Essay Published in "Rural Health Communications, Presidential Edition"
In the county where I farm, there is not a doctor, dentist, pharmacist, or hospital bed. Across our country, 700 counties or parts of counties, with a combined population of 35 million, have been identified as critical health shortage areas. Almost a third of our people live in rural areas, and yet they are served by less than 20 percent of our professional health personnel.
Rural America has many special needs. One of the most important is reform of our health care system to provide access to regular, high quality care for rural citizens at a cost they can afford.
As in many other areas, the Republican Administration has shown only ignorance of—an insensitivity toward—the health needs of rural people. Their needs will not be met through inaction, negativism, vetoes, and a failure of imagination and leadership.
The evidence of need is all around us—the necessity for more doctors and other health professionals in rural areas is only the beginning. We must improve the availability and effectiveness of transportation. We must insure that our rural hospitals remain modem and efficient. We must make health services—from dental care to prenatal and child care to mental health services—accessible and affordable.
Children in metropolitan areas average 2.3 visits to the dentist each year. In rural areas they average 1.6. People in rural areas are less likely to see a doctor in a given year than residents of urban areas. In rural areas, the rate of deaths from accidents is four times the national average. Medicare and Medicaid reimbursement payments are lower for rural areas than urban areas, even though the expenses of medical practice are higher in rural areas.
These statistics measure social injustice as much as medical inadequacy, because every shortfall in the health of our rural citizens shortchanges the rural poor the most. In a recent study, 70 to 80 percent of the children from low income families in rural areas had unconnected dental problems. The average life expectancy of migrant farmworkers is 49 years, a shocking 23 years less than the national average. The average annual Medicaid payment for a child from a low income family is $76 in central city areas. In rural areas it is $5.
We must move quickly to adopt health policy reforms that focus on the special needs of rural areas, and that bring care within the reach as well as the means of all our people. Specifically:
• We must encourage, rather than penalize rural medical practice. We must begin correcting the geographic maldistribution of health professionals, and encourage young professionals to train and practice in rural areas. Reimbursement under public programs should not discourage rural practice. We must minimize the burdens on the rural provider by making available services patterned after the continuing education programs of the Area Health Education Centers and the communication capabilities of the Medical Information Service via Telephone (MIST program) in Alabama.
• We must make regular care available to rural residents. Transportation facilities must be upgraded. Primary care, such as services by family practitioners, internists, and pediatricians, should be stressed. Preventive care, nutrition programs, the early detection of crippiers and killers, and the abatement of environmental and occupational health hazards must be emphasized. We should encourage group health practices, primary health centers, and community health centers.
• We must initiate reforms in health delivery that reinforce other rural development improvements, such as better housing, improved sanitation, more jobs, and other needed changes. Our purpose must be to promote the health of our people, not just to provide health services as such.
A strong, creative partnership between concerned professionals, interested citizens, and a streamlined, efficient, and responsive government can ensure that the health needs of our rural people are met with skill and compassion.
NOTE: The APP used October 1 as the date for this document. The original source stated that this appeared in the "October 1976" issue.
Jimmy Carter, Essay Published in "Rural Health Communications, Presidential Edition" Online by Gerhard Peters and John T. Woolley, The American Presidency Project https://www.presidency.ucsb.edu/node/347657