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. Rural adults have higher rates of use for tobacco and methamphetamines, while prescription drug misuse and heroin use has grown in towns of every size. Substance use can be especially hard to combat in rural communities due to limited resources for prevention, treatment, and recovery. Factors contributing to substance use in rural America include low educational attainment, poverty, unemployment, lack of access to mental healthcare and isolation.  Substance use disorders can result in increased illegal activities as well as physical and social health consequences, such as poor academic performance, poorer health status, changes in brain structure, and increased risk of death from overdose and suicide. 

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.

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.