DOES RACE PLAY A PART IN DETERMINING AN INDIVIDUAL’S ACCESS TO HEALTH CARE IN RURAL AMERICA?

Published Nov. 8, 2020, 12:21 p.m. by Moderator

 


Relationship between race and healthcare in rural areas in the United States


Abstract


In rural America, racial minorities are a forgotten lot. The rural Black, Native American and Hispanic communities lag behind their White counterparts when it comes to healthcare access and quality of life. Recent studies have shown that the gap in quality of life and access to healthcare between the races disfavors the rural minorities. These disparities can only be understood from a historical context and by digging into the social characteristics of rural America. Rural communities are ‘Balkanized’ and this aggregation of races has resulted in a deprived quality of health services for the areas that are majority Black, Hispanic, or Native American. The disparities are a consequence of higher illiteracy and lower-income levels among minorities as compared to their White counterparts.


Keywords: Race, Healthcare, Minorities, Rural, Urban


Introduction


The United States healthcare structure has frequently been a point of friction pitting the so-called ‘socialists’ who believe in universal healthcare for all and their opponents, the ‘conservatives’ who believe that healthcare for all is a mirage; everyone should be able to take care of their health needs without the intervention of taxpayers. This approach goes against the universal principle that “access to healthcare is a human right that shouldn’t be denied to any person because of their gender, race, religion, or economic background.”


 The statistics are damning. In 2013, the United States Census Bureau recorded that nearly 42 million Americans lacked health insurance. The number of insured has increased since then but the most recent data reports show that 29 million Americans still lack insurance (Kippenbrock, Odell & Buron, 2017).  According to the 2017 health insurance coverage data released by the Centers for Disease Control and Prevention; the percentage of Americans with no form of health insurance coverage stood at 12.8% of the national population (NCHS, 2017).


 The southern parts of the country are faring worst compared to the rest of the country. Texas has the uppermost percentage of uninsured Americans at 18.6%, Oklahoma 16%, Alaska 15.9%, Florida 15.2%, Georgia 14.7%, Mississippi 13.7%, Nevada 12.8% all surpassed the nationwide average (NCHS, 2017). The majority of the population in these Southern states is classified as rural and is predominantly White. Rural areas have fewer health care providers or medical centers. The rural populations are also mostly conservative and still hold biases that existed before the abolition of slavery. This makes healthcare for minorities, not a priority.


Problem Statement


Minority communities in the United States especially those in the rural areas face hardships in accessing healthcare and have a lower quality of life when compared with their White counterparts. Rural health facilities already lag in terms of personnel and equipment. In the cities, the hospitals are equipped with specialized equipment and qualified personnel. In the countryside, there is a lack of specialized healthcare providers or medical centers health care facilities and providers to provide access at all. Residents in rural areas have to travel long distances to nearby urban centers to receive specialized treatment. This is problematic when it comes to emergency treatment or life-threatening diseases. Rural areas have higher mortality rates compared to urban areas. Rural inhabitants in the Southern parts also registered higher levels of poverty and were more prone to adult smoking, physical idleness, heart diseases, and teenage pregnancies. The rural residents in the Midwest also had higher incidences of substance abuse, alcoholism, and suicides. In the Northeast, rural residents suffered most from dental loss (AHRQ, 2018).


In 2016, the number of Americans living below the poverty line was highest among Blacks at 22% and Hispanics at 19.4% and lowest among Whites at 11%. Studies also show that racial bias among healthcare professionals also limited access to healthcare. Health care practitioners had an upbeat outlook toward Whites and an unenthusiastic attitude towards non-Whites. Though there were no significant findings to conclude that this approach affected healthcare outcomes (AHRQ, 2018). It did make the patients treated in such a manner to have a negative feeling about seeking treatment. The discrimination happened during patient and caregiver interactions, medicine prescriptions, and patient follow-ups. Race is a big determinant of the healthcare that an individual can access, this is more prevalent in rural areas compared to urban areas (NCHS, 2017).


