By Liora Engel-Smith

Spend any time talking about rural health and you’re bound to hear about divides, disparities and deserts.

A new report from the Centers for Disease Control and Prevention found this litany of challenges amounts to higher rates of potentially preventable deaths in rural Americans under 80 as compared with their urban counterparts. The CDC studied potentially preventable deaths from 2010-2017 for five leading causes — cancer, chronic lung disease, stroke, heart disease and unintentional injuries, including fatal drug overdoses.

The study, released earlier this month, is the second time the CDC used data to understand the health differences between rural and urban areas in the United States. The federal agency released a similar, but less detailed report in 2017.

The report confirmed what many rural advocates have been saying for years — rural populations lag behind their urban counterparts on many health measures. The CDC found that rural communities had a higher share of potentially preventable death in 2010 from chronic diseases and unintentional injuries when compared with urban areas.

But by 2017, the gap between urban and rural communities widened on almost all the indicators, except for unintentional injuries, where urban areas saw a sharp rise in the rate of potentially preventable deaths, in large part due to the opioid crisis, the report said.

A graphic from CDC about the rural-urban divide
Graphic credit: CDC.

In North Carolina, where 41 percent — or 4 million people — live in rural areas, the study has larger implications.

“It’s obviously disturbing, given the fact that we’re not just seeing disparities,”
said Maggie Sauer, director of the state’s Office of Rural Health. “We’re seeing higher numbers of people [in rural communities] who are suffering and dying at a higher rate than some of our other communities.”

North Carolina’s potentially preventable death trends are on par with the CDC’s findings, Sauer said. In rural parts of the state, potentially preventable deaths from the five causes the CDC examined amounted to a little more than 3,600 in 2015, according to data from the office.

A slide that shows potentially preventable deaths in rural areas in North Carolina in 2015. This is an illustration of the rural-urban divide
Graphic credit: North Carolina Office of Rural Health.

Preventing these deaths, Sauer said, will take a variety of interventions including reducing the number of uninsured people in rural areas, increasing access to healthy food and affordable housing, as well as addressing economic factors that contribute to disease. But there are also relatively easy — and cost effective — interventions that could make a dent in these deaths, she said, such as educating people on the importance of wearing seatbelts.

Reasons for optimism?

Experts and rural advocates across the state and the nation said the CDC report findings are not surprising. Quantifying the disparities in this way could drive policy solutions, said Brock Slabach, senior vice president for member services at the National Rural Health Association, a nonprofit advocacy and research organization.

“You can’t deal with or solve a problem until you know that it exists,” he said. “And now that we know that it exists, I believe that we’re seeing the marshaling of resources that are being applied to try to address some of these problems.”

Sauer shares that optimism. Rural communities may not be resource-rich, but they have some unique strengths.

“The real asset that rural communities have is partnership, is collaboration, (and a) cultural philosophy about helping your neighbor,” she said.

That community-minded approach can be fertile grounds for creative solutions. She pointed to Madison County as an example of a community that found ways to address obesity, heart disease and diabetes through a program that focuses on primary care.

Community can be a powerful thing, but other drivers of health, such as socioeconomic status and education also need attention, said Pamela Tripp, CEO of CommWell Health, a federally qualified health center that serves a largely rural six-county swath in the southeastern part of the state.

“I think it has a lot to do with the money [in a community]. I do believe that community health care system and rural health centers are doing their part,” she said. “I think there needs to be more of those.”

The roughly 25,500 patients CommWell serves have better than expected health outcomes, thanks in part to coordinated care, case management and focusing on the whole patient, Tripp said. But these patients are up against an interlocking array of factors that can make their health worse.

Rural hospital closures

People without health insurance — many of them live in rural areas — tend to skip cancer and other screenings for lack of money, Tripp said, but early detection is key to better outcomes.

“If you don’t have access you’re not gonna get your prostate checked, you’re not gonna get your PSA done, you’re not gonna get that mammogram if you have a lump,” she said.

And when those patients receive a diagnosis of advanced cancer, Tripp said, they often have to travel to a city to receive the care they need because rural hospitals have either closed or can’t offer that kind of advanced care. It’s a problem in rural communities everywhere. According to UNC Chapel Hill’s Sheps Center for Health Policy Research, 161 rural hospitals closed across the country since 2005. During that time, 11 rural North Carolina hospitals have closed their doors, while others have declared bankruptcy.

Many times, Tripp said, the lack of services causes a lag between diagnosis and treatment of cancer in patients from rural areas.

Still, Tripp believes that North Carolina’s health care system is on the right path, particularly because of the shift to value-based care.

“I’m a firm believer in the community health system,” she said. “I’m a firm believer in rural health clinics. If we can continue to be funded … I do think that we can make a difference.”

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Liora Engel-Smith joined NC Health News in July 2019 and covers policies, programs and issues that affect rural areas. She has previously worked for the The Keene Sentinel in New Hampshire and the Muscatine...