As the United States marks its 250th anniversary, WTOP presents “250 Years of America,” a multipart series examining the innovations, breakthroughs and pivotal moments that have shaped the nation since 1776.
Delta Dental Federal Government Program is proud to partner with WTOP to bring you this series.
Rural health care in America has undergone significant transformation over the years, from traveling medical professionals to telehealth innovations. Despite these advancements, disparities still exist.
Historically people living in rural areas have faced limited access to medical and dental care due to provider shortages, geographical barriers and economic challenges. These obstacles have shaped the evolution of how health care is delivered to people in these communities.
In the late 19th and early 20th centuries, rural health care often relied on isolated physicians who served large geographic areas, and would sometimes be the only doctor for miles, according to the University of Nebraska Medical Center.
In 1921, the Sheppard—Towner Act created the first nationwide federal effort to support maternal and infant health, according to the Embryo Project Encyclopedia. It offered matching funds to states to help lower high death rates among mothers and babies, especially in rural communities.
Advocates said the program was essential for reducing the nation’s infant mortality rate. With federal support from the Sheppard—Towner Act, states opened nearly 3,000 prenatal clinics, held more than 180,000 infant‑care classes, conducted over three million home visits by public health nurses, and distributed educational materials nationwide between 1921 and 1928.
In 1946, President Harry S. Truman signed the Hill-Burton Act, also known as the Hospital Survey and Construction Act, into law. The policy provided grants and loans to support the construction of hospitals in communities that lacked adequate medical facilities.
The legislation had a strong impact in the south, where many new facilities were built using funds from the bill. However, the law also reinforced the belief of “separate but equal” in health care. After several lawsuits led by the National Association for the Advancement of Colored People, the “separate but equal” aspect was overturned by a federal court in 1963.
Over time, systemic disparities in rural health care have become more apparent. According to the Centers for Disease Control and Prevention, data shows that people living in rural areas are more likely to experience higher rates of chronic disease including heart disease and diabetes. They’re also more susceptible to premature death caused by chronic conditions.
Additionally, many rural communities face shortages of dental professionals, and financial barriers can make it difficult for providers to practice in underserved regions. A 2018 report found that older adults living in rural areas face higher rates of complete tooth loss, often as a result of untreated decay or advanced gum disease.
In response to these disparities, innovative solutions were created to close the gaps — one of the most significant advancements being the rise of telehealth. Telehealth allows patients to consult with health care providers remotely using digital technology, reducing the need for travel.
The American Telemedicine Association reports that telehealth usage rapidly increased during the COVID-19 pandemic, accelerating its adoption in rural areas.
Similarly, teledentistry has also transformed access to oral health care. The American Dental Association notes that teledentistry enables remote consultations, screenings, and patient education, which are particularly beneficial for underserved rural populations.
In addition to technological advancements, public programs such as Medicaid have played a critical role in improving rural health care access. According to the American Hospital Association, Medicaid covers over 16 million people in rural communities, helping to address common barriers faced by residents.
Although challenges remain, rural health care in the United States has evolved significantly from traveling physicians to technology aimed at reducing the disparities.
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