Understanding social determinants of health, or factors in the environment that can affect individuals' health outcomes, is necessary in understanding health disparities across different groups of individuals. One example of this is the difference in health outcomes between rural and urban communities – rural communities being those that are sparsely populated, are further away from urban metropolises, and subsequently have more limited access to healthcare resources. Rural communities experience significantly worse health outcomes, including higher infant and adult mortality rates, higher rates of cancer, heart disease, and childhood obesity, and lower use of health care services. This is especially true for preventative care that can treat health conditions before they worsen, and specialized care for specific health conditions. This is largely due to differences in accessibility, and a lack of infrastructure supporting rural communities.
Not only are rural communities more likely to be geographically far away from quality health care, but they may also face knowledge and financial barriers that prevent them from getting the care they need. Poverty rates are also higher in rural communities, and the proportion of rural adults with a college degree is less than those in urban areas. This educational disparity is another factor in rural communities’ inability to access healthcare easily, as it limits their knowledge as well as their financial abilities -- for some rural communities, the closest specialist may be hours away, increasing their financial and social burden by requiring them to find and travel to a more urban community to receive care. For example, while urban and rural counties may have similar numbers of hospital beds per capita, hospitals in rural counties have less access to specialty services, including fewer intensive care units, obstetric services, and cancer specialists, just to name a few. While 20% of the United States population lives in rural areas, only 11% of physicians practice in these areas, making clear how urban communities are prioritized over rural ones.
This “structural urbanism”, in which policy and infrastructure are catered to the needs of the urban population over the rural population, perpetuates the systemic disadvantages that rural communities face. Potential solutions for this structural urbanism are at the systemic level – policymakers should prioritize rural representation throughout policy development and implementation, and utilize evidence-based infrastructure like broadband internet, telehealth, and community education. Broadband internet, which would provide reliable, high-quality internet to rural communities, would allow these individuals to access telehealth appointments and other services virtually without financially burdening them. Health education resources, specifically ones that are tailored to the needs of rural residents, would also benefit rural communities by giving them helpful and accurate information -- for example, self-management programs that give participants knowledge and skills to help manage their conditions day-to-day.
By valuing rural communities and their needs as much as urban communities, and implementing policy changes to reflect that, the health disparities between these two groups may be mitigated.
Sources:
https://www.jmir.org/2021/8/e29575/ Assessed and Endorsed by the MedReport Medical Review Board
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