2020 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 fourth 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. In this issue you will see many of the states with rural counties have improved broadband internet access, as well as mental health, physical health and dental care access. Low birth weight has changed for the states as well, as the effects of “maternity deserts”, areas where maternal health care is scarce or absent, grows more obvious with each passing year.

With the past 20 months behind us, we would like to remind our readership that the 2020 data in this report card does not include any state data from the coronavirus (COVID-19) pandemic. That data will be available in the spring/summer of 2022, and will appear in our 2021 Rural Health Report Card.

As always, 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 shine a light on health care success stories and improvements made by those who take direct action to reduce health disparities. We hope the information we provided is of assistance to all rural health stakeholders in helping to craft long term 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 2020 U.S. Rural Health Report Card, including Billy Philips, Miguel Carrasco, Debra Curti, and Mike Penuliar.


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 2020 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 2020 rankings at a glance.