Guiding Public Health Resources

Guiding Public Health Resources: A Framework for Identifying High-Need Rural Counties

Posted on August 7, 2025 by Gabriel A. Benavidez

This entry is part 4 of 7 in the series September 2025

In our study, “Examining the Burden of Chronic Disease and Low Socioeconomic Status to Identify High-Need Rural Counties” our research team from Baylor University and the University of South Carolina set out to answer a straightforward but urgent question: How can we identify rural counties most in need of public health intervention? With public health resources, especially at the local level, continuing to diminish, it is critical to have a simple, effective, and replicable way to pinpoint communities that are disproportionately affected.

We focused on two key factors of public health importance: chronic disease burden and socioeconomic status. While each of these factors independently contributes to poor health outcomes, they do not always overlap. Some rural counties experience a high prevalence of chronic disease like obesity, diabetes, or hypertension, while others contend with high poverty, low education, and limited access to services. But a subset of counties experiences both, a double burden that significantly compounds health challenges. This combination is particularly concerning as chronic diseases already reduce quality of life and drives up healthcare costs, and when economic hardship is layered on top, communities and public health officials are limited in their ability to respond. By identifying the areas of highest need we can develop targeted public health mitigation strategies or targeted policy initiatives.

Using publicly available data from the CDC’s PLACES database and the American Community Survey, we evaluated the chronic disease and socioeconomic characteristics of 1,934 rural counties in the United States. We identified 534 high-need rural counties, which were those that had both a high prevalence of multiple chronic diseases and low socioeconomic status determined by median household income; proportion of residents with only a high school education; proportion of adults uninsured.

What we found among these 535 high need counties:

Nearly 80% of high-need rural counties were located in the Southeastern United States, demonstrating strong regional clustering of dually burdened counties
Significantly higher proportion of racial and ethnic minority residents than other rural counties
High-need counties had poorer geographic access to healthcare services, even when compared to other rural counties:
Residents in high-need counties have to travel significantly farther to reach hospitals with trauma care, obstetric services, federally qualified health centers, and rural health clinics.

Read the Article in JPHMP

Public health departments, researchers, or even advocacy organizations can replicate this method at even more granular levels using data they already have or can easily access. By identifying counties or even ZIP Codes that face multiple challenges, poor health and poor economic conditions, this framework can help prioritize interventions and resources more effectively. Whether that means identifying areas for needed expansion of primary care, investing in transportation solutions, or supporting community-based chronic disease programs, knowing where to act is the first step.

As public health practitioners think about where to focus limited resources, this framework can be part of the solution. It can help us move from general assumptions about rural health to specific, data-driven priorities. And perhaps most importantly, it shows us that not all rural counties face the same challenges, some are disproportionately burdened, and we have simple ways to find them.

Our team invites readers to explore our full article, “Examining the Burden of Chronic Disease and Low Socioeconomic Status to Identify High-Need Rural Counties,” and consider how this approach might be applied in your own community.

This project was supported in part by the Federal Office of Rural Health Policy, Health Resources and Services Administration.

About the Author

Gabriel A. Benavidez: Gabriel Benavidez, PhD, is an epidemiologist and assistant professor in the Department of Public Health at Baylor University. His research examines how access to healthcare services influences population health, with a particular focus on rural communities and geographic differences in health outcomes.