Q: What barriers to accessing healthcare do rural communities face?
Prof. Henning-Smith: Rural residents have a variety of challenges accessing care. In general, they have access to fewer providers, especially specialists, and they have longer travel distances to get to healthcare. Rural healthcare workforce shortages are pervasive, and have gotten worse since the COVID-19 pandemic. Rural areas across the country have also experienced the closure of critical healthcare facilities in recent decades, including hospitals, nursing homes, and pharmacies. Research from our own SPH Rural Health Research Center shows a decline in obstetric care for rural residents. In other words, from birth through old age, and everything in between, rural residents face increasing challenges in accessing the health care they need.
Q: What aspects of living in a rural community impact overall quality of life?
Prof. Henning-Smith: Rural areas can offer a wonderful quality of life. They are rich in natural resources and amenities and tend to have strong social capital. However, rural areas also tend to have fewer occupational and educational opportunities, more limited technological connectivity, older housing stock, and long-standing transportation challenges. With investment in rural infrastructure and opportunity, many rural areas are thriving. However, that investment is not equal across places.
It’s also important to note that rural areas are not monolithic – rural people and places are tremendously diverse. In our research, we tend to find the poorest health outcomes for rural residents who are Black, Indigenous, and people of color.
Q: How does a person’s environment — from immediate living environment to broader geographical environment — impact long-term health outcomes?
Prof. Henning-Smith: Our environment, including who we live with, the type of housing we live in, and what our community is like, has an enormous impact on our health and well-being. Our environment shapes a lot of the ways that we go about our daily life, including who we interact with, what we are exposed to, and what we have access to. For example, does your home, work, or neighborhood environment provide regular opportunities for meaningful social interaction, civic engagement, healthy eating, or physical activity? If it doesn’t, do you have the resources to access what you need outside of your home and community to stay healthy, such as transportation and technology? All of these issues impact our short- and long-term health outcomes.
Q: How is the COVID-19 pandemic continuing to impact the health of people in rural communities?
Prof. Henning-Smith: The COVID-19 pandemic has been devastating to many rural communities. Rural residents had more risk factors for COVID-19 headed into the pandemic, including an older population, more underlying health conditions, and more limited access to healthcare. Rural areas had higher mortality rates from COVID-19 for much of the pandemic, a sobering statistic that impacted whole communities. COVID-19 also stretched the rural healthcare workforce to its limits, with dire workforce shortages in many areas continuing to this day. On the flip side, the pandemic opened up opportunities for remote work, coupled with historic investments in broadband infrastructure, causing many people to rethink where they live, with some people opting to leave urban centers to live and work in rural areas. In fact, 2023 U.S. Census data showed population growth in many rural areas, including several Minnesota counties.
Q: What are you doing to advance health in rural communities?
Prof. Henning-Smith: My research focuses on aging, mental health, and social connectedness in rural communities, as well as on the social and structural drivers of health in rural places. Right now, I’m working with colleagues at the SPH Rural Health Research Center on several projects addressing rural health, including focus areas on medical debt, aging in place, housing, and elder abuse. I’m also collaborating with colleagues from across and beyond the University on research related to addressing rural healthcare workforce shortages, and on supporting the mental health of farmers and farm families. Finally, I lead the University of Minnesota Rural Collective, which provides opportunities for networking and collaboration for faculty and staff interested in rural issues from across the entire University system. In all of my work, I aim to advance health equity across geographic lines and to build on strengths and assets that abound in rural places.
Carrie Henning-Smith is deputy director of the School of Public Health Rural Health Research Center, Co-Director of the University of Minnesota Rural Health Program, and an Associate Professor in the Division of Health Policy and Management in the School of Public Health. Henning-Smith’s research focuses on social drivers of health, mental health, social well-being, and aging and long-term care for rural residents.