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Nearly 60 million people live and work in rural America. In Massachusetts, about 650,000 people call one of our 160 rural towns home. Rural communities are great places to live, work, and play, but they also face unique healthcare challenges. That’s why each year the National Organization of State Offices of Rural Health and its partners set aside the third Thursday of November to celebrate National Rural Health Day – to help to educate others about these challenges and highlight the innovative work being done by rural healthcare leaders to improve access to health care services.

The small towns of rural Massachusetts span the Commonwealth.  Our rural communities are known for their beauty, outdoor recreation, vacation destinations, an abundance of small farms, communities of artists, well known educational institutions, quintessential town centers, and New England charm. The map below shows the towns considered rural using the Massachusetts DPH State Office of Rural Health’s definition.


Our rural Massachusetts towns tend to be economically distressed.  Often former industries have left, leaving a lack of good employment and living wages. There is limited public transportation and infrastructure in these areas, making it difficult if you don’t own a reliable vehicle. A higher proportion of elderly lives in these communities. Housing stock tends to be older and often times in disrepair.  Affordable rental housing and senior housing are limited, despite the ever-increasing need. There is typically a shortage of primary care physicians and specialty providers, with some rural areas being served only by a safety net provider such as a community health center or single physician practice.

The lack of economic and social determinant supports has its impact. As in many rural regions nationally, Massachusetts rural residents tend to have worse health outcomes and there is a relatively high prevalence of substance use disorder and mental illness. The table below provides a few examples of these disparities.

  Chronic Disease Data for Massachusetts Rural vs Urban Areas

New England Rural Health Data Report: Rural Data for Action, Second Edition 2015

BRFSS Data All MA Rural All MA Urban
Current smoker 21.0% 17.4%
Currently have asthma 14.9% 10.8%
Diagnosis of arthritis 28.6% 23.6%
High blood pressure, not on medication 29.2% 22.8%
CDC Vitals Mortality Data:
All MA Rural Age–Adjusted Death Rates All MA Urban

Age–Adjusted Death Rates

Firearms mortality 8.74 3.56
Alzheimer’s disease 38.44 20.77
Parkinson’s disease 11.76 5.99
Chronic lower respiratory diseases 39.19 32.83
Cerebrovascular diseases including stroke 51.69 31.03
CDC Vitals Mortality Data:
Crude Rates
All MA Rural

Crude Rates

All MA Urban

Crude Rates

Diabetes mellitus 18.00 16.11
Influenza and pneumonia  31.58 20.46
Suicide 9.51 8.70
Chronic liver disease and cirrhosis  9.85 8.82

CDC Vitals Natality Data

All MA Rural

% of deliveries

All MA Urban

% of deliveries

Smoked during pregnancy 13.2% 7.6%
No or late prenatal care 11.4% 9.9%


National Rural Health Day is an opportunity to “Celebrate the Power of Rural” by honoring the selfless, community-minded, “can do” spirit that prevails in rural America. Our rural healthcare organizations and partners in Massachusetts are recognized health innovators at the forefront of healthcare transformation. Because of their great work, they have been able to attract federal and state support to pilot many new rural-appropriate models of care. This has included awards from the state’s Health Policy Commission, the Federal Office of Rural Health Policy, and the Department of Public Health. These pilot programs addressing rural disparities are being implemented, studied, and shared across the Commonwealth and nationally.

Collaboration is the key to success in rural communities. Successful partnerships are addressing clinical care, social determinants of health, and better linkages between them both. Rural community leaders are local people willing to step forward, share and implement a vision, and drive changes that benefit their neighbors.

The Massachusetts State Office of Rural Health at DPH has developed strong partnerships with rural healthcare providers and other rural health stakeholders and developed successful programs working to improve the health of the communities we serve and build better systems of care. Annually the Massachusetts State Office of Rural Health provides technical assistance and support to over 400 clients from a wide variety of provider types and has developed multiple communications, educational, and networking tools to bring together and assist critical access and rural hospitals, community health centers, medical practitioners, rural health clinics, behavioral health and oral health care programs, emergency medical services, community coalition leaders, local officials, and schools of health professions.

So on National Rural Health Day we want to take time to Celebrate the Power of Rural, thank the countless people working to improve the health of rural Massachusetts and work to continue this conversation past one day.  The hope is to transform National Rural Health Day from a single day event into a sustainable movement.  With your support, we can continue to bring attention to matters of rural health and honor those who can, and are, making a positive difference.

For more information, or to take the pledge for rural health visit


Written By:

Program Coordinator in the State Office of Rural Health program

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