Rural Health Needs Assessment Key Findings
Sarah D. Hohl, PhD, MPH, Hazel Behling, BA, and Savanna Kiefer, MPH, conducted interviews, analyzed data, and drafted briefings. Contact our office if interested in exploring partnerships or projects based on these findings.
Between 2022 and 2024, the Office of Community Health (OCH) Rural Health Team conducted a needs assessment to inform the OCH’s strategies in advancing health in rural Wisconsin. They interviewed 36 representatives from community organizations and the University of Wisconsin–Madison, including physicians from the University of Wisconsin Department of Family Medicine and Community Health (DFMCH), to identify shared priority health issues, factors that influence those health issues, and resources to address them.
Why rural Wisconsin? More than 25% of Wisconsin’s population resides in rural areas, compared with just 20% nationwide. Inequitable access to resources places rural Wisconsin communities at disproportionate risk of morbidity and premature mortality. Community, academic, and clinical organizations are actively addressing these issues.
Key Findings
Respondents identified four key shared priority health issues:
They also described eight key factors they perceive to influence the health of rural Wisconsinites:
- Community connection
- Cultural responsiveness
- Access to care
- Trust
- Economic opportunity
- Divisiveness
- Transportation
- Housing
Mental Health & Substance Use
Mental health challenges and substance use disorder (SUD) are significant and often co-occurring in rural Wisconsin.1 Nearly a quarter of the population engages in excessive alcohol use, with significant alcohol-related driving deaths.2 Despite this, rural counties have few mental health providers, including 20 counties without a single psychiatrist.3,4
Key Barriers
- Limited access to clinical care
- Transportation challenges requiring long-distance travel
- Economic instability and food insecurity
- Persistent stigma around mental health and substance use
Respondents emphasized that even when services exist, stigma and distrust can prevent individuals from seeking care.
“We don’t have a lot of providers […] outside of our county offices, especially in Darlington and in Lafayette County. People will go to Platteville, they’ll come to Monroe, they’ll go to Dodgeville to get mental health care.” – Respondent 3, University
“There are a lot of people that [say], ‘I can’t get free insulin. Why should addicts get free [Naloxone]? Why are our tax dollars going to this sort of a thing?’” – Respondent 21, Community
Addressing these challenges requires leveraging strong community networks and building partnerships across sectors. OCH strategies include:
- Engaging in community events and coalitions
- Supporting Patient and Family Advisory Committees
- Connecting community, clinical, and academic partners
- Pursuing aligned, grant-funded collaborations
Nutrition Security & Chronic Disease
People in rural Wisconsin experience disparities in food and nutrition security — access to healthy, safe and affordable food to promote well-being5,6 — and food-related chronic disease (e.g., diabetes and chronic heart disease).
Key Barriers
- Long travel distances to grocery stores
- Limited availability of fresh, high-quality foods
- Economic constraints
- Rising transportation costs
Respondents also highlighted the importance of cultural connections to food, particularly in Indigenous and immigrant communities.
“People often need to drive 20, 30 miles. And we know that people [are] often […] searching for fresher, higher quality foods. They will drive farther to try and get those, so they’ll end up spending more of other resources or they will have to change when gas prices skyrocket.” –Respondent 17, University
“There is some real kind of food systems changes that are not just about supporting more locally grown, nutritious foods […] but the cultural connections there, so supporting kids in their schools to get access to those foods, to learn how to grow them, to hear the stories about what these foods need in within their particular cultural teachings.” – Respondent 1, University
Improving nutrition security requires culturally responsive, community-driven approaches. OCH continues to:
- Actively participate in statewide and regional coalitions that address food and nutrition security
- Support community-based programming
- Align clinical, community, agricultural, and public health efforts to strengthen nutrition security
Reproductive Health
Lack of resources drives increasing disparities in health outcomes for women in rural Wisconsin.
Key Barriers
- Closure of obstetric units and limited hospital services
- Reduced funding for prenatal support programs
- Extremely limited abortion access
- Transportation barriers
- High rates of intimate partner violence
- Shortage of culturally competent mental health providers
In addition to widespread closures of obstetric units and few critical access hospitals providing obstetrics care, funding for Medicaid’s Prenatal Care Coordination program is decreasing. Policy changes and health care system constraints further exacerbate these challenges.
