Rural communities across the country, including in Northeast Ohio, have significantly higher mortality rates when compared to more urban communities, according to a U.S. Department of Agriculture report published in March.
The USDA report found rates of natural-cause deaths in 2019 were 43% higher than rates in urban populations among people among people ages 25 to 54. That gap was far wider than it was 25 years ago, when mortality rates were similar between urban and rural communities for this age group. The agency also found that white non-Hispanic men and women ages 25 to 54 had the greatest growth in mortality rate discrepancy over the past 25 years.
The USDA focused on this age range because "increased mortality rates in the prime working-age group are an indicator of worsening population health, which can have adverse implications for the economy and employment," according to the report.
Medical officials in Holmes and Tuscarawas counties, both predominantly rural, told Ideastream Public Media that higher mortality rates are due to inadequate access to care stemming from a variety of causes, including declining numbers of doctors, fewer rural hospitals, lack of transportation and inadequate internet service.
Jennifer Demuth, Tuscarawas County Health Department's director of Health Promotion & Community Relations, said the problems start with not having enough doctors.
"We do have less physicians in rural areas than our urban counterparts," she said. "And just the idea of having less physicians can make it very hard for rural residents to access care."
Jason Justus, the CEO of Pomerene Hospital in Holmes County, said one way to address the lack of physicians is for medical schools to prioritize rural health.
"You've got to make a dedicated effort to be able to invest in those programs and add additional residency slots and ... say, 'You don't always have to work in an inner city or a large metropolitan area to be able to fulfill your desire to care for community,'" he said.
Justus added another obstacle is the fact there are a declining number of hospital systems in rural communities.
According to Justus, between 120 and 160 rural, small-group community hospitals have closed since 2010. He added that nearly 25% of remaining rural hospitals are vulnerable to closing as well.
This has led to problems for women's health, particularly obstetrics and maternity care, he said.
"There's a new term that has really been ramping up quite a bit and that is 'OB deserts,'" he said. "There are many areas throughout rural communities, all throughout the country, where various hospitals have identified that they can no longer support the entire service line for OB or maternity, which means, those physicians are gone, the service lines are gone."
Justus said a cooperative effort to secure greater investment in local healthcare systems is needed to turn the tide of hospital closures.
“It really is going to need to be a balanced effort from the health care community working with their local representatives within the government or within the region to seek investment, from either a state or federal level agency, to fund these types of infrastructure building projects,” he said.
Beyond availability of healthcare, rural populations face obstacles accessing care due to factors such as a lack of transportation or not having the time to go see a doctor, Demuth said.
"Oftentimes, even if a rural resident can find a physician who is welcoming new patients, it's not always easy to get to that physician's office," she said. "Geographically, we're very spread out, and it can be difficult to get to a location where a physician office may be located."
It can also be difficult for these residents to use telehealth as many lack sufficient internet access, she said.
Demuth said Tuscarawas County addresses these problems through Healthy Tusc, a coalition of more than 30 health and social services agencies. The coalition tries to help ease access to healthcare by providing transportation, setting up mobile healthcare units, providing "pop up" health services in areas throughout the county and providing access to fitness facilities, healthy foods and more. The county also partners with a group, Empower Tusc, which helps residents address smoking, vaping and other hazardous addictions, she said.
One agency alone will not solve the problem, Demuth said.
“We could not achieve our goals without everyone working together," she said. "You know, as a health department, we can bring certain expertise and resources to the table. But we don't have all the pieces. Change and improvement doesn't happen in a silo.”
