The NCSL Blog


By Charlie Severance-Medaris

Roughly 60 million people live in rural and frontier communities.

Rural landscape; credit Centers for Disease ControlFrom amber waves of grain across the heartland to quaint ski and mining towns in the Rockies, these communities occupy a special cultural niche in the American fabric. However, these remote and sparsely populated areas also face special challenges, especially in accessing health care.

To bring awareness to the unique needs of these communities, National Rural Health Day is recognized today, and every third Thursday of November.

Just in time for the annual event, NCSL’s new postcard reports rural Americans have not seen quite the same health advances as their urban neighbors when it comes to preventing the five leading causes of death.

Although the United States has seen declines in four of five leading causes of death, rural areas have seen a slower decline. When compared with urban populations, rural communities still experience higher death rates from heart disease, cancer, unintentional injury, chronic lower respiratory disease (CLRD) and stroke.

 Services that can improve health and independence for those living with chronic disease—such as pulmonary rehab for patients with chronic obstructive pulmonary disease and cardiac rehab for those with heart disease—are typically far more difficult to access in rural areas.

According to the Centers for Disease Control and Prevention (CDC), unintentional injuries such as drug overdoses, falls and motor vehicle crashes are about 50 percent higher in rural areas than in urban areas. The CDC attributes this disparity to differences in socioeconomics, health behaviors and access to health care services.

Residents in rural counties often face difficulty accessing health care services. Those living in rural counties are more likely to be uninsured, live within a health professional shortage area and experience a local hospital closure.

These disparities become even more apparent when examining rates of death due to unintentional injury, the only leading cause of death to see an increase in the last 15 years. The opioid epidemic, which has hit rural communities especially hard, is largely to blame for this surge.

All five leading causes of death are potentially preventable. State leaders attempting to improve the health of their rural constituents have many policy options:

  • Focusing on health care workforce recruitment and retention. Many rural communities struggle to attract and retain health care professionals, especially behavioral and mental health care providers. Addressing shortages in health care workers is a key strategy for improving access to health care and preventive services for people in rural areas, and is highlighted in NCSL’s brief
  • Strengthening disease prevention, screening and treatment efforts. Prevention and screening can help address disparities in heart disease, cancer and CLRD.The Rural Health Information Hub's Rural Health Models and Innovations features examples of successful programs in rural areas experiencing health disparities. Rural health care providers can participate in programs such as state-level comprehensive control coalitions, including those supported by the CDC National Comprehensive Cancer Control Program, that focus on cancer prevention, screening and patient support.
  • Supporting healthier behaviors and neighborhoods. Tobacco use and obesity are significant risk factors associated with several leading causes of death. Tobacco use is associated with deaths from heart disease, cancer, CLRD and stroke, and obesity is associated with deaths from heart disease, cancer and stroke. For policymakers interested in tobacco control, the CDC and NCSL have several resources. The CDC also covers resources for lawmakers interested in addressing obesity.  
  • Improving health coverage. Strategies that make health insurance more affordable, increase the number of insurance providers in a community or facilitate coverage of more people can increase the number of rural Americans able to seek health care. NCSL maintains a variety of Medicaid and private insurance resources.
  • Continuing efforts to prevent opioid overdose deaths. While many states have already taken steps to address this epidemic, lawmakers and public health officials continue to search for innovative solutions. You can track the most recent developments in our injury prevention database and read more about strategies to prevent opioid addiction and overdose deaths in a recent blog.   
  • Expanding telehealth services. Telehealth can extend the reach of providers to rural communities, and provide counseling, diagnose certain medical conditions and even order prescriptions remotely. You can find more information in our telehealth brief.

You can find more information on the leading causes of death in our new postcard and can explore other policy options in our brief on improving rural health.

Charlie Severance-Medaris is a policy associate in the Health Program at NCSL.

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This blog offers updates on the National Conference of State Legislatures' research and training, the latest on federalism and the state legislative institution, and posts about state legislators and legislative staff. The blog is edited by NCSL staff and written primarily by NCSL's experts on public policy and the state legislative institution.