Many of the health issues that plagued rural America a decade ago are still prevalent today, research finds. "It is very discouraging," says the director of Southwest Rural Health Research Center.
We know the healthcare challenges facing the 60 million Americans living in rural areas, a population that is generally older, less-healthy, and less-affluent than people living in urban areas.
The health issues for rural America are variations on a theme. In one region, the leading health concern might be diabetes and obesity. In another area it might be substance abuse, or mental health, or oral health.
The underlying problem that ties these all together, however, is access. The plain fact is that there aren't enough providers in rural America to cover the people who live there.
A new guidebook out this week from Texas A&M School of Public Health makes this abundantly clear. Rural Healthy People 2020 is a follow-up report coming a decade after the highly successful Rural Healthy People 2010.
Thumb through this reference book, which compiles stats and data from a number of sources, and you get the impression that living in rural America is hazardous to your health.
For example, RHP 2020 notes that people with a health emergency who live more than 30 minutes from a hospital emergency department have a 46% mortality rate, compared to a 21% mortality rate for people living within 30 minutes of an ED.
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Jane Bolin, PhD, JD, BSN |
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RHP 2020 notes that while 17% of the U.S. population lives in a rural area, only 9% of primary care physicians practice in rural areas.
Jane Bolin, PhD, JD, BSN, senior editor of Rural Healthy People 2020 and director of the Southwest Rural Health Research Center, says it's difficult to determine if rural healthcare delivery has progressed over the past 10 years.
"I wouldn't say the problems have gotten much worse, but the priorities have remained the same and many of the problems, not for lack of trying, have remained the same," Bolin says. "People are trying to address these issues, but it's difficult."
"The takeaway we found for Rural Healthy People 2020 a decade later is that many of the issues remain the same, many of the goals have not been met. There has been some modest progress in target areas, but there continue to be significant concerns expressed about access to healthcare, either insurance, emergency care services, and primary care services."
The study ranks the top issues facing rural healthcare providers, based on the survey responses of more than 1,200 providers from across the country.
The closure of more than 50 critical access hospitals across the nation in the past five years–and the threat of a nearly 300 hospitals closing in the near future–represents the greatest threat and challenge to rural health.
"It is very discouraging when we are continuing to deal with closures of critical access hospitals and reduced payments to doctors," Bolin says. "These small rural hospitals are doing everything they can, they're operating with no margins. They're losing money. It's really tough for them."
Health Challenges
Nutrition and weight status in rural America moved from No. 10 in RHP 2010 to No. 2 in the latest survey, just ahead of diabetes.
"Many people consider those to be part and parcel of the same issue," Bolin says. "People are becoming more obese, yet they seem to live in food deserts where there is just junk food, and diabetes rates are continuing to climb."
Mental health and access to mental health services climbed to No. 4 on the list. That's not surprising, Bolin says, because more than 85% of mental health professional shortage areas are in rural areas.
"Depression and diabetes go hand in hand. They have high rates of comorbidities," Bolin says.
"There hasn't been the same concern shown for reimbursement for mental healthcare services, although that is beginning to be addressed under the Affordable Care Act. In many rural areas, their only recourse for someone acting out violently or who is causing disturbances with mental health problems is to put them in jail. That is hardly adequate for someone who needs mental healthcare services."
Topping off the Top 5 is substance abuse, tracking right behind mental health issues, which really is no surprise. People who don't have access to proper mental health services likely will self-medicate with whatever may be more readily available. For example, nonmedical prescription opioid abuse is raging in many parts of Appalachia.
Other areas of concern identified in the survey include heart disease and stroke, a lack of physical activity, and tobacco use.
Poverty Pervasive
Many of these problems affecting rural America play out in a backdrop of grinding poverty. The study notes that two-thirds of rural counties in this country have poverty rates at or above the national average. In rural Florida, for example, the poverty rate is at the historically high level of 20.3%.
Related to this poverty is the scarcity of jobs, the relatively low pay of the jobs that do exist, and the higher mortality and injury risks associated with jobs in agriculture, mining, fishing, and other manual labor common in rural areas.
Bolin and the team at A&M who compiled Rural Healthy People 2020 should be commended for providing a valuable resource that doesn't sugarcoat the problems facing rural America.
If you care about rural health, download the study and keep it as a reference. Better yet, make sure that every media source you know, and every elected official from the town selectmen to your U.S. Senator has a copy of this reference.
The problems are right there in front of us, in every state in the union. The job of rural advocates is to make sure people see them.
John Commins is the news editor for HealthLeaders.