Hostname: page-component-7479d7b7d-qlrfm Total loading time: 0 Render date: 2024-07-14T15:18:56.908Z Has data issue: false hasContentIssue false

Medicalization of Rural Poverty: Challenges for Access

Published online by Cambridge University Press:  01 January 2021

Abstract

This article provides a broad survey of issues facing rural communities and suggests that medicalization of poverty concepts and interventions need to be tailored to those populations. Rural poverty may be both broader and deeper than in urban areas. Those challenges seem to produce a constellation of health conditions, as rural residents struggle with unemployment and lack of opportunities. Relatedly, rural communities struggle to maintain financially viable hospitals and specialty providers. The article closes by offering a snapshot of rural-specific strategies to address these issues.

Type
Symposium 1 Articles
Copyright
Copyright © American Society of Law, Medicine and Ethics 2018

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

See, e.g., “About RUPRI,” RUPRI, available at <http://www.rupri.org/about-rupri/> (last visited July 11, 2018).+(last+visited+July+11,+2018).>Google Scholar
Domm, P., “Goldman Says This May Become the Longest Economic Expansion in History,” CNBC, May 8, 2017, available at <https://www.cnbc.com/2017/05/08/goldman-says-u-s-economy-may-be-slowly-growing-into-the-longest-expansion-in-history.html> (last visited July 11, 2018).+(last+visited+July+11,+2018).>Google Scholar
Kochanek, K. D., Arias, E., and Anderson, R. N., “Leading Causes of Death Contributing to Decrease in Life Expectancy Gap Between Black and White Populations: United States, 1999-2013,” NCHS Data Brief, no. 218 (2015): 1-7, at 1, available at <https://www.cdc.gov/nchs/data/databriefs/db218.pdf> (last visited July 11, 2018).+(last+visited+July+11,+2018).>Google Scholar
Brasch, S., “Is the Economic Recovery Leaving Rural America Behind?,” Modern Farmer, December 5, 2013, available at <https://modernfarmer.com/2013/12/economic-recovery-leaving-rural-america-behind/> (last visited July 11, 2018).+(last+visited+July+11,+2018).>Google Scholar
Singh, G. K. and Siahpush, M., “Widening Rural-Urban Disparities in Life Expectancy, U.S., 1969-2009,” American Journal of Preventative Medicine 29, no. 2 (2014): e19-e29, available at <http://www.ajpmonline.org/article/S0749-3797(13)00590-4/pdf> (last visited July 11, 2018).Google Scholar
Patient Protection and Affordable Care Act, Pub. L. No. 111-148, 124 Stat. 119 (March 23, 2010); Health Care and Education Reconciliation Act of 2010, Pub. L. No. 111-152, 124 Stat. 1029 (March 30, 2010).Google Scholar
See, e.g., Rural Policy Research Institute, “About RUPRI,” RUPRI, available at <http://www.rupri.org/about-rupri/> (last visited July 11, 2018); see also Williams, D. Jr. and Holmes, M., “Rural Health Care Costs: Are They Higher and Why Might They Differ from Urban Health Care Costs?,” North Carolina Medical Journal 79, no. 1 (2018): 51-55, available at <http://www.ncmedicaljournal.com/content/79/1/51.full.pdf+html> (last visited July 11, 2018); “6 Charts that Illustrate the Divide Between Rural and Urban America,” PBS News Hour, March 17, 2016, available at <https://www.pbs.org/newshour/nation/six-charts-illustrate-divide-rural-urban-america> (last visited July 11, 2018).Google Scholar
U.S. Department of Agriculture, Economic Research Service, “Rural Poverty & Well-being,” available at <https://www.ers.usda.gov/topics/rural-economy-population/rural-poverty-well-being/> (last visited July 11, 2018).+(last+visited+July+11,+2018).>Google Scholar
See generally Tickamyer, A. R., Sherman, J., and Warlick, J., eds., Rural Poverty in the United States (New York: Colombia University Press, 2017).Google Scholar
