Unhealthy People, Unhealthy Towns: A Healthcare Crisis in Rural America

The Chronicle of Higher Education is a nationally respected publication that serves the world of academia—primarily colleges and universities across the United States and abroad. Understandably, it tends to focus on topics of interest to faculty and administrators such as how to address current issues in course curriculum, funding challenges, federal regulations, and the like.  However, late last year the Chronicle published a piece that focused on life in an area of rural southeast Missouri known as the Bootheel; A Dying Town was grounded in research findings that connected the dots between education and health. The findings: “Educational disparities…economic malaise and lack of opportunity are making people…in the Bootheel sick. And maybe even killing them.”

Since 2014, eight healthcare facilities in rural Missouri have closed, including four hospitals. The most recent casualty is the only hospital in Ripley County, scheduled to close October 15, 2018. Nearly all have been located in the southeastern part of the state and the situation has been deemed as a crisis with no end in sight.

The most recent data from iVantage Health Analytics paints a bleak picture for healthcare not just in Missouri but in many states. As dire as the situation is in rural southeast Missouri residents of Mississippi, Texas, Louisiana, and Georgia have even higher rates of healthcare vulnerability.

Factors that Impact Closures

iVantage data confirm more Americans than ever before have access to the healthcare they need because of the Affordable Care Act, but considerable gaps remain. The group identified twelve Health Disparities metrics that make hospitals and clinics particularly vulnerable to closure:

  • Adult Obesity Rate
  • Child Poverty Rate
  • Unemployment
  • No Medical Insurance
  • Healthcare Costs
  • Smoking
  • Access to Affordable, Safe Housing
  • Access to Mental Health Providers
  • Diabetes Screening Rate
  • Access to Primary Care Physicians
  • Access to Dental Care Providers
  • High School Graduation Rate


Areas with the greatest percentage of health disparities are those most vulnerable to hospital closure. In other words, those who need quality healthcare the most are the ones who will be left behind.  

Far-Reaching Impact

The problem of closing hospitals and clinics doesn’t just mean residents will have to drive a little farther to see a doctor; it has far-reaching economic impact. When residents do not have access to quality healthcare, they aren’t able to work; this impacts local business and industry productivity. When they earn less money, workers don’t have as much to spend in local grocery stores, gas stations, or restaurants. When sick children aren’t able to go to school, local districts receive less funding. And, when facilities close, local residents trained in healthcare lose their jobs and are often forced to move elsewhere for work. In other words, unhealthy residents lead to unhealthy towns.

It’s Time to Roll Up Our Sleeves

The closing of hospitals isn’t just a rural Missouri problem—nor are poverty, housing, or the lack of education. There are towns all across our country in desperate need of resuscitation on many fronts. Every dying town takes a toll on its state, and eventually on our great nation. These problems are not going to take care of themselves, and it is essential that we tackle them together.


Dr. Roberta Ross-Fisher is a national leader in quality assurance, educator preparation, and empowerment-based learning. She supports educational institutions and non-profit agencies in areas such as accreditation, competency-based education, and teacher/school leader prep programs design.  Roberta also writes about academic excellence and can be contacted for consultations, webinars, and on-site workshops through her site (www.robertarossfisher.com).