Abstract: The literature examining the relationship between access to public recreational facilities and health outcomes among rural populations has several notable limitations. First, they frequently overlook community structural characteristics (Moxley and Procter 1995; Young 2009) that potentially influence the availability of recreational facilities within communities. Second, most studies fail to include measures of health outcomes outside of rates of physical activity and obesity. This study addresses these shortcomings by identifying key structural influences on differences in access to recreational resources across all 100 counties in the state of North Carolina. The intent here is to illustrate disparities in access between rural and urban areas and to assess how this relates to a range of population health measures, including obesity and diabetes rates, length and quality of life, and adverse health behaviors (e.g., smoking and alcohol consumption).
Methods: The study examines how a county’s position within the rural-urban continuum (USDA ERS), median household income, racial composition, and market forces (retail per capita) impact access to non-exclusive (open access and low-cost) public recreational facilities. Measures are drawn from the 2010 U.S. Census and the NC Office of State Budget and Management. Separate measures of per-capita acreage of outdoor public recreation sites operated by town and county-level agencies and per-capita and municipal operating expenditures for county parks and recreation were obtained from the NC Office of State Budget and Management and the Department of State Treasurer. The purpose of using multiple measures of public recreational resources was to develop a composite framework for gauging the quality of services available across all 100 counties. County-level population health measures are drawn from the University of Wisconsin Population Health Institute’s County Health Rankings & Roadmaps and the North Carolina State Center for Health Statistics.
Results: Preliminary analysis indicates that higher-income counties, those with underrepresented racial minority populations, higher retail per capita, and that are within close proximity to a state park all have greater access to public parks and recreational services. Disparities in access are also associated with a host of county-level population health outcomes as well as adverse health behaviors.
Implications: The results of this study further highlight the vulnerability of rural areas across the state of North Carolina with regards to issues of access to fundamental public services. These findings are particularly relevant as many rural counties across the state are still recovering from devastation caused by widespread flooding in the wake of Hurricane Matthew in the fall of 2016.
