Rural Health Disparities to the Fore

HRSA Administrator Dr. George Sigounas met with the National Rural Health Association Policy Institute on Feb. 7 at D.C.'s Omni Shoreham Hotel, pledging the agency's support in reducing "higher rates of chronic disease … higher mortality and high rates of avoidable death" among rural residents.
HRSA Administrator Dr. George Sigounas met with the National Rural Health Association Policy Institute on Feb. 7 at D.C.'s Omni Shoreham Hotel, pledging the agency's support in reducing "higher rates of chronic disease … higher mortality and high rates of avoidable death" among rural residents.

 

Echoing recent Administration  calls to action on opioids and HIV in rural America, Dr. George Sigounas in the opening of a comprehensive address Thursday to long-time advocates observed that "there are 252 rural counties in the United States without any health care providers."

After noting the recent $100 million federal push to address the opioid crisis, he received stirring applause from a ballroom of some of the nation's most seasoned rural experts before itemizing glaring health disparities still facing the nation's geographically distant communities and their 57 million residents -- spread over more than 80 percent of the country's land mass.

"Recently, the CDC ... looked at excessive death rates and saw, first of all, that rural tended to be worst when looking at the leading causes of death," Dr. Sigounas said. "This data all but assured that the discussion needs to broaden to more than just health finance and workforce, (but) also focus on ... health disparities."

These include, he said, "higher disease burden, significant challenges in terms of workforce, health insurance coverage, as well as some higher risk factors that one might argue are more prevalent in our rural communities."

For example, he said, the incidence of heart disease in small town America  is 56 percent higher than in metropolitan areas -- or, more starkly, by some 26,700 "excess deaths"; chronic lower respiratory disease, 75 percent higher; unintentional or accidental injuries, 37 percent higher; and while cancer fatalities declined nationwide from 2003 to 2017, they fell at a 62 percent slower rate  in rural America.

And there now is "a widening gap" of almost three years in life expectancy between urban and rural dwellers, Dr. Sigounas said, citing research by HRSA health equity scientist Gopal Singh that has alarmed the rural health community since it was first published in 2013 HRSA Exit Disclaimer. There has been little marked improvement since.

One in five Americans live at a distance from U.S. cities, but rural areas are served by only about 11 percent of practicing physicians. According to the rural association, more than half of all car accident fatalities HRSA Exit Disclaimer happen in rural areas, often for lack of immediate trauma care -- contributing to a 22 percent increased risk of injury-related death outside of metropolitan areas. Finally, there are more than twice the number HRSA Exit disclaimer of primary care shortage areas in rural communities as there are in urban areas.

Dr. Sigounas and Tom Morris, HRSA's rural health chief, compared notes Thursday morning before the Administrator's presentation to the gathered rural advocates.
Dr. Sigounas and Tom Morris, HRSA's rural health chief, compared notes Thursday morning before the Administrator's presentation to the gathered rural advocates.

 

Disparities crop up, time and again, in the data, Dr. Sigounas stressed: of the nation's 15 million chronic obstructive pulmonary disease sufferers, for example, the Centers For Disease Control and Prevention has reported that the prevalence among rural Americans is 8.2 percent, compared to 4.7 for their urban counterparts -- "nearly two-fold higher in rural areas," Dr. Sigounas noted. The condition (known as COPD) is exacerbated by limited local availability of respiratory therapy and higher rates of hospital readmissions for complications like bronchitis and pneumonia.

Further implicated in the care shortage equation, cancer rates are significantly lower  in rural communities -- but cancer death rates are much higher than in major metropolitan areas of the country, for lack of screening, early detection and nearby treatment centers. HRSA and the National Cancer Institute "continue to (work) on these disparities," Dr. Sigounas said. 

In a similar vein: rural counties experienced a nine percent decline in obstetrics services from 2004-2014 alone -- equating to a loss of local services to expectant mothers and their newborns in some 179 rural counties.  Today, less than half of rural counties have hospital-based obstetrics services, leading to increasing home births and pre-term deliveries, the HRSA-funded Rural Health Research Center has found.

On a promising note, Dr. Sigounas announced ten winners in the Maternal and Child Health Bureau's Addressing Opioid Use Disorder in Pregnant Women and New Moms Challenge. The winning innovations are technology-driven solutions designed to improve access to quality health care, including substance use disorder treatment, recovery, and support services for pregnant women with opioid use disorders, their infants, and families, especially those in rural and geographically isolated areas.

Each Phase 1 winner was awarded a share of $100,000 and will move on to Phase 2 to develop their prototype and begin small-scale testing through July 2019.

Date Last Reviewed:  February 2019