The Crisis in Rural Health Care
The new Kansas Center for Rural Health is exploring ways to reduce and eliminate health disparities in rural Kansas.
In an effort to address health disparities in rural parts of Kansas, the University of Kansas School of Medicine has formed the Kansas Center for Rural Health. The center is housed on KU Medical Center’s Salina campus, which is shared by the KU School of Medicine and KU School of Nursing. In making the announcement at the center’s launch in February 2022, KU officials said the center will advance the missions of the schools and KU Medical Center by improving lives and communities in Kansas and beyond through innovation in education, research and health care.
“Through the creation of the Kansas Center for Rural Health, we can find ways to reduce or eliminate these health disparities in rural Kansas by providing the infrastructure needed to support collaborations among researchers, educators and rural health stakeholders across the state,” said Akinlolu Ojo, M.D., Ph.D., MBA, executive dean of the KU School of Medicine and professor of medicine and population health.
Rural areas in Kansas and across the country face many challenges to bettering the health of their communities, including higher percentages of uninsured people than in urban areas and aging populations dealing with more chronic conditions. Moreover, attracting and retaining health care providers to practice in rural communities can be difficult, and many rural areas suffer shortages of physicians, nurses and other professionals.
“There are so many reasons for health disparities, so it will take a multi-disciplinary and multi-sector approach in each and every community to make an impact,” said Robert Moser, M.D., executive director of the Kansas Center for Rural Health and former dean of the KU School of Medicine-Salina. “While some common social determinants contribute to rural health disparities, good community health assessments must help identify those most common for a specific community or region. The model of care to address those will require considering the local and regional resources, and new collaborative partnerships will need to be developed.”
Part of the center’s mission is to address some of the myths that surround the people who live in rural communities and their health care needs. Simon Craddock Lee, Ph.D., MPH, is the chair of the Department of Population Health in the KU School of Medicine. Lee said many people assume that rural America is one homogeneous monolith — entirely agricultural and uniformly white.
“Rural America is more heterogeneous and demographically diverse than we often think it is,” Lee said. “For example, several counties in western Kansas have recently shifted minority-majority as changes in industrial employers have helped new communities to grow and thrive.”
Lee added that while metropolitan communities have a longer history as destinations for immigrants and minorities, counties further from a metroplex are still developing the infrastructure and resources to support the educational, health care, housing and other needs of a more diverse population.
Lee said that there is also a misconception that living out in rural areas is healthier than residing in urban areas.
“Since 2016, we have known that rural counties nationally report some of the highest rates of premature death, lagging far behind other counties,” Lee said. “Perhaps more alarming, while urban counties continue to show improvement, nearly one in five rural counties has experienced worsening premature death rates over the past decade.”
HEALTH DISPARITIES IN RURAL AREAS
- Rural death rates are higher for both men and women.
- The suicide rate is significantly higher in rural areas particularly among adult men and children.
- Hypertension is more common in rural areas. (128.8 per 1,000 individuals in rural areas versus 101.3 per 1,000 individuals in urban areas)
- Only ONE-THIRD of all motor vehicle accidents occur in rural areas but TWO-THIRDS of the deaths attributed to these accidents occur on rural roads.
- Death and serious injury accidents account for 60% of rural accidents versus 48% of urban.
- While 25% of the U.S. population lives in rural areas,
only 10% of U.S. physicians work in those areas.
- More than 470 rural hospitals have closed in the last 25 years.
- There are only 40.1 SPECIALISTS per 100,000 people in rural areas versus 134.1 in urban areas.
- 20% of rural communities lack mental health services compared to 5% of metropolitan counties.
- There are only 40 DENTISTS per 100,000 people in rural areas versus 60 per 100,000 in urban areas.
- 53% of rural emergency medical services are staffed by volunteers, compared with 14% in urban areas
The National Rural Health Association; National Center for Health Statistics, National Vital Statistic System, Mortality
Lee said although all rural Americans have substantial mortality disadvantages compared with their urban counterparts, Black rural residents are at particularly high risk for chronic diseases, including diabetes, hypertension and kidney disease. Similar disparities are also experienced by other rural populations of color, particularly Native American communities. Even newer Hispanic communities in the rural Midwest are experiencing significant disparities in health and health care, despite the fact that Hispanics are, on average, younger than other racial/ethnic groups.
Lee said among all Americans, nearly one-third admit they avoid visiting their doctor “even when they think they should”; however, those avoiding care are disproportionately more likely to be rural residents.
