In-Depth: Rural Reality

Pennsylvania with counties marked as either rural or non

Over 300,000 Pennsylvanians, 13% of the rural population, live more than 30 minutes from the nearest hospital and 32% are more than 30 minutes from the closest labor and delivery unit.

Rural health in Pennsylvania

Pennsylvania has the third-largest rural population in the nation, according to the commonwealth’s Department of Health and Human Services’ Rural Health Transformation Plan, with nearly 1 in 5 (19%) residents living in U.S. Health Resources and Services Administration (HRSA)-defined rural areas.

Geographic isolation, workforce shortages, hospital and clinic closures, and limited access to specialty care are just a few of the threats facing rural residents’ health. Rates of chronic disease, challenges to maternal and infant health, and behavioral health needs are greater in rural areas. In addition, rural Pennsylvanians in general are aging and in poorer health than those living in urban areas.

Higher rates of serious illness like coronary heart disease (9%), diabetes (12%) and conditions like obesity (36%) underscore the need for investment in rural health services solutions. While rural overdose rates are lower, suicide deaths in rural Pennsylvania are significantly higher than in urban areas (15 versus 12 per 100,000; see Harvest and Hardship). Inadequate prenatal care (8% of pregnancies in rural versus 6% in urban areas), reflects the lack of local maternal health services providers and significant transportation challenges. Over 300,000 Pennsylvanians, 13% of the rural population, live more than 30 minutes from the nearest hospital and 32% are more than 30 minutes from the closest labor and delivery unit.

Between 2020 and 2023, eight acute care hospitals closed, by which time nearly half of rural hospitals were operating at a loss. Three rural hospitals closed labor and delivery units during 2025, creating new and larger maternity care deserts. Only 10% of Pennsylvania’s physicians, 6% of dentists, and 10% of the state’s hospital beds are in rural counties.

Major Research Areas - Pitt Public Health

School of Public Health Departments	Subject	Departments	Pitt School Collaborations
BCHS Behavioral and Community Health Sciences	Aging, Cognition and Neurodegenerative Diseases	BCHS, Biostatistics, EPI, HuGen, IDM	Health and Rehabilitation Sciences, Medicine, Nursing
Biostatistics Biostatistics and Health Data Science	Cardiometabolic Health and Chronic Disease Prevention	Biostatistics, EOH, EPI, HPM, HuGen	Engineering, Medicine, Nursing
EOH Environmental and Occupational Health	Maternal, Child and Reproductive Health Equity	BCHS, Biostatistics, EOH, EPI, HPM, HuGen	Dental Medicine, Engineering, Medicine, Nursing
EPI Epidemiology	Infectious Diseases, Global Health and One Health	BCHS, Biostatistics, EOH, EPI, IDM	Engineering, Nursing
HPM Health Policy and Management	Cancer Biology, Genetics and Precision Medicine	Biostatistics, EOH, EPI, HPM, HuGen, IDM	Engineering, Medicine, Nursing
HuGen Human Genetics	Mental Health, Substance Use and Violence Prevention	BCHS, Biostatistics, EPI, HPM, HuGen	Medicine, Nursing, Pharmacy
IDM Infectious Diseases and Microbiology	Health Equity, Social Determinants of Health and Policy	BCHS, EOH, EPI, HPM, IDM	Engineering, Health and Rehabilitation Sciences, Medicine, Nursing

Public Health at Pitt

Pitt’s School of Public Health grew from civic leaders’ recognition of a clear need to investigate the causes of illness and forge long-term approaches to prevent disease at the community and population levels. It’s a commitment that still resonates across the school’s three-part mission of research, education and service.

“Our research is of high quality, rich and directly applicable to community needs regardless where people live,” Dean Maureen Lichtveld, MD, MPH, says of the school’s multidisciplinary efforts in disciplines that reach from neighborhoods to the halls of Congress. “Precision public health drives us to predict to prevent.”

As seen in the table above, Pitt Public Health examines questions that touch nearly every facet of the human experience across the lifespan. Faculty share these insights with students who are taking part in undergraduate courses and those pursuing advanced degrees and postgraduate training, as well as colleagues throughout the health care spectrum, neighborhood partners and public health professionals in government and nonprofit organizations. In 2025, public health investigators have published more than 900 manuscripts in scientific journals to disseminate the newest information to improve population health. Many of these research findings are instrumental to addressing the health burden many rural communities face.

Collaboration with other experts is foundational to success in any field—but even more so in scientific research. School of Public Health investigators partner with researchers at Pitt, in Pittsburgh and across national and international borders, as well as government and community stakeholders to study pivotal questions affecting population health. Following are some examples:

public health researcher taking samples of the water

East Palestine train derailment

Long after the television cameras left, many residents were left wondering what the environmental consequences might mean for their health in the months and years ahead.

