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Health Care in Rural America
Over 46 million Americans, or around 15% of the US population, live in rural areas (Centers for Disease Control and Prevention, 2017). Although it might seem like a small percentage, the number of people should not minimize the need for solutions to their problems. There are significant inequalities between the health of rural and urban Americans. Rural Americans tend to be older and are more likely to develop and die from heart disease, cancer, unintentional injury, chronic lower respiratory disease, and stroke than the urban population (Centers for Disease Control and Prevention, 2017). In addition to the high risk of health issues, rural Americans experience many challenges in receiving quality health care, including fewer hospitals, physicians, and resources aimed at improving health in urban areas. Enhancing public healthcare programs by improving accessibility, increased communication, and convenient transportation in rural areas would encourage more rural Americans to seek health care from a professional. Health care for rural Americans is less accessible than their urban counterparts, which prevents rural patients from seeking treatment for their underlying health concerns. Notably, the rural population is at a higher risk of COVID-19 in comparison to urban areas. The rural population also has greater reports of cigarette smoking, high blood pressure, and less leisure-time physical activity (Centers for Disease Control and Prevention, 2017). These can catalyze obesity, diabetes, hypertension, asthma, and other underlying health issues that make people more susceptible to COVID-19. Furthermore, as many people need treatment for a long time period, they would be unable to work and provide support for their families. As rural communities experience higher poverty rates and are less likely to have health insurance, many people might not be able to go through treatment considering the consequences (Centers for Disease Control and Prevention, 2017). With the high cost of transportation to a vaccine distribution center, poverty affects many people’s ability to get the Covid vaccine and adequate treatment. Furthermore, fewer vaccine distribution centers in rural areas force people to travel further and invest more in transportation than people in urban areas. These reasons leave rural communities particularly vulnerable to Covid. Therefore, a public health program must be created for rural areas in order to help prevent the spread of Covid and other issues that rural communities experience. The use of public transportation is more abundant in urban settings; the need for more methods of transportation in rural areas is critical. In rural areas, clinics are more spread out in comparison to urban areas, where they are much closer together. As a result, rural Americans experience long travel distances to health care appointments, specialty practices, and emergency room visits. The distribution of health care facilities in combination with commuting time often discourages rural Americans from seeking care. A possible solution to the lack of transportation between rural areas and health care facilities would be for health care facilities to establish partnerships with several transportation methods, including taxi services, public buses, and hired drivers (Cheney, 2018). In addition, there is a shortage of family physicians who work in rural areas, and students in medical school show less interest in family medicine (American Academy of Family Physicians, 2019). Family physicians are crucial to rural communities since many people use their local family physician as their primary care specialist. With an insufficient number of family care specialists, the health of rural communities is deteriorating. An increasing number of rural areas find that their local hospitals are closing, as over 170 rural hospitals have closed nationwide since 2005, with 32 that closed in 2019 and 2020 (Tribble, 2020). As a result of insufficient funding, these hospitals were already struggling to operate and found it difficult to function. The problems with closing health care facilities include patients having to find new treatment areas often further away and physicians who worked in the facilities having to find new jobs. As there are more jobs within urban areas, many providers must go to bigger cities in order to get a job, further driving health care services out of rural communities. Closure of rural hospitals rapidly leads to a higher mortality rate as it increases nearly 6%, as people may need life-saving treatment but not have time or resources to find a new hospital (Tribble, 2020). Without their local hospital, people may not feel compelled to go to a different hospital for problems they consider minuscule, and they may not be able to detect health problems early on. With this in mind, some may find it counterproductive to fund a service that many people feel discouraged from using and doctors not interested in taking over positions within rural communities. However, funding health services is what will encourage people to utilize these resources. As a means of being more equitable and considerate of rural health care obstacles, Congress approved billions in federal relief funds for health care providers as an estimated 70% of income stopped as patients avoided the emergency room, doctor’s appointments, and elective surgeries (Tribble, 2020). In late April of 2020, federal officers gathered funds for rural hospitals and Covid-19 hotspots. These funds helped hospitals substantially: around 850 small critical access hospitals took full advantage of the three-billion dollars to improve their facilities (Tribble, 2020). These hospitals managed to open Covid testing centers, purchase more equipment, and increase capacity. Access to high-quality health care services for rural Americans is dependent