February 19, 2020
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AHA: Improvements in rural health greatly needed

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Robert A. Harrington

The American Heart Association issued a presidential advisory calling for rural populations to be a priority in health research, programming and policy.

“The evidence is clear that to achieve the American Heart Association’s mission to create a world of longer, healthier lives, we must address the unique health needs and challenges of people in rural America,” AHA President Robert A. Harrington, MD, FAHA, Arthur L. Bloomfield Professor of Medicine and chair of the department of medicine at Stanford University, and chair of the advisory’s writing committee, told Healio.

The document outlined factors for health disparities between rural and urban populations, including individual factors, social determinants of health and factors related to health delivery systems.

Risk disparities

“There is a 3-year life expectancy gap between rural and urban populations, with rural areas having 20% higher death rates for cardiovascular disease and stroke than urban areas, and 40% higher CVD prevalence rates. At the same time, rural women face higher maternal death rates compared to urban women, a difference largely driven by an increase in cardiovascular deaths,” Harrington said in an interview. “In addition, rural populations have higher rates of tobacco use, physical inactivity and obesity, which have given rise to higher rates of diabetes and hypertension. People in rural areas also are more likely to experience mental and behavioral health challenges, including higher rates of depression and suicide, than those in urban areas. Creating a world of longer, healthier lives demands that we address these inequities.”

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CVD prevalence in rural vs. urban populations.

Specific factors affecting rural populations compared with urban ones include lower incomes; fewer years of education, as higher education level is tied to greater longevity; poor housing quality; poor roads and public transportation options, which can lead to delays in medical treatment and unmet medical needs; and less access to grocery stores selling nutritious foods, Harrington said in an interview.

“Also contributing to poorer health outcomes in rural America are inadequate systems for health care delivery,” he said. “Rural hospitals are under enormous financial strain. Many have closed in the past decade and many more are in jeopardy of closing. Long distances and lack of access to transportation make it difficult for rural populations to access acute, preventive and emergency care. Rural areas face significant shortages of doctors, nurses and other health care providers — shortages that are expected to worsen in coming years as the rural population ages. Also, rural populations are more likely to be uninsured than people in urban areas. It shouldn’t be this way. We are committed to utilizing the American Heart Association’s capacity in research, education, quality improvement, programs and policy to partner with other stakeholders to address disparities in rural health.”

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The document proposes a number of potential solutions regarding innovation, policy and research.

“We must address the shortage of health professionals in rural areas and encourage the development of new rural-specific, team-based care models,” Harrington told Healio. “Telehealth and digitally enabled health care can improve access to health services for rural populations. Health care providers and facilities must be paid in such a way that recognizes the unique elements of care delivery in rural areas, supports the delivery of high-quality care and enables them to remain financially viable. Finally, we must support policies such as Medicaid expansion and insurance market reforms to improve access to care and promote the economic prosperity of rural communities.”

Tailored solutions

It will be particularly important to determine which solutions work best in rural communities, he said.

“We cannot assume that approaches that have worked in urban or suburban populations will be successful in rural populations,” Harrington told Healio. “We need to ensure team-based care models work as intended, interventions to mitigate the effects of social determinants of health are effective and improvements at the systems level have their desired impact. Answering these questions and improving health in rural America will require the sustained commitment of health care and other stakeholders. The American Heart Association is committed to working with strategic partners to support and develop solutions to improve rural health in America.”

The authors wrote that solutions could include virtual expansion of the AHA’s quality initiatives to better serve rural populations, support of policies that promote more accessible and affordable health care, partnerships with venture and institutional investors to apply technologies to improve health equity, a rise in funding for rural health initiatives and an expansion of the reach of educational initiatives into rural areas. – by Erik Swain

For more information:

Robert A. Harrington, MD, FAHA, can be reached at 300 Pasteur Drive, Stanford, CA 94305; email: robert.harrington@stanford.edu; Twitter: @heartbobh.

Disclosures: Harrington reports he received research grants from AstraZeneca and Bristol-Myers Squibb. Please see the document for all other authors’ relevant financial disclosures.