On November 16, we celebrate National Rural Health Day, a time to recognize the approx 65 million people, or one in five Americans, living in rural America and the potential barriers to health care they may face. While rural areas have more land, fewer people, scenic landscapes and a strong sense of community, residents often face barriers to accessing health care services (PDF | 2.2 MB) needed to reduce disparities between rural and urban health outcomes .
A portrait of health in rural America
According to the National Institutes of Health (NIH), Rural Americans are more likely to die prematurely of the nation’s leading causes of death, including heart disease, cancer, lung disease and stroke. They also have higher rates of obesity and diabetes and are at greater risk of fatal car accidents, suicides and drug overdoses. In addition, research shows that rural communities struggle with recruiting and retaining health care providers and face ongoing, long-term shortages of health care providers.
The Centers for Disease Control and Prevention (CDC) reports that, over the past two decades, suicide rates have been consistently higher in rural areas than in urban areas. Between 2000 and 2020, Suicide rates rose 46 percent in non-metro areas versus 27.3% in metro areas. The CDC further reports that its rates Drug overdose deaths are increasing in rural areas, surpassing the rates in urban areas. Although the percentage of people reporting illegal drug use is lower in rural areas, the the results of use seem to be higher. In fact, the US opioid epidemic has disproportionately affected specific rural areaswith 1600 percent and 1141 percent increases in opioid-related deaths in the rural Midwest and Northeast between 1999 and 2016. In comparison, opioid-related deaths increased by 158 percent in urban areas during the same period.
Responding to Disparities in Behavioral Health
Strengthening access to suicide prevention and mental health services and substance use and overdose prevention are top priorities highlighted in the new SAMHSA Strategic Plan 2023-2026. Equity, one of the guiding principles outlined in the Strategic Plan, includes ensuring that everyone, including people living in rural America, has a fair and equitable opportunity to be as healthy as possible. In conjunction with providing access to quality services, this includes addressing factors that influence behavioral health outcomes, such as employment and housing stability, insurance status, proximity to services, and culturally responsive care. For these reasons, SAMHSA is committed to supporting rural communities to achieve a better quality of life through its rural behavior programs.
Focus on Rural Health Behavior Programs
Two of SAMHSA’s Rural Behavioral Health programs include the Rural Opioid Technical Assistance Regional Center (ROTA-R) and the Rural Emergency Medical Services (EMS) training grant. ROTA-R is a regional, rural program that develops and disseminates high-quality education and technical assistance to address opioid and stimulant use. ROTA-R teams identify model programs and develop and refine locally tailored prevention, harm reduction, treatment, and recovery activities for opioid use disorder and/or stimulant use disorder. ROTA grantees conduct regional needs assessments, partner with leaders such as State and Tribal Opioid Response grantees, and offer personalized training and technical assistance, including a local toll-free resource line.
While the need for a strong and diverse rural EMS workforce with the ability to address behavioral health crisis care is high, Training to create and maintain such a workforce is difficult (PDF | 1.1 MB) in rural areas. To help meet this need, the EMS Training grant program provides support to rural EMS services operated by local or tribal governments and rural nonprofit EMS services. The purpose of this program is to recruit and train EMS personnel in rural areas, with a particular focus on addressing substance use disorders (SUD) and co-occurring substance use and mental disorders (COD). Recipients use grant funds to strengthen the rural EMS workforce by maintaining necessary licenses and certifications, while providing training on SUD, COD, and the principles of trauma-informed, recovery-based care for health emergencies. Despite real infrastructure challenges, Rural EMS Training grantees have reported notable accomplishments, such as strengthening the workforce needed for EMS in the midst of a global pandemic and building training capacity that can sustain that workforce over the long term. Grantees have repeatedly emphasized the role of the Rural EMS Training grant in enabling agencies to continue to perform vital EMS functions, not only at the height of the COVID-19 pandemic, but for years to come.
Serving rural residents through 988
In 2020, Congress designated 988 to operate through the existing National Suicide Prevention Lifeline. Given 988’s ability to provide crisis counseling to anyone in any location, it has great potential to improve behavioral health crisis response capacity in rural areas. 988 is part of a multifaceted continuum of behavioral health crisis care. Officials must continue to build local crisis care infrastructure to ensure rural callers can be referred to appropriate resources and facilities as needed while working with behavioral health providers and emergency response. Building on rural America’s strong tradition of community building and collaboration, 988 can be integrated into a strong crisis care continuum to better serve these areas.
Rural areas are rich in community, culture and resources. They are critical sources of water, food, energy and recreation for the nation, they make up 97 percent of America’s land and accounts for much of the country’s vital natural resources. Observing Rural Health Day is an opportunity to draw attention to and honor rural health care providers, communities, organizations and all stakeholders dedicated to ensuring good health in rural America.
