Written By: Neha Maddali
Although there has been much-renewed interest in building sustainable health infrastructure, rural America has been consistently left behind in these new and exciting developments. Historically, rural communities throughout the United States lack access to healthcare. Therefore, it remains extremely important that the public health sector discovers and implements innovative solutions to this increasingly pressing problem.
The Disproportionate Care Within Rural America
While only 14 percent of Americans (approximately 46 million people) reside in rural areas, these represent almost two-thirds of primary care health professional shortage areas in the country. This approximates to over 4,100 shortage areas that lack primary care physicians and staff in the country[1]. Additionally, a 2018 report determined that the average time to drive to a hospital in rural communities was 17 minutes, compared to 10.4 minutes for those in urban areas [2]. When critical care is needed, these 7 minutes can be the difference between life and death.
As a scribe working in a rural Emergency Department, I see those in need of care desperately struggle to find much-needed resources. For these residents, this hospital is the only one within a 35-mile radius. However, even when one travels 35-40 minutes to receive care, it might not result in the best treatment. In this hospital, there is no specialized team to respond to codes. For women that go into labor at any unpredictable time, there is no OB-GYN service after 5 PM. In this Emergency Department, the providers are not emergency-medicine trained. These 3 scenarios only highlight some of the many disparities in rural medicine.
Factors that Influence this Inequity of Care
Rural populations within the United States generally have worse health outcomes and shorter life expectancies than their urban counterparts. While education and race are two factors that influence mortality risk, rural populations additionally are typically older, face more mental health and substance abuse conditions, and have a greater burden of chronic conditions.
In addition to worsening health outcomes and a greater mortality risk of chronic illnesses, rural health infrastructure has been exhausted. Since 2011, there have been more hospital closures than openings in the United States, with 2/3 of hospital closures occurring in rural areas [3].
Lastly, factors outside of hospital care themselves influence rural communities’ access to care. Those within rural areas have limited access to public or private transportation systems, which affect their ability to make clinic appointments, vaccinations, or access testing services. Residents additionally have limited broadband connectivity, which impacts their medical knowledge on important updates and prevention [4].
Ultimately, these factors leading to disproportionate care have been heightened by the COVID-19 pandemic. For example, although telehealth has been one of the most used services in response to the limited in-person meetings due to the pandemic, this successful alternative has been extremely limited in rural areas that lack high-speed internet access.
Future Steps: What Can We Do?
Ultimately, the challenges within rural healthcare are not exclusive to the United States. Many lower and middle-income countries face the same barriers. Therefore, examining and implementing many of the solutions that these countries have executed, could serve as a potential solution to the healthcare crisis among rural residents.
One potential solution is the use of drones to provide access to essential resources to vulnerable populations. The Unmanned Aircraft Systems (UAS) Program in the College of Nursing at the University of Alabama has tested a novel way to use drones to deliver medications for rural women in preterm labor. In rural hospitals, prescriptions for fetal fibronectin and betamethasone, important medications to predict risk for and prevent pre-term delivery, are not available. Alabama researchers have engineered a creative solution. Using a drone, an urban clinic can send the medicine and testing kits, which nursing staff can easily send back for further analysis [5]. While this has not been implemented, these demonstrations provide a potential innovative intervention to resolve inequitable access to much-needed medical materials.
Another intervention whose importance has been reintroduced in the COVID-19 pandemic is the use of community healthcare workers (CWHs). These workers are trained health care providers that are locally engaged in small neighborhoods. The goal of CHWs is to deliver public health information, improve health literacy, focus on prevention, and give residents information about health resources available to them. Many local governments, such as in North Carolina and Texas, have invested funding into CHW training programs and have seen improvements in rural health outcomes [6].
Ultimately, several interventions have been implemented to reduce the inequity in rural medicine, but there is still much more to be done. Individuals at the local, state, and federal levels must collaborate to produce more effective solutions to give rural residents the access and care they deserve.
References:
[1] Waldrop, T. and Gee, E., 2022. Center for American Progress. [online] How States Can Expand Health Care Access in Rural Communities. Available at: <https://www.americanprogress.org/article/how-states-can-expand-health-care-access-in-rural-communities/> [Accessed 27 February 2022].
[2] Lam, O. and Broderick, B., 2022. How far Americans live from the closest hospital differs by community type. [online] Pew Research Center. Available at: <https://www.pewresearch.org/fact-tank/2018/12/12/how-far-americans-live-from-the-closest-hospital-differs-by-community-type/> [Accessed 27 February 2022].
[3] Stone, W., 2022. In rural America, patients are waiting for care — sometimes with deadly consequences. [online] NPR. Available at: <https://www.npr.org/sections/health-shots/2022/02/10/1078134622/in-rural-america-patients-are-waiting-for-care-sometimes-with-deadly-consequence> [Accessed 27 February 2022].
[4] Nuako A, Liu J, Pham G, et al. Quantifying rural disparity in healthcare utilization in the United States: Analysis of a large midwestern healthcare system. PLoS One. 2022;17(2):e0263718. Published 2022 Feb 10. doi:10.1371/journal.pone.0263718
[5] Steele, J., 2022. UAH researches whether future rural healthcare can be delivered by drones. [online] The University of Alabama in Huntsville. Available at: <https://www.uah.edu/news/news/uah-researches-whether-future-rural-healthcare-can-be-delivered-by-drones> [Accessed 27 February 2022].
[6] Kannarkat, J., Krampe, N., Hughes, L. and Silimperi, D., 2022. Solving Rural US Health Care Challenges With Frugal Innovation: Low-Costs, High Returns | Health Affairs Forefront. [online] Healthaffairs.org. Available at: <https://www.healthaffairs.org/do/10.1377/forefront.20220222.972908> [Accessed 27 February 2022].
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