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Myths and Realities About the Rural Poor

IN Rural Reach

There are many myths afoot about the poor who live in rural America. You may have an outreach effort that is relying on your ability to reach the rural poor. Take these myths about rural America into account in planning and executing your work:

Myth #1:  If you’ve seen one rural area, you’ve seen them all. Not much variation between one place and another.

The truth is that rural America is not a single entity, but an array of places and peoples.  It’s very tempting to generalize about the rural poor and let it go at that, to advocate that they’re “all like this” or “all like that”; the truth is, while there is data to show the rural poor differ from other groups in America, there’s also evidence that not all rural areas are poor or in the depths of poverty.  Some places have managed to fight the ravages of isolation and stand out as a beacon among all others. Rural communities are diverse, differing widely, and strategies must be tailored to a specific population of interest. There’s no “typical” rural place, no one-size-fits-all description that fits every local context.

Despite all this diversity, rural America is predominantly white, non-Hispanic (78%, versus 64% in the entire U.S.), with a greater percentage of female-headed families with no husbands and related children under five living in poverty (58% to 47%).

Myth #2: Rural living is healthy living—sunshine and fresh air leads to generally good health.

Not so, unfortunately: Rural American counties have had the highest rates of premature death for many years, lagging far behind urban and suburban counties. Also, fewer people in rural America are insured, fewer graduate college, and more children live in poverty in rural America.

On almost any indicator of health, rural communities rank far below their urban and suburban counterparts. Here’s a small sampling of the health rates that are worse for rural Americans:

  • Obesity is higher in rural America.
  • COPD rates in rural areas are double those in urban areas
  • HIV rates are growing in rural America with no access to care
  • Diabetes rates are higher and rural Americans are more likely to die from it
  • The risk of suicide is higher in rural communities, particularly for males
  • Rural fatality from trauma is twice as high as in urban areas
  • Rural Americans have higher rates of hypertension
  • Among uneducated rural residents, higher rates of dementia and Alzheimer’s have been reported
  • Rates of severe headache or migraine, low back pain, and neck pain among adults aged 18 and over are higher
  • Disability measures among adults aged 18 and over
  • Vision limitations among adults aged 18 and over
  • Hearing limitations among adults aged 18 and over

Myth #3: But at least rural health systems—hospitals, physicians, mental health facilities—are strong and vibrant.

To make all that health data about rural Americans even worse, rural health systems are in just about as bad a shape as the people who live there. Many elements of the rural healthcare system—hospitals, physicians, mental health providers, dentists, and pharmacies—have pulled up stakes and moved back to the city, or opted not to locate in rural areas in the first place. Consider:

Rural hospitals:  Since 2010, 82 rural hospitals have closed nationwide and as many as 700 are at risk of closing in the next 10 years.  And the loss of a rural hospital goes beyond even vital medical care—it represents a loss of identity, a loss of community.

Hospital maternity wards:  Many times, it’s not the entire rural hospital that closes, but an important wing. A study published last year found that one in 10 rural counties had lost their ob-gyn wards in the past 10 years. Today, researchers estimate that fewer than half of the country’s rural counties still have a hospital that offers obstetric care.

Children’s oral health:   Oral health for children is harder to find in rural areas, where there are higher patient to dentist ratios.

Physicians: Only 10% of the country’s doctors practice in rural areas.  According to the National Rural Health Association, for every 10,000 people in rural areas there are only 13.1 doctors, while for every 10,000 people in urban areas there are 31.2 doctors

Mental health care: Finding mental health care is even harder than finding primary care—61% of rural Americans live in a federally-designated mental health professional shortage area.  A new study in the American Journal of Preventive Medicine finds that a majority of rural counties (65%) do not have a psychiatrist and almost half of rural counties (47%) do not even have a psychologist.

Pharmacies: More than 16% of the independently owned rural pharmacies in the United States shut down between March 2003 and March 2018.

Myth #4:  The push to blanket the entire US with broadband coverage has been successful, as rural America has the same great Internet  access as cities.

Far from true: According to the Federal Communications Committee’s findings, more than half of all rural Americans still lack access to high-speed broadband. A recent Pew Research Center Poll found that nearly one-quarter of all rural Americans reported major problems accessing high-speed internet.  This affects businesses in rural areas, as well as school kids:  Imagine that, to complete your school homework each night (or to study for a test, or email your teacher, or chat with your friends on social media) you had to drive to the nearest McDonald’s or other local business with a free WiFi connection, then sit in the parking lot with your computer in your lap, all because your home has no Internet access. Such is the bottom-line reality for millions of students across the country, according to Anne Hazlett, assistant to the secretary for rural development at the U.S. Department of Agriculture.

What does all this mean for your efforts to reach out to the rural poor in America? It means there’s no “one size fits all” theme to rural America and there are significant challenges going on there. To learn more, give us a call or drop us a line at Hirons: 317.977.2206.


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