Introduction

This report ties together two important threads of work with a focus on rural America: (1) access to paid family and medical leave and paid sick time in rural communities; and (2) the distances to particular types of important health services, specifically hospital-based maternity/obstetrics care, neonatal intensive care unit (NICU) and neonatal care, hospital-based pediatric care, hospital-based cardiology services, hospital-based cancer screenings and cancer treatment services, and skilled nursing facilities in rural areas of the United States.

We show that access to paid leave should be considered a social determinant of health just as access to health care and other economic stability indicators are. Like access to and affordability of health care, people's ability to affordably and securely take time away from work to receive and seek health services or care for ill loved ones is critical to healthy people, families and communities—and because of long distances to important types of health care services in rural America, the need for paid leave is greater yet access is lower.

Policy discussions about health, economics, community development, and job quality are often siloed. Yet workers’ expanded access to paid leave is deeply connected to improved community health and reduced health disparities, workforce retention, and economic growth and competitiveness. Paid family and medical leave for serious personal and family caregiving needs and access to paid sick time to recover from a routine illness or seek preventive health services contribute to better individual and population health, reduce health care costs, improve workforce retention and earnings, improve well-being, and boost the economy.

Rural communities are often excluded from discussions that tie together health, economics, and jobs. Paid leave and other policies that make it easier and more affordable for people to find care for children, loved ones with disabilities, and older adults have unique importance for people living in rural communities, who face longer distances to travel to seek health services for themselves or a loved one and are often concentrated in poorer-quality jobs that do not offer paid leave.

In this report, we show that rural America—which tends to be older and to have populations with more caregiving and health needs than people in other parts of the United States—has been left behind relative to metropolitan communities with respect both to access to paid family, medical, and sick leave and to hospital-based health care services; and, to a lesser extent, to skilled nursing facilities. Rural workers have less access to both paid leave for serious family and medical needs and paid sick time than people in metropolitan areas. And, as our data demonstrate, people in rural areas must typically travel three to four times further to critical hospital-based health care services than people in urban areas—and much, much further in isolated rural areas.

Communities in persistent poverty, many of which have concentrated populations of Black, Latine, Asian and Native American populations, face greater barriers on both fronts. People in rural areas with high concentrations of Latine populations are especially burdened with long travel distances to important types of hospital-based health care and reduced access to paid leave and paid sick time. This is likely to affect the health, economic security and well-being of rural populations and the economic competitiveness and attractiveness of rural areas, and it exacerbates existing disparities in economic opportunity between rural and non-rural areas of the United States.