Regardless of their race, poor rural Americans face similar problems that make it extremely difficult for them to receive adequate health care, reported two experts at the 1997 Biennial Symposium on Minorities, the Medically Underserved, and Cancer in Washington, DC. Many rural Americans are white working poor, noted Linda Linville, phd, assistant director for cancer control at the University of Kentucky Markey Cancer Center in Lexington. Although they technically do not belong to a racial minority, white working poor individuals generally are among the medically underserved.
Limited literacy and physical isolation prevent many of these people from obtaining needed care, she said. As medical providers consolidate facilities because of budgetary considerations and thus close many of the clinics and centers located in small communities, patients need to travel longer distances over bad roads through areas devoid of public transportation. The white rural population, in particular, is also aging as more and more young people seek job opportunities in towns and cities.
Everything is related to everything else, said Linville's colleague, Sandral Hullett, MD, mph, executive director of West Alabama Health Services, Inc., in Eutaw, Alabama. Poor education, economic scarcity, and health problems overlap, Hullett observed.
Preventive care is very important, but crisis is what people are used to because of the many interlocking problems in their lives. In addition to transportation, long waiting times and limited hours of service can become obstacles to receiving care for people who cannot afford to miss work or pay for child care.
Significant Social and Cultural Barriers
Social services are a vital element of health care, Hullett added, because the traditional doctor-patient model does not work for the rural poor. Mental health issues, in particular, receive scant attention despite their extreme importance.
Cultural values, such as male dominance and fatalism, can also become significant barriers to appropriate health care, Linville noted. Some husbands, for example, object to male doctors examining their wives private parts, despite a shortage of female health-care providers.
The economic aspects of managed care raise particularly serious issues for the availability of rural health care, Hullett noted. Technology must be cost-effective in order to be available in rural area, she observed. Incentives to keep providers in small communities must also become a priority, she said.