A Lack of Transportation: The Impact on the Health of Rural Americans

A Research Brief by: Faith Harron

FHMillions of rural Americans face a disproportionate lack of transportation, affecting their access to health care. This, compounded with the generally lower educational attainment, elevated age and lower income in comparison to urban areas, leads to poorer health outcomes. The lack of transportation across America has been heavily discussed, but in most rural areas, little has changed. In rural areas, the spatial distribution of the population complicates public transportation programs, while the low-income status and seemingly low demand may deter companies such as Lyft and Uber from being sufficiently present in these areas. By improving local transportation infrastructure and thus increasing access to care in rural areas, the health status and overall quality of life in rural communities would drastically improve.

Several studies have found that communities and individuals with access to transportation have a much higher health service utilization compared to those who do not have access, such as rural regions. In communities that offer public transportation programs, residents had four more chronic care visits annually. Additionally, rural residents have a lower demand for specialty care leading to increased reliance on general practitioners. This lower demand is met with increased access barriers to specialists. In fact, rural residents must travel two to three times farther than their urban counterparts for medical care, and perhaps even farther for certain specialty treatments. In summary, these factors require rural residents to travel farther for care but they lack the transportation to do this. Without adequate health care, patients face poorer health outcomes, shorter life expectancies, and higher health care costs long-term.

There are several interventions that could revolutionize transportation and access to health care in rural communities. While policies from the state legislature may impact a community downstream, the direct actions of local stakeholders are most impactful. In rural communities, most hospitals have limited funding for transportation programs. Therefore, it is through funding the state legislatures could impact rural communities and ensure that local programs are sustainable. With this funding, local hospitals should establish internal transportation programs, as this would allow patients who receive treatment recommendations and prescriptions to follow physician orders. Without this option, these patients may otherwise be forced into forgoing necessary treatment plans. Local governments creating a bus/dial-a-ride system with set routes and schedules has also proven to be effective in multiple rural communities. Finally, local cab or rideshare companies establishing a program that transports community members at low costs to appointments has potential to be very effective. Overall, programs that start in the community and are run by the community, are most likely to be trusted and utilized by rural residents.

The challenge for public health workers, health administrators, and citizens, as rural areas continue to evolve and demographic composition changes, is to push through barriers surrounding transportation in rural areas to ultimately improve the health of the population and improve quality of life. All Americans have the right to access comprehensive health care. Definitively, transportation plays a large role in ensuring that this right is met.