Princeton, N.J.—A great deal of recent national attention has been paid to the challenges facing residents in rural communities. Today, running counter to prevailing national narratives, a new poll by NPR, the Harvard T. H. Chan School of Public Health and Robert Wood Johnson Foundation shows rural residents are largely optimistic about the future. For the most part, rural residents like where they live—in large part because of strong connections to their families and neighbors—and generally feel their lives are turning out as they expected, if not better. This optimism is, however, tempered by concerns for drug abuse and addiction in their communities and the health of their local economies.
The survey of 1,300 adults age 18 or older living in rural America explores topics across a range of areas of life including several that are directly linked to health such as jobs, education, and economic opportunity. Among the findings, 70 percent of rural residents say their health is good, very good, or excellent; 85 percent respond similarly about their mental health. And while 86 percent of rural residents have health insurance, compared with 91 percent nationally, half identify health care costs as a serious problem for their family finances.
Research shows that education and jobs are linked to better opportunities for health. Rural residents believe the number of good jobs in their local community will either stay the same or increase in the next five years. When asked what would be most helpful to their local economies, rural residents identify the creation of better long-term jobs (64%), greater support for local public schools (61%), improvements in access to health care (55%), and job training and skills development (51%) as critical areas for investment.
Beyond hopes and concerns for their local economies and schools, a majority of rural residents agree opioid addiction is a serious problem in their community (57%), with about half of them personally knowing someone who has struggled with opioid addiction (49%). Almost one-quarter of rural adults (23%) say that drug addiction or abuse is the most urgent health problem currently facing their community, followed by cancer (12%) and access to care (11%).
“What has been widely recognized is the serious economic problems facing rural communities today. What has not is that drug/opioid abuse in rural communities is now viewed with the same high level of concern as economic threats,” said Robert J. Blendon, co-director of the survey and the Richard L. Menschel Professor of Health Policy and Political Analysis at Harvard T.H. Chan School of Public Health.
Strong Connections to Family and Neighbors are Key
Residents value living in a rural community for a number of reasons. Most identify “closeness” and social connection, life in a small town, and “being around good people” as their community’s greatest strength. The majority of rural residents report feeling attached to their local community (81%); research has demonstrated that adults who are socially active live longer and are healthier than their more isolated peers.
More than two-thirds (67%) of rural residents say their neighbors have helped them in times of need.
When asked why they choose to live in their community, about one-third of rural adults say it is because of family (31%).
Yet 43 percent of rural parents report their adult children have moved away, primarily in pursuit of long-term job opportunities.
More than half (52%) of rural residents say they are active in solving problems in their local community, although younger adults report higher levels of participation.
“These findings elevate commonalities across rural communities in the strength of social connections, the power of civic engagement, and the dedication to improving local conditions and opportunities,” said Katrina Badger, a program officer at RWJF, who grew up in small-town Ohio. “If we, as a nation, work to empower rural communities in advancing their own solutions, all of us are going to be better off.”
Rural America: A Diversity of Views and Experiences
The findings make clear that there is no singular rural America or one rural mindset. Nearly one in five rural residents has a college or graduate degrees (19%), while half have a high school education or less. A great majority of those polled report that religion or spirituality are important to them (81%). And with respect to racial/ethnic diversity, one in six rural residents are Black or Hispanic (16%), two percent are American Indian/Alaska Native, and some five percent identify as LGBTQ.
Rural residents are divided on whether local problems will be solved in the next five years and many see a need for outside help to solve them. Among those who say outside help is needed, nearly one in three believe state government will play the greatest role (30%) and fewer than one in five look to the federal government (18%). Compared to rural adults without college degrees, those with college degrees are less optimistic about solving major community problems and see a greater need for outside help.
People living in rural America are also divided politically, with affiliations split evenly across Republican, Democrat, and Independent parties. And personal experiences of financial well-being are split by age, education level, race and ethnic background, and region of the country. For example, younger residents (ages 18-49) are more likely to say the number of good jobs in their community has increased and that their personal financial situation has improved in the past five years, compared to older residents (ages 50+).
Public health officials, local leaders, community members, and policymakers can use the poll to understand rural priorities and guide decisions to improve local health and well-being.
The survey was conducted June 6-August 4, 2018, among a nationally representative, probability-based telephone (cell and landline) sample of 1,300 adults age 18 or older living in the rural United States. Interviews were conducted in English and Spanish. The margin of error for total respondents is ±3.6 percentage points at the 95% confidence level. The sample of Rural Americans is defined in this survey as adults living in areas that are not part of a Metropolitan Statistical Area (MSA) or in MSAs with a population under 50,000. This is the definition used in the 2016 National Exit Poll.
About the Harvard T.H. Chan School of Public Health
Harvard T.H. Chan School of Public Health brings together dedicated experts from many disciplines to educate new generations of global health leaders and produce powerful ideas that improve the lives and health of people everywhere. As a community of leading scientists, educators, and students, we work together to take innovative ideas from the laboratory to people’s lives—not only making scientific breakthroughs, but also working to change individual behaviors, public policies, and health care practices. Each year, more than 400 faculty members at Harvard Chan School teach 1,000-plus full-time students from around the world and train thousands more through online and executive education courses. Founded in 1913 as the Harvard-MIT School of Health Officers, the School is recognized as America’s oldest professional training program in public health.
NPR's rigorous reporting and unsurpassed storytelling connect with millions of Americans everyday—on the air, online, and in person. NPR strives to create a more informed public—one challenged and invigorated by a deeper understanding and appreciation of events, ideas, and cultures. With a nationwide network of award-winning journalists and 17 international bureaus, NPR and its Member Stations are never far from where a story is unfolding. Listeners consider public radio an enriching and enlightening companion; they trust NPR as a daily source of unbiased independent news, and inspiring insights on life and the arts. Learn more at npr.org/about or by following NPR Extra on Facebook, Twitter and Instagram.
About the Robert Wood Johnson Foundation
For more than 40 years the Robert Wood Johnson Foundation has worked to improve the health and health care of all Americans. We are striving to build a national culture of health that will enable all Americans to live longer, healthier lives now and for generations to come. For more information, www.rwjf.org. Follow the Foundation on Twitter at twitter.com/rwjf or on Facebook at facebook.com/RobertWoodJohnsonFoundation.
Across the nation, many rural communities are finding inspiring solutions to improve health, equity and well-being.