Pitt investigators from the Schools of Public Health, Medicine, Health and Rehabilitation Sciences, and the Swanson School of Engineering are collaborating on a project to investigate possible health consequences to residents following derailment of a train carrying industrial chemicals in East Palestine, Ohio.

When a Norfolk Southern freight train derailed in East Palestine, Ohio, in February 2023, images of burning tank cars and a towering plume of smoke quickly captured national attention. The crash released vinyl chloride and other hazardous chemicals into the surrounding environment, raising urgent concerns among residents about potential long-term health effects.

For researchers at Pitt Public Health, the disaster also raised critical scientific questions about how chemical exposures might affect the health of people living in rural communities along the Ohio–Pennsylvania border.

To begin answering those questions, Lichtveld is co-leading a National Institute of Environmental Health Sciences-funded, time-sensitive study examining post-derailment environmental exposures and their potential health effects.

Long after the television cameras left, many residents were left wondering what the environmental consequences might mean for their health in the months and years ahead.

The multidisciplinary project convenes Pitt investigators from the Schools of Public Health, Medicine, Health and Rehabilitation Sciences, and the Swanson School of Engineering. The team includes environmental health researchers James Fabisiak, PhD, and Firoz Abdoel Wahid, MD, PhD; liver disease researcher and the project’s coprincipal investigator Juliane Beier, PhD; clinical research coordinator Olisa Okonkwo, MD; environmental engineers Carla Ng, PhD, and Oindrila Ghosh, PhD; and behavioral health researcher Laura Dietz, PhD.

“This kind of disaster raises immediate health concerns, but the health consequences can unfold over years or even decades,” Lichtveld says. “Our goal is to assess what residents may have been exposed to and what that could mean for their health in the years ahead.”

The project takes a community-engaged research approach, guided by a community advisory board. Trained community-based researchers partner with Pitt investigators and undergraduate and graduate students from the School of Public Health to recruit participants and assist with data collection.

Monitoring Environmental Exposures

One component of the study focuses on measuring potential contaminants in homes near the derailment site. Train derailments and many other environmental disasters often result in exposure to a mixture of chemicals rather than a single contaminant. Researchers collected air, water and soil samples from homes within an eight-mile radius of the crash to better determine whether residents may still be encountering chemical exposures.

Indoor-air samples were analyzed for volatile organic compounds, including vinyl chloride, while water and soil samples were assessed for per- and polyfluoroalkyl substances, commonly known as PFAS, and other contaminants. Passive-air samplers were also placed near several homes to monitor air quality over longer periods.

Preliminary findings suggest that most homes tested fell within U.S. Environmental Protection Agency (EPA) guidance levels. However, some measurements detected vinyl chloride concentrations that have exceeded EPA guidance for chronic exposure, emphasizing the importance of continued monitoring.

Potential Liver Health Impacts

Another part of the project examines whether chemical exposures could worsen underlying liver disease among residents.

That work is led by Beier, whose research interests focus on liver disease progression. Her team is collecting blood and urine samples as well as using a noninvasive imaging technique called FibroScan to evaluate liver stiffness and fat accumulation—early indicators of liver disease, a condition that can often develop without symptoms.

"There are no nerve receptors on the liver, so people typically don't feel anything as the disease progresses," Beier says. "It often goes unnoticed unless blood work shows elevated liver enzymes."

Early findings suggest that traditional blood tests may miss subtle signs of liver injury. In the study so far, abnormal liver enzyme levels were detected in some participants, while FibroScan imaging identified additional individuals with early indicators of liver damage.

Characterizing these patterns is especially important because liver disease can take decades to progress to advanced stages, including cancer, since vinyl chloride is a known liver carcinogen.

Children's Health

A third component of the study focuses on families' concerns about children's health following the derailment.

Researchers surveyed parents living within 10 miles of the crash site about their children's health and development. "Many families reported children's anxiety about potential exposures, and some parents described respiratory symptoms and mood changes among their children after the incident," indicated Dietz, who leads this part of the study.

"These types of environmental disasters can have physical and psychological impacts on communities," Lichtveld says. "Listening to residents' concerns is a critical part of accurately determining the full scope of adverse health effects."

Working with the Community

Community engagement has been central to the project. During listening sessions organized collaboratively with the community advisory board, residents shared their experiences and concerns about the department and its aftermath, sometimes becoming emotional as they described how the event continues to affect their families.

The research team hopes the work will provide communities with clearer information about environmental exposures and potential health risks.

"After a disaster like this, communities want answers about what it may mean for their health in the years ahead," Lichtveld says. "Research like this helps us anticipate potential risks and provides communities with the information they need to make decisions about their health."