“First, it is harder to access care, and there are fewer providers, clinics and hospitals serving rural communities. Further, when rural residents do access the health system, that care is more likely to be uncoordinated,” Lee said. “On top of that are other socioeconomic barriers to care, such as transportation, lower rates of insurance coverage, as well as concerns about lack of privacy, stigma and a paucity of culturally competent interventions targeted and tailored to diverse rural communities.”
The concept of the Kansas Center for Rural Health was developed over the last two years by the Rural Health Task Force, which started as a KU School of Medicine initiative comprised of medical school faculty and staff, along with community partner representatives. After evaluating existing programs and identifying areas of need to chart a path toward improving the health of all Kansans, the task force developed comprehensive strategies in key areas of rural health — including medical school admissions, medical education, graduate medical education and multi-specialty practice-based research.
Recognizing the need to use a broad approach to addressing rural health disparities and needs, the KU schools of Nursing and Health Professions were included in the rural health task force, which has evolved into the KU Medical Center Rural Health Council.
Moser was appointed executive director, while Karen Weis, Ph.D., the Christine A. Hartley Rural Health Nursing Endowed Professor for the School of Nursing-Salina, serves as director of research, and Lynn Fisher, M.D., associate professor of family and community medicine at the KU School of Medicine-Wichita, is the center’s associate director of service and education.
The Kansas Center for Rural Health will provide a forum for members of the KU Medical Center community to come together with external partners to champion rural health across the state, facilitate ongoing discussions and collaborations around rural health and elevate awareness of research opportunities and rural-focused initiatives.
Moser said in the months since the launch of the center, his team has been busy setting up the infrastructure and partnerships necessary to make the initiative a success.
“One of the things I’m most excited about is the formation of the Rural Health Council,” Moser said. “The council’s mission is to develop a multi-disciplinary and multi-sector collaborative group focused on rural health and includes anyone at the medical center and our three campuses with an interest in rural health.”
Moser said the Rural Health Council has set up several focus areas for the council members, including workforce/pathways; maternal, child and family health; behavioral health/mental health; community health across the lifespan; and multi-specialty rural practice-based research.
One of the center’s most important partnerships is with The University of Kansas Health System’s Care Collaborative. The Care Collaborative is a patient safety organization dedicated to delivering high-quality clinical care to improve the health of people living in rural Kansas communities. It consists of a network of health care providers and care teams who use evidence-based treatment models to achieve the best outcomes. Patients receive advanced, cost-effective care close to home and experience better results.
“We plan to partner with the Care Collaborative and others in their work with rural health entities to support local innovation in addressing disparities, including using community partners like public health and extension services,” Moser said. “The results have shown that focusing on common high-risk, low-volume, time-critical diagnoses can have a tremendous impact on health outcomes.”
Moser said another crucial element in the success of the Kansas Rural Health Center is getting buy-in from rural health care systems, communities and providers in Kansas. Moser, who practiced rural medicine in Tribune, Kansas, for more than 20 years, knows firsthand the rewards and challenges of rural practice.
“I appreciate that rural health care providers have limited time for activities outside of patient care and the limited resources available when trying to implement change,” Moser said. “A big part of the center’s mission is to develop a model to support rural providers adopting evidence-based guidelines by using our staff to collect and analyze data for them.”
Moser said the center can serve as a liaison between the rural providers and the research and expertise that may be needed to address disparities and improve care.
Moser is quick to add that the Kansas Center for Rural Health is not just working with rural physicians, but also nurses and nurse practitioners who work in rural parts of the state. That sentiment is echoed by Lisa Larson, Ph.D., RN, dean of KU School of Nursing-Salina.
“As an integral part of the rural health care workforce, nurses bring a crucial perspective to the health disparities in these parts of the state,” Larson said. “I know my nursing colleagues are looking forward to working with the center to enhance the well-being of all Kansas citizens.”
In the meantime, Moser said his center staff has been busy writing grant applications and working on partner recruitment.
“It is always a challenge to launch a new endeavor like this,” he said. “But we have a great team and motivated partners, so I am confident we will soon start having a major impact on reducing the health care disparities that far too many Kansans are experiencing.”
The Kansas Center for Rural Health receives support from the Patterson Family Foundation and the Salina Regional Health Foundation.
Exploring Disparities in Health and Health Care
In this special issue of Kansas Medicine + Science, we are taking a closer look at the impact health disparities are having on the health of Americans.