U.S. To See Wider Gap Between Healthier, Rural Populations And Sicker Ones

During the last 50 years, improved access and rapidly expanding technology have improved American health care, with many of these advantages extending to rural communities where sound public health measures have slashed death and suffering from infection and nutritional deficiencies.

Simultaneously, better access to physicians and hospitals has reduced death from heart attack, stroke, and some forms of cancer. Unfortunately, wide gaps remain, says a University of Alabama rural health expert. These “disparate outcomes” are the major theme of rural health care today.

Dr. William Curry, dean of UA’s College of Community Health Sciences, predicts these disparities will improve in some areas – but may also worsen in others. “The answer lies in the different paths that rural communities seem to be taking,” said Curry. “Because economic development and educational opportunities vary significantly within rural America and rural Alabama, we will begin to see wider gaps between a healthier rural America and a sicker one. The disparities between these depressed rural communities and the rest of the nation will grow larger and even more distressing.”

Curry said there is more to healthy communities than just health care, and even more than economic development, education and transportation can bring. Already we are seeing an unraveling of the fabric of many rural communities, he said. A recent Columbia University study showed alarming rates of drug use among rural America’s eighth graders. “In such communities,” he says, “our image of a stress-free, crime-free, idyllic rural childhood is gone.” As such, Curry predicts the following to occur in the near future:

Effective strategies to improve access to health care will be replicated across the country. Successful programs to identify and mentor rural students into and through health professions, culminating in rural practice, will be national models.

Some promising strategies will not succeed. One of these is telemedicine. Despite the attraction of high tech access through video cameras beaming images to remote experts, most patients will need more personal care to make a difference in outcomes. Telemedicine will succeed in sending radiology and pathology images, as it does already. Videosurgery may find limited use, but most of rural American is rural, not frontier, and the successes of the military in this field are unlikely to spread anytime soon.

Targeted public health measures will gain support. These will involve partnerships between the governmental and private sectors. Contracting and collaboration will blur the lines, especially in rural areas. Physicians, nurses, and other professionals will need to understand population-based strategies and how to work as a team. The federal government will establish a Center for the study of disparate health outcomes, at the Centers for Disease Control or within the National Institutes of Health.

Interdisciplinary approaches will catch on as a way to share talent and scarce budgets. Finally – and not a moment too soon – rural America will lead the way in developing better health care through a team approach, involving physicians, nurses, social workers, and managers.