Identifying High-Need Counties for Resource Planning

The development of a rural-focused tool is needed to help policy makers identify specific under-resourced communities or those in high need of specific public health intervention. This project's purpose was to develop a resource to identify urban and rural high-need counties in the areas of:

• Health care infrastructure/workforce
• Burden of chronic disease
• Socioeconomic environment

Previous work from the University of South Carolina Rural Health Research Center (USCRHRC) titled "Identification of High-Need Rural Counties to Assist in Resource Location Planning" has served as a tool for policy makers to identify rural areas with a high need for safety net providers. This project updated the previous work by the USCRHRC. The previous analysis was updated with current data and included a newly created metric that allows for the inclusion of each of the nations' approximately 1,975 rural counties rather than the 174 counties that were the focus of the previous report.

Using county-level urban influence codes (UIC), we limited our analysis to only those counties classified as rural (UIC = 3-12). All datasets were linked together using county Federal Information Processing System (FIPS) codes to create one large data file. Counties were examined in three core areas:

• Health care workforce (number of providers in primary care, obstetrics, cardiology, and dentistry)
• Chronic disease prevalence and mortality (diabetes, obesity, high blood pressure, high cholesterol, chronic kidney disease)
• Socioeconomic environment (unemployment, uninsured, no college education, median household income)

This allowed researchers to examine the variation across all counties. Choropleth maps in ArcGIS were also made to visualize where counties with the most needs are located and potentially if there are specific geographic clusters across the country.

Publications

• Examining the Burden of Chronic Disease and Low SES to Identify High-Need Rural Counties
  Journal Article
  University of South Carolina Rural Health Research Center
  Date: 09/2025
  This study identifies rural counties with high chronic disease burden and low socioeconomic status; describes the geographic and demographic patterns of these high-need counties; and examines whether counties with greater need also experience reduced geographic access to critical health care services.
• Identification and Characteristics of Under-Resourced and High-Need Rural Counties
  Policy Brief
  University of South Carolina Rural Health Research Center
  Date: 04/2026
  This brief provides a metric describing how publicly available county-level data on health care workforce, chronic disease prevalence, and the socioeconomic environment of rural communities can assist policymakers in identifying the highest need counties for targeted policy initiatives and public health intervention.