Life in Rural America:
Part II

Rural adults are satisfied with their quality of life and feel safe in their communities, but many struggle to stay ahead of mounting medical and housing expenses and to access the health care they need.

For many across rural America, the ability to stay healthy is challenged by financial hardships and difficulty accessing adequate and affordable health care. Despite these challenges, the majority of rural adults are satisfied with their quality of life and feel they can make an impact in their local community, a finding echoed from the first Life in Rural America poll. People living in rural America are also more likely to see their communities as very safe, compared to adults nationally. At the same time, nearly half of rural adults have experienced problems affording medical bills, housing, or food in the past few years and more than a quarter lack access to adequate health care.

These are the primary findings of the latest poll from NPR, the Harvard T. H. Chan School of Public Health, and the Robert Wood Johnson Foundation. The second in a series, the poll surveyed 1,405 adults ages 18 or older living in rural America about their personal experiences with health, social, civic and economic issues.

Key Findings

• A majority of rural adults (62%) say people like them can make an impact in their community, including more than one-quarter (27%) who believe they can make a big impact. More than half (61%) belong to a health, social, or community service group.

   

• One-third (33%) say homelessness is a problem in their rural community, while more than one in five (22%) worry their housing conditions affect their family’s health or safety.

   

• One-quarter of rural adults (26%) say there has been a time in the past few years when they needed health care but didn’t get it.

   

• Asked why they weren’t able to get health care, nearly half (45%) said they couldn’t afford it and nearly one in five (19%) said they couldn’t find a doctor who would take their health insurance. Physical access is another challenge, with nearly one-quarter citing distance (23%) or difficulty getting appointments during the hours they needed (22%).

   

• When asked what was the most important thing that could be done to improve their health, more than a third (36%) of rural adults identify options related to fixing health care, including improving access, quality, and reducing costs.

   

Safety and satisfaction in rural communities

Although the survey finds trying economies realities compounded by a lack of quality health care in rural communities, most adults report being satisfied with their lives. When asked to rate their overall quality of life, about three-quarters (73%) rated it as excellent or good, including about one-quarter (24%) who rated it as excellent.

The poll also found that the vast majority of rural adults think their communities are safe. When asked how safe their local community was from crime, if at all, almost nine in 10 surveyed say it was very (45%) or somewhat (43%) safe from crime. Only 1 percent say their community was not at all safe from crime.

This overall feeling of safety appears unique to rural America and exists in stark contrast to the rest of the country. Only about one in five adults nationally (22%) say their local community is very safe from crime and 5 percent said it’s not at all safe.    

Challenges with housing and the digital divide

One-third of rural adults (33%) say homelessness is a problem, including 15 percent who call it a major problem. These rates are substantially higher among rural Native Americans, where half report homelessness is a problem in their local community (50%). More than one in 10 people living in rural America say they have experienced housing problems in their current residence that impacted their health, including the safety of drinking water, mold and other environmental problems.

The survey also revealed that a lack of reliable, broadband (high-speed) internet access has created a major divide between rural and urban communities. About one in five rural adults (21%) say access to high-speed internet is a problem. Those who are using the internet do so for health information (68%), for banking or financing (61%), or for their job or other business-related activities (54%), underscoring the need for reliable high-speed access.

Summary

Overall, these findings illustrate that people living in rural America are largely civically and socially engaged, see their communities as safe, and value their quality of life. However, a minority of rural adults struggle with experiences in areas of life that carry major consequences, including financial insecurity, housing problems, trouble accessing affordable, quality health care, and a lack of high-speed internet access.

About the survey

At the start of 2019, researchers interviewed 1,405 rural adults age 18 years and older living in the rural United States. The sampling of respondents contains, by U.S region: South (43%), Midwest (32%), Appalachia (18%); by race/ethnicity: white (78%), Black (8%), Latino (8%), Native American (2%); by age: 50+ years old (53%) and 18–49 years old (47%).

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