Rural life can provide benefits and drawbacks for Tennesseans. On this week’s episode of HealthConnection, Dr. Carole Myers, a professor emeritus in the University of Tennessee College of Nursing, talks with Dr. Tracey Stansberry, a UT College Of Nursing faculty member and a Tennessee Healthcare Campaign board member, about health disparities between rural and urban Tennesseans.
WUOT’s Carole Myers: Rural people in general are older, poorer and less healthy than their urban counterparts. Relatively poor access to healthcare access is one factor, but it’s not the whole story. Various economic, political, social and other factors exert both positive and negative influences. So, Dr. Stansberry, let’s jump right in and begin defining the problem you’re discussing: rural health disparities.
Tracey Stansberry: So, health disparities are preventable differences in health outcomes and usually we’re speaking about populations when we refer to health disparities and while we expect there to be some difference in health outcomes for instance, among different ages of people, what we are most concerned about are preventable differences which are not acceptable. My primary focus today in this conversation and in my research is the going disparity between rural and urban health outcomes.
Well, say more, Dr. Stansberry, about the significance and the effects of health disparities in rural areas. Let’s look at the problem a little deeper.
Well, we’ve known for the last couple of decades that the nation’s rural disparity is growing, and we have seen evidence of that. While health outcomes in urban areas are improving, they are declining or worsening in rural areas. A particular concern is that younger people in their working years are dying earlier, though that’s a concern beyond just the fact that they are passing away earlier. We are concerned about those years of productivity lost and the impact that that would have on a rural community. We would expect that that could depress local economies and accelerate a downward spiral of poor health and poverty in these communities. Any type of insult to the income and the economy of a rural community can further have negative impacts on the health of those communities and of the citizens that live there. You mentioned earlier this declining access to care imbalance, one of the biggest areas of concern are the rural hospital closures. Tennessee does lead the nation on a per capita basis for hospital closures and this can have a negative impact on critical healthcare access, so people can’t reach those services when they need them, particularly emergency care. But also, when a hospital closes this can pull the rug out from underneath their economy. More recently, we decided ‘so what’s going on with these hospitals that are still operational despite all the odds stacked against them’. We examined six different hospitals, five of which were across rural Tennessee, and we also spoke with leaders in Kentucky from one small community there. What we learned was that while many of these community hospitals are surviving, they aren’t necessarily thriving.
What can we as a state do to effectively tackle these disparities that we’ve just discussed?
A multi-layer approach to solutions will be needed, but one measure stands out and that’s expanding Medicaid in Tennessee.
This transcript has been lightly edited for content.
Note: The Tennessee Health Care Campaign released a report in March 2024 on the second of two studies on rural hospital closures. The complete 2024 report can be accessed here and policy recommendation are available here.
