Lack of access to hospitals, grocery stores is killing rural residents: study

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SALEM, Ohio — People who live in rural areas have less access to hospitals and grocery stores than their big city counterparts, a predicament with potentially dire consequences.

Rural Americans are more likely to suffer from conditions like heart disease, diabetes, kidney disease and hypertension, and more likely to die from those afflictions, the U.S. Department of Agriculture’s Economic Research Service concluded in a study released in March.

The mortality rate for those chronic diseases is 43% higher in rural areas versus urban areas, the Economic Research Service found. Statistical areas with less than 50,000 people are considered rural for the purposes of the study.

The disparities grow even worse among certain demographics. Women living in rural areas have higher mortality rates than men.

Researchers attribute the disparity between rural and urban communities to a lack of health care and difficulty finding healthy foods in regions with few grocery stores — studies show poor diet is a key factor in developing conditions like diabetes and heart disease — and no public transportation.

The study looked at two time periods, 1999 to 2001 and 2017 to 2019. The gaps would likely be worse if the years encompassing the coronavirus pandemic were considered, experts said.

To be clear, denizens of the nation’s urban areas face their own problems.

“Homicide rates are quite high in urban areas,” said Danielle Rhubart, an assistant professor of behavioral health at Penn State.

But the threats to those who live in between the fields and hills that lie far outside the country’s major cities make fewer headlines.

Why is it like this?

Hospitals cluster in populous cities like Pittsburgh and Cleveland, giving rural Americans with complex medical needs a longer drive for necessary care.

Compounding the problem, “rural America has seen a decline in access to healthcare over the last several decades,” Rhubart said.

A 2022 American Hospital Association Report found that 136 rural hospitals closed between 2010 and 2021. The report cited low patient volumes and low reimbursement rates — rural Americans are more likely to rely on Medicare and Medicaid, which reimburse health care providers at lower rates than private insurance.

“It’s also really hard to recruit physicians in rural healthcare facilities,” Rhubart added.

Supermarket chains that sell fresh produce also don’t want to set up shop in places with fewer potential customers, said Kristin McCartney, director of West Virginia’s SNAP Ed program and a public health specialist at West Virginia University.

“The commercialization of the food system has cut out rural areas who don’t have the bigger bang for the buck,” she said. “And mom and pop stores have been driven out of the market” by dollar stores.

The result is a longer drive for rural Americans, and even a 20 mile commute is a high hurdle to clear for poor families without extra money to spend on gas, experts say.

Many of the families the Central Pennsylvania Food Bank works with don’t have cars, instead relying on informal transportation networks made up of friends and family, said Zach Zook, policy research senior manager for the food bank. When no one is available, they can’t get to the grocery store, he said.

Some low-income families simply can’t afford fresh fruits and vegetables, Zook added. “Income is the single most important determinant of food insecurity,” he said.

The only grocery store in Snow Shoe, Pennsylvania — population 765 — closed last year, leaving residents of the tiny borough to shop at a dollar store or make a 17-mile drive to the nearest grocery.

While the closure stemmed from a fire that broke out in the building that housed the store, experts say Snow Shoe’s loss is not unique to small towns.

“Your main option may be a convenience store or a gas station,” Zook said.

Some families find processed foods cheaper, said Bart Hodel, a pastor at the Church of the Nazarene in Charleston, West Virginia and a volunteer at the Midwest Food Bank. “Our church serves a housing project, kids are oftentimes taking care of themselves, they’re going to eat what’s quick and easy and what’s available,” a list that includes chips and pop tarts.

Is there anything that can be done about it?

Not all is lost, experts say.

Investment in rural areas by government agencies and nonprofits can make a difference.

Residents of Vinton County — which has a population of 12,800, making it Ohio’s least populous county — had no place to buy fresh fruit and vegetables until 2017, when a nonprofit grocery store opened in the county seat of McArthur.

Policy changes also make a difference. Zook noted that food insecurity dropped in 2021 when the child tax credit was temporarily expanded, giving families under a certain income threshold $300 per month for each child younger than 6.

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