Living in a rural community in Michigan offers unique experiences, from exploring densely forested hiking trails to enjoying the vibrant fall colors and miles of freshwater shoreline. These are just a few of the wonderful experiences that make up being a Michigander or a Yooper if you are from the Upper Peninsula (U.P.). However, rural living also presents distinct challenges, particularly in the realm of health care.
Some of the challenges of living in rural communities can manifest as increased risk for poorer health outcomes. For instance, the distance required to travel to see a health care provider may lead to fewer visits to obtain regular preventive screening, ultimately leading to undiagnosed hypertension, or a late-stage cancer diagnosis. Lack of access to exercise facilities, as well as rural food deserts (which lack nutritious and affordable foods), are associated with obesity which is a precursor to many other conditions, such as heart disease and Type 2 diabetes. Fewer workforce opportunities in rural areas are part of a cycle of a poor working class, entrenched poverty, and lack of health insurance that can prevent access to essential health services.
Michigan's Rural Reality
In the state of Michigan, 53 counties are designated rural, and 30 are designated urban. Even in these urban counties, people still reside in rural areas. There are several federal definitions of what constitutes urban or rural, but approximately 67% of Michigan's counties are designated as rural in some capacity, and around 20% of the State's population, or approximately 2 million people, reside there. Based on population growth trends from 2020 to 2023, rural counties accounted for approximately 40% of the population growth in the State of Michigan.
A vast majority of the United States is considered rural, with large portions of most states falling under this definition. The 2020 Michigan Primary Care Needs Assessment shows that rural residents bear a disproportionate burden of health outcomes and disparities, including:
- Two million rural Michiganders are on a pathway to poor health outcomes because of where they live
- 3 out of the top 5 counties that have the highest rates of food insecurity are rural
- Rural counties have the lowest rates of annual flu vaccine
- The highest rates of preventable hospitalization, obesity, maternal tobacco use, uninsured populations, and late or no prenatal care are all dominated by rural counties
- 4 out of 5 of the counties that have the lowest rates of a yearly wellness visit are rural
Consider how public health agencies provide services in the state. There are several areas where counties collaborate on a single agency to provide a public health structure across vast geographic regions. Fourteen combined public health agencies offer public health coverage for 53 of Michigan's rural counties. Many times, these service areas are widely geographically dispersed. For instance, the Western Upper Peninsula. Health Department covers an area of almost 14,000 square miles. That's greater than the size of Maryland, and it takes two hours to travel that distance in good weather. In early March, the U.P. received 24 inches of snow in one night, and a late-spring ice storm shut down the U.P.
The Luce-Mackinac-Alger-Schoolcraft health department in the U.P. covers an area of nearly 11,000 square miles, approximately the size of Massachusetts. The District 10 Health Department in lower Michigan covers 10 counties and approximately 8,000 square miles, which is about the size of New Jersey. Due to a shortage of primary and specialty health care providers in these areas, these agencies often find themselves providing primary health care services in addition to their public health responsibilities.
What measures are being taken to address rural health issues? Two initiatives led by Michigan State University stand out.
In January 2024, the nation's first-ever community-wide prenatal and infant cash prescription program, Rx Kids, launched, providing life-changing financial security to an entire generation of children and more than 2,000 Michigan families. The expansion of the program has since grown to include five counties in the Eastern Upper Peninsula, working to improve health, support families in accessing the necessary resources to thrive, and revitalize the local economy.
One of the challenges of living in the Eastern Upper Peninsula of Michigan is the lack of a local Neonatal Intensive Care Unit (NICU). Suppose a baby is born prematurely or with complications. In that case, families must travel three hours to the nearest NICU, which means additional expenses for lodging and transportation. This not only puts a strain on the family but also on the local economy, as families often must take time off work to make these trips. 
Haley Stewart, a participant in the Michigan State University Rx Kids program, recently gave birth to a baby girl. Haley shared that the local economy can beunpredictable due to the seasonal nature of employment opportunities in areas where tourism is a significant economic driver. Even simple errands, such as grocery shopping, can be complicated due to the distance some families must travel to access healthy foods or attend medical appointments.
In the fall of 2024, MSU launched its online MPH Rural Public Health concentration to address workforce development needs and equip students with the skills and knowledge necessary to work effectively as public health leaders and practitioners in rural communities. Many stakeholders, including health delivery systems and public health departments, advocated for a master's-level public health program that offers a rural learning track.
MPH student Shelly Bundy faced some of the challenges associated with living in a rural community during her childhood in Montana. Her personal story sheds light on the real-life impact of these challenges. Due to the lack of orthodontic care in her area, Bundy recalls having to take an entire day off from school once a month, and her mom had to take a day off from work to drive 90 minutes to the orthodontist's clinic. When suffering a shoulder injury from participating in school sports, obtaining an MRI required a four-hour round-trip drive. These appointments to manage one child's health interfered with both school and work.
"The potential for disaster in birthing situations is astronomical," said Bundy. "My sisters live and work in my hometown. My older sister was able to deliver her baby at the local hospital because she had a healthy pregnancy. If there had been complications, she would have been sent an hour and a half from home to a hospital that could handle it. My youngest sister, however, was not so lucky. She delivered this past December and was forced to make that long drive because there were no closer doctors. Decembers in Montana are unpredictable. She got extremely lucky with fair weather and safe roads. Still, it was a stressful situation for the family at a vulnerable time."
Whether you live in a rural community in Michigan or Montana, many of the lived experiences are similar, with distant travel and additional strains on the family to manage basic care needs, such as an injury, dental care, or childbirth. Despite these challenges, people living in rural communities often serve as public health advocates for their families, finding ways to thrive and demonstrating remarkable resilience in navigating health and wellness.
Learn about MSU's MPH Rural Health Concentration
MSU's online MPH Rural Public Health concentration equips students with the skills and knowledge to work effectively as public health leaders and practitioners in rural communities. Three courses in rural public health round out a 43-credit program and focus on topics such as unique contexts of rural communities, including historical, political, and social influences, rural determinants of health, public health systems, health outcomes, and disparities, opportunities to analyze why and how social drivers of health interact to impact outcomes, and leadership and advocacy skills that are necessary to advocate for rural public health system- and policy-level change.
April 11, 2025