Research Justification


Does race play a part in determining an individual’s access to health care? For the non-observer, this looks like a far-fetched idea but evidence suggests it does. Race does play a role in access to healthcare. In the 2018 Quality & Disparities Report, Agency for Healthcare Research and Quality documented the healthcare disparities between the racial groups. The report documents general health conditions, healthcare access, and the use of medical services across ethnic minorities. Even though the overall quality of healthcare has improved, ethnic minorities particularly those in rural areas still face an uphill task accessing quality healthcare. The report also cites that high illiteracy levels, poverty, and lack of Spanish speaking healthcare providers negatively affected healthcare access for minority communities (AHRQ, 2018).


Data collected by the National Center for Health Statistics (2017) shows that poverty and educational levels are lowest among rural Blacks and Hispanics. This means that there is a likelihood that rural Blacks and Hispanics will have little to no health insurance coverage and they will probably work in the lowest paying jobs which in turn makes health insurance unaffordable. At least three-quarters of rural Blacks live in Mississippi, South Carolina, North Carolina, Texas, Alabama, Louisiana, and Georgia while over 25% of rural Hispanics live in Texas, California, Colorado, Arizona, and New Mexico. These are the states that also have the highest number of uninsured Americans. The purpose of this research to examine the main obstacles that limit access to healthcare in rural minority communities and propose recommendations that should be implemented on a community level to improve access to healthcare (NCHS, 2017).


Literature Review


Agency for Healthcare Research and Quality (2018) reports that there were no remarkable differences between racial subgroups in the United States; the report cites a telephone survey conducted by Blendon and contemporaries. The survey results showed that Afro-Caribbean and African-born Blacks had less access to healthcare compared to U.S born Blacks but it was the U.S born Blacks that rated their healthcare as the worst. Hispanics and Asian Americans also faced challenges accessing quality healthcare compared to Whites. Native Americans rated their healthcare worst of all the racial groups (AHRQ, 2018).


James et al (2015) found that rural populations have poorer quality healthcare, higher mortality rates, and are more segregated based on racial lines. The study established that majority of the youth in the rural areas were minorities. The majority of the ethnic minorities had not seen a doctor in more than a year. They described their health as poor and complained of obesity.  All the minority groups in the survey had a likelihood of having no health care provider compared to Whites (James et al, 2015).


He further writes that each racial group faced particular health issues; Whites were more prone to binge drinking, Blacks to heart disease and stroke, Asian-Americans to tuberculosis, and Native Americans to suicide (James et al, 2015). The study also showed that rural minorities were mostly young, unemployed, and less educated.  Employment rates were highest among Asians (65.2%) and Hispanics (61.1%), with Whites (52.3%), Blacks (46.3%), and Native Americans respectively (45%).  In terms of education; 35.4% of Asians had college degrees, Whites (16.0%), Blacks (8.4%), Native Americans (8.5%). Annual incomes below $25000 were highest among Blacks (61.8%), Native Americans (56.3%), and Whites (31.8%). Obesity was more prevalent among Blacks (45.9%), Native Americans (38.5%), Hispanics (35.5%) and Whites 32.0) (James et al, 2015).


Edge & Bruce (2013) postulate that discrimination has adverse health effects in different ways. Health discrimination exposes individuals to unsafe material, social isolation, economic deficiencies, and insufficient medical care. It can also lead to mental health issues such as depression and anxiety, poor physical health, and dangerous lifestyle choices such as substance abuse and alcoholism. The paper states that racism in healthcare is overt, non-verbal, and non-physical. This usually takes the form of ignoring the patient, being rude, dismissing the patient before any care has been provided, prescribing the wrong medication. ‘Visible’ minorities were more likely to report discrimination than ‘Invisible’ minorities.


Linguistic challenges also played a part in limiting access to healthcare. Individuals and groups had different coping mechanisms; some were active and confrontational. They would report incidences to authority or the media while others were passive and ignored the incident. This passive approach was associated with high blood pressure among Indian immigrants while among southeast Asians it reduced depression and anxiety. The paper further states that the divergence in coping mechanisms was a consequence of social support systems and economic resources. Refugees are more likely to be discriminated against because they lack resources and social support systems (Edge, 2013). Healthcare access is a function of race and location. Rural minority communities have it the worst.


