When Climate Disrupts Care: Confronting the Health Impacts of Climate Change in Rural America

By Dr. Robert Macnee

When we talk about the health impacts of climate change, the conversation often centers on cities—extreme heat in urban centers, poor air quality, rising emergency visits. But in many rural areas, the climate crisis is showing up in ways that are harder to track and more difficult to treat.

It's not just about wildfires, floods, or extreme heat. It’s about what those environmental changes do to the fragile systems rural communities already depend on. Hospitals in these regions are grappling with interrupted care, stretched workforces, and overwhelmed infrastructure.

Environmental disruption is disrupting care.

When hazards such as floods or wildfire smoke disrupt health care access, rural hospitals often face delays in providing care, staffing shortages, and interruptions to essential services. With fewer resources and tighter margins than urban hospitals, even short-term disruptions can strain finances and limit care delivery. Climate-related events deepen the challenges faced by resource-constrained rural hospitals and reports from 2024 indicate that up to 30% of rural hospitals could be at risk of closing[1].

Chronic illness meets fragile infrastructure.

Heart disease, respiratory illness, and mental health conditions—all of which are exacerbated by environmental factors—are already prevalent in rural communities. Access to specialty care remains limited; in some regions, the nearest specialist may be over two hours away. While telehealth holds promise, its potential is unevenly distributed—22.3 percent of Americans in rural areas lack coverage from fixed terrestrial 25 Mbps broadband[2], the minimum recommended for telehealth. This digital divide means that the very tools meant to bridge care gaps often deepen them. Unless we treat broadband as critical infrastructure, digital innovation could continue to leave rural patients behind.

Mental health is climate health.

Environmental stress—whether from a hurricane, drought, or crop failure—carries emotional weight. In rural areas, where stigma can be a formidable barrier, people often suffer in silence and struggle to access support. Building trust through community-driven engagement isn’t a nice-to-have. It’s the cornerstone of climate resilience in healthcare.

So where do we go from here?

In rural communities increasingly affected by climate events, infrastructure needs are evolving. Climate preparedness, flexible staffing models, reliable broadband, and resilient transportation systems are emerging as critical components for ensuring continuity of care. Co-developing solutions with rural communities—rather than designing them in isolation—can help ensure strategies are locally grounded and culturally relevant. As rural hospitals face mounting climate-related pressures, their ability to serve as both healthcare providers and resilience anchors may depend on how these broader systems are supported.

In a follow-up post, I will share more about how rural health leadership is working to tackle these issues.

[1] Center for Health Care Quality and Payment Reform

[2] USDA