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2019 U.S. RURAL HEALTH REPORT CARD – Grading the state of rural health in America

RURAL REPORTS – Rural health reporting from across the nation and around the world

RHQ CONFERENCE CALENDAR – Upcoming U.S. rural health conferences

RHQ is pleased to present our third annual U.S. Rural Health Report Card.

Each state’s individual report card page includes a complete list of all the indicators that went into that state’s final score, and also includes a detailed discussion of “What’s Good” and “What Needs Work” in the state. We’ve also continued to grade what has become one of the most important factors in a state’s report: Telemedicine access.

With the onset of the coronavirus (COVID-19) pandemic, the widespread expansion of telehealth and telemedicine technology has dominated rural health care discussion. In our Rural Reports section above, you will see many states are investing in and expanding broadband access across rural areas, bringing online health care access to more rural people nationwide.

However, this Report Card will only show 2019’s rural health care measures, as that is the only complete data set available to us. 2020 rural health care measures will be available in our next Rural Health Report Card.

We compiled this report to provide policymakers, practitioners and the public with a snapshot of each state’s rural health status relative to other states across the nation. These state report cards underscore ongoing challenges that face many rural communities, but they also highlight health care success stories and improvements made by those who take direct action to reduce health disparities. We hope the information we provide will be of assistance to all rural health stakeholders in helping to craft effective solutions.

This research was supported by the Texas Tech University Health Sciences Center and the F. Marie Hall Institute for Rural and Community Health.

We thank our colleagues who provided expertise and greatly assisted in the creation of the 2019 U.S. Rural Health Report Card, including Billy Philips, Catherine Hudson, Mike Penuliar, Debra Curti, and Miguel Carrasco.


The key findings for each state are summarized in each of the individual state report cards in the PDF.

Each state’s final grade and overall rank appear prominently at the top of each page alongside a listing of each state’s grades in each of 10 differently weighted rural health measures. Below the final grade for each state, numbers and arrows indicate each state’s 2019 State Rural Health Rankings for the three equally weighted categories: Mortality, Quality of Life and Access to Care.

Each report card also includes a state map that delineates rural and urban counties by color (red means rural) along with a brief list of facts about each state’s rural population.
Finally, every report card offers a summary of “What’s Good,” “What Needs Work,” and the “Urban-Rural Divide” in state mortality rates. Urban-rural difference in mortality is defined as the result of the z-score of rural counties minus the z-score of urban counties of the same state; the county with the smallest value is ranked the highest.

In Figure 2, all nine U.S. Census regional divisions are numbered and color coded based on their final average rankings. The top third is in green, the middle third is yellow, and the bottom third is red. Further details about divisional rankings (composite scores calculated using all 10 health variables) are detailed in Table 3. The map in Figure 3 color codes each state individually and provides their final 2019 rankings at a glance.

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