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Summer 2014 • Kentucky
ments. The average per capita rural income
is $7,417 lower than in urban areas. That
income disparity is even greater for minorities living in rural areas. Nearly 24 percent
of rural children live in poverty and there
is a significantly higher reliance on Food
Stamps. An additional effect of poverty is
that many rural populations, including the
elderly, have typically lacked health insurance, although this is something that is
addressed by the Affordable Care Act.
Because of the geography and local resources, many of those employed are likely to be
in hazardous occupations: farming, forestry,
mining, etc. This makes the likelihood of
serious workplace accidents all the more
likely, thus increasing the urgent need for
access to emergency and trauma services.
But rural geography and roads may mean
that it is a difficult two hours or more to the
nearest urban hospital. Local emergency
services are often run by volunteers, adding
to the time for help to arrive. Additionally,
because of the roads and lack of emergency
services, two-thirds of deaths from motor
vehicle accidents occur in rural areas.
What Makes
Rural Health Care
Different?
A Brief Summary
By Fiona Young-Brown
To some, the recent closure of Nicholas
County Hospital may not have seemed such
a big deal. After all, it only had 16 beds.
That’s nothing compared to the hospitals in
Lexington. But in order to understand the
true impact of this and other county hospital closures, one must look behind the numbers of beds and look at the hospital’s role
in the community. (See the article by Tanya
Tyler in this issue on hospitals as a community resource.) One must also understand
the differences in rural and urban health,
because only when understanding those factors, does the importance of the small medical practice become apparent.
Let’s look at the four basic differences in
rural health.
Rural areas have:
1. Different population.
2. Different culture
3. Different geography
4. Different resources
Despite the traditional concept of homogeneity in the country, there is an increasing
racial diversity in rural America, particularly
from migrant workers and immigrants.
These populations may have difficulty
accessing transportation to get to larger
urban areas, and also experience linguistic
and cultural problems when trying to access
local health care.
Rural areas also have higher poverty rates,
which influences everything from access
to quality food to ability to pay for treat-
Small rural communities tend to be closeknit and self-reliant. There is often an
unwillingness to seek help outside the
community. However, there is also concern
about being treated by a doctor whom
everyone knows because of privacy issues.
As a result, those dealing with mental health
or sexual health issues are much less likely
to seek help. Twenty percent of nonmetropolitan counties lack mental health services,
compared with five percent of metropolitan
counties. Suicide rates are higher, as are
incidences of many conditions such as heart
disease, cerebrovascular disease, and more.
Obesity is also a common problem, with
limited access to fitness facilities or walking
trails, and lack of quality food. We imagine
that rural residents must have a wonderful
diet of fresh homegrown produce, but often
the reality is a daily intake of low quality
items purchased at the neighborhood grocery store.
To all of these factors, we add the desperate
shortage of qualified medical professionals
in rural areas. A little less than one quarter
of the nation’s population lives in non-urban
locations; only one tenth of the nation’s physicians live and work there. This is a population in need.
Sources:
Rural Healthy People 2010—”Healthy
People 2010: A Companion Document for
Rural Areas,” is a project funded with grant
support from the federal Office of Rural
Health Policy. The full document is available
for download at the following site:
http://srph.tamhsc.edu/centers/rhp2010/
Volume1.pdf
Hall MJ, Owings M. Rural and urban hospitals’ role in providing inpatient care, 2010.
NCHS data brief, no 147. Hyattsville, MD:
National Center for Health Statistics. 2014.
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