Almost a quarter of all Veterans in the United States, 4.4 million, return from active military careers to reside in rural communities. Veterans choose rural communities for a variety of reasons: closer proximity to family, friends and community; open space for recreation; more privacy; lower cost of living; or less crowded towns and schools. While Veterans may enjoy the benefits of rural living, they may also experience rural health care challenges that are intensified by combat-related injuries and illnesses.
In rural areas, basic levels of health care or preventative care may not be available to support residents’ long-term health and well-being.
Compared to urban areas, rural communities tend to:
- Have higher poverty rates
- Have more elderly residents
- Have residents with poorer health
- Have fewer physician practices, hospitals and other health delivery resources
Just like any rural resident, it may be difficult for rural Veterans and their caregivers to access health care and other services due to rural delivery challenges, including:
- Hospital closings due to financial instability
- Fewer housing, education, employment and transportation options
- Greater geographic and distance barriers
- Limited broadband internet
- Higher uninsured rates
- Difficulty of safely aging in place in rural America
VA recognizes the need to provide accessible care to rural Veterans and allocates 32 percent of its health care budget to rural Veteran care.
There are 4.4 million rural and highly rural Veterans with 2.7 million enrolled in VA.
- 61 percent of rural Veterans are enrolled in the VA health care system – significantly higher than the 41 percent enrollment rate of urban Veterans
- 58 percent of rural enrolled Veterans have at least one service connected condition
- 8 percent of enrolled rural Veterans are women
- 10 percent of enrolled rural Veterans are minorities
- 44 percent earn less than $35,000 annually
- 27 percent do not access the internet at home
Rural Veterans enrolled in VA's health care system are also significantly older: 55 percent are over the age of 65.
- This older Veteran population is medically complex and more likely to be diagnosed with diabetes, obesity, high blood pressure and heart conditions that require more frequent, ongoing and costly care
The next generation of rural Veterans also has multiple medical and combat-related issues, which will require significant on-going access to care.
- More than 301,000 rural Veterans served in Iraq and Afghanistan
VA uses the Rural-Urban Commuting Areas (RUCA) system to define rurality. Developed by the Department of Agriculture (USDA) and the Department of Health and Human Services (HHS), the RUCA system takes into account population density as well as how closely a community is linked socio-economically to larger urban centers. RUCA is based on how the U.S. Census Bureau counts citizens.
- Urban Area: Census tracts with at least 30 percent of the population residing in an urbanized area as defined by the Census Bureau.
- Rural Area: Land areas not defined as urban or highly rural.
- Highly Rural Area: Sparsely populated areas – less than 10 percent of the working population commutes to any community larger than an urbanized cluster, which is typically a town of no more than 2,500 people.
Click here to learn more about RUCA.
The Rural Veterans Health Care Atlas is a comprehensive resource for rural and Veteran stakeholders (including, but not limited to, researchers, planners, and policy decision makers, as well as clinicians and patient care teams) to enhance health care delivery to rural Veterans, enrollees and patients. The first edition consists of 17 chapters; 7 are core chapters and 10 are disease-specific chapters on the following topics:
- Post-traumatic stress disorder
- Alcohol use disorders
- Tobacco use disorders
- Chronic obstructive pulmonary disease
- Congestive heart failure
- Coronary artery disease
- Chronic renal failure