The Dilemma of Rural Health

Hey everyone! It’s Jada again! This week I want to introduce a topic that has become a passion of mine– rural health. In my previous blog, I talked about my desire to become a physician assistant (PA). This career can also play a huge role in improving rural health, which is an increasingly important issue especially here in Iowa.

The public health program has taught me to think beyond the surface level of labeling populations “healthy” or “sick”. The healthy/sick determinants are based on a multitude of different underlying attributes, such as socioeconomic status, race, gender, age, location, employment, etc. One of these determinants that really stuck out to me was location. I remember being introduced to the topic of rural health in a class we have here called Fundamentals of Public Health. A woman from Great Plains, a center for agriculture health, came in to talk about farmers and the health barriers they face. I think part of the reason this stuck out so much to me is not only has this issue been in front of my face my entire life (Iowa native), but farming is such a large industry in Iowa. Farming is all around us here in Iowa, no matter what city you live in.

For starters, let’s look at rural health here in Iowa.

Screen Shot 2019-03-16 at 10.58.30 AM

This map shows all the counties in Iowa that are deemed “health professional shortage areas” (HPSA) in red. This map is by the Iowa Department of Public Health(IDPH).

Looking at this map alone, shows how big of a problem it is here in my home state. Just about 50% of Iowan counties are shown in red. Let the number sink in for a second. These are the people that will have to drive long distances for a routine checkup. An hour long ride to the doctor. These are people with general practitioners that also serve as their OBGYN, podiatrist, orthopedics,  allergist, cardiologist, etc. When I first processed this thought, my question was now what do people in these areas do in the event they get severely injured or deathly ill? The times when driving 30 minutes is even too long?

The IDPH recognized this problem long ago and has since then attempted to use many different strategies to fix this. They have started many different research plans geared towards intervention and access analysis as well as launching various campaigns (Read Madison’s post about these!). But how does the role of clinicians fit into solving the problem?

Screen Shot 2019-03-16 at 10.56.30 AMHere’s the answer! This is a map of rural health clinics strategically placed throughout Iowa. Notice how their placement tends to match up with the HPSAs from the previous map?

PAs specifically can offer a big help with these clinics. PAs in these clinics, or in any setting, increase the number of patients seen in a day. PAs can diagnose and treat, just like a doctor which allows for more patients to be seen. In many instances, PAs serve as general practitioners. The National Commission of Physician Assistants reported that over 25% of PAs nationally serve as general practitioners in public and private practices. Although that number might seem small, the profession is a projected to grow 37% by 2026! The IDPH recognizes how efficient and beneficial PAs can be in the rural underserved areas and now offers new PAs large incentives. They offer large sign-on bonuses for agreeing to work in these areas as well as 3-5 year service contracts to pay off student loans. As the number of available clinicians increases, the number of rural health clinics will also increase.

Along with rural health clinics, there are also hospitals known as Critical Access Hospitals(CAHs). These hospitals are meant to serve rural communities in emergency situations, and are often connected to a rural health clinic. There is a CAH located in Anamosa, which is about an hour north of Iowa City. This hospital is also connected to their rural health clinic. A few PAs there work as  general practitioners but also serve in the ER or other departments part time. PAs play a versatile role in bridging the gap in rural healthcare settings.

Screen Shot 2019-03-16 at 1.13.34 PM   Map of Iowa’s CAHs

Here at Iowa’s undergrad Public Health program, I am able to take courses that give me more exposure to this topic. These rural communities in Iowa tend to be agricultural communities, which also plays a role in the rural health disparity. Some classes I’m excited to take in regards to this include Agriculture, Food Systems, and SustainPublic Health Policy and Advocacy, and Geography of Health.

If you’re interested to learn more about rural health in Iowa check out this website! http://idph.iowa.gov/ohds/rural-health-primary-care

Thanks for reading!! If you have any questions regarding this post, about admissions, or public health in general, please reach out to us at: CPH-Undergrad@uiowa.edu

Check back next week for a new post! Enjoy your spring break!!

Jada

 

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