National Minority Health Month: Health Disparities in Rural America
The Department of Health and Human Services honors the month of April as National Minority Health Month, an opportunity to highlight the unique needs of minority populations across the United States.
Rural communities face unique challenges, from limited resources and geographic isolation, to low population density and persistent poverty. Rural Americans are at disproportionate risk of being uninsured, lacking access to care, and experiencing worse health outcomes, but even within rural populations there are disparities based on gender and race/ethnicity. Recently, the Center for Disease Control (CDC) found that rural communities have increasing racial diversity, increasing the importance of understanding the demographics of rural America and the breakdown of health disparities to identify how best to eliminate these disparities and improve the health of all rural Americans.
Economic Opportunity Effects Outcomes
Lack of economic opportunity in rural America effects health choices and outcomes. Poverty and health are inextricably linked the result of a multitude of factors both directly related to health care such as access to providers and those impacting health such as access to healthy foods.
- 18% of rural populations are living below the poverty threshold, compared to less than 16% in urban areas (HRSA Health Equity Report 2017)
- 62% of rural Black Americans and 53% of rural Hispanic Americans are living in poverty (income under $25,000 annually) compared to 32% of rural White Americans. 44% of rural Hispanic Americans and 28% of rural Black Americans have less than a high school education (compared to 15% of rural White Americans) (CDC MMWR)
As a result, 25% of Black Rural Adults and 23% of Hispanic Rural Adults were unable to see a doctor in the past year (study from 2012-2015) because of the cost (compared to 15% of White Rural Adults). While only 16% of rural White Adults have no health coverage, 27% of rural Black Adults, 39% of Hispanic Adults, and 15% of Native American Adults have no health coverage.
While access to care is an issue for all rural populations, it is of greater issue in majority minority rural communities. Twenty percent of Americans live in rural areas, while only nine percent of the nation’s physicians practice in these areas. While 3 of 5 rural white Americans live in Health Professions Shortage Areas (HPSAs), a shocking 3 out of 4 rural minority Americans do (71% Blacks, 76% Hispanics, 73% Native Americans).
Access to care and utilization of available care services are directly related to outcomes. While all rural Americans are more likely than urban Americans to report fair or poor health status, rural minority populations report even higher rates of fair or poor health status: 19% of rural White Adults, 29% of rural Black Adults, 28% of rural Hispanic Adults, and 29% of rural Native American Adults.
Maternity Care and Infant Mortality
HRSA’s 2017 Health Equity Report showed that the difference in urban and rural life expectancy begins at birth: the highest infant mortality rate occurs in small rural communities. Infant mortality rates are 15% higher in rural counties, and the most rural counties have the highest infant mortality rate, 32% higher than the lowest rate for suburban areas. Yet, between 2004 and 2014 more than 200 rural hospitals stopped providing labor and delivery services. When distance to maternity care is directly correlated with outcomes, this care shortage has a devastating effect on the health of both the mother and the infant.
Rural counties with higher percentages of African American women were more than 10 times as likely as rural counties with higher percentages of white women to have never had hospital-based obstetric services and more than 4 times as likely to have lost obstetric services between 2004-2014.
Substance Use and Treatment
Substance Use Disorder (SUD) and substance abuse related deaths have grown exponentially in recent years in rural America as the spread of opioids, fentanyl, and heroin have created a growing epidemic. Overall, substance use rates are higher in minority populations in rural communities: 23% of rural Native Americans, and 16% of both rural Hispanic and Black Americans engage in binge drinking.
While the opioid epidemic is often portrayed as an issue primarily for White Americans, Native American communities, almost entirely rural, have been gravely impacted by the crisis. By 2014, the CDC reported that Native Americans had the highest death rate from opioids. Rates of opioid related deaths have increased in White, Native, Hispanic and Black communities in rural America.
Seeking Solutions for Rural Minority Communities
Attention to racial and ethnic disparities in care has increased among policymakers; however, there is little agreement on what can or should be done to reduce these disparities. NRHA previously published a Policy Paper on Racial and Ethnic Health Disparities in Rural America and found that there are some key solutions that can begin to improve outcomes for rural minority populations including: telemedicine, cultural competency training, improved data collection, and grassroots community involvement.
The elimination of these disparities in health status will require important changes in the ways health care is delivered, financed, and documented. This Minority Health Month and throughout the year, NRHA will continue to advocate for access to health care for all rural Americans, especially for particularly vulnerable populations such as ethnic and minority populations living in rural and medically underserved areas. Ensuring access to care for all rural Americans will help us move forward to greater health equity.