The following is the opinion and analysis of the writer:
Tauhidur Rahman
In rural Arizona, getting to a doctor can mean driving more than 20 miles — sometimes much more. But distance, while important, is only the most visible part of a much deeper problem. For many residents, access to health care is shaped not just by geography, but by income, infrastructure, and the design of the systems meant to serve them.
A statewide effort to transform rural health care highlights the scale of the challenge. Nearly 800,000 Arizonans, about 11% of the state, live in rural communities where incomes are lower, chronic diseases are more common, and access to primary and preventive care is limited. Rural residents earn, on average, $24,000 less than their urban counterparts and are more likely to rely on public insurance. These economic realities are closely tied to health outcomes.
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The disparities are stark. Rural Arizonans face higher mortality from cancer, cardiovascular disease, diabetes and suicide. Maternal health indicators tell a similar story: higher infant mortality, greater incidence of severe maternal complications, and more mothers receiving no prenatal care. In some parts of the state, access to maternity services is minimal or nonexistent. These are not isolated gaps. They reflect systemic differences in how health care is delivered and accessed.
It is tempting to view these disparities primarily as problems of supply (i.e., too few hospitals, too few doctors, too much distance). But that explanation is incomplete. Even when services are available, many people face barriers that make them difficult to use. Rural residents travel, on average, more than seven times farther than urban residents to reach a provider, but distance interacts with other constraints: limited transportation, conflicts with work schedules, and fragmented care systems.
These conditions create a system in which access exists in theory but not always in practice.
From my own research in Arizona and globally, I have seen a consistent pattern: Health outcomes depend not only on resources, but on people’s ability to use them. When individuals face constant financial pressure, limited time, and complex systems, even well-designed programs can fall short. Health, like poverty, is closely tied to agency, the ability to make choices and act on them.
Arizona’s Rural Health Transformation Program recognizes many of these challenges. The plan focuses on expanding telehealth, deploying mobile clinics, strengthening the health care workforce, and improving coordination across systems. These are important and necessary steps. Telehealth can reduce geographic barriers, mobile units can bring services closer to communities, and workforce investments can help address persistent shortages.
But infrastructure alone will not be enough if it does not align with how people live.
A telehealth appointment requires reliable internet, time flexibility, and familiarity with digital tools. A mobile clinic improves access only if people are aware of it, trust it, and can incorporate it into their daily routines. In other words, expanding services must go hand in hand with making those services usable.
This is where Arizona has an opportunity to lead. First, we need to think of health policy more broadly. Income stability, transportation, and broadband access are not separate from health. They are central to it. Second, simplifying systems can make a significant difference. Streamlined enrollment, better care coordination, and reduced administrative barriers can improve outcomes without necessarily increasing spending.
Third, community-based approaches matter. Programs that work through trusted local institutions and community health workers can bridge the gap between formal systems and everyday realities. Finally, we need to rethink how we measure success. The number of clinics or services available is important, but what ultimately matters is whether people are able to use them consistently and effectively.
The rural health gap in Arizona reflects choices about how systems are structured and how resources are deployed. By focusing not only on expanding access but also on strengthening people’s ability to act, we can move toward more meaningful and lasting improvements.
Because in the end, health care is not just about proximity. It is about whether care is truly within reach.
Tauhidur Rahman is an Associate Professor of Agricultural and Applied Economics at the University of Arizona and Founding Director of the Initiative for Agency and Development (IfAD).
