Parents in Rural America and Their Struggle to Access Equitable Medical Care for Their Children

Introduction

Access to healthcare is a fundamental right for all children — yet parents living in rural America often face steep barriers when trying to secure medical care for their families. This research paper explores the unique challenges rural parents encounter, the cultural values that shape their communities, and the innovative programs making a difference. By understanding these realities, we can work toward building a more equitable healthcare system for all families, regardless of where they live.

Description

Seventeen percent of the American population lives in a rural area (Korhonen, 2024). While the number of Americans living in rural areas has remained constant around 55 million since the 1960s, its share of the total population has decreased from 30%. Today, 1 in 5 American children — approximately 14.5 million — live in rural areas.

For this paper, "rural" is defined following The Journal of Rural Health’s standard: a county is classified as rural when it does not contain a town with 50,000 or more residents (Probst et al., 2016). While rural parents face national challenges, the rural population is highly localized, with two-thirds living west of the Mississippi River and nearly half living in the South.

A defining characteristic of rural America is persistent poverty.

• 82% of counties with persistent child poverty are rural.

• 86% of low-employment counties and 80% of low-education counties are also rural.

• 95 of the 100 poorest counties in America are rural.

• 25% of rural children live below the Federal Poverty Line (Probst et al., 2016).

Demographics are shifting: while rural counties remain predominantly white (70% vs 61% nationally), Hispanic populations are growing. Without Hispanic migration, many rural counties would have seen a population decline (Bettenhausen et al., 2021). Additionally, 5.9 million rural households are intergenerational, and rural children are more likely to grow up in two-parent households than urban children (Smalls).

Sociocultural and Psychosocial Issues and Concerns

Employment patterns for rural parents have changed dramatically.

• Agriculture now accounts for only 6% of rural jobs.

• Most rural jobs are hourly service positions (retail, hospitality) with irregular schedules and long commutes.

• Over half (51%) of rural households with children live 200% below the Federal Poverty Line, despite high workforce participation (Vernon-Feagans & Swingler, 2020).

Additional stressors include:

• Limited access to public transportation.

• Spotty internet and cell phone service (21% of families lack reliable broadband).

• Concerns about educational quality due to teacher shortages and fewer professional development opportunities.

From a healthcare perspective:

• One-third of rural parents live more than 30 miles from a major medical center (Morning Consult, 2021).

• Rural areas have fewer physicians: one per 1,761 residents versus one per 1,449 in urban areas.

• Nearly half of U.S. counties lack a general pediatrician; 82% of those are rural.

• There are 40 pediatric specialists per 100,000 rural residents compared to 134 per 100,000 urban/suburban residents (Bettenhausen et al., 2021).

Limited healthcare access and lower health literacy often lead rural parents to delay or forego preventive care and rely on emergency services for non-emergent issues (Marcin et al., 2015).

Cultural Values

Rural parents are deeply connected to their communities.
They value:

• Proximity to extended family and community roots.

• Affordable housing.

• Perceived safety (lower violent crime rates).

Rural families often rely heavily on relatives for childcare, particularly given the distance and cost barriers to formal childcare services (Morning Consult, 2021).
Strong ties to religious organizations, schools, and neighbors help build resilient social support networks.

Culturally Responsive Practices

School-Based Health Centers have become an important public health solution in rural communities.

• Centrally located schools provide easy access to preventive healthcare.

• These centers eliminate transportation barriers and offer confidential mental health services (Belcher, 2004).

• Services are typically available regardless of a family's ability to pay.

Telemedicine has also become crucial in addressing healthcare disparities.

• It connects rural families to pediatric specialists located in distant urban centers.

• Applications include video appointments, transmission of diagnostic files, and remote monitoring of chronic conditions.

• Some rural schools have begun integrating telehealth services into their school-based health centers, improving outcomes for conditions like asthma and diabetes (Marcin et al., 2015).

Reflections on Equity and Practice

Achieving equitable healthcare access for rural children requires acknowledging and creatively addressing the distinct challenges rural parents face.
Key focus areas include:

• Building strong generalist social work skills to meet broad needs.

• Understanding insurance policies (Medicaid, ACA plans, and employer-provided insurance common in rural areas).

• Becoming familiar with government programs, grants, and funding streams designed to assist rural families.

• Advocating for expanded telehealth initiatives and School-Based Health Centers.

It is essential to resist the "out of sight, out of mind" mentality that often marginalizes rural communities. Rural parents are hardworking, resilient, and deeply connected to their communities. Their decision to raise families in these environments deserves respect, and healthcare providers and social workers must meet them where they are — both geographically and culturally.

Implications for Equity-Minded Practice

Social justice for rural families involves:

• Access to livable wages and predictable work schedules.

• Reliable high-speed internet access.

• Transportation assistance to healthcare and work.

• Culturally respectful healthcare partnerships that build trust and improve health literacy.

Rural communities are increasingly diverse. Social service and healthcare models must evolve to meet the needs of Hispanic, Native American, and other minority families living in rural America.

By focusing efforts on strengthening health infrastructure and respecting the resilience and intelligence of rural parents, we can help ensure that every child — no matter where they live — has access to high-quality medical care.

References

Belcher, M. (2004). The Impact of a Rural School-Based Health Center on Students and Their Families in Sneedville, Tennessee: A Case Study (Doctoral dissertation).

Bettenhausen, J. L., Winterer, C. M., & Colvin, J. D. (2021). Health and poverty of rural children: An under-researched and under-resourced vulnerable population. Academic Pediatrics, 21(8). https://doi.org/10.1016/j.acap.2021.08.001

Korhonen, V. (2024, December 5). Size of urban and rural population U.S. 2023. Statista. https://www.statista.com/statistics/985183/size-urban-rural-population-us

Marcin, J. P., Shaikh, U., & Steinhorn, R. H. (2015). Addressing health disparities in rural communities using telehealth. Pediatric Research, 79(1–2), 169–176. https://doi.org/10.1038/pr.2015.192

Morning Consult. (2021, August). Understanding Rural Parents' Child Care Needs. Prepared for Bipartisan Policy Center.

Probst, J. C., Barker, J. C., Enders, A., & Gardiner, P. (2016). Current state of child health in rural America: How context shapes children’s health. The Journal of Rural Health, 34(S1). https://doi.org/10.1111/jrh.12222

Smalls, B. (n.d.). Promoting intergenerational health in rural Kentuckians with diabetes. ClinicalTrials.gov. https://clinicaltrials.gov/study/NCT06080425

Vernon-Feagans, L., & Swingler, M. M. (2020). Early development and family life in rural America. In National Symposium on Family Issues (pp. 201–235). https://doi.org/10.1007/978-3-030-37689-5_8