Dudenhefer, P., Poverty in the Rural United States, Persistent Poverty in Rural America (Boulder: Westview Press 1993): 37-46, available at <https://www.irp.wisc.edu/publications/focus/pdfs/foc151c.pdf> (last visited February 12, 2018); Thiede, B., Greiman, L., Weiler, S., Beda, S., and Conroy, T., “6 Charts That Illustrate the Divide Between Rural and Urban America,” PBS, March 17, 2017, available at <https://www.pbs.org/newshour/nation/six-charts-illustrate-divide-rural-urban-america> (last visited July 11, 2018).Google Scholar
Misra, T., “A Complex Portrait of Rural America,” City-Lab, December 8, 2016, available at <https://www.citylab.com/equity/2016/12/a-complex-portrait-of-rural-america/509828/> (last visited July 11, 2018).+(last+visited+July+11,+2018).>Google Scholar
Gurley, supra note 14.Google Scholar
MacGillis, A., “The Original Underclass,” The Atlantic, September 2016, available at <https://www.theatlantic.com/magazine/archive/2016/09/the-original-underclass/492731/> (last visited July 11, 2018)(“The barely veiled implication…is that the people undergoing these travails deserve relatively little sympathy — that they maybe, kinda had this reckoning coming. Either they are layabouts drenched in self-pity or they are sad cases consumed with racial status anxiety and animus toward the nonwhites passing them on the ladder.”).+(last+visited+July+11,+2018)(“The+barely+veiled+implication…is+that+the+people+undergoing+these+travails+deserve+relatively+little+sympathy+—+that+they+maybe,+kinda+had+this+reckoning+coming.+Either+they+are+layabouts+drenched+in+self-pity+or+they+are+sad+cases+consumed+with+racial+status+anxiety+and+animus+toward+the+nonwhites+passing+them+on+the+ladder.”).>Google Scholar
See Gurley, supra note 14.Google Scholar
See Kozhimannil, K. B. and Henning-Smith, C., “Racism and Health in Rural America,” Journal for the Health Care of the Poor and Underserved 29, no. 1 (November 22, 2017): 35-43, available at <https://preprint.press.jhu.edu/sites/default/files/KozhimannilFinalCE%20preprint.pdf> (last visited July 11, 2018).Google Scholar
Frederique, K. and Moore, M., “Opioids Became a Crisis Because They Kill So Many White Americans,” The Hill, November 13, 2017, available at <http://thehill.com/opinion/healthcare/360162-opioids-became-a-crisis-because-they-kill-so-many-white-americans> (last visited July 11, 2018).+(last+visited+July+11,+2018).>Google Scholar
Mortality and Life Expectancy in Rural America: Connecting the Health and Human Service Safety Nets to Improve Health Outcomes Over the Life Course, National Advisory Committee on Rural Health and Human Services Policy Brief (October 2015): 1-10, at 1, available at <https://www.hrsa.gov/advisory-committees/rural/publications/mortality.pdf> (last visited July 11, 2018).+(last+visited+July+11,+2018).>Google Scholar
See id. at 2.Google Scholar
See id. at 7-8,9.Google Scholar
“Rural Americans at Higher Risk of Death From Five Leading Causes,” CDC, January 12, 2017, available at <https://www.cdc.gov/media/releases/2017/p0112-rural-death-risk.html> (last visited January 25, 2018).+(last+visited+January+25,+2018).>Google Scholar
See id. at 1545-1546.Google Scholar
See id. at 1545-1546.Google Scholar
See id. at 1545.Google Scholar
Case, A. and Deaton, A., “Rising Morbidity and Mortality in Midlife Among White Non-Hispanic Americans in the 21st Century,” PNAS 112, no. 49 (2015): 15078-15083.Google Scholar
See id. at 15081.Google Scholar
See, e.g., Friedsam, D., “Does the Rural-Urban Frame Help Explain Health Status?” Health Affairs Blog, April 30, 2018, available at <https://www.healthaffairs.org/do/10.1377/hblog20180426.201480/full/> (last visited July 11, 2018).+(last+visited+July+11,+2018).>Google Scholar
