Florida is about to make a significant investment in rural health. The question is whether those investments will reach the people who need them most.
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In June, the Health Resources and Services Administration announced nearly $140 million in new funding to improve health in rural communities. As Florida and the nation look for ways to help people in these areas, there is an opportunity to think beyond doctors’ offices and hospitals. One of the most important pieces of rural health infrastructure may be something far more basic: transportation. For many rural residents, access to healthcare doesn’t end with whether a provider or clinic exists. It begins with whether they can get there.
That challenge became clear during a recent University of Florida project in Levy County, which is one of 33 counties in the state that the Florida Department of Health officially designates as rural. A team working through UF’s Research, Engagement and Applied Consulting in Healthcare (REACH) program developed a phased rural commuter transportation proposal in April after examining gaps in health services and workforce development. Transportation quickly emerged as a problem that connected all of these issues.
In geographically large counties like Levy, limited transportation can make it harder for residents to access medical appointments and education. It can also make it harder for employers to recruit and retain workers. A lack of reliable mobility can therefore become both a health barrier and an economic barrier.
Florida already recognizes the connection in one important way. The state’s Transportation Disadvantaged Program operates in all 67 counties and provides transportation for eligible residents who lack access to other options, including trips to medical appointments, employment, education and other life-sustaining services. The opportunity now is to think bigger. And three changes could make a difference.
First, transportation should be included in rural health planning. When state and federal officials consider investments in rural health, transportation access should be evaluated alongside provider availability, facilities and technology.
Second, health and transportation planning should be connected to workforce development. The same transportation system that gets a patient to a medical appointment can help a worker get to a job, a student get to class or a family reach other essential services. In rural communities, these challenges often overlap.
Third, rural communities should help design the solutions. Transportation models developed for densely populated metropolitan areas cannot simply be transplanted into geographically dispersed rural counties. Routes, schedules and services need to reflect how people actually live and work. That last point is especially important because rural policy can too easily be designed from a distance.
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Research can identify gaps, but residents and local leaders understand the circumstances behind those numbers. Working with rural stakeholders in Levy County reinforced a simple lesson: the people who live with a problem every day often have the clearest understanding of what a workable solution looks like. The same principle applies to rural transportation.
The goal should not be to create transportation systems for the sake of transportation. It should be to remove barriers that prevent people from participating in the healthcare, employment and educational systems that support healthy communities.
Preventing a missed doctor’s appointment because someone could not find a ride may not sound like a health policy. Helping a worker reliably reach a job may not sound like public health. Connecting a student to educational opportunities may not sound like healthcare. But all these factors shape whether people can live healthy, economically secure lives.
As Florida takes advantage of new opportunities to strengthen rural health, policymakers should broaden the definition of what that investment requires. More providers matter. Better facilities matter. Technology matters. But so does a road, a bus, a reliable ride or a transportation system designed around the realities of rural life.
If Florida wants its rural health investments to work, it should make sure people have a way to reach them. Transportation isn’t just how people get to healthcare. In rural Florida, it is part of healthcare.
Megan McCarthy of Minneola is a doctoral student in the Department of Health Services Research, Management and Policy at the University of Florida College of Public Health and Health Professions.
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