Respondents emphasized that their communities’ limited access to care, including obstetrics, mental health care, and transportation are key influences on morbidity and mortality among women and birthing people. They noted that hospital closures, coupled with changes in state policies that limit what and how reproductive care is delivered, exacerbate poor outcomes for birthing people. Several respondents explained how lack of culturally relevant mental health services, compounded by limited resources for survivors of domestic violence, additionally negatively impacts reproductive health.
“I really worry about reproductive health, and lack of access to not only reliable providers, but clinicians able to provide reliable contraception.” – Respondent 18, Physician
“The overall lack of therapists and counselors and […] social services workers to address the needs of rural folks, especially females who have experienced some form of sexual violence or domestic abuse, really is hard. […] The few counselors and therapists often don’t have the cultural knowledge they need to be able to serve this distinct population.” – Respondent 29, University & Community
Addressing these challenges requires leveraging strong community networks and building partnerships across sectors. OCH strategies include:
- Supporting advisory committees and community engagement
- Facilitating partnerships across clinical and community sectors
- Advancing training and workforce development initiatives
Cultural Responsiveness
Rural Wisconsin is characterized by rich cultural, religious, racial, ethnic, and socioeconomic diversity. The area includes the U.S.’s fourth-largest Plain population,7 immigrants account for 11% of the rural agricultural workforce,8 and most of Wisconsin’s American Indian or Alaska Native tribal members live in rural counties.9 Respondents said limited access to transportation, clinical care, economic opportunity, and food security is exacerbated by a lack of cultural responsiveness —learning from and responding to communities’ diverse beliefs, values, experiences, and identities.10 These factors hinder inclusion and optimal health across diverse communities in and beyond rural Wisconsin.
“I mean, they don’t like me, but we’re here, we have to make money, you know. And you just need to be quiet for whatever they say. We listen. A lot of people talking about Latinos here. They don’t like you guys, you know. And I know that they don’t like me either, but you just be quiet. You just need to be quiet in this community because this is a white community.” –Respondent 33, Community, a Latina respondent recalling a conversation with an Asian community member
“In a rural community, [refugees] might not have as many people that look like them […] or similar background. There might not be as many points of worship. They might not have access to groceries they’re looking for.” – Respondent 15, Physician
Improving cultural responsiveness requires:
- Valuing and integrating diverse perspectives
- Expanding culturally appropriate services
- Strengthening inclusive community networks
OCH supports these efforts through:
- Community engagement and site visits
- Educational programming for residents and clinicians
- Partnerships with culturally specific organizations
Conclusion and Sources
This needs assessment highlights both significant challenges and strong opportunities within rural Wisconsin. Mental health, substance use, nutrition, chronic disease, and reproductive health are deeply interconnected and shaped by broader social determinants.
Across all areas, several themes are clear:
- Access to care remains a critical barrier
- Cultural responsiveness is essential for effective intervention
- Community partnerships are key to sustainable progress
The OCH Rural Health Team is committed to building long-term, mutually beneficial relationships with rural communities and aligning resources, programs, and partnerships to address these priorities.
- Wisconsin Department of Health Services. Wisconsin mental health and substance use needs assessment. Wisconsin Department of Health Services; 2017.
- Wisconsin Department of Health Services. Alcohol: adult use dashboard. Wisconsin Department of Health Services; 2022. Accessed November 12, 2024.
- University of Wisconsin–Madison Population Health Institute; Wisconsin Community Resilience and Response Task Force. A just recovery for rural health equity in Wisconsin. University of Wisconsin–Madison; 2021.
- Wisconsin Policy Forum. Rural counties face psychiatrist shortage. Published 2018. https://wispolicyforum.org/research/rural-counties-face-psychiatrist-shortage/. Accessed November 12, 2024.
- American Immigration Council; Upwardly Global. The role of immigrants in revising the Great Lakes region. American Immigration Council; 2024.
- Rural Health Information Hub. American Indian/Alaska Native population, 2022—Wisconsin. Published 2022. https://www.ruralhealthinfo.org/charts/24?state=WI. Accessed November 20, 2024.
- Wisconsin Office of Rural Health. Rural Wisconsin demographics, 2022. Wisconsin Office of Rural Health; 2022.
- American Immigration Council; Upwardly Global. The role of immigrants in revising the Great Lakes region. American Immigration Council; 2024.
- Rural Health Information Hub. American Indian/Alaska Native population, 2022—Wisconsin. Published 2022. https://www.ruralhealthinfo.org/charts/24?state=WI. Accessed November 20, 2024.
- Minnesota Department of Health. Culturally responsive care: access to care, services, and programs that are culturally specific, honoring, and appropriate. Minnesota Department of Health; 2019.