See, e.g., Auerbach, J. and Gelman, A., “Age-Aggregation Bias in Mortality Trends,” PNAS 113, no. 7 (2016): E816-E817, available at <https://doi.org/10.1073/pnas.1523465113> (last visited July 11, 2018); Auerbach, J. and Gelman, A., “Stop Saying White Mortality Is Rising,” Slate, March 28, 2017, available at <http://www.slate.com/articles/health_and_science/science/2017/03/is_white_mortality_rising_not_really.html> (last visited June 22, 2018); Guo, J., “‘How dare you work on whites': Professors under fire for research on white mortality,” The Washington Post, April 6, 2017, available at <https://www.washingtonpost.com/news/wonk/wp/2017/04/06/how-dare-you-work-on-whites-professors-under-fire-for-research-on-white-mortality/?noredirect=on&utm_term=.7d7323e3a4ba> (last visited July 11, 2018); Semuels, A., “Is Economic Despair What's Killing Middle-Aged White Americans?” The Atlantic, March 23, 2017, available at <https://www.theatlantic.com/business/archive/2017/03/economic-despair/520473/> (last visited June 22, 2018).Google Scholar
See James, C. V. et al., “Racial/Ethnic Health Disparities Among Rural Adults — United States, 2012–2015,” Centers for Disease Control & Prevention, Morbidity and Mortality Weekly Report 66, no. 3 (2017), available at <https://www.cdc.gov/mmwr/volumes/66/ss/ss6623a1.htm> (last visited July 11, 2018) (noting that although rural populations are less diverse, rural racial/ethnic minority populations suffer substantial health, access to care, and lifestyle challenges that should not be overlooked).Google Scholar
Johnson, J. and Wagner, J., “Trump Declares the Opioid Crisis a Public Health Emergency,” The Washington Post, October 26, 2017, available at <https://www.washingtonpost.com/news/post-politics/wp/2017/10/26/trump-plans-to-declare-the-opioid-crisis-a-public-health-emergency/?utm_term=.a48bcea0297e>(last July 11, 2018).(last+July+11,+2018).>Google Scholar
Runyon, L., “Why is the Opioid Epidemic Hitting Rural America Especially Hard?” NPR, January, 4, 2017, available at <http://nprillinois.org/post/why-opioid-epidemic-hitting-rural-america-especially-hard#stream/0> (last visited January 25, 2018).+(last+visited+January+25,+2018).>Google Scholar
Substance Abuse Research Alliance, “Prescription Opioids and Heroin Epidemic in Georgia-A White Paper,” (2017):1-60, available at <http://www.senate.ga.gov/sro/Documents/StudyCommRpts/OpioidsAppendix.pdf> (last visited July 11, 2018).+(last+visited+July+11,+2018).>Google Scholar
Cunningham, C. A., “The Opiate Crisis in Rural America,” National Association of State EMS Officials, available at <https://www.nasemso.org/Advocacy/PositionsResolutions/documents/The-Opiate-Crisis-in-Rural-America.pdf> (last visited January 25, 2018).+(last+visited+January+25,+2018).>Google Scholar
DiJulio, B., Kirzinger, A., Wu, B., and Brodie, M., “Data Note: Americans' Challenges with Health Care Costs,” The Henry J. Kaiser Family Foundation, March 2, 2017, available at <https://www.kff.org/health-costs/poll-finding/data-note-americans-challenges-with-health-care-costs/> (last visited July 11, 2018). (last visited July 11, 2018).' href=https://scholar.google.com/scholar?q=DiJulio,+B.,+Kirzinger,+A.,+Wu,+B.,+and+Brodie,+M.,+“Data+Note:+Americans'+Challenges+with+Health+Care+Costs,”+The+Henry+J.+Kaiser+Family+Foundation,+March+2,+2017,+available+at++(last+visited+July+11,+2018).>Google Scholar
Barker, A. R. et al., Health Insurance Marketplaces: Premium Trends in Rural Areas, RUPRI Center for Rural Health Policy Analysis Rural Policy Brief, May 2016, available at <https://www.public-health.uiowa.edu/rupri/publications/policy-briefs/2016/HIMs%20rural%20premium%20trends.pdf> (last visited July 11, 2018); Williams and Holmes, supra note 7, at 53-54.+(last+visited+July+11,+2018);+Williams+and+Holmes,+supra+note+7,+at+53-54.>Google Scholar
Khazan, O., “Why are ther so Few Doctors in Rural America,” The Atlantic, August 28, 2018, 2014, available at <https://www.theatlantic.com/health/archive/2014/08/why-wont-doctors-move-to-rural-america/379291/> (last visited September 14, 2018).+(last+visited+September+14,+2018).>Google Scholar
