Pre-Collegiate Global Health Review
Healthcare Disparities in Rural Regions of the United States
By Abby Bojalad, Sewickley Academy, Sewickley, Pennsylvania, USA
From the ongoing COVID-19 pandemic to Medicare and Medicaid access, healthcare is even more of a focus on the political agenda in the United States. With consideration to healthcare disparities, the discrepancy of the level of care between highly populated urban areas and rural areas should take center stage. The numerous healthcare issues, however, that exist in rural areas are oftentimes neglected by the mainstream media and federal government. Approximately 46 million Americans reside in rural regions (Centers for Disease Control and Prevention [CDC], 2017), therefore ensuring that this population receives sufficient and quality healthcare must be a priority.
Figure 1. Life expectancy at birth by level of urbanization in the United States.
Recent studies have shown that individuals living in rural communities are more likely to develop heart disease, cancer, chronic lower respiratory disease, and stroke (CDC, 2017). In addition to these serious conditions, they are also 50% more likely to fall victim to unintentional injuries than individuals who live in urban areas (CDC, 2017). Furthermore, due to increased poverty rates, insurance coverage is less common in rural areas than in urban areas, where 10.1% and 12.3% of their citizens are uninsured, respectively (Day, 2019). These various disparities regarding healthcare in rural regions compared to urban regions are anything but arbitrary and have been shown to stem from several key factors regarding lifestyle and location.
Most healthcare facilities are in suburban or urban areas, far from rural communities (“Healthcare Disparities & Barriers to Healthcare,” 2021). If an unintentional injury were to occur far from these urban hospitals and healthcare facilities, ambulance response time is substantially longer (“Healthcare Disparities & Barriers to Healthcare,” 2021), and depending on the severity of the injury, delayed treatment can result in death. Traveling to suburban or urban areas for routine doctor’s visits can also be a burden for those living in rural areas, as additional expenditures may include costs for transportation and requiring time off from work. The considerable rates of poverty in rural areas can deter citizens from paying for travel into urban areas, where 91% of physicians reside (“Rural Health Disparities”, 2021). The neglect of routine doctor visits can worsen pre-existing conditions such as asthma and diabetes and can place these individuals at a higher risk for more serious conditions and medical emergencies.
Contrary to popular belief, the customary diets in rural areas are often unhealthy and high in fat due to the lack of nutritious foods in supermarkets, which also contributes to the high prevalence of certain medical conditions in these regions (CDC, 2019). The few supermarkets located in these areas are typically smaller and rarely provide healthy, nutritious foods such as fresh produce, milk, and eggs that can boost one’s immune system and decrease their risk of disease and illnesses (“Rural Hunger,” 2019). Such diets that individuals residing in rural regions are more likely to consume cause a buildup of atherosclerotic plaque that narrows the arteries, hindering or preventing the flow of blood to vital organs such as the brain and heart. Hence, the consumption of these foods can lead to the development of dangerous and even fatal conditions.
To understand why individuals in rural areas are disproportionately uninsured and affected by serious medical conditions, it is essential to consider the poverty demographics of these rural areas. As of 2018, 78.9% of counties below the federal poverty line in America were considered non-metro counties, and one in four rural counties suffered from extreme poverty (Farrigan, 2020). While enduring extreme poverty, individuals cannot afford adequate healthcare services or insurance coverage. Without insurance, medical bills are extremely costly, and most living in poverty would rather skip a doctor's appointment than attend and cope with the economic strain that comes with the bill. Due to this, the overall health and wellness demographics of the region suffer, and many who live there are placed at an increased risk for serious health concerns.
Ultimately, there are undoubtedly significant disparities in rural healthcare, and the issue is often overshadowed by other items on the political agenda. Data provided by numerous sources such as the CDC and U.S. Census Bureau ascertains the causes of these healthcare disparities, and these issues can be remedied by the creation of new legislation. The limited and low-quality supermarkets, high poverty rates, and lack of hospitals in rural areas affect their respective populations remarkably. Accordingly, creating more easily accessible healthcare facilities and supermarkets with healthier options in rural regions of the United States could significantly minimize morbidity and mortality rates in these communities.
Center for Surveillance, Epidemiology, and Laboratory Services (CSELS). (n.d.). About Rural Health. Centers for Disease Control and Prevention. Retrieved February 20, 2021, from https://www.cdc.gov/ruralhealth/about.html
Day, J. C. (n.d.). Rates of Uninsured Fall in Rural Counties, Remain Higher Than Urban Counties. United States Census Bureau. Retrieved February 20, 2021, from https://www.census.gov/library/stories/2019/04/health-insurance-rural-america.html
Farrigan, T. (2020). Extreme Poverty Counties Found Solely in Rural Areas in 2018. Economic Research Service: U.S. Department of Agriculture. Retrieved February 21, 2021, from https://www.ers.usda.gov/amber-waves/2020/may/extreme-poverty-counties-found-solely-in-rural-areas-in-2018/
[Figure 1] Life expectancy at birth (years) by levels of urbanization, U.S., 2005–2009] [Chart]. (n.d.). American Journal of Preventative Medicine. https://www.ajpmonline.org/article/S0749-3797(13)00590-4/fulltext
Healthcare Disparities & Barriers to Healthcare. (2021). Stanford Medicine. Retrieved February 20, 2021, from http://med.stanford.edu/ruralhealth/health-pros/factsheets/disparities-barriers.html
Notaro, K. (2020, March 18). Rural America [Photograph]. Creative Commons Search. https://search.creativecommons.org/photos/4b699545-611a-4282-8dd7-3a3810b91ffe
Rural Health. (2019). Centers for Disease Control. Retrieved February 20, 2021, from https://www.cdc.gov/chronicdisease/resources/publications/factsheets/rural-health.htm
Rural Health Disparities. (2021). The University of Arizona Mel and Enid Zuckerman College of Public Health. Retrieved February 20, 2021, from https://crh.arizona.edu/topics/disparities
Rural Hunger and Access to Healthy Food. (2019). Rural Health Information Hub. Retrieved March 3, 2021, from https://www.ruralhealthinfo.org/topics/food-and-hunger