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Federal report shows increased divide between rural, urban health outcomes

A doctor shows a tablet to a patient who is sitting on an exam table in a doctor's office.
The Dying Early in Rural America report called for greater investment in rural communities to address their worsening health outcomes.

The Centers for Disease Control and Prevention issued a report late last month showing that rural communities are dying from preventable causes, such as cancer, heart disease and stroke, at higher rates than those in urban communities.

The report, Dying Early in Rural America, examined premature deaths between 2010 and 2022 for the five leading causes of death: cancer, stroke, heart disease, chronic lower respiratory disease and unintentional injuries, such as falls and car accidents. During this time, more than 6 million premature deaths took place, the report found. The report defines early death as when someone dies before reaching the average life expectancy of 79 years.

The report called for greater investment in rural communities, including public health, to address these discrepancies. The CDC takes a leading role in this effort, said Macarena C. García, senior health scientist in the CDC's Office of Rural Health.

"We fund and guide public health programs in rural communities," she said. "We develop and disseminate resources that are tailored to rural public health needs."

One place where additional resources and other support is crucial is maternal care, said Dr. Alex Heintzelman, a family doctor in the city of Columbiana.

"Maternity deserts across the country in rural places are increasing, and access to obstetric services for women is particularly becoming limited," said Heintzelman, who also serves as a clinical assistant professor of family and community medicine at Northeast Ohio Medical University. "It is relatively expensive to operate a labor and delivery unit in a hospital, and in rural places where there are less people. And with the nation's declining birth rates, there are less deliveries, so that becomes increasingly difficult to fund."

No hospitals in Columbiana County deliver babies, Heintzelman noted, adding that this poses a problem since delays in providing medical support during birth can be dangerous.

"For something like labor and delivery, where a burst can come in at any time, there can be a deterioration of the mother or the child," Heintzelman said.

One way these problems can be addressed is by increasing the number of doctors in rural communities, according to Dr. Randall Longenecker, assistant dean of rural and underserved programs at Ohio University. An effective way to increase this number is through more medical residencies in rural locations, Longenecker said.

"The most effective thing we could do is to intervene in the last three years of training, because that's when most physicians make their decisions about whether they go into a further fellowship and a specialty, or whether they actually go into primary care practice in a rural or even urban underserved location," Longenecker explained.

However, there are obstacles to making this move, including a long-standing cap on the number of medical residencies in the country, Longenecker said. There are also problems with how residencies are funded. The current system funds residencies based on where the hospitals, which are largely urban, are located, opposed to where a resident is practicing, which could be rural.

"If you were going to do one thing, the most effective tool we have is residency training," Longenecker said. "And if you were to do one thing [to increase rural residencies], that would be to change the way funding goes to residency training in rural and urban underserved locations."

There is legislation to address this payment issue, called the Rural Physician Workforce Production Act of 2023, Longenecker added.

The proposed legislation would allow hospitals, critical access hospitals, sole community hospitals and rural emergency hospitals to "receive payment for time spent by a resident in a rural training location if the resident trains for at least eight weeks in the location and the hospital pays the salary and benefits of the resident during this time. Additionally, hospitals may receive payment for all time spent by residents in a residency program in which 50% of all training is in rural locations, regardless of where the training occurs or specialty," according to Congress.gov.

However, Longenecker said this legislation has been introduced for the past six years without gaining much momentum.

Stephen Langel is a health reporter with Ideastream Public Media's engaged journalism team.