Geographic health disparities are a key problem for public health and care delivery. The health of people especially in rural areas is of great concern to health systems, as in these areas, the mortality rate is higher than in urban areas.
In the US alone, mortality in rural areas reaches 831 people per 100,000 population, compared to 704 people per 100,000 population in urban areas. Rural residents in the US have higher rates of chronic diseases such as diabetes, obesity, chronic obstructive pulmonary disease, and suffer more from stroke, unintentional injury, tobacco use, opioid overuse, cancers associated with modifiable risk factors, suicide, poorer health in mothers, reduced trust in the care system, but also limited access to care.
Geographical health inequalities are also seen in health systems in other high-income countries, with the worst health being found in rural areas of Australia and Canada.
In France and the Netherlands, there is evidence of worse perinatal health for women living far from hospitals, indicating that living in a rural area is a risk factor.
The above is highlighted in a study published in JAMA titled “Mapping Health Disparities in 11 High-Income Nations“, by researchers from the University of Augusta, Georgia, USA, the international health policy program of the Commonwealth Fund of New York and the education department of the Scottish Health Service. The aim of the study was to describe health inequalities in 11 high-income countries.
The study involved a random sample of 22,402 respondents aged 18 and over from Australia, Canada, France, Germany, the Netherlands, New Zealand, Norway, Sweden, Switzerland, the UK and the US. The investigation involved 10 health indicators and 3 domains (health status and socioeconomic risk factors, affordability of care, access to care).
The pandemic brought to the fore the geographic health disparities of rural areas and exacerbated them. Rural populations had higher death rates from COVID-19. The COVID-19 variant hit rural areas the hardest, where vaccination rates were lower.
In addition, health professional shortages and health facility closures increased during COVID-19, compared to pre-COVID-19 trends. While the US invested more health resources in rural areas during this period, further interventions are needed to mitigate geographic health disparities.
Despite known and documented disparities internationally, the researchers point out that policymakers have limited understanding of the prevalence of geographic health disparities.
Results
In 11 countries there were 21 cases of geographical health inequalities, in 13 of which rural residence was a protective factor and in 8 it was a risk factor.
The US had statistically significant geographic health disparities in half of the indicators (5 of 10 indicators), the most of any country, while Canada, Norway, and the Netherlands had no statistically significant geographic health disparities.
The indicators with the most occurrences of geographic health inequalities were in the area of access to care.
The country with the lowest rates of respondents with multiple chronic conditions (178 out of 1004, i.e. 15.8%), mental health conditions (114 out of 1004, i.e. 10.3%), or material difficulties (62 out of 1004 , i.e. 6.1%) was Germany.
The US had the highest or one of the highest rates of multiple chronic conditions (704 of 2489 or 28.4%), mental health conditions (781 of 2489 or 29.0%), or material difficulties (415 of 2489 or . the 16.3%).
In terms of affordability of access to care by adults in the region, the US had the highest rates of skipping necessary medical (39%) or dental care (36.2%).
Norway and Sweden had the lowest missed medical care at 8.2% and 11.2%, respectively, and the lowest missed dental care at 21.4% and 22.2%, respectively. The two countries also had the lowest rates of serious problems with not being able to pay medical bills, with Norway limited to 6.3% of citizens and Sweden to 7.5%, while in the US the figure rises to 22.4%.
People living in rural areas in Canada (89.9%), Sweden (86.7%) and the USA (89.2%) had the least access to medical care and the lowest rates of having a regular doctor or care facility ). As for cases requiring treatment of a medical problem on the same day, only 33% of Swedes, 38.2% of Canadians, 46.9% of Norwegians and 49.2% of Americans had access.
The Netherlands was the country with the best access to medical care, with 97.7% having a regular clinician or place of care, and 71% receiving care on the day they needed it and only 30.7% having difficulty accessing it in late night care.
