Rural transportation services

Rural transportation services are a suggested strategy to increase mobility and access to health care for rural populations^{3, 4}. Available evidence suggests that such services can increase mobility among vulnerable populations such as older adults, people with disabilities, and individuals with low incomes^{5, 6}, and increase access to medical services^{5, 7}, grocery stores, other retailers, and community activities⁸. However, additional evidence is needed to confirm effects.

Rural areas with limited or minimal transportation services are especially challenging for residents with health conditions that make driving difficult and make them reliant upon others to access health care services, grocery stores, and other resources⁹. A Canada-based study suggests that older adults living in rural areas are less likely to undertake a trip when they lack access to a ride than older adults residing in cities; experts recommend that travel for these residents be supported through community-based low cost transit options, such as carpools or vanpools arranged by non-profit or faith-based groups¹⁰. A California-based survey of residents of rural, affordable housing complexes reported that residents are willing to use ride sourcing and car sharing services located at their complex; however, these services generally require payment from a credit card or bank account, which not all residents have¹¹. Transit by rural ride sourcing services is often arranged through websites or apps, which older adults may find challenging to use, especially if they have minimal previous internet experience, do not have a smart phone, or have limited broadband services¹². A study based on national survey data suggests that growing rural communities are associated with increased commuting by public transportation, regardless of the timing of the commute¹³. A Texas-based study indicates that taxpayers value rural transportation services for older adults and are willing to financially support such services¹⁴. Efforts to improve rural transportation services should include increased funding and infrastructure assessments that consider accessibility, as rural areas continue to age at a higher rate than the rest of the country^{9, 15}.

Rural transportation services may increase access to employment^{5, 16} and provide opportunities for higher wages for individuals who live in rural areas¹⁷. Rural transportation may benefit local economies¹⁸ by supporting the productivity and viability of local businesses through increased access for those who do not or cannot drive⁵. Furthermore, by supporting access to employment, transit may reduce government spending on public assistance programs such as the Supplemental Nutritional Assistance Program (SNAP)⁵ and allow people to reside in the community of their choice⁵.

Rural transportation networks often have high per capita costs and are frequently personalized based on the needs of users¹⁹. Efforts to track and evaluate the operating costs of rural demand-response programs can help improve performance and reduce program costs²⁰. Experts suggest that modeling demand-response transit services in rural areas can be used by transit agencies to predict the ideal frequency of trips to meet the community’s transit needs, based on population density, number of older adult residents, and average income²¹. Transit agencies should engage rural residents and existing local programs with transportation components that serve rural residents who cannot easily travel, such as meal delivery services, medical transports, and senior centers, in the planning process¹⁵. To meet the transportation needs of rural populations, especially aging residents, partnerships between non-profits, governments, and the private sector, along with health care systems and disability service providers, are needed to coordinate and expand existing services; create additional transportation options; and remove barriers to transportation, such as advance scheduling requirements and limited run times for transit services^{12, 15}. Organizations that serve rural residents can also partner to coordinate existing efforts to transport clients with similar routes or destinations^{6, 8}.

Cost benefit analysis finds positive net benefits for rural transportation services overall²². Based on data from 2017, there were $2.20 in benefits for every dollar invested in Greater Minnesota rural transit services⁵.

Rural transportation systems have the potential to decrease disparities in mobility and access to health care for residents of rural areas, particularly older adults, individuals with disabilities, and individuals with low incomes, as they are less likely to be able to drive or afford private vehicles^{1, 3, 4, 5, 6}. Available evidence suggests that establishing or expanding transportation services in rural areas can support transit equity for vulnerable residents who lack alternative travel options, which may also include immigrants and ethnic minorities¹³. Among these residents, improved rural transportation services may improve quality of life through access to care, employment, and opportunities for social connection and recreation^{1, 5}. Lack of transportation services in rural areas can restrict access to health care and delay treatment for both acute and chronic health conditions, as well as limiting access to education, employment opportunities, and sources of fresh, healthy food²⁹. Rural residents may become dependent upon family or friends when reliable transit services are unavailable in their community⁹. Rural residents who cannot afford or access transit services may experience increased social isolation⁹.

Rural populations are aging at a faster rate than those in urban or suburban areas and have higher rates of disability among residents; therefore, rural residents are more likely to have a condition which makes it difficult to drive, regardless of their ability to afford a private vehicle⁹. For older adults and individuals with disabilities living in rural areas without transportation services, losing the ability to drive and travel with ease may diminish their sense of control over their life, independence, and self-respect¹². Older adults living in rural areas may continue to drive until forced to stop, as there are no alternative transportation services available¹².

Even when transportation services are available in rural areas, the price of travel may still be unaffordable for those with the greatest need for services⁹.