Rural Well-Being

Rural communities are integral to our entire nation’s economy, our culture, and our future. One in five people in this country live in rural places, and one in four of those rural residents are people of color. Our current and future sources of water, energy, and food are inherently rural, and people raised in rural communities provide essential leadership and workforce for both rural and urban America. Rural areas have higher rates of entrepreneurship critical to job growth, and rural businesses have higher five-year survival rates than urban areas and businesses. Rural locales are the primary home for the manufacturing, energy, agriculture, and forestry sectors that drive much of the wealth generation at the foundation of our economy. The well-being of rural areas, and their very existence, impacts all major systems in our country. 

Understanding the Need

Compared to their non-rural counterparts, people living in rural areas have higher rates of unemployment, lower educational attainment, and less access to healthcare and social services. These factors directly affect an individual's health and well-being. Rural residents face several documented health disparities. For example, rural residents are more likely to have chronic diseases such as heart disease, obesity, and diabetes, in comparison to non-rural residents. Social and environmental factors have contributed to decreased life expectancy in rural areas, with the gap between rural and urban life expectancy widening since the 1990s. In addition, children's health outcomes are worse in rural areas, with higher infant and child mortality. 

Several social, environmental, economic, and physical factors in rural communities affect the conditions in which rural residents grow up, live, work, and age (SDOH):

  • Healthcare: The closure of rural hospitals and long distances to provider offices, specialists, and emergency services limit access to care in many rural communities. Rural residents are also more likely to live without health insurance, which poses barriers to accessing needed care.

People in rural communities are 25% more likely to live in poverty and face mortality rates 18% higher than people in metro areas. Rural communities also have the highest rates of incarceration in the nation. Rural workers earn less, are more likely to be injured on the job, and are less likely to have benefits like paid leave or healthcare. 91 of the 100 most disadvantaged communities in the United States are rural.

Recent economic struggles have accelerated these challenges, with rural communities hit harder by the economic downturn. Following the pandemic, it took three years for rural employment to catch up, while urban areas recovered much faster with higher wages. This slow recovery mirrors the uneven impacts of the 2008 crash.  People in rural communities are deeply connected to each other — on both an economic and a social level. Hardships are experienced on a communal level, and people in rural communities take great pride in supporting each other and creating community solutions.  

According to the National Survey on Drug Use and Health, approximately 23% of rural adults reported having any mental illness in 2022. In addition, 5.7% of adults in rural areas reported having serious thoughts of suicide during the year. While the prevalence of mental illness is similar between rural and urban residents, the services available can be very different. Mental healthcare needs are often not met in many rural communities across the country because adequate services are not present. Substance use can be especially hard to combat in rural communities due to limited resources for prevention, treatment, and recovery. 

A recent Washington University study found that people in rural areas tended to score lower in overall psychological well-being, a measure that includes sense of purpose, self-acceptance, and positive relationships with others, among other signs of good mental health. Importantly, those differences disappeared when researchers controlled for other factors that can separate rural and urban communities, including education levels, income, and the presence of social networks. In other words, it appears that a lack of these resources — not rural living in itself — is the real threat to psychological well-being.

Rural Missouri/Illinois

Rural Missouri is dying. Citizens of the region consistently experience worse health outcomes in most areas of life. The rural population accounts for 1.5 million people who are overrepresented in every leading cause of death. Life expectancy is shortening, and there are not enough providers to meet healthcare needs. Overdose, suicide, and mental health outcomes are growing exponentially, resulting in devastating outcomes. The rural health crisis is overwhelming, complex, and in immediate need of intervention. MO Rural Health Association 

Illinois’ rural counties have higher rates of smoking, obesity, child poverty and teen pregnancies compared to urban or suburban counties. It is also more difficult to access health care in rural communities. The Kaiser Family Foundation estimates that only 23.3% of Illinoisans’ mental health needs can be met with its current workforce. 93.7% of rural hospitals in Illinois are in designated mental health shortage areas.  In both Missouri and Illinois, there are zero rural emergency hospitals.

Marillac Mission Fund’s Response

We envision that rural communities across the bi-state region are healthy places where each and every person belongs, lives with dignity, and thrives.

To be eligible to apply within this focus area, applicants must work to increase the well-being of rural residents through direct interventions that improve mental health, address disordered substance use, strengthen a sense of belonging, increase community participation, and ultimately enhance quality of life.

RHIhub's Am I Rural? tool can be used to help determine whether a specific location is considered rural. To be eligible to apply within this focus area, applicants must fall within our geographic footprint and meet at least one definition of “rural” using existing classifications.