Rural Transportation: Challenges and Opportunities


Transportation, as it relates to health and healthcare, is widely acknowledged to have unique features in rural communities, but there is limited research on specific challenges and potential policy interventions to alleviate them. A study of more than 1,000 households in North Carolina found that those with a driver's license had 2.3 times more health visits for chronic care and 1.9 times more visits for regular checkup care than those who did not have a driver's license, and those who had family or friends who could provide them with transportation had 1.6 times more visits for chronic care than those who did not. Despite the importance of travel and mobility, transportation services are seriously lacking in many rural areas. Nearly four percent of rural households — almost two million rural residents — do not have access to a car; rural areas are also much less likely to have access to public transportation services. The National Rural Health Association cited transportation as a key policy concern for older adults' well-being in their 2014 legislative agenda, but research is lacking on specific rural transportation challenges and potential policy solutions.

For this study, we surveyed key informants in all fifty states by phone (n=39) and email (n=74). Fifty of those informants were from State Offices of Rural Health, and 63 were from programs funded by the U.S. Administration on Aging and the Centers for Medicare & Medicaid Services, including Aging and Disability Resource Centers and Area Agencies on Aging. We also consulted with state and national organizations with relevant expertise.

Six themes emerged from the interviews describing different types of rural transportation challenges: infrastructure (mentioned by 63% of key informants), geography (46%), funding (27%), accessibility (27%), political support and public awareness (19%), and socio-demographics (11%). We describe each of these in detail, along with illustrative quotations, in the policy brief.

University of Minnesota Rural Health Research Center
Carrie Henning-Smith, Alex Evenson, Amanda Corbett, Katy Kozhimannil, Ira Moscovice