So far, about 160 residents have enrolled in the study. Researchers hope many will continue participating in a larger, multiyear effort that could track environmental exposures and health outcomes over time.

For Lichtveld, the project also demonstrates the importance of rapid, coordinated scientific response following environmental disasters.

"By bringing together expertise from across disciplines and working closely with the community, we can generate the evidence needed to protect public health after events like this," she says.

One Health connects us all

"In the early part of 2024, even people who had been studying these viruses for decades would not have remotely predicted that cattle could be a host for bird flu."
Suresh Kuchipudi

Research on the links between environmental conditions and human health in Pittsburgh date back to the school's founding in 1948. In October of that year, weather conditions trapped toxic industrial emissions at ground level along the Monongahela Valley. By the time rain came to clear the air five days later, 20 people had died and thousands were sickened in what became known as the Donora Smog—an event still notable as one of the worst air pollution disasters in the nation’s history.

Today, Pitt Public Health is a leader in research focused on One Health—a collaborative, multidisciplinary approach that recognizes the interconnectedness of human, animal, plant, and environmental health. In 2024, the state Department of Agriculture designated the school as coordinating institution for the Pennsylvania One Health Consortium, an association of more than a dozen academic, government and conservation groups to facilitate research, education, policy and community engagement on a wide scale. The consortium’s second annual meeting is set for June in Pittsburgh.

Research into animal diseases is also to Pennsylvania’s economic health. The agriculture industry supports over 593,000 jobs and 49,000-plus farms across 7 million acres, according to the U.S. Department of Agriculture. Key sectors include dairy, livestock, poultry, and specialty crops like mushrooms, for which the commonwealth ranks first nationally. And while farm numbers have decreased, the total value of products sold increased 33% since 2017 to $10.3 billion, indicating high-value production.

Human bird flu transmission routes - Wild birds carry bird flu arrow to poultry H5N1 bird flu has a fatality rate of up to 90% chickens arrow to cows but also arrow from wild birds to cows and transmission within poultry species, cow arrow to humans arrow from poultry to humans and transmission within species in humans Animal pathogens like avian flu can devastate livestock populations and interrupt the food supply, says Alex Hamberg, VMD, PhD, state veterinarian.

Highly pathogenic avian influenza (HPAI), first identified in the 1990s, has even been found in Antarctic penguins, and was detected most recently in Pennsylvania in 2022. Disease spread has resulted in the loss of hundreds of millions of birds across the country, says Hamberg. The disease has now spread to cattle, cats, other mammals and a few people whose work brings them into close contact with birds and cattle—causing at least one human death since 2024.

In fact, Pennsylvania is now the nation’s hotspot for bird flu, with over 7.4 million chickens lost in the state, primarily in Lancaster County. The state accounts for over half of all U.S. bird flu cases this year. While risks to the general public are low, the outbreak has triggered “crisis mode,” threatening the state's poultry industry.

Veterinary science and academic research, however, can contribute to the development of updated testing and diagnostic tools for HPAI and other animal diseases, says Hamberg.

At Pitt, infectious disease expert Suresh Kuchipudi, PhD, MVSc, MBA, is tackling HPAI and other diseases that spread between animals and humans in studies being funded by grants totaling $4.1 million from the National Institute of Food and Agriculture and the U.S. Department of Agriculture Animal and Plant Inspection Service.

“All of these studies have public health significance,” Kuchipudi, professor and chair, Department of Infectious Diseases and Microbiology, and principal investigator, says of studies, which range from mechanisms of viral infiltration into different tissues to developing new, more portable tools to aid viral detection and novel vaccines to be evaluated in cattle.

“It’s only a matter of time before this virus starts circulating among people,” says Kuchipudi. “It hasn’t happened yet, but we know how quickly that can change with zoonotic viruses, he adds, noting the emergence of COVID-19.

Unlike birds and other animals, in which the avian flu virus targets the lungs and brain, infection in dairy cattle causes severe udder inflammation known as mastitis, resulting in thick, clotted milk and decreased milk production. More troubling are the elevated levels of virus that are shed in the milk of affected cows—contamination that has been linked to cow-to-cow viral transmission through milking machines and fatalities among cats that consume infected raw milk, raising serious risks to animal and food safety.

“In the early part of 2024, even people who had been studying these viruses for decades would not have remotely predicted that cattle could be a host for bird flu,” says Kuchipudi.

Using primary cell culture models under carefully controlled lab conditions in Pitt’s Regional Biocontainment Laboratory, the Kuchipudi team will safely examine how H5N1 “bird flu” infects udder tissue in cattle and triggers mastitis, helping pinpoint the biological steps that lead to inflammation and virus shedding in milk.

