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accessHealthNews.net
October 2021
Volume 8 | Issue No. 50
W
hat is the state of rural health
care in Missouri? Some might say
fragmented, while others see hope.
For rural America, the glass may be
half full, or at least trending in that
direction.
During the Missouri Rural Health
Association's 2021 Get Link'd Annual
Conference, Brock Slabach, chief
operating officer of the National Rural
Health Association (NRHA), delivered
the keynote address that talked
about the state of rural health, as
well as advocacy efforts underway
to implement health policy changes
that address some of Missouri's most
flagrant health inequities.
This advocacy has gained momentum
after the COVID-19 pandemic
provided an impetus for policy makers
to see, clear eyed, what's broken,
and with pressure from advocates,
how to fix it.
"We have unprecedented challenges
that exist right now in the rural safety
net," Slabach said. "We were already
stretched to the limits before the
pandemic with comorbidities and
mortalities that challenged our rural
communities. Then the pandemic
hit. And it has increased the levels of
complexity for providing care and
taking care of the populations that we
serve."
Policy makers are now connecting the
dots and understanding how social
determinants of health and a lack
of health equity moves downstream
to manifest poor health outcomes in
both rural and urban communities.
It's important to note that access to
quality care contributes only 20% to
one's overall health and wellness.
Other social determinants of health,
which are non-clinical, make up the
highest predictors of health outcomes.
Socioeconomic factors make up 40%
and include things like education,
job status, family and social support,
income, and community safety. One's
physical environment makes up 10%.
Health behaviors like tobacco and
alcohol use, diet and exercise, and
sexual activity make up the remaining
30%.
TWO SIDES OF THE SAME COIN
Although resilient, rural and urban
communities share many of the
same social determinants of health,
like access barriers to care, poverty,
food deserts, transportation, and
broadband access.
Broadband redlining, which occurs
when certain communities are denied
access, is another shared problem.
Not everyone can afford satellite
or cable broadband services when
available. Without this basic need,
crucial telehealth services remain
inaccessible. According to the
Federal Communications Commission,
19 million Americans still lack access
to high-speed internet.
Missouri is ranked 34th nationwide for
broadband access. In a survey by the
Missouri Department of Elementary
and Secondary Education, 23% of
Missouri students lack broadband
access, 258 school districts reported
that students lack access due to
broadband affordability, 84 school
districts lack physical access to
broadband, and Missouri ranks in
the bottom five for low-cost internet
access. In May, the $3.2 billion FCC
Emergency Broadband Benefit
Program was launched to help
lower the cost of internet for eligible
households. Missouri continues to
make strides to address the digital
divide, but there is a long way to go.
As for transportation, where it may
take rural people two or three hours
by car to see a provider, it may take
urban people two or three hours on
the bus to see a provider.
A FRAGMENTED SYSTEM OF CARE
However, rural Missourians face a
particular hurdle-the damning number
of hospital closures and hospitals
at-risk for closure continues to pack
a resounding blow to the small-town
safety net.
Since 2010, 138 rural hospitals have
closed. Nine of these hospitals have
closed in rural Missouri — and that's
not all. Fifteen of Missouri's 60 rural
hospitals are at risk for closure, 26
are vulnerable, and 11 are most
vulnerable according to statistics
Slabach cited from the Chartis Center
for Rural Health.
"Rural communities are older, sicker, and poorer. Premature deaths
outpace urban rates, rural communities have historically high health
professional shortages compared with urban communities, and oral
health care availability is much more scant."
