on health and poverty outcomes nationally,” Badger says.
The RWJF report says living in a rural community is one disadvantage, but low-income people of color are “multiply disadvantaged” because of their class and race.
While rural poverty rates declined from 2013 to 2017, RWJF reports, 32% of Black residents are still living in poverty, compared to 13.5%of white residents.
And for Black people who live in predominantly white rural areas, they’re particularly at risk of mental illness due to poverty and racism, according to a 2020 report published in Psychiatry Advisor.
Badger agrees that “extensive evidence points to racism as a major cause of health disparities within rural areas.”
And so, achieving health equity for rural populations “requires removing obstacles to health such as poverty, discrimination, and their consequences — including powerlessness and lack of access to good jobs with fair pay, quality education, and housing, safe environments, and health care,” she says.
Badger says an effective health equity plan would prioritize the health and well-being of rural indigenous and Black people “who have suffered centuries of health-damaging trauma and oppression.”
In addition to “dismantling systemic racism in rural areas through strategies that increase economic opportunity,” RWJF also suggests ensuring all rural residents have access to reliable internet.
Rural residents are less likely than urban residents to have broadband — which prevents opportunities for telemedicine, education, and employment.
“In most states, urban residents had a higher rate of broadband subscription than their rural counterparts, though a number of states in the Northeast had higher rates of broadband subscription among rural households,” Michael Martin said in a 2018 computer and internet use report.
To build a world where rural residents have equal access to healthcare, RWJF also recommends ending “the suppression of Indigenous, African American, and Latino/Hispanic voters by increasing opportunities for voter registration and enacting universal mail-in voting in every state.” In addition, “constructing and maintaining rural clinics that address social as well as healthcare needs” and investing in rural car-sharing are also much-needed solutions.
“We will not achieve a culture of health in our nation without rural people and places experiencing that culture of health,” Badger says.