In partnership with North Dakota State University, the Kuchipudi team is also developing new diagnostic tests for influenza D virus (IDV), a lesser-known infection that is endemic in cattle worldwide but was previously thought to cause only mild illness. Newer IDV strains are growing in severity and are potentially transmissible to humans. Current antibody detection tests cannot distinguish exposure to different lineages of IDV in cattle and no vaccine is available.

In addition to new diagnostic tests, the team will develop a nasal spray vaccine to protect cattle from IDV and prevent the disease from spreading.

A third seeks to determine how bird flu viruses like H5N1 adapt to infect cattle and ways to mitigate risk of transmission. The Kuchipudi team will examine mechanisms used by bird flu strains H5, H7 and H9 to infect cells in various tissues including the lungs, digestive system and mammary glands. Understanding how viral mutations affect the virus’s ability to infect cattle could reveal the risk of spreading beyond the mammary gland and provide risk-assessment tools to help protect animal health and strengthen food security.

“We propose to develop a model based on the sialic acid [sugars on cell surfaces] receptors in cattle and other ruminants like sheep and goats to create a risk assessment of emerging zoonotic flu viruses,” he says.

A fourth project aims to develop and validate innovative diagnostic platforms for HPAI detection in poultry, wild birds and environmental samples.

“We will be looking to create portable, field-deployable but highly sensitive tools to detect the virus,” says Kuchipudi. “Field-deployable, sensitive tools to detect emerging zoonotic viruses such as avian influenza, are essential for detecting threats early at the animal–human–environment interface, a core principle of the One Health approach.”

The team will be developing multiple diagnostic platforms, including an electrochemical sensor in collaboration with Penn State University.

Jay Mckenzie on the back of the ambulance with the doors open

Pitt-Bradford student Jay Mckenzie is an emergency medical technician (EMT) and firefighter for the City of Bradford Fire Department, and a history and political science major.

Other regional outreach and collaboration

The University of Pittsburgh’s Bradford campus sits along state route 346 in McKean County, about 150 miles northeast of Pittsburgh and 80 miles south of Buffalo, N.Y. Undergraduates who choose Pitt-Bradford can study the humanities as well as social, physical, computational and biological sciences. The campus boasts smaller class sizes, individualized attention and a welcoming atmosphere. New partnerships are closing gaps where disparities with Bradford’s urban counterparts remain.

Pitt’s Bradford campus is continuing to partner closely with the University’s Schools of the Health Sciences to address challenges that affect patient care and overall public health in rural Pennsylvania, explains Richard Esch (MBA, KGSB ’98), president of Pitt’s Bradford and Titusville campuses since 2022.

In collaboration with the School of Public Health, Pitt-Bradford will establish a new Center for Rural Engagement to serve as a hub for place-based education, research and community engagement to address the challenges and opportunities within northwestern Pennsylvania, including efforts to improve rural health outcomes while also enhancing health care workforce development.

“The center will build on recent successes we’ve had in addressing public health challenges in the region,” says Esch, who is also a proud Pitt-Bradford alumnus (BS, ES ’83).

For example, Pitt’s School of Dental Medicine will offer dental hygiene and dental assistant courses at Pitt-Bradford in person and online. Clinical training will also take place locally at Universal Primary Care, a federally qualified health center. “This will allow local residents to get greater access to the quality dental care they require right in their communities,” he adds. “Being able to learn where they live will allow students to earn a degree at a reduced cost while increasing the likelihood that they will stay in the community to provide care following graduation.”

The program began accepting dental assistant students in April, with plans to offer prerequisite courses for dental hygiene students in the fall with a program kickoff in July 2027.

In addition, Pitt-Bradford and the School of Health and Rehabilitation Sciences launched a four-year degree program in emergency medicine that is being offered on the Bradford campus. Students earn their emergency medical technician and paramedic certifications and are required to complete over 500 hours of caregiving with local medical services, health clinics and fire departments.

“Similar to the dental partnership, this program is providing critical services to the communities that need it the most while producing homegrown paramedics who will then be able to be employed in the region,” Esch continues. “We are excited about the additional opportunities we can engage, through the Center for Rural Engagement, to enhance these activities and identify additional opportunities to improve public health for all. We are also very thankful for the continued support of the School of Public Health in addressing the rural health challenges impacting our state.”

Brian and C.J. are grateful for the resources available through the Erie County Health Department when their children needed immunizations to enter school and depended on such services before the couple was able to get health insurance through C.J.'s employer. Even with insurance, finding appropriate care remains difficult, she admits. "What it boils down to is people in rural areas choose whether or not to seek help, and they really do choose," she says.

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Care in the Country Can Get Complicated