Nashville General Hospital CEO Joseph Webb, DSc, FACHE, explains how health systems are addressing care gaps in the country's most underserved areas.
Editor's Note: Joseph Webb, DSc, FACHE, is the CEO of Nashville General Hospital.
It is no exaggeration to say that area codes determine as much about health and life expectancy as genetic predisposition, lifestyle, or daily habits. A community's built environment, including housing, parks, roads, and access to food and healthcare facilities, varies widely between rural, suburban, and urban communities, and it has a profound impact on the health of the people who live in them.
Gaping disparities exist, and on a wide scale. In fact, more than 80% of counties across the country lack access to services needed to maintain, much less improve, their health. That's approximately 30 million people in the continental United States who live in "healthcare deserts."
That sad fact has a real impact on all aspects of healthcare, including at its most basic level. Ongoing, regularly scheduled checkups with a primary care provider corresponds with better outcomes and reduced healthcare spending and the odds of a premature death. But that's for people fortunate enough to have access to that care. For those who live more than 30 miles from a provider and cannot reach one by foot or public transportation, lack of access to preventative services is more than just inaccessible. It is literally a matter of life or death.
People in rural areas are more likely to die from preventable or treatable diseases, such as heart disease, cancer, chronic respiratory ailments, and stroke than their urban and suburban counterparts. An analysis by the American Medical Association found that while overall mortality for Americans decreased between 1999 and 2019, mortality rates for rural residents between 25 and 64 years old rose by 12% in that same period.
The Growing Problem of Shrinking Access
The number of healthcare deserts in Tennessee makes it 15th in the nation. Twenty-three of its 95 counties, representing more than 36% of the state's population, or approximately 2.5 million residents, are designated as healthcare deserts, and slightly more than 27% of that population is rural. The healthcare services they lack include pharmacies, primary care providers, hospitals, emergency services, and community health centers.
Related, but no less impactful, factors include income, health literacy, and even internet access. Telehealth could help rural residents, but only a little more than 55% of Tennesseans have access to high-speed internet, compared to the nationwide average of 99.2%.
Changing demographics play a role, too. As urban Nashville gentrified, long-time residents were priced out, and so they moved out, which created new areas without sufficient access to healthcare.
This phenomenon is hardly contained to our region. The University of Texas reported that gentrification in Austin pushed low-income persons of color out of economically ascendant neighborhoods and into outlying areas that now have a rising population of disadvantaged residents. This "Great Inversion" has occurred in metro areas throughout the United States, and in Austin alone suburban poverty increased by 129% between 2000 and 2015.
Add to that an ongoing wave of rural hospital closures. More than 100 such facilities closed between 2013 and 2020, and 40% of all rural hospitals, already at risk of closing before the pandemic, were crippled further. Tennessee has seen the second-highest number of hospitals close since 2010.
Joining Forces to Bridge Healthcare Disparities
Low health literacy drives increased healthcare costs and poor outcomes, so elevating health literacy is obviously essential to creating healthier populations and communities. Collaboration with existing community organizations, such as churches, can be a powerful force in bringing education around health to people where they already live.
Local problems are driving local solutions. Tennessee Governor Bill Lee's recently proposed $52.6 billion budget includes $82 million to reimburse public hospitals for uncompensated care, primarily in rural areas, with more than $18 million dedicated to attracting 150 primary care residents to those regions.
Here at home, Nashville General Hospital is reaching beyond its service area through the Congregational Health & Education Network (CHEN), created in 2017 to address health disparities by training and providing resources that remove barriers to care in local communities. The CHEN framework is built upon four pillars: education starting in kindergarten, health literacy, access to care, and member support. And the soon-to-open Nashville Healthcare Center-Bordeaux in North Nashville will provide a comprehensive array of primary and specialty healthcare services in what once was a healthcare desert.
Eliminating healthcare deserts requires the combined efforts of fiercely dedicated individuals, proactive and imaginative community stalwarts, and deeply committed governmental entities and healthcare organizations. Only by working as a cohesive, goal-driven team can we address the wide-ranging disparities that create shortfalls in care among those who have been underserved for entirely too long.
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Roughly 80% of the nation's counties, covering 30 million people, are classified as healthcare deserts, where access to healthcare is a challenge.
Residents living in a healthcare desert face barriers to care that include geographical challenges and social determinants of health, and are more in need of management for chronic issues.
Health systems are addressing these deserts through telehealth platforms and unique partnerships that extend much-needed services to residents.