Frontier areas are the most rural settled places along the rural-urban continuum, with residents far from health care, schools, grocery stores, and other necessities. Frontier is often thought of in terms of population density and distance in minutes and miles to population centers and other resources, such as hospitals.
Many frontier counties are located in the West, a part of the country where individual counties tend to cover a large geographic area. Even counties that have a town with a hospital, grocery store and other services may encompass areas that are much more rural and isolated, making them frontier counties. Frontier areas face challenges in providing access to health and human services even greater than the challenges faced by less isolated rural communities.
There are more organizations related to Frontier in the organizations section.
Frequently Asked Questions
- What is the definition of frontier?
- How much of the U.S. is frontier?
- How can I find out if my county is a frontier county?
- What are some of the challenges facing frontier areas?
- What are some of the health care challenges in frontier areas?
- Are there funding or reimbursement advantages to being considered a frontier area?
What is the definition of frontier?
Frontier areas are sparsely populated rural areas that are isolated from population centers and services. While frontier is sometimes defined as counties having a population density of six or fewer people per square mile this does not take into account other important factors that may isolate a community. Therefore, preferred definitions are more complex and address isolation by considering distance in miles and travel time in minutes to services.
Definitions of frontier for specific state and federal programs vary, depending on the purpose of the project being researched or funded. Some of the issues that may be considered in classifying an area as frontier include population density, distance from a population center or specific service, travel time to reach a population center or service, functional association with other places, availability of paved roads, and seasonal changes in access to services. Frontier may be defined at the community level by county, by ZIP code or by census tract. See the National Center for Frontier Communities' The Meaning of Frontier for descriptions of all major definitions.
Rural-Urban Commuting Areas (RUCAs) can be used to identify very remote areas, which could be considered frontier-like due to their isolation from population centers. Under the RUCA definition, types of rural and urban are defined by proximity to urban areas and the portion of the population that commute for work from place to place. For instance, a RUCA code of 10 is assigned to isolated, small rural census tracts. The WWAMI Rural Health Research Center publication RUCA Version 1.11 Travel Distances to Urbanized Areas and Larger Rural Towns discusses a method of combining the Rural-Urban Commuting Area (RUCA) codes with travel distance to urban areas and larger rural towns, in order to identify areas that are very remote. RUCAs are available by census tract and by ZIP code area.
Federal legislation to improve access to health services in frontier areas resulted in the USDA Economic Research Service and the HHS Office or Rural Health Policy developing the Frontier and Remote (FAR) area codes. A first draft of the FAR methodology based on urban-rural data from the 2000 decennial census was posted in the federal register for public comment in November 2012. The draft methodology provides distinct FAR categories, ranging from one that is relatively inclusive (18 million FAR residents) to one that is more restrictive (4.8 million FAR residents).
Four FAR levels were developed because rural areas experience degrees of remoteness depending on the accessibility of different types of goods and services. A relatively large number of people live far “high-order” goods and services, that are usually located in large urban areas, such as advanced medical procedures, major household appliances, and regional airport hubs. FAR Level 1 approximates this degree of remoteness by measuring the average travel time within a zip code area to the closest large urban center. A smaller number of people live far from “low-order” goods and services that can usually be found in smaller urban centers, such as grocery stores, gas stations, and primary health care services. FAR Level 4 approximates this much higher degree of remoteness by measuring travel time to smaller urban centers. Users of the FAR codes will be able to choose the definition that bests suits their specific application.
FAR codes are being updated based on 2010 data and should be available by the end of this year. Information
and maps on the draft methodology are available at:
USDA – Economic Research: Frontier and Remote Area Codes
How much of the U.S. is frontier?
The number of people living in the frontier and the amount of land that is frontier will vary depending on the definition of frontier used. In 2011, the National Center for Frontier Communities asked each of the State Offices of Rural Health (SORH) to designate which of their state’s counties were frontier. The SORH designated 46% of the land area of the United States as frontier, and over 5.6 million people lived in these areas in 2010.
The North Carolina Rural Health Research and Policy Analysis Center's map, Frontier Counties, United States, 2004, identifies 452 counties that meet the Center's definition of fewer than seven people per square mile, with a total population for those counties of nearly 2.9 million people.
Based on the USDA Economic Research Service's Urban Influence Codes, over three million people live in rural counties that were not adjacent to a metropolitan or micropolitan county (having an Urban Influence Code of 11 or 12) in 2003, and these counties covered an area of over 770,000 square miles. According to the USDA Economic Research Service's most recent RUCA codes, in 2000 13.4 million people lived in a census tract with a RUCA code of 10, which is assigned to the most isolated, small rural census tracts.
How can I find out if my county is a frontier county?
There are several answers to this question.
You can determine if your county meets the "six or fewer people per square mile" definition of frontier by using the U.S. Census Bureau's State and County Quick Facts. Select your state and then your county. Scroll down to the Geography Quick Facts section near the bottom of the page and look for "Persons per square mile."
