User:Katielewis02/Rural health

Copied from Rural Health Lead Section Paragraph 2:

On average, People who live in rural areas have different health care needs than people in urban or suburban areas, and rural areas often suffer from a experience health disparities and barriers in access to healthcare compared to the urban population . Globally, rural populations face increased burdens of noncommunicable diseases such as cardiovascular disease, cancer, diabetes, and chronic obstructive pulmonary disorder, contributing to worse health outcomes and higher mortality rates. Factors contributing to these health disparities include There are differences in demography, remote geography, individual healthy increased rates of health risk behaviors, lower population density, decreased health insurance coverage among the population, lack of health infrastructure, and work force demographics. For example, many rural communities have different age distributions Specifically, they have higher dependency ratios, with a higher percent of residents either too young or too old to work. People living in rural areas also tend to have less education, lower socioeconomic status, and higher rates of alcohol and tobacco use, and higher mortality rates when compared to their urban counterparts. In many regions of the world, t Additionally, the rate of poverty is higher in rural populations globally, contributing to health disparities due to an inability to access healthy foods, healthcare, and housing. is a higher rate of poverty among rural dwellers, and poverty is one of the biggest social determinants of health.

Copied from Life Expectancy Section:

Life Expectancy and Mortality

Studies show that in many parts of the world, Rural areas within the U.S. have been found to have a lower life expectancy than urban areas by approximately 2.4 years. Mortality due to non-communicable diseases such as heart disease, cancer, chronic lower respiratory disease, and stroke, as well as unintentional injuries such as automobile accidents and opioid overdoses is higher in rural U.S. populations compared to urban areas. In 1999, the age-adjusted death rate was 7% higher in rural areas compared to urban areas. However, by 2019 this difference had widened, with rural areas experiencing a 20% higher death rate compared to in urban areas. The higher mortality rate in rural areas compared to urban areas is referred to as the rural mortality penalty, and this disparity is associated with the increased density of poverty in rural communities. There is some evidence to suggest that the gap may be widening in these countries as economic conditions and health education has improved in urban areas. as more public health resources are directed away from rural areas towards densely populated urban areas.

These trends are also observed on a global scale, as data collected from 174 countries found the maternal mortality rate to be 2.5 times higher in rural areas compared to urban areas. Additionally, the likelihood that a child born in a rural area will die before the age of 5 is 1.7 times higher than a child born in an urban area.

From 1986 through 1996 in Canada, among people assigned male at birth, life expectancy was 2.79 years lower among those in the most rural areas versus the most urban areas. Before or during the 2000s in Australia, among all people, it was 6 years lower. Before or during the 1990s in China, among people assigned female at birth, it was 1.13 years lower. But among those assigned male, it was 10.74 years.

On one hand, there are some countries where the trend is reversed. For example, from 2000 through 2007 in the United Kingdom, people assigned female lived about 1.5 more years, and people assigned male lived 2 more. On the other hand, that statistic comes from comparing upper class rural people to upper class urban people. Many of the upper class rural people presumably acquired their wealth by working in urban areas, and they moved to the countryside for retirement. Around the world, people who are born in rural areas in low income households struggle more to get out of poverty.

Copied from Access to Healthcare:

People in rural areas generally have less access to healthcare than their urban counterparts. Fewer medical practitioners, mental health programs, and healthcare facilities in these areas often mean less preventative care and longer response times in emergencies. The lack of resources in rural areas have resulted in utilization of telehealth services to improve access to speciality care, as well as mobile preventative care and treatment programs. Teleheath services have the potential to greatly improve access to providers in remote areas, however, barriers such as lack of stable internet access create disparities to accessing this care. There have been increased efforts to attract health professionals to isolated locations, such as increasing the number of medical students from rural areas and improving financial incentives for rural practices.

Add to bottom of telehealth:

While telehealth services have been beneficial to improving access to care, there are still challenges that remain to provide this care in rural areas. Many rural communities are not equipped with internet connection or technology necessary for a patient to access telehealth services within their home. A survey conducted in 2019 found that people living in rural areas are twice as likely to not have access to the internet connection than urban counterparts. Additionally, lack of internet access was more prevalent among the elderly population and within racial and ethnic minority communites, which could contribute to the existing disparities in accessing care.

