Vicki Shabo and Hannah Friedman, Health, Work, and Care in Rural America (Washington, DC: New America, Nov. 17, 2022)

People in rural America live an average of three to four times further from types of important hospital-based health care and skilled nursing facilities than people in urban communities. These long distances—combined demographic factors related to age, income, employment, and less access to paid and unpaid leave than people in metropolitan areas—create unique challenges for people in America’s rural communities. Without access to paid sick time and paid leave for serious family and medical needs, workers are often forced to manage taking care of themselves or loved ones without pay while struggling to make ends meet, potentially jeopardizing their health, job, or economic security.

Drawing on original research, this report offers a clear case for why guaranteed public paid leave policies should be considered a social determinant of health for rural people just as access to health care facilities and other economic stability indicators are. Paid leave could improve the health, wellbeing, and economic security of rural workers and families, and increase the economic competitiveness of America’s rural communities.

Our key findings are here.