“Meeting the Primary Care Needs of Rural America: Examining the Role of Non-Physician Providers,” National Conference of State Legislatures, available at <http://www.ncsl.org/research/health/meeting-the-primary-care-needs-of-rural-america.aspx> (last visited September 14, 2018).+(last+visited+September+14,+2018).>Google Scholar
“About Rural Health Care,” National Rural Health Association, available at <https://www.ruralhealthweb.org/about-nrha/about-rural-health-care> (last visited January 25, 2018); see Substance Abuse Research Alliance, supra note 37, at 5 (discussing shortage of substance abuse and medication-assisted treatment in rural areas).+(last+visited+January+25,+2018);+see+Substance+Abuse+Research+Alliance,+supra+note+37,+at+5+(discussing+shortage+of+substance+abuse+and+medication-assisted+treatment+in+rural+areas).>Google Scholar
“83 Rural Hospital Closures: January 2010-Present,” UNC: The Cecil G. Sheps Center for Health Services Research, available at <http://www.shepscenter.unc.edu/programs-projects/rural-health/rural-hospital-closures/> (last visited January 25, 2018).+(last+visited+January+25,+2018).>Google Scholar
“Rural Hospital Closures Since 2010,” Stroudwater, July 7, 2017, available at <http://www.stroudwater.com/?resources=analyses-rural-hospital-closures-since-2010> (last visited July 11, 2018).+(last+visited+July+11,+2018).>Google Scholar
“CMS Proposes $43B in Cuts to Disproportionate Share Hospital Payments,” Advisory Board July 31, 2017, available at <https://www.advisory.com/daily-briefing/2017/07/31/dsh-cuts> (last visited July 11, 2018).+(last+visited+July+11,+2018).>Google Scholar
Wishner, J., Solleveld, P., Rudowitz, R., Paradise, J., and Antonisse, L., “A Look at Rural Hospital Closures and Implications for Access to Care: Three Case Studies,” The Henry J. Kaiser Family Foundation, July 7, 2016, available at <https://www.kff.org/report-section/a-look-at-rural-hospital-closures-and-implications-for-access-to-care-three-case-studies-issue-brief/> (last visited July 11, 2018).+(last+visited+July+11,+2018).>Google Scholar
See Percy, S., “Georgia's Hospitals: Rural Hospitals In Crisis,” Georgia Trend, December 2016, available at <http://www.georgiatrend.com/December-2016/GEORGIAs-HOSPITALS-Rural-Hospitals-In-Crisis/> (last visited July 11 2018). (last visited July 11 2018).' href=https://scholar.google.com/scholar?q=See+Percy,+S.,+“Georgia's+Hospitals:+Rural+Hospitals+In+Crisis,”+Georgia+Trend,+December+2016,+available+at++(last+visited+July+11+2018).>Google Scholar
U.S. Internal Revenue Service, “New Requirements for 501(c) (3) Hospitals Under the Affordable Care Act,” available at <https://www.irs.gov/charities-non-profits/charitable-organizations/new-requirements-for-501c3-hospitals-under-theaffordable-care-act> (last visited July 11, 2018); Daly, R., “IRS Makes First Revocation of Hospital Not-for-Profit Exemption Under 501®,” HFMA, August 15, 2017, available at <https://www.hfma.org/Content.aspx?id=55271> (last visited July 11, 2018).+(last+visited+July+11,+2018);+Daly,+R.,+“IRS+Makes+First+Revocation+of+Hospital+Not-for-Profit+Exemption+Under+501®,”+HFMA,+August+15,+2017,+available+at++(last+visited+July+11,+2018).>Google Scholar
See Percy, supra note 49.Google Scholar
National Federation of Independent Business v. Sebelius, 567 U.S. 519, 587-88 (2012).Google Scholar
Luthra, S., “Lack of Medicaid Expansion Hurts Rural Hospitals More Than Urban Facilities,” Kaiser Health News, September 7, 2016, available at <https://khn.org/news/lack-of-medicaid-expansion-hurts-rural-hospitals-more-than-urban-facilities/> (last visited July 11, 2018).+(last+visited+July+11,+2018).>Google Scholar
Lindrooth, R. C., Perraillon, M. C., Hardy, R. Y., and Tung, G. J., “Understanding The Relationship Between Medical Expansions and Hospital Closures,” Health Affairs 37, no. 1 (2018): 111-120, at 117-119.Google Scholar
