Expert Response 8

One of the biggest challenges to our current health care system is the deeply underserved rural populations. Many rural areas lack access to advanced health care facilities, including diagnostics like MRIs, and those in such areas often have to travel great distances to access necessary care or even emergency services. For those with low mobility or no access to a car, in particular, this poses a significant hurdle to care, even for curable or preventable illnesses. As well, the jobs available in rural areas are more likely to be industrial or agricultural in nature, requiring the use of large machinery and/or significant amounts of physical labor, which isn’t comparable to the office-based jobs more common in urban areas. With such physical strain and use of such machinery come additional risks for serious injury or death. Finally, in some rural areas, substance abuse is a significant issue, and this is in some ways directly connected to the previous two issues. Without access to necessary treatments and specialized providers, some have resorted to alcohol to cope with chronic pain from injuries, and the current opioid crisis is partly due to doctors having to fill gaps in care with painkillers so that those unable to access appropriate care and physiotherapy are able to continue working. As these prescriptions stop without the root cause of the patient's pain resolved, some turn to the black market, where tainted supplies have led to thousands of overdoses. Finally, many in rural areas live at, near, or below the poverty line, and in nations without universal health care, this leaves them without medical coverage altogether. This means that minor issues are often left uninspected and untreated until they become major, possibly life-endangering conditions. Even a small injury or routine illness can easily transform into something altogether different without access to basic care. These are all significant causes for the kinds of increased preventable deaths suggested by the cited report.

The follow-up question poses the opposite, that those in rural areas have decreased preventable deaths from illness and injury. This flies in the face of most studies and even common sense, but it wouldn’t be wise to simply write this off, if it were coming from a reputable source. Rather, the first thing I would want to do is review the evidence being cited, and compare it to the evidence that supports the other side. If I’m hearing this report from a third party, there are any number of ways the report could have been misconstrued or misunderstood, so I need to go back to the data to understand what’s going on. While it seems unlikely, if it turned out that the evidence – from a peer-reviewed source that can be confirmed by other reputable sources – legitimately did show that the opposite actually was the case, then I would have to change my understanding of the situation. Regardless of our own assumptions about what seems like “common sense”, we have to rely on evidence-based studies for our foundation of knowledge.

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