Spotlight on health in rural America

November 17, 2011 marked the first National Rural Health Day. On this day, the nation was encouraged to celebrate the strengths in rural communities as well as the health related challenges they face.

Today, rural communities across the country face severe health issues like lack of affordable health insurance or access to a health care provider. According to the Center for Rural Affairs (CRA) individual choices nor lack of doctors aren't to blame for unhealthy rural communities. The CRA points to local economies as the cause in the high rates of unhealthy rural communities, claiming that many rural and/or remote communities rely heavily on low wage and small business economies. Both of which do not offer health insurance because of the high-cost associated with health benefits.

Another interesting problem facing rural communities is that are a good number of people who are privately insured precisely because there less health benefit available in the local economy. However, rural areas tend to be "underinsured", CRA states, "Rural people have high rates of “underinsurance,” or health benefit coverage that provides less coverage at higher cost." Astonishing figures about the disparate amount of money rural communities are paying for inadequate health insurance can be found here.

Culturally-sensitive or culturally-specific health care is a critical component of making health care a priority for rural communities. In Eagle on the Upper Yukon of Alaska a community of elders deals with issue of attachment to place. For this community the only medical care, for hundreds of miles, is provided by a 40 foot trailer. It is difficult to get comprehensive health care while your located in one of the most remote areas in the United States. Native elders are giving up "life-extending" medical care because there are none available in the area. As this story on Alaska Public Radio says that elder claim their spirits don’t rest unless they die at home.

A different rural case is that of the rural California Central Valley. The Latino population is growing in areas such as King and Tulare County. It is becoming more important to have adequate and appropriate health care services for this already undeserved community. A strategy being used in these communities is having health advocates that can translate the values and cultural norms associated with health for both the patient and the health care provider. This article discusses the great contribution bilingual health advocates and states that the “promotoras” have become “health navigators” for the rural Latino community.

Another issue is that of having access to appropriate primary-care providers. In general, rural areas have had less access to hospitals and clinics than urban hubs. This may be due to the lack of health care providers in those areas. Currently there is a push in Sacramento, CA to implement a state-run scholarship program for medical students to encourage them to serve undeserved rural areas in California.

A similar program exists on the UC Davis campus where students are encouraged to work in rural areas as part of their medical training. The program is called Rural-PRIME (PRograms In Medical Education) and it claims that by 2015 the state will be have a major physician shortage and states that "Twenty percent of the population in California lives in rural areas, but only nine percent of physicians practice rurally." Programs such as these do create more of an incentive for people to work in less well known areas, but even having access to medical technology limits people's desires to work in rural areas. A legal ruralism blog post discusses how having the ability to telecommunicate through the use new technological gadgets like the ipad may help settle anxieties around these issues.

The question of health in rural areas is multidimensional as portrayed through the examples above. The case may be about mobility and distance; or having no primary care service provider in the area; or lack of knowledge around health issues or why preventive medicine is important (as this blog post about rural women's health explores the issue more in depth). I think what's most important about this national day is the acknowledgement and recognition of the healthy assets that are already in place in rural communities and offers potential models for the rest of the country.