Vohra et al.: Designing Rural Health Policy
In Designing Policy Solutions to Build a Healthier Rural America, authors Sameer Vohra, Carolyn Pointer, Amanda Fogleman, Thomas Albers (all of the School of Medicine, Southern Illinois), Anish Patel (J.D. Candidate, Georgia Law), and Elizabeth Weeks (Georgia Law) discuss barriers in the rural health policy sphere and provide a framework for policy solutions to build a healthier rural America.
To develop this framework, the authors identify and evaluate three main problems confronting health policy in rural communities: disparity between health policies and access in urban versus rural areas, inability to define the term “rural” properly, and Rural Health Policy designations. After discussing each barrier for rural health policy, the authors provide suggestions on how to address them.
For the disparity between policy and access in urban versus rural areas, the authors discuss past studies that have depicted these significant disparities, particularly those that discuss the life expectancy and mortality rate of rural populations compared to urban populations. Children’s health outcomes are particularly affected by adverse childhood experiences like poverty. The rate of children living in poverty is 1.3 times higher in rural areas than in urban areas. Further, physician coverage in urban areas is much higher than in rural areas, particularly among mental healthcare providers. Urban areas have 33.2 psychologists and 17.5 psychiatrists per 100,000 people, compared to 9.1 psychologists and 3.4 psychiatrists in rural areas.
The second problem in developing health policy in rural communities is the inability to define the term “rural” properly. The Census Bureau defines rural as anything “not urban” i.e., more than 2,500 population. However, this definition falls short, as evidenced by Stanley County, South Dakota, which has a population of 2,994, but 70 percent of that population lives in one city, Fort Pierre. The Office of Management and Budget expanded the Census Bureau’s definition of rural population to encompass less than 10,000 people. Some federal offices blend the two definitions, but that can mean a difference of up to 50 million people depending on which definition is used. Furthermore, there is the problem of only defining “rural” in terms of population and population density. Many more factors define rurality, such as social identity, sense of community, and others.
Finally, the authors discuss Rural Health Policy Designations. These are designations made by policymakers to combat the former problems; however, the authors suggest they miss the mark. Each designation has a list of criteria that each entity must meet to qualify for these specialized programs. However, these are susceptible to the same weaknesses already discussed. For example, the Rural Referral Center designation states a hospital must be in a rural area, with no way to define “rural.” Depending on the definition, a particular hospital may or may not qualify, despite the need for funding.
When describing the solutions, the authors quickly point out these solutions are not exhaustive but merely the beginning of “a series of investments that the federal government can make.” These solutions include using the Rural Policy Research Institute’s (RUPRI) definition of rural, which attempts to work on the nuance of rural identity; using new models to fund rural hospitals; enhancing the rural health workforce through debt forgiveness and pipeline programs; addressing the rural opioid epidemic; and focusing on social issues affecting health.
In sum, the authors take a vast subject and identify the starting point for multiple research areas. As concluded by the authors, federal and state policymakers will need to “spend more time understanding rural communities with better and more focused research applied to problems rural communities face.”
