Dartmouth report IDs challenges of rural health care

By William Skipworth/ NH Bulletin

Dr. Joanne Conroy, president and CEO of Dartmouth Health, wrote in a report released Friday that a recent meeting of rural health leaders in Hanover “offered a clear and urgent mandate: advancing rural health is not optional.”

In the U.S., 20% of Americans live in rural areas, yet only 9% of physicians serve rural areas. In May, the Rural Health Symposium, hosted by Dartmouth Health and the Giesel School of Medicine, brought 271 people from the rural health field to Hanover to address the repercussions of that.

Panelists at the symposium discussed the factors within rural areas driving disparities and deficits in health care. Some of the factors identified include transportation issues, rural hospital closures and provider shortages, threatened cuts to Medicaid and Medicare, (which since the symposium have become imminent) lack of affordable housing, and poverty. They also discussed underinvestment in public infrastructure, mistrust in health care institutions, and how poor social networks — particularly for LGBTQ patients and patients of color — impact health outcomes.

In addition to poor health outcomes, panelists argued these factors are resulting in higher hospital readmissions, patients receiving less preventative care, and more people using informal sources for medical advice. Panelists also floated potential solutions: creating a new designation for rural emergency hospitals, expanding telehealth, and partnerships with community health workers, housing trusts, and nongovernmental organizations.

There was also a panel focused on how preventable causes of early death like cardiovascular disease, diabetes, and cancer are significantly higher in rural areas. They argued this was the result of policies designed for urban areas without regard for the different circumstances of rural areas, that generational poverty in rural areas plays a role, and that each rural area is unique, requiring different approaches.

“The symposium reinforced a central theme that echoed across multiple sessions: no single institution or sector can solve rural health inequities alone,” the report read.