Rural Health

Illinois residents living in rural areas face unique challenges and health disparities that impact cancer prevention, screening and early detection, and diagnosis, treatment, and survivorship.

Lack of health insurance coverage is a significant barrier to accessing needed health care and to maintaining financial security. Individuals without insurance coverage may have serious health consequences as individuals may seek less preventative care and delay care. Uninsured individuals may be unable to pay medical bills, resulting in financial consequences and medical debt.

The Health Resources Services Administration (HRSA) has defined Health Professional Shortage Areas (HPSAs), which are geographic areas, population groups, or health care facilities designated by HRSA as having a shortage of health professionals. Medically Underserved Areas (MUAs) and Medically Underserved Populations (MUPs), identify geographic areas and populations with a lack of access to primary care services.

The Southern Illinois University School of Medicine Department of Population Science and Policy published a report, Building a Healthier Rural Illinois, describing the most pressing issues facing rural Illinois.

Rural counties have higher rates of smoking, obesity, child poverty, and teen pregnancies compared to urban counties. The result is Illinois residents living in rural areas are more likely to die from the five leading causes of death (heart disease, cancer, unintentional injuries, chronic lower respiratory disease, and stroke).

Rural hospitals also provide fewer mental health services. Mental health providers are often in shortest supply.

Rural communities are at a disadvantage because of food, health care, social service, and internet data deserts. Many rural communities have insufficient access to essential services, such as grocery stores, health care providers, public transportation, and educational institutions, as compared to urban communities.

Rural areas also experience organizational and technological disconnections. Large areas across Illinois cannot access broadband or internet with speeds of at least 25 Mbps. In addition to having limited or no quality high speed internet access, many rural residents do not have the hardware or skills needed to take advantage of high-speed internet. A lack of access to technology prevents rural residents from accessing work and learn at home opportunities, applying for jobs or schools online, and maximizing opportunities to receive care via telehealth. Many rural residents, especially older individuals, may either distrust technology or lack the know-how to access services that were pushed online like virtual physician visits.

Rural residents also suffer from disconnected social service sectors. The lack of collaboration between health care systems, schools, and public health departments may result in duplication of services. Increased collaboration between these entities could reduce silos and duplication of services.

The Federal Communications Commission reports on internet service providers reporting broadband service. The FCC currently defines a “broadband” internet connection as one that provides at least 25 Mbps for download speed and 3 Mbps for upload.

For some types of cancer, patients living in rural areas may be more likely to be diagnosed with cancer at a more advanced and less treatable stage. Strategies to enhance access include reducing travel distance to access health care by offering mobile screening/treatment and telemedicine. Mobile cancer screening and treatment may connect rural communities with health care services. Services provided by mobile units include various cancer screenings, prevention education, early detection, and health counseling.

The following strategies will help to build healthy rural communities, improve health, and reduce cancer disparities. More information on these strategies is available at https://www.countyhealthrankings.org/take-action-to-improve-health/what-works-for-health.

Provide educational and behavioral interventions that support patients’ ability to actively manage their condition(s) in everyday life.

Combine information about HPV and the benefits of vaccination with efforts to support vaccine series completion (e.g., patient and parent education or reminders, physician education, etc.).

Engage professional or lay health workers to provide education, referral and follow-up, case management, home visiting, etc. for those at high risk for poor health outcomes; also called promotores de salud.

Tailor health care to patients’ norms, beliefs, and values, as well as their language and literacy skills.

Position registered nurses within a parish or similar faith community, or in a health care system to serve as a liaison to congregations; also called parish nursing or congregational nursing.

Provide health insurance outreach and support to assist individuals whose employers do not offer affordable coverage, who are self-employed, or who are unemployed.

Increase patients’ health-related knowledge via efforts to simplify health education materials, improve patient-provider communication, and increase overall literacy.

Expand incentives such as scholarships and loans with service requirements and loan repayment or forgiveness programs for health care providers who practice in rural or other underserved areas.

Inform adolescents, young adults, and parents about HPV and its consequences, as well as the benefits of vaccination, via videos, printed materials, online content, or in-person efforts.

Provide continuous, comprehensive, whole person primary care that uses a coordinated team of medical providers across the health care system.

Use payments, vouchers, and other incentives to encourage patients to undergo preventive care, such as screenings, vaccinations, etc.

Provide culturally sensitive assistance and care coordination, and guide patients through available medical, insurance, and social support; also called systems navigators.

Support joint decision making between health care practitioners and patients through shared decision making (SDM); part of patient-centered care.

Expand medical school training and learning experiences focused on the skills necessary to practice successfully in rural areas.

Establish transportation services for areas with low population densities using publicly funded buses and vans on a set schedule, dial-a-ride transit, volunteer ridesharing, etc.

Deliver consultative, diagnostic, and treatment services remotely for patients who live in areas with limited access to care or would benefit from frequent monitoring; also called telehealth.

Provide mental health care services (e.g., psychotherapy or counseling) via telephone or videoconference.

Provide reminders, education, or self-management assistance for health conditions, especially chronic diseases, via text message.