Health care providers and patients in rural areas face vastly different obstacles than do their counterparts in urban areas. Rural Americans face health disparities in health care absent in urban areas. Economic factors, cultural and social differences, educational shortcomings, lack of recognition by legislators and the sheer isolation of living in remote rural areas impede rural Americans in their struggle to lead a normal, healthy life.
Access to Health Care
Although nearly one fourth of the American population resides in rural areas, only about ten percent of physicians practice in rural America. 60 dentists per 100,000 population practice in urban areas, while only 40 dentists per 100,000 population practice in rural areas. From 57 to 90 percent of first responders in rural areas are volunteers. Rural hospitals and physicians receive dramatically less in Medicare payments than those to their urban counterparts for equivalent services, and more than 470 rural hospitals have closed in the past 25 years. Twenty percent of nonmetropolitan counties lack mental health services versus five percent of metropolitan counties. In 1999, 87 percent of the 1,669 Mental Health Professional Shortage Areas in theUnited States were in non-metropolitan counties and home to over 30 million people. . Rural residents have greater transportation difficulties reaching health care providers, often travelling great distances to reach a doctor or hospital.
Economic Disparities
Rural residents earn on the average $7,417 less per capita than residents of urban areas and are more likely to live below the poverty level; nearly 24% of rural children live in poverty. These disparities occur even more frequently among minorities living in rural America. Rural residents are less likely to have employer-provided health care coverage or prescription drug coverage, and the rural poor are less likely to be covered by Medicaid benefits than their urban counterparts. An analysis by the Carsey Institute at the University of New Hampshire found that while 22 percent of Americans lived in rural areas in 2001, a full 31 percent of the nation's food stamp beneficiaries lived there.
Increased Health Risk
Death and serious injury accidents account for 60 percent of total rural accidents versus only 48 percent of urban. Although only one-third of all motor vehicle accidents occur in rural areas, two-thirds of the deaths attributed to these accidents occur on rural roads. Rural residents are nearly twice as likely to die from unintentional injuries other than motor vehicle accidents than are urban residents. Rural residents are also at a significantly higher risk of death by gunshot than urban residents. Significant numbers of rural youth abuse alcohol and use smokeless tobacco. Forty percent of rural 12th graders reported using alcohol while driving compared to 25% of their urban counterparts. Rural eighth graders are twice as likely to smoke cigarettes (26.1% versus 12.7% in large metro areas.) Those living in non-Metropolitan Statistical Areas are 1.45 times as likely to have cerebrovascular disease as those in Metropolitan Statistical Areas. 128.8 individuals per 1,000 population in non-Metropolitan Statistical Areas have hypertension while only 101.3 individuals per 1,000 population have hypertension in Metropolitan Statistical Areas.The suicide rate among rural men is significantly higher than in urban areas, particularly among adult men and children. The suicide rate among rural women is escalating rapidly and is approaching that of men. Medicare patients with acute myocardial infarction (AMI) who were treated in rural hospitals were less likely than those treated in urban hospitals to receive recommended treatments and had significantly higher adjusted 30-day post AMI death rates from all causes than those in urban hospitals.
(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://www.srph.tamhsc.edu/centers/rhp2010/
WWAMI Rural Health Research Center study, funded by the Federal Office of Rural Health Policy, described in: Baldwin L-M, MacLehouse RF, Hart LG, Beaver SK, Every N, Chan L. Quality of care for acute myocardial infarction in rural and urban U.S. hospitals. Journal of Rural Health 2004;20(2):99-108.)