Copied from: Rural Residence as a Social Determinant of Health

More recently, public health has also identified spatial disparities as a key component of inequity. Lutfiyya et al. contend that rurality is a root or fundamental social determinant of health. Social determinants of health such as poverty, unequal access to healthcare, education deficits, stigma, and racism are all contributing factors to health inequalities, according to the CDC. Research on "place-based" determinants have historically pointed towards urbanization (e.g., redlining, gentrification) but health disparities also persist in rural areas as well. For example, 20% of the population in the United States is considered rural, but only 9% of physicians serve rural communities, which points to unequal access to healthcare. Cosby et al. refers to the differences in mortality and morbidity between urban and rural residents as the "rural mortality penalty."

Lutfiyya et al. discuss the introduction to the theory of fundamental causes of health and mortality by Link and Phelan and its important omission of rurality and space. While socioeconomic status is fundamentally understood to be a persistent driver of health inequity, this concept was not expanded to include root causes spurring the socioeconomic disparities. Using the four features which characterize a fundamental social cause of health, Lutfiyya et al. demonstrate that rural residency is a root cause of health inequities. The aforementioned four characteristics are: "(1) it influences multiple disease or health outcomes; (2) it affects these outcomes through multiple risk factors; (3) it impacts access to resources that may be used to either avoid risks or minimize the consequence of disease; and (4) the association between the fundamental cause and health is reproduced over time through the replacement of intervening mechanisms."

Working Conditions

The median income of rural households is typically lower than urban households. In 2021, the US Census Bureau reported the median rural household income to be approximately $17,000 lower than urban households. Additionally, there are higher rates of poverty in rural areas compared to urban areas, impacting the ability for rural residents to pay for healthcare services and basic living needs. One contributing factor is that rural areas have less availability of jobs that pay a living wage and offer health benefits.

Industries such as mining, logging, and farming are prevalent in rural areas, which are associated with special health problem of their own. These professions are associated with health complications due to injuries, exposures to toxic chemicals, and exposure to diseases from animal waste. These industries also impact the environmental health in the surrounding community by contaminating their air and water with toxins.

Health Behaviors

Rural residents are more likely to exhibit health risk behaviors than urban residents. There are higher rates of smoking and exposure to second hand smoke, and lower reports of seatbelt use in rural areas compared to urban. Additionally, the rural residents report less leisure-time physical activity and higher caloric consumption, likely contributing to the increased rates of obesity in rural areas. Factors contributing to these behaviors include lack of exercise facilities, lack of nutrition specialists at healthcare facilities, lack of access to affordable healthy foods, and lack of health education. Efforts to encourage the adoption of positive health behaviors in rural areas could help to promote better health outcomes and reduce mortality rates

Rural health projects[edit]

Rural health improvement projects worldwide tend to focus on finding solutions to the three main problems associated with a rural health system: communication systems, transportation of services and goods, and healthcare worker shortages. Due to the lack of access to professional medical care, one approach to improving rural healthcare is distributing health information in an understandable way, such as the Hesperian Health Guides' book, Where There is No Doctor, and World Hope International's app, mBody Health. These tools provide information on diseases and treatments to help community members navigate their health, however, there is little evidence that this approach improves health outcomes.

Other community based programs focus on promoting health behaviors and increasing utilization of available health resources, such as the mother and infant health program called the Sure Start Project in rural India. An evaluation of the organization showed that community organization surrounding maternal and infant health improvement leads to increased use of health services and improvement in the health of the mother. Similarly, the Consejo de Salud Rural Andino (CSRA) in Bolivia has improved healthcare for rural communities by promoting community education and healthcare clinics. Evaluations of this organization have found that implementation of the CSRA has effectively reduced the under-5 mortality rate in rural Bolivia.

