Rural Americans, including Hoosiers, are more likely to die from five leading health issues than people who live in cities, a new report says. Residents in rural areas are hit harder with heart disease, cancer, unintentional injury, chronic lower respiratory disease (CLRD) and stroke, according to the Centers for Disease Control and Prevention’s (CDC’s) Morbidity and Mortality Weekly Report.
One reason: those who live in rural areas tend to be older, poorer and sicker than their urban counterparts, the report says. “Rural America typically has more poverty, which means less access to health care and less health insurance,” says Scott E. Renshaw, M.D., who specializes in family medicine at Indiana University Health. Access to care in rural areas has several barriers, including limited access to specialty care and limited transportation options.
Nationally, about 19 percent of U.S. residents live in rural areas, according to the 2010 U.S. Census. However, between 10 to 14 percent of Hoosiers live in rural areas. Residents in rural areas have higher rates of cigarette smoking, which increases the risk of dying from heart disease, stroke and CLRD. The most deadly CLRD is chronic obstructive pulmonary disease, or COPD, which includes emphysema and chronic bronchitis. Cigarette smoking is the leading cause.
Indiana ranks 10th in the U.S. in consumption of tobacco, which is the leading cause of preventable disease and death in the United States, the CDC says.
The report found that unintentional injuries in rural America are approximately 50 percent higher than in urban areas, which is a shockingly high gap, Dr. Renshaw says. The report points to several factors, including high-speed car crashes; higher rates of overdose death from opioid pain relievers and heroin; behavioral factors such as drunk driving and lack of seatbelt use; and delayed access to treatment for life-threatening injuries.
Behavior and cultural components in rural Indiana can be hard to fight against, Dr. Renshaw says. Some rural residents still don’t wear seatbelts, especially on farmland or for short distances, he says. And smoking cigarettes and eating unhealthier food may not even be questioned—children repeat their parents’ habits. “I hear all the time that ‘my dad ate bacon and eggs every day, and he lived to 100,’” he says.
Even when searching for healthy foods, Hoosiers often face challenges such as “food deserts,” areas that lack access to healthy food, such as fruits and vegetables. The closest grocery store may only be a convenience store or small mom-and-pop shop with an expensive and/or small selection of fruits and vegetables. “It costs money to stay healthy,” Dr. Renshaw says. Junk food, canned processed food and frozen meals are often cheaper and easier to find.
A critical access to care issue is the lack of primary care physicians in small towns and rural areas. Rural Hoosiers may not have a regular relationship with a doctor, who can help monitor their health issues, catch problems earlier and encourage healthy behaviors. Instead, residents might rely on urgent care centers and emergency rooms. “[These are] “one and done. There’s no relationship. There’s no continuity of care,” says Dr. Renshaw. “Urgent cares have their place, but they aren’t designed to, nor can they, provide long-term health care.”
Yet, many new medical school graduates have no interest in practicing in areas outside big cities and their suburbs. “I think a big concern is recruitment and retention,” Dr. Renshaw says. “Medical students don’t want to come back to small towns.” Nationwide, only 11 percent of physicians choose to practice in rural areas, the CDC says.
In addition, many Hoosiers may fall into a gap in which they don’t qualify for Medicaid but can’t afford health insurance premiums. “A lot of times in rural Indiana, you’re working minimum wage or slightly above minimum-wage jobs,” Dr. Renshaw explains. “Even if your employer offers health insurance, you often can’t afford [the premium].”
The report calls for the creation and implementation of programs that give special attention to rural communities. Rural areas need programs that include a focus on effective prevention and treatment of opioid misuse and improved access to treatment for chronic conditions.
In the interim, Dr. Renshaw says it’s important that physicians who treat rural Hoosiers are aware of reports like this one so they can zero in on the top issues. For example, they could have more discussions with patients about how and why to stop smoking and ask every patient about seatbelt use.
-- By Melanie Padgett Powers