For rural hospitals, the road to improving health outcomes is filled with obstacles — and opportunities
Article | June 11, 2025
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In the evolving landscape of health access, rural communities present persistent and unique challenges. While poverty exists everywhere, urban poverty is often clustered in concentrated areas, making it easier to identify and, potentially, to address. In contrast, rural poverty tends to be more diffuse and, in some ways, less visible. You may not see many unhoused individuals on the streets of rural towns, but that doesn’t mean homelessness isn’t present. It often manifests as couch surfing, inadequate housing or transient living situations — conditions that are harder to quantify and support.
Transportation also presents a significant barrier. Many rural areas lack public transit, have limited ride-share options and require long drives to access care. These regions often exist in food and pharmacy deserts and face critical shortages in primary and dental care, along with substantial gaps in mental health services. Additionally, a lack of infrastructure and funding makes hospital operations difficult to sustain. As a result, many rural hospitals are either merging with larger systems or closing altogether. About one-third of all rural hospitals are at risk of closure, with nearly half of those at immediate risk due to severe financial distress.
Other systemic issues include post-hospitalization challenges, where patients are discharged without stable income and face significant healthcare expenses — particularly after long or complex admissions, such as for sepsis or psychiatric care. Policy factors, such as Medicaid expansion decisions, also affect access. Provider shortages — especially in maternal healthcare — continue to worsen outcomes. Between 2011 and 2023, more than 290 rural hospitals, nearly a quarter of all rural obstetric units, stopped offering maternity services.
In many rural regions, the hospital is more than just a care provider — it’s the largest local employer. That means the social needs of its workforce often mirror those of its patients. As anchor institutions, rural hospitals are uniquely positioned to drive improvements in community conditions, both within their facilities and across the region.
The critical role of social needs data
Health outcomes are often more influenced by social needs than by clinical factors. Prevention and treatment of chronic disease is made much more difficult when patients also face poverty, food insecurity. or housing issues. Despite the many challenges rural hospitals face, they have an opportunity to advance access by addressing SDOH in ways that are measurable and actionable.
The publicly available, patent pending Vizient Vulnerability Index™ measures 43 indicators across nine domains — including housing insecurity, access to broadband, availability of healthy food, air and water quality, and crime rates. The data shows clearly that where you live and the resources (or lack thereof) available to you can directly shape your health trajectory.
For instance, as food insecurity and poverty increase nationwide, so do rates of diabetes, maternal complications and more. Diabetes, in particular, has shown strong correlations with social conditions. Among all measured variables, food deserts are the most reliable predictors of diabetes prevalence and complications, such as amputations and kidney disease.
Maternal health outcomes also are closely tied to social context. Maternal hypertension is more common in economically distressed areas. Similarly, severe maternal morbidity is more frequent in neighborhoods with fewer insured working-age adults. The risk of both are increased in areas with fewer social resources — other adults that a pregnant patient can rely on.
Turning data into action
Social needs data shouldn’t just be used for reporting — it should inform strategy. Hospitals and health systems can use insights at the individual level (inpatient and outpatient screenings, z-codes, EMR) and community level (public data describing neighborhood resources such as z-codes, census data) to drive a range of targeted interventions, including:
- Strategic clinic placement: Mobile clinics can be difficult to implement in sparsely populated areas, but they can be effective when positioned at community hubs like churches, parks or local centers.
- Employee support programs: Providing transportation, housing assistance, childcare and low-cost care options to employees — particularly those in lower-wage roles like food service and maintenance — can reduce instability and promote community resilience. Research shows high staff turnover is often linked to regions with high social vulnerability, suggesting workforce retention is deeply tied to social conditions.
- Community partnerships: Collaborating with trusted local organizations — such as YMCAs, faith-based groups and recreation centers — can help embed outreach efforts into the fabric of rural communities. However, these efforts must be consistent, reliable and sustained to build trust and effectiveness.
- Telehealth optimization: Telehealth holds promise for expanding access, but only if the technological infrastructure exists to support it. Many rural areas still lack reliable broadband. One potential solution is enabling local clinics to host in-office virtual visits, where patients connect with specialists at larger hospitals via telehealth.
- Outreach to at-risk populations: Community health workers — who often share lived experiences with the communities they serve — can build bridges between patients and providers. They offer culturally appropriate education, support disease management, assist with follow-up care and serve as trusted advocates within the community.
- Collaborative care networks: Regional care alliances that include hospitals, community organizations and local leaders can help coordinate efforts and share resources, especially in under-resourced areas.
A long-term commitment to equity
Health access in rural areas is not a quick fix — it’s a long-term journey. Whether by using data to inform new technologies and partnerships or advocating for policies that support the rural healthcare workforce, every step toward improving health outcomes has the power to transform lives. The social determinants of health in rural areas are distinct and demand equally nuanced solutions. Rural hospitals have the potential to lead not only as care providers but as stewards of community well-being.
The time to act is now. By measuring what matters and investing in data-informed, long-term strategies, rural health systems can help create healthier futures for the communities they serve.