on an ample supply of physicians, but there is a shortage of health care workers. In recent years, medical students’ interest in family medicine and rural practice has declined as a result of various beliefs: family medicine has fewer jobs in rural areas versus urban areas and practicing in a rural community will not adequately repay costly medical school debt. As a means of increasing the recruitment of medical school students, rural areas are actively teaching them the needed skills and providing the necessary funding for rural medical education (American Academy of Family Physicians, 2019). Although, if the methods used by rural areas to boost interest are ineffective, people may find it useless and wasteful to invest in increasing the number of practicing physicians in rural areas. Still, family medicine serves as a crucial element of rural medicine, as 42% of all medical visits in rural areas are to family physicians (American Academy of Family Physicians, 2019). Family physicians put in extensive effort to obtain the trust of their patients and provide irreplaceable care to their local communities. Until funding is provided to solve the lack of family physicians, the United States’ rural areas continue to be medically unequal compared to urban areas. Telemedicine is the administration of health care services and information through electronic programs and online communication technology. Recently, telehealth dramatically expanded to prevent the spread of COVID-19 and keep both patients and health care workers safe. However, telehealth requires broadband access, or high-speed internet, which is uncommon in rural areas of America (Ralls and Moran, 2021). As many companies have begun to digitize almost all aspects of their businesses, the lack of high-speed internet in rural areas causes a major disadvantage. In areas with significant poverty rates, the internet is exceedingly expensive: roughly 25% of households in non-urban areas do not have access to broadband internet (Ralls and Moran, 2021). Since rural areas have fewer family providers and local hospitals, telemedicine is becoming increasingly important, but many people will be unable to meet their physicians without access to the internet. Children in rural areas who experience mental, behavioral, and developmental disorders encounter more community and family issues than children in urban areas facing the same disorders (Centers for Disease Control and Prevention, 2017). Therefore, a mental health first aid program was formed to assist rural areas that experience challenges in accessing mental health services and a shortage of mental health providers. This program created an eight-hour course to train rural communities to recognize mental health and substance use issues. By providing the course, the program taught many people how to support someone developing a mental illness or experiencing a crisis (Rural Health Information Hub, 2021). Similar to the mental health first aid program’s effort to address these issues, another program was established to address the issue of drug and alcohol abuse. Adults in rural areas have higher tobacco, methamphetamines, heroin use and prescription drug misuse than urban areas (Rural Health Information Hub, 2021). In order to detect issues early on and prevent complications later in adulthood, the “keepin’ it REAL rural” program was initiated as a drug and alcohol prevention course for middle school students specific to rural areas in Pennsylvania and Ohio. Adapted to a more suitable version for middle school students, this program led to a significant reduction in drug and alcohol abuse and should be more widely replicated in all rural areas of America (Rural Health Information Hub, 2021). On top of this, it is also vital that rural America takes the necessary measures to prevent domestic and family violence. Women in rural areas are more likely to experience domestic and family violence than women in urban areas due to problems with geographical isolation and cultural and social characteristics of living in small communities. The fear of stigma, shame, and community gossip often prevents women from speaking up. To allow women to comfortably seek help, and further reduce violence against pregnant women and women with infants, the “Domestic Violence Enhanced Home Visitation Program (DOVE)” was established to reduce violence against pregnant women in rural Missouri. Participating women received a brochure with information about the violence cycle, danger assessment, safety planning, community resources, and national hotline information. As a brochure-based intervention for women experiencing domestic violence, the program significantly decreased the number of violent incidents against women receiving DOVE intervention (Rural Health Information Hub, 2021). The success of the programs mentioned emphasizes that more funding is necessary in order to make the program available to the rest of rural America. The problems mentioned with health care in rural areas and many others are significantly causing rural Americans to suffer greatly. Individuals in rural areas are not fortunate enough to have easy access to healthcare programs due to poor communication, impractical transportation, affordability, and a lack of physicians and facilities. These challenges in rural areas must be addressed through funding and targeted programs. To assist the beginning of a mass movement, health care providers can assist patients in understanding their insurance coverage along with the financial consequences of some health plans.
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This article is written by Paige Glowacki, a rising senior at The Hockaday School in Dallas, Texas. After learning of the difficulties of getting access to specialty care in remote towns in Texas, I was inspired to research this topic. By being another voice promoting awareness, I hope to advocate for change.