One major problem is the trend of rural hospitals closing, leaving nearby residents further to go to receive emergency care.

According to an article recently published in the Vital Record by Christina Sumners, people living in rural areas face greater health challenges than their urban counterparts. It seems that simply living some distance from health care providers can create disparities in care that are difficult to overcome.

“Access is the number one issue that has the most negative impact or effect,” said Jane Bolin, PhD, JD, BSN, professor at the Texas A&M School of Public Health, senior editor of Rural Healthy People 2020 and director of the Southwest Rural Health Research Center.

These issues of access include lack of health insurance, as often there may be a lack of competition among insurance carriers, leading to unaffordable rates, and a lack of nearby health care providers—from doctors, nurses and emergency care to dentists and pharmacists—which leads to increased risk of illness or even death.

However, even with perhaps an obvious cause, quantifying the problem isn’t simple, and neither are the solutions. Even classifying what constitutes a rural area isn’t an easy thing, and different federal agencies have different methods. “Ultimately, how we’re able to classify level of ‘rurality’ depends upon what we can drill down, which is completely dependent upon what is in the data,” Bolin said. “You might ask where to make the rural versus urban cut-points, but that too depends on what you wish to do.”

Still, there are some areas that nearly everyone can agree are rural, and people living there tend to experience a variety of health disparities.

One major problem is the trend of rural hospitals closing, leaving nearby residents further to go to receive emergency care. Such closures lead to other problems as well. “Every time a rural hospital closes it is a crisis and tragedy for that town,” Bolin said. “In addition to losing the services, the small town also loses the workers, specialists, families, and revenue that accompanies higher-paid workers and professionals.” Vulnerable hospitals tend to be especially common in Southern states and all states that did not expand Medicaid with the Affordable Care Act, according to Becker’s Hospital Review. Oklahoma is an example of both.

One of the groups hurt the most by hospital closures might be new mothers living in rural areas. Texas A&M School of Public Health researchers found that rural women are more likely to be rehospitalized after giving birth—and that’s if they make it to the hospital to have their babies in the first place.

The health disparities don’t end after the child is born. In fact, rural children have a higher prevalence of mental, behavioral and developmental disorders than those living in cities and suburbs, according to the Centers for Disease Control and Prevention (CDC).

“Rural children have many challenges with few resources—such as psychiatrists, psychologists, social workers, and counselors—to help them or their parents find needed support,” Bolin said. “Rural school districts are not well funded, and so they likely do not have the school nurses, school counselors, and psychologists to pick up on childhood mental, behavioral or developmental problems.”

Just as the problems are complicated, so are the solutions, but Bolin said it all begins with focus on the issue and advocacy. “Rurality is considered to be one of the 14 biggest health disparities,” she said. “So, if someone is a minority, unemployed, poor and rural they face almost insurmountable challenge, and this is especially critical in forgotten parts of the United States like coal-mining country, rural Appalachia, Indian reservations, the Lower Rio Grande and the U.S.-Mexico border. I would point to all of these health care access issues and add hopelessness, so if we can shed light on the issue and advocate for people in these areas, we can start to make a difference.”

Locally, Community Health Center of Northeast Oklahoma, Inc., continues to serve the area with the finest in personalized healthcare for the entire family with locations in Afton and Grove. For details or to schedule an appointment contact (918) 257-8029 or (918) 801-7504, check us out on the web at, follow us on Facebook, Twitter and Google+.

– Lee Hilliard, D.Min., Th.D., CAC, is the Outreach and Enrollment Specialist at the Community Health Center of Northeast Oklahoma. For local enrollment assistance with Marketplace, Insure Oklahoma or SoonerCare, please contact Lee at 918-219-4486 or