Julia Slater headshot
For life-long urban dwellers, rural America tends to exist in our minds as a blurry muddle of cultural myths. Maybe we have a conception of rural America as backwater and uneducated. Maybe rural America is perceived as a cultural safety deposit box where the best of America’s values are kept safe. It’s America’s breadbasket, America’s dumping grounds, a place of extraction, a ghost town.
The real rural America is complex and has just as many overlapping legacies, histories, identities and struggles as the rest of the country, if not more. However, all this myth distracts us from the reality of rural areas. And right now, that reality has been disproportionately adversely impacted by the COVID-19 pandemic. Of the nation’s 1,976 rural counties, 1,357 are “red zone” counties – counties with 100 or more new one-week infections per 100,000 residents. In North Carolina, rural areas are faring even worse with 85% of rural counties classified as a red zone. In fact, the 10 North Carolina counties with the highest rates of COVID-19 deaths are all rural counties.
Deeply-rooted systemic inequities in non-metro areas have made rural Americans uniquely vulnerable to COVID-19 infection and death. Residents of rural areas are older and have higher rates of chronic diseases. Higher rates of poverty complicate long-standing issues regarding rural access to health care. Residents are less likely to be insured and face barriers in signing up for Medicaid even if they do qualify.
It also doesn’t help that health care infrastructure in rural areas is underfunded and inadequate. Rural hospitals have extremely limited resources and can be easily overwhelmed by even a small number of COVID-19 cases. Health centers – few and far between – continue to close. Six rural hospitals have closed in North Carolina since 2014, leaving roughly 50 rural hospitals in the state. Emergency medical services are often staffed by volunteers with long response times due to the long distances they must travel. Rural North Carolina county health departments are understaffed, and many areas can only manage limited access to testing. Telehealth could be a promising option, but a third of rural North Carolinians have issues accessing the internet.
All of these overlapping barriers have kept rural North Carolinians from getting the care they deserve not only during the pandemic but for decades. Only now, they’re dying at grievously high rates because of it.
Rural areas were already more vulnerable to labor market shocks relative to urban areas. Due to the pandemic, research has found unemployment levels have increased more for rural Americans than for urban ones. All over the country, local businesses have been forced to shut their doors at a rapid rate absent adequate government support, but these closures are likely to hit rural areas even harder. Rural residents already contended with fewer available job opportunities. Fewer locally-run establishments forces rural North Carolinians to travel even farther for basic necessities like groceries or medicine and creates opportunities for large corporations to exploit desperate workers.
Rural communities of color have been hit especially hard by the pandemic. Last year, rural Americans overall had 175 COVID-19 deaths per 100,000 people, whereas racially diverse rural areas had COVID-19 death rates of 258 per 100,000. These death rates were highest for Indigenous peoples. A U.S. Department of Health and Human Services report last month acknowledged that racial disparities in the COVID-19 cases and deaths are due to “long-standing systemic inequalities and structural racism.”
Many urbanites may have a tendency to overlook issues centering around rural areas. They aren’t prominently featured in our news diets or on our social media feeds. When we do come across a “rural problem,” we may dismiss it. Barely anyone lives there anyway, right? Compounding this potential availability bias, misleading media coverage of “Trump country” and rural America’s politics has led to the conflation of “white” and “rural” and the conflation of “conservative” and “rural.” Not only does this whitewash the narrative of rural America and create the myth of a monolith, but this has led to a concerning reflex in some left-wing circles to be dismissive of rural politics and rural problems.
However, this reflex results in the high rural COVID-19 death rates we’ve seen over the past year that never should’ve happened. Long-standing vulnerabilities in rural communities that have gone ignored for decades contributed to COVID-19’s spread in an incredibly damaging way. Rural North Carolinians deserve policy solutions that target their unique challenges, so their communities can be healthy and thrive. North Carolina cannot ignore hundreds of thousands of its own.