Health Disparities in Rural Childhood Injury

Erin Ficker, MPAff, CSPS
children facing a water source wearing boots

Twenty percent of Americans, one in five, live in rural areas according to the U.S. Census Bureau. Rural areas are found in every region and corner of the country and make up 97% of land in the United States.i Rural communities are generally sparsely populated, located far from urban centers, distinct from one another, and have low housing density. A shared reality is the environmental conditions (i.e., social determinants of health) for rural populations that impact safety and wellbeing of children and adolescents living in those areas.

Children and adolescents in rural areas are at increased risk for a wide range of injuries: 

  • In general, injury rates are approximately 55% higher for children and adolescents in rural areas compared to those in urban areas.ii 
  • Unintentional injury death rate among children and adolescents in rural areas is nearly twice that of children and adolescents in urban areas. 
  • Child and adolescent motor vehicle traffic injury death rate in rural areas is more than twice the rate in urban areas.ii
  • Child and adolescent unintentional drowning death rate is 49% higher in rural areas than urban areas.
  • Adolescent suicide rate is approximately 47% higher in rural areas than urban areas.ii

Some health disparities (e.g., adequate treatment received in a timely manner) that impact injury risk and injury outcomes in rural communities are closely linked to: 

  • long travel distances to specialty and emergency careiii 
  • greater distance traveled by cariv
  • lack of access to public transportationiv
  • lack of access to childcarev
  • exposure to specific environmental and occupational hazardsvi

Addressing Rural Childhood Injury 

Addressing child and adolescent injury in rural communities is challenging and requires states and rural communities to partner to:    

  • Increase availability and use of data to support prevention work: Rural communities need to be able to review data that reflects not just the entire state or county, but, when possible, their own community or similar communities to theirs. Sally Kerschner, Coordinator of Maternal and Child Health Injury Prevention from the Vermont Department of Health identifies the need for Title V agencies to work with state-level partners to better share and use data to understand the full picture of rural and agricultural injury among children.vii  
  • Test, evaluate, and spread innovative injury prevention strategies and programsLocal partnership and data on how childhood injury occur can empower communities to take action and tailor responses. For example, if motor vehicle crash injury and death are largely due to not wearing seat belts, partnerships with parents and youth can focus on understanding the local context and testing and evaluating strategies to promote the use of safety belts. Once evaluated, these strategies can be shared with other rural communities.
  • Remove barriers to working togetherSiloed approaches to preventing rural childhood injuries can be addressed by Title V agencies and local communities committing to a shared vision and action plan to eradicate root causes of health disparities. As an example, Tennessee has a partnership network that reaches all counties to ensure representatives from rural communities deliver the state’s information, messages, and resources. 



[i] U.S. Census Bureau. (2019). What is Rural America? United States Census Bureau. Retrieved January 21, 2021 from

[ii] Centers for Disease Control and Prevention. (2020). Web-based Injury Statistics Query and Reporting System, 2015-2018. Retrieved December 30, 2020 from

[iii] Centers for Disease Control and Prevention. (2017). About Rural Health. Retrieved  March 25, 2020 from

[iv] Rural Health Disparities Introduction—Rural Health Information Hub. (n.d.). Retrieved January 13, 2021, from

[v] National Children’s Center for Rural and Agricultural Health and Safety. (May 2019). A Roadmap for Delivering Child Care in Agricultural Communities. Retrieved January 13, 2021 from

[vi] Centers for Disease Control and Prevention. (2017). About Rural Health. Retrieved March 25, 2020 from

[vii] Kerschner, S., (2021, January 12) Personal Interview [Personal Interview]

Child Safety Topics
Health Equity