Research: Lack of public transit and safe places to walk and bicycle has major health impact on rural Missouri

In 2016, bicycling, walking, parks, and trails are moving forward in Missouri in a way they never have before--a vast improvement from the 5, 10, and 20 years ago.

But the improvements we see across Missouri are not yet universal.  We see many parts of the state where the relatively new movement for vibrant, liveable, walkable, bicycleable communities has taken hold very well--but many others where it has not yet taken hold.

As the statewide bicycle and pedestrian advocacy organization, we would like to see Complete Streets, Bicycle Friendly Communities, Walk Friendly Communities, bicycle, pedestrian, and trails plans, access to public transportation, and all the rest happen in every part of Missouri.

So where in Missouri are these things missing?

One place is the smaller towns and communities across rural Missouri. We have previously summarized research showing how fewer opportunities for walking, bicycling, trails, and other day-to-day outdoor recreation opportunities mean that people who live in rural communities have higher rates of obesity and other related negative health outcomes.

Now a report from the Missouri Department of Health and Senior Services confirms this, with far more detailed information about the health disparities in rural Missouri than has previously been available.

The bad news: Physical activity-related health outcomes notably poorer in rural Missouri

Physical activity rates notably lower in rural areas of Missouri

Residents of rural areas have significantly less access to safe places to walk and bicycle and report significantly less physical activity than urban residents in Missouri.

  • Residents reporting no use of parks, trails, etc: 63.9% in rural areas vs 50.9 in urban areas (p. 62)
  • No leisure-time physical activity: 26.4% in rural areas vs 22.0 % in urban areas (p. 62)

Obesity Rates Notably high in Missouri Rural Areas 
Obesity rates in Missouri are higher than the national average (click for full-size version)
Obesity rates in Missouri are higher than the national average; in rural Missouri they are higher yet - in large part because of lack of access to safe places to walk and bicycle

Rural Missouri has a significantly higher obesity rate than urban portions of the state.

  • 32.3% of rural Missouri residents obese vs 28.9 of urban residents.  (27.8 of U.S. residents are obese)(p. 62)

Even large Missouri cities and metro areas have lower access to parks and physical activity than the U.S. average for similar places.

But the smaller cities and towns across rural Missouri have even less access to places to walk and bicycle and to public transit. The lack of access to public transit and safe places to walk and bicycle is a major public health issue for Missouri.

Larger metro areas in Missouri have public transportation systems--though they are underfunded.  But many do not realize that rural Missourians depend on public transportation as well.  Rural public transportation systems like OATS are vital for elderly, disabled, youth, and other vulnerable populations that exist in every rural city and county in Missouri.

Traffic fatality rate in rural Missouri double the urban rate

The traffic fatality rate in rural Missouri is more than double the urban rate.

  • Traffic death rate: 26.1 per 100K rural Missouri; 12.6 urban (p. 36)
  • Traffic injury hospitalization rate: 10.9 per 100K rural Missouri; 8.3 urban

Heart Disease, Stroke, Blood Pressure, Cholesterol, Kidney Disease, Diabetes rates are all higher in rural Missouri

The overall age-adjusted death rate for residents in rural Missouri is significantly higher than that in urban areas, as are the rates for  heart disease, stroke, high blood pressure, cholesterol, kidney disease, and diabetes.

  •  Overall death rate: 853.4 per 100K in rural areas of Missouri vs 778.9 in urban areas (p. 19)
  •  Heart disease death rate: 246.4 per 100K in rural areas of Missouri vs 220.3 in urban areas (p. 24)
  •  Stroke death rate: 54.5 per 100K in rural areas of Missouri vs 49.7 in urban areas (p. 34)
  •  High blood pressure: 37.4% of Missouri's rural residents vs 32.6% of urban residents (p. 63)
    Motor vehicle fatality rates in rural Missouri are DOUBLE the rate in urban areas (click for full-sized version)
    Motor vehicle fatality rates in rural Missouri are DOUBLE the rate in urban areas
  •  High cholesterol: 46.9% of Missouri's rural residents vs 43.5% of urban residents (p. 63)
  •  Kidney disease death rate: 19.2 per 100K in MO rural residents vs 17.0 urban (p. 47)
  •  Diabetes death rate: 23.3 per 100K rural vs 22.8 urban (p. 45)

Note: Death rates per 100K are all age-adjusted.  See the full report for details.

Let's support comprehensive transportation funding in Missouri

Health departments around rural Missouri say that the major health issues above are related to:

  • Lack of public transportation – reduces access of older, disabled, young, poor, and other vulnerable populations to medical care, dental care, food, recreation/fitness, and needed health/community services. These people depend on rural public transport like OATS to meet these vital needs.
  • Lack of safe places to walk and bicycle – communities with safe places to walk and bicycle have healthier residents

Missouri invests just $0.09 per resident in public transportation.  Missouri invests NO state transportation funding in walking/bicycling. Every proposal for solving Missouri's current transportation funding crisis funds highways only, ignoring the vital need for public transportation and safe places to walk and bicycle in every community across Missouri.

The good news: We can do a LOT to solve this problem

The good news is, now that know that problem, we also know many of the solutions. These are solutions that have worked in communities across Missouri, the U.S., and the world.  They will need some adaptation and accommodation to work in rural and smaller communities across Missouri, but they can and do work.

Note only that, but we have several small, rural Missouri communities across the state that have been working to incorporate walking, bicycling, and trails into their communities with excellent success. So we know it can work here in Missouri, too.

What does the recipe for success in rural Missouri communities look like?

More resources for health, walking, bicycling, and trails in rural communities

This summary is also available as a printable PDF report.

Source and images: Health in Rural Missouri: Biennial Report 2012 - 2013, Missouri Department of Health and Senior Services, Office of Primary Care and Rural Health


Working for better health and access to bicycling, walking, and trails in all Missouri communities--rural, urban, and suburban--is a primary goal of our Vision for Bicycling and Walking in Missouri.

Your ongoing membership and generous financial support help turn our Vision into reality!