Rural transportation services
Rural transportation services provide transportation across large areas that have low population densities and lack established public transportation systems. Services may include shared transportation options such as publicly-funded buses and vans running on fixed routes and schedules, more flexible pick-up and drop-off with smaller vehicles (e.g., dial-a-ride and other demand-response programs), or volunteer ridesharing programs1.
What could this strategy improve?
Expected Benefits
Our evidence rating is based on the likelihood of achieving these outcomes:
Increased mobility
Increased access to health care
Potential Benefits
Our evidence rating is not based on these outcomes, but these benefits may also be possible:
Increased access to employment
What does the research say about effectiveness? This strategy is rated expert opinion.
Rural transportation services are a suggested strategy to increase mobility and access to health care for rural populations2, 3. Available evidence suggests that such services can increase mobility among vulnerable populations such as elderly adults, people with disabilities, and individuals with low incomes4, and increase access to medical services5, grocery stores, other retailers, and community activities6. Rural transportation services may also increase access to jobs7, provide opportunities for higher wages for individuals who live in rural areas8, and benefit local economies9. However, additional evidence is needed to confirm effects.
Rural transportation networks often have high per capita costs, and are frequently personalized based on the needs of users10. Efforts to track and evaluate the operating costs of rural demand-response programs can help improve performance and reduce program costs11. Researchers also suggest that organizations that serve residents in rural areas partner to coordinate existing efforts to transport clients with similar routes or destinations4, 6.
A Texas-based study suggests that taxpayers value rural transportation services for elderly adults and are willing to financially support such services12. Cost benefit analysis finds positive net benefits for rural transportation services overall13.
How could this strategy impact health disparities? This strategy is rated likely to decrease disparities.
Implementation Examples
The U.S. Department of Transportation provides capital and operating assistance for rural transit through Section 5311 grants. Low income populations are considered as a factor in the grant formula14. As of 2014, 81% of U.S. counties have some form of rural transit service; 428 rural transit agencies provide fixed-route service and 266 rural transit agencies offer demand-response (e.g., dial-a-ride) and fixed-route services across the U.S.1.
The Rural Passenger Transportation Technical Assistance Program (RPTTAP) and the Tribal Passenger Transportation Technical Assistance Program (TPTTAP) provide technical assistance to small communities to create and improve rural and tribal public transportation15. These programs were created by the U.S. Department of Agriculture (USDA) and are administered by Community Transportation Association of America15.
Some state government agencies have established vanpools to transport rural residents to employment opportunities in rural and urban areas; California and Wisconsin are two examples16, 17, 18.
Implementation Resources
National RTAP - National Rural Transit Assistance Program (National RTAP). History of National RTAP.
National RTAP-State toolkit - National Rural Transit Assistance Program (National RTAP). State RTAP manager’s toolkit.
Edrington 2014 - Edrington S, Brooks J, Cherrington L, et al. Guidebook: Managing operating costs for rural and small urban public transit systems. College Station, TX: Texas A&M Transportation Institute; 2014.
Mattson 2016 - Mattson J. Rural transit fact book 2016. Fargo, ND: North Dakota State University (NDSU), Upper Great Plains Transportation Institute, Small Urban and Rural Transit Center; 2016.
TRB-Ellis 2009 - Ellis E, McCollom B. TCRP Report 136. Guidebook for rural demand-response transportation: Measuring, assessing, and improving performance. Washington,DC: Transportation Research Board (TRB); 2009.
APTA-Resources - American Public Transportation Association (APTA). Research and technical resources.
Footnotes
* Journal subscription may be required for access.
1 Mattson 2016 - Mattson J. Rural transit fact book 2016. Fargo, ND: North Dakota State University (NDSU), Upper Great Plains Transportation Institute, Small Urban and Rural Transit Center; 2016.
2 National RTAP - National Rural Transit Assistance Program (National RTAP). History of National RTAP.
3 RHIhub-Transportation - Rural Health Information Hub (RHIhub). Transportation to support rural healthcare.
4 Marr 2015 - Marr EJ. Assessing transportation disadvantage in rural Ontario, Canada: A case study of Huron County. Journal of Rural and Community Development. 2015;10(2):100-120.
5 Yang 2017 - Yang H, Cherry CR. Use characteristics and demographics of rural transit riders: A case study in Tennessee. Transportation Planning and Technology. 2017;40(2):213-227.
6 Bond 2017 - Bond M, Brown JR, Wood J. Adapting to challenge: Examining older adult transportation in rural communities. Case Studies on Transport Policy. 2017.
7 Thakuriah 2011b - Thakuriah (Vonu) P. Variations in employment transportation outcomes: Role of site-level factors. Papers Regional Science. 2011;90(4):755–72.
8 Thakuriah 2013 - Thakuriah (Vonu) P, Persky J, Soot S, Sriraj PS. Costs and benefits of employment transportation for low-wage workers: An assessment of job access public transportation services. Evaluation and Program Planning. 2013;37:31–42.
9 Peng 1998 - Peng ZR, Nelson AC. Rural transit services: A local economic and fiscal impact analysis. Transportation Research Record: Journal of the Transportation Research Board. 1998;(1623):57-62.
10 Stommes 2005 - Stommes ES, Brown DM. Moving rural residents to work. Transportation Research Record: Journal of the Transportation Research Board. 2005;(1903):45–53.
11 TRB-Ellis 2009 - Ellis E, McCollom B. TCRP Report 136. Guidebook for rural demand-response transportation: Measuring, assessing, and improving performance. Washington,DC: Transportation Research Board (TRB); 2009.
12 Israel Schwarzlose 2014 - Israel Schwarzlose AA, Mjelde JW, Dudensing RM, et al. Willingness to pay for public transportation options for improving the quality of life of the rural elderly. Transportation Research Part A: Policy and Practice. 2014;61:1-14.
13 Godavarthy 2015 - Godavarthy RP, Mattson J, Ndembe E. Cost-benefit analysis of rural and small urban transit in the United States. Transportation Research Record: Journal of the Transportation Research Board. 2015;2533:141-148.
14 US DOT-Section 5311 - US Department of Transportation (US DOT). Fact sheet: Formula grants for rural areas, section 5311. 2012.
15 CTAA-Rural - Community Transportation Association of America (CTAA). Summary: Rural & tribal passenger transportation technical assistance through CTAA.
16 CalVans - California Vanpool Authority (CalVans). California’s single source for ridesharing to work or college in a CalVans vehicle.
17 Sampson 2014 - Sampson R. CalVans: An easy ride to the hard work on a farm. California Vanpool Authority. 2014.
18 WI DOA-Vanpool - Wisconsin Department of Administration (WI DOA). Joining a vanpool.
Related What Works for Health Strategies
To see citations and implementation resources for this strategy, visit:
countyhealthrankings.org/take-action-to-improve-health/what-works-for-health/strategies/rural-transportation-services
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countyhealthrankings.org/whatworks