You can use the National Center for Frontier Communities' Frontier Areas from 2010 U.S. Census list based on data from the 2010 Census and feedback from the State Offices of Rural Health.
The U.S. Department of Agriculture's Economic Research Service provides a list of Rural-Urban Commuting Area (RUCA) codes for each state. A RUCA code of 10 is assigned to isolated, small rural census tracts.
What are some of the challenges facing frontier areas?
The isolation and distances that classify an area as frontier results in long trips to attend school, shop for groceries, get health care, and reach other basic services. Public transportation options are often limited or unavailable in frontier areas, making access to needed services difficult for low-income households, the elderly and disabled. Frontier areas face seasonal travel barriers that can make travel difficult. For those living in mountainous areas, some roads and passes may be closed in winter, leading to longer travel times. Residents may find that winter driving in the frontier extends travel times because they need to slow down to adequately account for road conditions and limited visibility. Flooding caused by melting snow and heavy rains can force the closer of main roads for unexpected and extended periods of time in both mountainous and flatland landscapes. Some island residents and residents of roadless areas are limited to air access, when airplanes are able to fly.
The economy in frontier areas is often based on a few specific resources or activities and is more at risk of economic downturns and boom-bust cycles. Farming, ranching, tourism, logging, and mining are some of the economic activities found in rural areas. Frontier communities may be more vulnerable to less desirable sources of business income, such as nuclear waste disposal. Frontier areas where much of the land is federally owned may lack an adequate tax base to pay for needed services.
The USDA's Economic Research Service report, Understanding Rural Population Loss, notes that counties with low population density, such as frontier counties, are most at risk for population loss. Communities with cultural or natural amenities are likely to fare better than remote communities that have fewer attractions to offer tourists and retirees.
What are some of the health care challenges in frontier areas?
The National Center for Frontier Communities' publication Addressing the Nursing Shortage: Impacts and Innovations in Frontier America notes that over 30% of frontier counties lack a hospital. Frontier counties that do have hospitals may face higher costs than non-frontier hospitals, due to the lower volume of patients served. Frontier counties with nurse shortages or no hospitals are often clustered together, compounding the distance residents must travel to reach a hospital.
Frontier areas face the same difficulties as other rural areas in maintaining their health care workforce. These thinly populated regions cannot easily compete with the wages and amenities offered to physicians and nurses by hospitals and clinics in metropolitan areas. Even communities that do have adequate staffing are often one doctor or nurse away from a shortage. For more information, please see our guide on Health Care Workforce.
Some areas must cope with seasonal variations in health care needs, when the population surges with tourists or retirees. Limited health resources in frontier areas, including volunteer health services and costly medical evacuation services, may be needed to care for people vacationing in the area, taking away from the resources available for local residents. For more information, please see the Seasonal Population Fluctuations in Rural and Frontier Areas: Phase One: The View from State Offices of Rural Health and Impact of Seasonal Population Variations on Frontier Communities: Maintenance of the Healthcare Infrastructure.
Rural communities are at higher risk for substance abuse among youth, higher motor vehicle fatalities, hypertension, cigarette smoking, suicide, and death from serious injuries. While many studies have identified health disparities for all rural communities, fewer have focused specifically on the remote rural areas of the frontier. The National Center for Frontier Communities' report, Frontier Youth: Living on the Edge, provides an overview of the behavioral health issues facing frontier youth, using rural data where frontier-specific data is not available, but with discussion that focuses on frontier. According to the December 2003 working paper from the WWAMI Rural Health Research Center, "Prevalence and Trends in Smoking: A National Rural Study," 24.9 percent of residents in remote rural areas smoke, compared to 22 percent in urban areas. Obesity in remote, rural areas tends to be higher than in urban areas, and a college education may have less impact in these remote areas to reduce levels of obesity (A National Study of Obesity Prevalence and Trends by Type of Rural County, Journal of Rural Health, Spring 2005.)
Are there funding or reimbursement advantages to being considered a frontier area?
Most of the programs that frontier areas can access for grants and enhanced reimbursement are available through shortage designations, including the Health Professional Shortage Area (HPSA) and Medically Underserved Area (MUA) designations, rather than through a designation as a frontier area. The Community Health Center program gives special consideration to sparsely populated or frontier areas. One program that is specific to frontier is the Community Health Integration Demonstration Program (F-CHIP) is a frontier-specific demonstration program which is testing new reimbursement models for rural hospitals in Montana, Wyoming, Alaska and North Dakota.
A clause in the Patient Protection and Affordable Care Act of 2010 (ACA) provides enhanced Medicare reimbursement rates to “Frontier States.” These states are defined in the ACA as all states in which at least 50% of counties have an average population density of 6 people per square mile or fewer. Currently, states that meet these criteria are Montana, Nevada, North Dakota, South Dakota and Wyoming.
Frontier communities are rural and so qualify for many rural-specific funding programs, such as the Office of Rural Health Policy's Rural Health Care Services Outreach Grant Program and Rural Health Network Development Grant Program. For additional funding programs available to frontier and other rural areas, please see RAC's Funding section.