Equitable care for rural Iowans: an editorial

Statistics show that 20% of Americans live in rural areas, yet only 9% of doctors live in those same communities (van Dis, 2006).

According to Stanhope and Lancaster (2016) social justice is an equitable balance of burdens and benefits for all community members. Benefits include things like quality education, access to healthcare, and access to wealth and resources, while burdens include things such as taxes, exposure to unsafe environmental factors, and military service (Stanhope & Lancaster, 2016). Populations with unrestricted access to the benefits of society will have better outcomes than those with restricted or no access to benefits, regardless of the contributions and efforts of each group.

Social justice seeks to eliminate disparities perpetuated by systemic oppression by giving disadvantaged communities greater unrestricted access to the benefits of society.    Working as a nurse in Iowa, I provide care for many patients from rural communities. Many patients report missing scheduled appointments and delaying seeking treatment because of the distance and time it takes to see a care provider. Nelson and Gingerich (2010) explain that elderly rural Americans are more likely to have chronic conditions, be considered low-income and are less likely to seek preventative treatment than their urban counterparts. According to research by Merwin, Snyder, and Katz (2006), barriers to rural healthcare include lack of financial resources, and lack of transportation to providers, since there are fewer providers and facilities in rural communities. Statistics show that 20% of Americans live in rural areas, yet only 9% of doctors live in those same communities (van Dis, 2006).

             It is common on my palliative care unit to admit patients who had waited too long to seek care and find themselves beyond the point of curative treatment. In these cases, primary and secondary prevention methods are unable to function as the safety nets they are in communities with greater access. It is frightening to think how many of those patients would have sought treatment if they had simply access in their own community. I have listened as patients grieve their circumstances, wishing they had acted sooner, but they were limited in access to care and pay with their lives.  

            Nelson and Gingerich (2010) make suggestions for improving healthcare access for rural Americans through the collaboration of rural providers to identify and address the most pressing community needs and populations. This assessment should also occur through discussion with community members with a focus on improvement models that have already helped other communities, such as the growing field of telemedicine.

            Individual nurses can have an impact on social justice for rural patients by listening to them as they describe their needs and problems, and advocate on their behalf.  Nurses can also be active in organizations that support political candidates and legislation that aid rural communities in gaining access to adequate healthcare. Volunteerism in these communities is also a valuable contribution of working nurses, whether it be in free or pop-up clinics. These actions can be taken by the nurses on the personal, community and national levels with the intent of creating a more equitable distribution of healthcare resources for rural Americans. 

References

 Merwin, E., Snyder, A., & Katz, E. (2006). Differential Access to Quality Rural Healthcare: Professional and Policy Challenges. The Journal of Health Promotion & Maintenance - Family and Community Health, 29(3), 186–194. Retrieved from http://journals.lww.com/familyandcommunityhealth/Abstract/2006/07000/Differential_Access_to_Quality_Rural_Healthcare_.5.aspx

Nelson, J. A., & Gingerich, B. S. (2010). Rural health: Access to care and services literature review. Home Health Care Management & Practice, 22(5), 339–343. doi: 10.1177/1084822309353552

Lancaster, J. (2016). Applications of ethics in the community. In M. Stanhope & J. Lancaster (Eds.), Public health nursing: Population-centered health care in the community (9th ed., pp. 121-138). St. Louis, MO: Elsevier

van Dis, J. (2002). Where we live: Health care in rural vs urban America. Journal of the American Medical Association, 287(1), 108. doi: 10.1001/jama.287.1.108-JMS0102-2-1