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INDIANA – “COVID hit rural communities a little bit later than urban (communities) last year, but once they hit those communities, they hit them hard,” said Brian Dixon, Regenstreif Institute’s director of public health informatics.

According to the U.S. Census Bureau, Rural America makes up about 15 percent of the nation, but recent data shows rural America is outpacing metro areas for COVID-19 deaths. The delta variant has shown rural communities are at high risk, much of that because of geographic disparities. FOX59’s Beairshelle Edmé continues her series finding out how this health disparity impacts rural Hoosiers. You can watch & read the first report on racial disparities below.

COVID-19 is killing rural Americans twice as much as their neighbors in urban areas, according to the latest data from Rural Policy Research Institute.

Sadly, thousands of Hoosiers face the same rural health disparity.

Purdue classifies 33 of Indiana counties as a rural mix and 41 as rural. Recent New York Times’ data found most of the state’s hotspots are in these rural communities, with the exception of two urban counties LaPorte and Porter.

“Many of these issues have existed for a long time in rural communities so these are systemic, rural problems that need to be addressed, but they would have helped us to fight COVID if we had addressed them before,” Dixon explained.

Experts FOX59 talked with say at least three of these issues lead to Indiana’s rural health disparities.

One of them is a lack of health care staff, especially in primary care.

“We’ve seen this in studies that if people have a relationship with a doctor they trust, and have been able to talk to that doctor, they’re much more likely to get vaccinated,” said Dr. Emily Backer with the Howard County Health Department.

But the Indiana Rural Health Association (IRHA) CEO Cara Veale found, “Access to a provider is a limitation. The only other area, or one of the other areas, an individual may look for information is social media, and unfortunately, what we’re seeing on a lot of or social media platforms is misinformation about the pandemic.”

Dr. Backer says misinformation is the biggest challenge in the pandemic.

“I’ve had a lot of conversations as a primary care doctor with people that aren’t vaccinated and tried to explain the data to them– tried to explain the risks– and you know for some people, it’s just a blank wall where there’s no convincing them,” the physician detailed.

Dr. Backer works for the Howard County Indiana Health Department.

Regenstrief Institute considers Howard County 1 of 10 rural COVID hotspots with more hospitalizations per capita than urban areas.

As of mid-October, the Indiana Department of Health (IDOH) reports nearly 50 percent of the eligible population there was fully vaccinated. It’s 60 percent in Marion County and 80 percent in Hamilton County, both nearby urban metros. Marion County is about 12 times larger and Hamilton County is four times, yet both are significantly ahead in vaccinations.

In mid-October, IDOH also found nearly 17 percent of individual Howard County residents tested are positive. That’s higher than nearby urban areas.

Like other rural or rural mix communities dealing with high COVID-19 numbers, Howard County faces a second geographic disparity.

“Lack of access to internet can be a barrier because we’ve seen with healthcare now– with COVID there was a lot of telehealth activity, for example. Well if you live in a rural community and you don’t have broadband internet, you cannot connect to those providers remotely,” explained Dixon, also an associate professor at IUPUI’s School of Public Health.

Without dependable internet for telehealth, many rural Hoosiers are forced to find an open health care provider, which requires a vehicle.

“Transportation issues continue to grow in a negative trend, unfortunately,” Veale described.

It’s a third rural health disparity.

“… you don’t have transportation, then you’re essentially cut off from the healthcare system.”

Brian Dixon, Regenstreif Institute’s director of public health informatics.

Most rural Hoosiers won’t find public transportation to travel for, “… things like testing, COVID testing facilities, COVID vaccine options, and so really the health disparities we saw pre-pandemic were just simply exacerbated,” IRHA’s executive director explained.

Lack of healthcare staff, internet access and transportation all contribute to rural health disparities, but COVID-19 has doubled down on just how serious these issues are for rural Indiana’s health.

We checked in on the state’s plans to address these issues. Here are their plans:


“The Indiana Department of Health continues to work with community partners around the state to provide education, outreach and access to vaccine in vulnerable and underserved communities. This effort includes engaging trusted community leaders to help share vaccine messaging to populations that may be hesitant, sending text messages and emails to residents of specific ZIP codes to alert them to the availability of testing and vaccine mobile clinics, and engaging in regular calls with stakeholders including the Indiana Rural Health Association, local health departments, hospitals and healthcare providers. In addition to these efforts, we have provided significant funding to local health departments in all areas of the state to support their COVID-19 response efforts. Our goal from the beginning has been to make vaccine information and registration accessible to every Hoosier, which is why we partnered with 211, which has a Spanish line, access to other translation services and also provides assistance for those with hearing or vision impairments and those without internet service. IU Health continues to offer free transportation to vaccination appointments for months.”

Indiana Department of Health (IDOH) spokeswoman


“The digital divide in our state has become even more apparent since the pandemic. To address this, the Office of Community and Rural Affairs is currently rolling out the third round of the Next Level Connections Broadband Grant, which is part of a $1 billion infrastructure program the Governor announced in 2018. For this third round of the grant program, OCRA has received broadband funding requests totaling over $606 million from internet providers around Indiana. Earlier this year, the Governor signed a budget from the Indiana General Assembly that appropriated an additional $250 million for continued broadband expansion. These new dollars will contribute to multiple programs, including helping fund the newest broadband initiative, the Indiana Connectivity Program. The new broadband program connects Hoosiers that lack internet access with service providers and assists with the expense of extending broadband to these locations. To apply for consideration, Hoosiers should submit their information online at or call the Indiana Broadband Connect Center at 833-639-8522. Under Lt. Gov. Suzanne Crouch, our office will continue these efforts to expand broadband to all corners of Indiana.”

Office of Community and Rural Affairs Executive Director Denny Spinner