Access to health care is a real challenge for rural communities

About 25 percent of Americans are residents of rural communities. Urban and suburban residents typically have access to public transportation, innovative medical care, and cutting-edge prevention programs; however, rural residents often do not have such resources.

Residents of Appalachia, much of which is rural, are more likely to die from cancer than their non-Appalachian counterparts. This staggering statistic highlights rural America’s unique set of challenges, including access to adequate health care.

Sadly, Appalachian adults are more likely to develop and die from cancer than their counterparts partly due to higher rates of obesity and inactivity, according to Eugene Lengerich, professor and associate director of health disparities and engagement, Penn State Cancer Institute and regional principal investigator for the Appalachia Community Cancer Network (ACCN).

Fortunately, ACCN’s research shows that faith-based intervention programs can help reduce the prevalence of overweight and obese adults in Appalachia. “Faith-based organizations are seen as pillars in the community and serve as a meeting point for populations that may be spread out over a wide geographical area,” he said.

Scherezade K. Mama, assistant professor of kinesiology at Penn State, is working with Lengerich to implement Walk by Faith, a partnership with faith groups designed to increase physical activity and reduce the number of adults who are overweight and obese, thereby reducing the risk of cancer. “Community members view faith-based organizations as trustworthy, so partnering with them lends credibility to an intervention and increases community buy-in,” she said.

The Pennsylvania Office of Rural Health (PORH), a federal-state partnership that helps rural communities build health care services, is led by Lisa Davis, a Penn State alumna, and housed in the College of Health and Human Development.

PORH helps ease constraints at rural hospitals by providing funding through the Medicare Rural Hospital Flexibility Program, which allows select Master of Health Administration (MHA) students to serve at Tyrone Hospital, a rural facility.

Alex Brennsteiner, director of oncology quality and safety for the Allegheny Health Network Cancer Institute in Pittsburgh, completed the two-year assistantship at Tyrone Hospital while earning his MHA at Penn State. The experience revealed the unique obstacles rural hospitals face.

“The most significant thing that I took away from the experience of working in a rural hospital was that while major strides are being made to optimize health outcomes, much work is left to be done,” Brennsteiner said. “Not only do rural hospitals face challenges related to their location, but maintaining the appropriate level and scope of services for the populations they serve can become a financial impossibility.”

Joe Adams, director of revenue cycle and information technology at Tyrone Regional Health Network, has worked with each Penn State MHA student placed at Tyrone Hospital.

“They get to see and experience how management operates in a small facility where staff is typically lean and most managers wear more than one hat,” Adams said. “They really become part of our team and help us get more accomplished.”

Pharmacy chains and other venues that now offer in-store health clinics could help ease the burden for rural populations, according to recent work by Samantha DiMeo, health policy and administration undergraduate student; Catherine Baumgardner, senior instructor of the online Master of Health Administration program; and former Penn State professor Deirdre McCaughey.

“Retail health clinics have the potential to increase access to care for underserved and rural populations; however, the business model of these clinics is profit centered, therefore clinics are primarily located in urban and more affluent areas,” DiMeo said. “Our research revealed that retail health clinics can serve as a way to reduce unnecessary emergency room visits, increase access to care, and reduce wait times, and we are hopeful that the business model will align to fill the need in these populations.”

Rural America is also where the majority of the nation’s food supply is grown; therefore farmworkers and their families are often caught in the health care gap.

Throughout the United States, immigrant workers complete the majority of rural farming. They are uninsured at three times the rate of other groups due to poor availability of health care options in Spanish, few culturally appropriate health services, and lack of transportation, according to Shedra Amy Snipes, assistant professor of biobehavioral health.

Furthermore, Snipes said farmworkers are routinely exposed to occupational health risks, such as exposure to pesticides, which can cause a cascade of health problems, including cancer. Wearing protective gear may help reduce exposure to pesticides; however, use is often avoided because workers say it makes them overheated and uncomfortable.

To address the issue, Snipes recently created and studied the feasibility of the intervention, Protect Yourself! (¡Protejase!). Farmworkers received protective gear and used a smartphone app that promoted wearing gloves, safety boots, long shirts, and head covers. The study significantly improved farmworkers’ use of the gear, and the program could have a broader impact moving forward.

Already part of the solution, PORH works with agricultural producers and their employees to ensure compliance with the EPA’s Worker Protection Standard.

Additionally, PORH and the DentaQuest Institute recently initiated the Medical Oral Expanded Care Collaborative to increase access and improve oral health care in rural Pennsylvania.

State and federal governments have multiple definitions of "rural," which differ from agency to agency. To learn more, visit http://porh.psu.edu/porh/definitions-rural.

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Last Updated November 16, 2016