Expert: Rural Adults Are ‘More Likely to Die of Almost Every Single Illness,’ Yet Access Disparity Continues to Run Counter to Incidence

Pharmacy Times interviewed Jakob Jensen, PhD, professor in the Department of Communication at the University of Utah and member of the Huntsman Cancer Institute, on a study he was the senior author of that assessed rural residents’ beliefs and perceptions of cancer-related information in comparison with those of urban residents.

Alana Hippensteele: So, Dr. Jensen, what is access to health care infrastructures like for adults living in rural areas?

Jakob Jensen: I'm a rural person myself. I originally was born and raised in a town of 600 people in eastern Montana. So, I have a deep familiarity with access issues, a lot of rural communities are without a hospital, some are without a clinic. Even when they have a clinic or a hospital, sometimes their health care staff rotate.

So, you might have a doctor, for example, on Monday, but not the rest of the week. Or you might have a rural public health nurse. In the afternoons on Thursdays and Fridays, you obviously, given that limited infrastructure, you don't have specialists, you likely don't have direct access to a lot of analysis and detection tools. And so, for rural adults, and individuals living in a rural community, you get used to having to travel for your health.

Living in Circle, Montana, if I wanted really any kind of health care beyond just our basic rural clinic, I had to travel 4 hours to Billings, Montana. And so, that creates logistical and access issues that they don't just exist on the page, they they're real things. They affect whether you go in when you feel pain or feel a symptom, or even when you go in, which I think becomes a huge obstacle in health care.

Alana Hippensteele: Absolutely. How does this level health care access compare to that of adults living in urban areas?

Jakob Jensen: Well, there are issues for adults living in urban areas as well. And I don't want to be too utopian with my perspective on what it's like to live in the city. Again, I'm a country mouse. But access is the big thing—you have a proximity to care, and the ability to schedule appointments in a more flexible manner. That's just not possible to replicate for our rural adults. And the deeper you get into the health care system, the more this is magnified.

So, the more that you need beyond consultation with a general practitioner, or with a public health nurse, the more that there are huge service gaps between urban and rural individuals, right. So, I would just say, I currently live in Salt Lake City. So, when I want to see a dermatologist, we have a dermatology clinic here that, if you call in at 7 in the morning, they'll schedule you for that day, and you can just come in and they'll check a mole for you. For rural adults, that's just not something they have access to. And that's a telling example because skin cancer rates are much higher in rural adults. For example, melanoma is identified at a later stage. So, notice that that access disparity runs counter to the incidence, right? The urban adult can make the appointment, the day of the rural adult is not even though the rural adult is at higher risk.

Alana Hippensteele: Right? What is the impact of less access to health care infrastructures on adults living in rural areas—you touched on that a bit, but just kind of perhaps diving into that a little further.

Jakob Jensen: Rural adults are far more likely to die of almost every single illness you can think of. When they're diagnosed with an illness, it's far later stage than their urban counterparts and they're less likely to engage in follow up clinical visits.

In fact, a follow up rate for rural adults is not even a third of what it is for our urban adults. So as a provider, be mindful those rural adults are far less likely to come to return appointments. And in fact, it might even have implications for how you schedule, right. And a lot of practitioners that serve large rural populations are mindful of this. And they'll think like, can we schedule this follow up sooner? Or can we try to schedule it around another activity where I know you're going to be here? Because when there's a 4-hour distance, it's just everything becomes harder or something like that, right?

And then some people are dealing with a larger distance than 4. I mean, you know, that's hoping that 4 hours from you, there is the specialist you need. Sometimes that specialist is 12 hours. Sometimes that specialist is 2 states away. And it's also important to remember that when you think about rural populations, remember that there's so much geographic difference in disparity. So rural adults, for example, in the Western United States, the distance is a huge issue, because the Western United States is so huge, right? Where there are also geographic issues, for example, for rural adults in the South, the Midwest, and the Northeast. Sometimes their cost barriers are higher, right. Sometimes there's other barriers they must navigate. But, you know, in the West, distance is just a huge part of the day-to-day life for our rural adults.