Methodology


Description/Goals of the Project:


For this research, the qualitative research method is preferred as it is the most applicable to rural communities and the literacy levels of rural participants. On-site interviews, personal observations, and focus groups are the key data gathering techniques for the study. Secondary data resources included patient medical records sourced from participants and publicly available health-related documents provided by participants that pertain to the study. Interviews are carried out based on a list of interview questions. Nonetheless, subjects are free to speak about personal experiences in whichever way they choose. The questions are geared at measuring the impact of community and individual mentoring health programs on improving health awareness among minority community adults. Patients of all racial groupings are interviewed about the quality of healthcare services at their local community centers. Consent is obtained before any interview commences.  50 participants should be chosen randomly. They should be over 18 years. The participants should be mostly rural folk of average income from ethnic minorities but a third of the participants should be Whites. Attention should be focused on non-verbal cues and body language.


Women participants are more open with their health issues compared to less forthcoming men. For hospitalized patients, interviews are conducted by their guardians or primary caregivers. Data analysis followed the deductive approach. The findings of this study are dictated and grouped based on the research question. All the data should be transcribed using analysis software (CAQDAS).  The data is then organized according to the research questions. The data is then coded into concepts and patterns. The data is then validated for accuracy and reliability through triangulation and member checking. In triangulation, compare the findings from the focus groups and the one on one interviews to show congruence for issues raised. In the case of corroboration, the issues are categorized as important and representative of the sample pool. Member checking involves holding an open session with participants where they freely discussed the findings. Agreement with the findings indicates that the results are accurate representatives of the sample pool and inaccurate when the issues are disputed. All in all ethnic minorities are more likely to rate their healthcare situation as worst while Whites tend to be more positive about their healthcare. The final report should show the existing racial disparities between ethnic minorities and Whites in rural communities. Healthcare access is also affected by education levels and poverty levels.


Hypothesis Being Tested: That an outpatient advocacy program will


(1) decrease medical slip-ups caused by substandard service;


(2) increase the number of minorities seeking healthcare;


(3) increase patient, community, and hospital staff satisfaction; and


(4) decrease healthcare disparities among minorities.


References


          Agency for Healthcare Research and Quality (2018). Race, Ethnicity, and Language Data: Standardization for Health Care Quality Improvement.U.S. Department of Health & Human Services. Retrieved from https://www.ahrq.gov/research/findings/final-reports/iomracereport/reldata2.html  


Cummings, J. R., PhD., Lucas, S. M., M.P.H., & Druss, Benjamin G,M.D., M.P.H. (2013). Addressing public stigma and disparities among persons with mental illness: The role of federal policy. American Journal of Public Health, 103(5), 781-5. Retrieved from https://search.proquest.com/docview/1349240853?accountid=45049


Edge, S., & Newbold, B. (2013). Discrimination and the health of immigrants and refugees: Exploring Canada’s evidence base and directions for future research in newcomer receiving countries. Journal of Immigrant and Minority Health, 15(1), 141-148. doi:http://dx.doi.org/10.1007/s10903-012-9640-4


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Hall, W. J., Chapman, M. V., Lee, K. M., Merino, Y. M., Thomas, T. W., Payne, B. K., . . . Coyne-Beasley, T. (2015). Implicit Racial/Ethnic bias among health care professionals and its influence on health care outcomes: A systematic review.American Journal of Public Health, 105(12), 2588. doi:http://dx.doi.org/10.2105/AJPH.2015.302903


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Stepanikova, I., & Cook, K. S. (2008). Effects of poverty and lack of insurance on perceptions of racial and ethnic bias in health care. Health Services Research, 43(3), 915-930. doi:http://dx.doi.org/10.1111/j.1475-6773.2007.00816.x


James, V., Moonsinghe, R., Wilson-Frederick,S., Hall,J., Penman-Aguilar,A.,  & Bouye, K. (2015). Racial/Ethnic Health Disparities Among Rural Adults — United States, 2012–2015. US National Library of Medicine National Institute of Health66(23): 1–9. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5829953/


Kippenbrock, T., Lo, W., Odell, E., & Buron, W. (2017). Nurse practitioner leadership in promoting access to rural primary care. Nursing Economics, 35(3), 119-125. Retrieved from https://search.proquest.com/docview/1907283481?accountid=45049


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