Several organizations provide and enhance access to healthcare services in rural areas. Examples include the Mud Creek Clinic in Grethel, Kentucky, which offers free and reduced-priced healthcare to residents of Appalachia. Additionally, St. Vincent Health's Rural and Urban Access to Health program in Indiana facilitates access to care for under-served populations, including Hispanic migrant workers. As of December 2012, the program had facilitated more than 78,000 referrals to care and enabled the distribution of US $43.7 million worth of free or reduced-cost prescription drugs.

NGOs play a significant role in supporting healthcare systems in various countries. NGOs supply a large portion of hospital beds and clinical care needs in countries in Africa including Ghana, Tanzania, and Zimbabwe. Similarly organizations like the Child Family Health Organization (CFHI) in Ecuador and the Philippines

promote medical pluralism, integrating traditional medicine practices with western medicine, despite facing obstacles like organizational culture and financial viability. In the Philippines, organizations like Child and Family Health International (CFHI) focus on primary care and health justice, particularly in rural and low-income communities. Through partnerships with local groups and leadership, CFHI aims to address persisting inequities and disparities despite the presence of universal healthcare in the country,

In Ecuador, organizations such as Child Family Health Organization (CFHI) promote the implementation of medical pluralism by furthering the knowledge of traditional medicine as practiced by Indigenous peoples in a westernizing country. Medical pluralism arises as a deliberate approach to resolving the tension between urban and rural health and is manifested in the practice of integrative medicine. There are currently ongoing efforts to implement this system regionally, more particularly in the nation of Ecuador. It accomplishes the mission of raising awareness for more adequate healthcare systems by immersing participants (including health care practitioners and student volunteers) in programs, both in-person and virtually, that are rooted in community involvement and provide glimpses into the healthcare systems present in vastly distinct areas of the nation. Research examines the role of NGOs in facilitating spaces or "arenas" for spotlighting the importance of traditional medicine and medical pluralism; such "arenas" facilitate a necessary medical dialogue about healthcare and provides a space to hear the voices of marginalized communities. CFHI's efforts are supporting Ecuador's implementation of an integrated system that includes alternative medicine. The process of doing so is, however, challenged by four main obstacles. These four obstacles include "organizational culture", "financial viability", "patient experience and physical space" and, lastly, "credentialing". The obstacles continue to challenge the ongoing work of CFHI and other NGO's as they aim to establish a healthcare system that represents the ethnic diversity of the nation.

In the Philippines, Child and Family Health International (CFHI) is a 501(c)3 nonprofit organization that works on global health in Quezon, Lubang, and Romblon, Philippines focusing on primary care and health justice by offering health services and promoting health education. The Philippines program works through urban and rural clinics/health stations, respectively in Manila and the villages on remote islands known as geographically isolated disadvantaged areas. Their main goal to achieve health equity and social justice is carried out through leadership of local Filipinos and partnerships with community groups. Although universal healthcare is in place in the Philippines, CFHI addresses persisting inequities and disparities in rural and low-income communities.

Educational Attainment:

Access to education is a social determinant of health, as people with higher degrees of education more likely to live longer and be healthier. Socioeconomic status impacts the likelihood that a child will graduate high school and continue to college. Without a high school or college degree, people are less likely to obtain a high paying job, which is associated with an increased risk of health problems such as heart disease, diabetes, and depression. People from rural communities are more likely to have a lower socioeconomic status and have lower educational attainment compared to urban residents. The percentage of adults who did not graduate high school has decreased from 23.6% to 13.1% in rural areas and 18.8% to 11.4% in urban areas between 1960-2019, demonstrating the improvement in educational attainment over time. Despite the progress made, there still exists disparities, as the percentage of urban residents with a bachelors degree or higher in 2019 was 34.7% compared to 21% of rural residents.

The impact of education on health status extends beyond income level, as less education is a risk factor for having low health literacy. Health literacy is the ability for a patient to understand health information and how to manage their health by following instructions from their provider. People with low health literacy are less likely to have health screening and seek preventative healthcare services, putting them at risk for having a poorer health status and hospitalization. Health education programs in rural areas can be implemented to improve health literacy and health outcomes in these communities.