Barker, A. R., Kemper, L. M., McBride, T. D., and Mueller, K. J., Rural Policy Brief: Health Insurance Marketplaces: Premium Trends in Rural Areas, RUPRI Center for Rural Health Policy Analysis, available at <https://cph.uiowa.edu/rupri/publications/policybriefs/2016/HIMs%20rural%20premium%20trends.pdf> (last visited July 11, 2018).+(last+visited+July+11,+2018).>Google Scholar
See id.; see also Semanskee, A. et al., “Insurer Participation on ACA Marketplaces, 2014-2018,” Henry J. Kaiser Family Foundation, Health Reform, November 10, 2017, available at <https://www.kff.org/health-reform/issue-brief/insurer-participation-on-aca-marketplaces/> (last visited July 11, 2018).+(last+visited+July+11,+2018).>Google Scholar
Gelburd, R., “Federal Open Enrollment Now Even Shorter Than It Was Before,” The Hill, October 6, 2017, available at <http://thehill.com/opinion/healthcare/354229-federal-open-enrollment-period-is-now-shorter-than-it-was-before> (last visited July 11, 2018).+(last+visited+July+11,+2018).>Google Scholar
Mangan, D., “Trump Administration Health Reps Told Not to Participate in Obamacare Outreach Nationwide, as Advocates Claim ‘sabotage,’” CNBC, September 27, 2017, available at <https://www.cnbc.com/2017/09/27/federal-health-reps-told-not-to-participate-in-obamacare-outreach.html> (last visited July 11, 2018).+(last+visited+July+11,+2018).>Google Scholar
Jost, T., “The Tax Bill and the Individual Mandate: What Happened, and What Does It Mean?” Health Affairs, December 20, 2017, available at <https://www.healthaffairs.org/do/10.1377/hblog20171220.323429/full/> (last visited February 12, 2018).+(last+visited+February+12,+2018).>Google Scholar
See Gorenstein, D. and Kasperkevic, J., “Health Care Premiums for 2018 Set to Go up by as Much as 50 Percent,” Marketplace, October 5, 2017, available at <https://www.marketplace.org/2017/10/05/health-care/uncertainty-healthcare-premiums-increase-2018-50-percent> (last visited July 11, 2018).+(last+visited+July+11,+2018).>Google Scholar
See 42 C.F.R. § 1001.952(n) (8).Google Scholar
See, e.g., Sheinin, A. G., “’Broadband Deserts’ Hinder Growth in Rural Georgia,” The Atlanta Journal-Constitution, June 11, 2017, available at <http://politics.myajc.com/news/state--regional-govt--politics/broadband-deserts-hinder-growth-rural-georgia/Fx3iwMdptBtTfMpdz0CgtJ/> (last visited July 11, 2018).+(last+visited+July+11,+2018).>Google Scholar
See Lindrooth, supra note 54, at 111.Google Scholar
See O.C.G.A. § 31-7-72.Google Scholar
Weldon Freeman, Press Release No. 0151.17: “USDA Invests More Than $1 Billion to Improve Health Care in Rural Areas,” USDA, November 17, 2017, available at <https://www.usda.gov/media/press-releases/2017/11/17/usda-invests-more-1-billion-improve-health-care-rural-areas> (last visited July 11, 2018).+(last+visited+July+11,+2018).>Google Scholar
Nolin, J., “Rural Hospital Measure Clears Path for ‘micro’ Hospitals,” Tifton Gazette, February 7, 2018, available at <http://www.tiftongazette.com/news/rural-hospital-measure-clears-path-for-micro-hospitals/article_97115402-0c33-11e8-861e-0b6ca029e873.html> (last visited July 11, 2018).+(last+visited+July+11,+2018).>Google Scholar
See Rural Health Information Hub, “Rural Care Coordination Toolkit,” available at <https://www.ruralhealthinfo.org/tool-kits/care-coordination> (last visited July 11, 2018).+(last+visited+July+11,+2018).>Google Scholar
“Frontier Community Health Integration Project (FCHIP),” Rural Health Information Hub, available at <https://www.ruralhealthinfo.org/new-approaches/frontier-community-health-integration-program> (last visited July 11, 2018).+(last+visited+July+11,+2018).>Google Scholar
“Health Extension Rural Offices (HEROs),” Rural Health Information Hub, October 11, 2017, available at <https://www.ruralhealthinfo.org/community-health/project-examples/981> (last visited July 11, 2018).+(last+visited+July+11,+2018).>Google Scholar