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Rural America’s Health Crisis Seizes States’ Attention

Dr. George Pink is a professor who studies rural health, not a doctor who tries to provide it. For the sake of his own blood pressure, he’s grateful.

“Not a day doesn’t go by that I don’t thank God I’m an academic and not the CEO of a rural hospital,” Pink, a health policy professor and deputy director of the rural research program at the University of North Carolina at Chapel Hill, said recently. “Recruiting providers, finding money, dealing with payers and lawsuits, dealing with the poor health outcomes, opioid addiction.”

It’s a lot.

Rural residents are in poorer health than those living elsewhere and have less access to treatment, partly because so many rural hospitals and health clinics have shuttered in recent years. As state legislatures begin their 2020 sessions, many lawmakers are struggling to find answers.

Brock Slabach, senior vice president of the nonprofit National Rural Health Association, said big ideas are needed to truly change the trajectory of rural health. The good news is that because of scale, rural areas are promising places to test out innovations in the delivery and financing of health care.

“They have defined populations and identifiable characteristics,” said Slabach, who used to be an administrator at a rural hospital in Mississippi. “That means when you are trying an intervention, you can see whether it’s working without all the variables you might have in urban areas. In that way, rural areas are the perfect laboratories.”

Why the Disparity?

By most measures, the health of those living in rural areas is significantly worse than elsewhere. Mortality rates for the five leading causes of death — heart disease, cancer, unintentional injury, low respiratory disease and stroke — are all higher in rural areas, as is the overall mortality rate. And the gap is growing.

The suicide rate is higher in rural counties. Although the overall rate of death from drug overdoses is higher in urban areas than in rural ones, the reverse is true for certain drugs such as oxycodone and methamphetamines. Also, women in rural areas are more likely to die from overdoses than those in cities.

Health policy analysts cite multiple reasons for the rural disparities: poverty, and therefore less access to both health insurance and nutritious foods; higher rates of smoking, especially among young people; higher rates of obesity; and lower rates of exercise.

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