Health in the Middle of Nowhere, USA

By Margaret Walker – Feinberg School of Medicine and Northwestern Institute for Public Health and Medicine, MD/MPH candidate

As the daughter of a primary care doctor in my small hometown, I learned about rural medicine at the dinner table. I didn’t realize that I was attending lessons on social determinants of health, population health, and the US healthcare system. I just thought I was getting a window into an amazing world in which my mom worked. As I venture deeper into my MD/MPH experience, I am noticing the lack of discussion and knowledge about rural health.

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There are real and distinct differences between small towns and urban areas. Many of which manifest as health disparities. For example, access to care is an issue everywhere, but in rural areas, access isn’t all about wealth. There is an issue of raw distance. In addition, the art of medicine is different in these areas. Family doctors are the “largest single source of physicians in rural areas” as they tend to take care of generations of the same family from birth to death [1]. They act as the pediatrician, internist, gynecologist, obstetrician, geriatric physician, and palliative care specialist. They make house calls as well as take care of acute illness. This means that one needs to travel even further for quality care for a unique issue. 

screen-shot-2017-01-02-at-6-05-56-pmAs Northwestern continues to expand (see image for locations) by acquiring hospitals and doctors, they will need to consider their broader and changing community. This institution cares about addressing health disparities and working to improve health within the Chicago area. However, Northwestern is also in the business of training leaders. Future medical and public health leaders need to realize that 20% of this country lives in a rural area but around 10% of physicians work in rural areas. In addition, rural public health departments face greater expectations and lower resources due to their small size [2]. Policies that are made with the best of intentions may work well in an urban area, with ample doctors and public health programs, but will be unrealistic in other communities. Even doctors working at large tertiary hospitals, like Northwestern Memorial Hospital in downtown Chicago, will come into contact with rural patients. Rural citizens will travel from far away to Chicago for their specialized care. These patient’s priorities and their access to resources after care will likely be different from an average urban or suburban citizen. It is important that both medical and public health students receive education on the public health differences in rural areas regardless of where they work after graduation.

Many of my professors and classmates did not grow up or work in rural areas. However, these are the current and future leaders of medicine and the ones with the political and economic power to influence change in this country. We must be willing to address health disparities of underserved populations, rural and urban, as well as be willing to develop policies and care delivery models that will work for all.

Photo by Markus Spiske via Pexels: Creative Commons

[1] Rosenblatt RA, Hart LG. Physicians and rural America. Western Journal of Medicine. 2000;173(5):348-351.

[2] Rosenblatt, Roger A., Susan Casey, and Mary Richardson. “Rural–urban differences in the public health workforce: local health departments in 3 rural western states.” American journal of public health 92.7 (2002): 1102-1105.

Extra source for demographic information: http://www.aafp.org/about/policies/all/rural-practice-paper.html

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About NPHR Blog (223 Articles)
The is the blog of the Northwestern Public Health Review journal. The blog and journal are both student run and contain research articles, opinions, interviews and other content pertaining to public health.

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