About Rural Health

What Makes Rural Pennsylvania Unique?

Rural Pennsylvania’s beautiful scenery and abundance of natural resources make it easy for its residents to feel proud of where they live. Winding roads cut through vibrant forests and open fields adorn the mountainous terrain. Nearly 7.7 million acres are occupied by 59,300 farms, encircled by communities characterized by a strong work ethic, a sense of security, and residents committed to small-town living.

Health and Economic Challenges in Rural Pennsylvania

Though picturesque and charming, rural Pennsylvania faces challenges specific to its population and location. On average, residents are older, prone to health issues, and financially disadvantaged. Access to health care is often limited, and policies aimed at improving access don’t always have the same impact on urban and rural residents. In the winter, ice and snow on those scenic winding roads make driving conditions hazardous. Disparities exist in educational and employment status, and the economic hits to manufacturing and industry sectors have taken a toll on already impoverished residents.
People living in rural Pennsylvania choose to do so. Despite challenges, they are dedicated to their home. They deserve the same dedication to efforts to improve their communities’ health.

Who Lives in Rural Pennsylvania?

Almost a third of Pennsylvania’s population live in areas designated as rural. These residents are quite homogenous, with non-whites making up six percent of the population and Hispanic/Latino only three percent of the population. Rural Pennsylvanians tend to be older; about 20 percent of the population is under age 18, while 28 percent are Baby Boomers and 18 percent are 65 and older. Like the nation as a whole, the elderly population is quickly growing.
Rural Pennsylvanians have limited financial resources, inhibiting their ability to address needs in education and infrastructure. Average household income in 2014 was $60,986, which is $15,442 less than the urban average. Since 1970, rural Pennsylvania’s per capita income gap has doubled, manifesting itself as more prevalent poverty. Over 14 percent of residents are below the FPL, and 33 percent are below 200 percent FPL. The rural unemployment rate in 2015 was 5.6 percent, and eight rural counties had rates above 10 percent.

Rural Pennsylvania Education and Employment

Twenty percent of rural Pennsylvania residents have a bachelor’s degree or higher. Of those age 25 and older, 12 percent do not have a high school diploma. Many of those who obtain a higher degree leave rural areas – a phenomenon known as “brain drain.” Relative to urban areas, few rural residents are employed in professional and management jobs. From 2010-2014, half of rural Pennsylvanians were employed in manufacturing, wholesale/retail, or health care and social services. Each year, 14,000 to 15,000 migrant farm workers travel to Pennsylvania to harvest crops. Many rural Pennsylvanians work for health care providers and educational institutions, with hospitals being one of the largest employers. In rural areas, health care tends to be provided at a lower cost, where each health care dollar “rolls over” about 1.5 times. However, more than half of rural health care dollars leave the communities to be spent in urban areas.

What Health Issues Do Rural Pennsylvanians Face?

From infants to the elderly, major improvements can be made to rural health. Residents see a higher prevalence of elder abuse/neglect, alcohol-related automobile deaths, poor access to dental care, and limited access to mental health services. For the 20 percent of Pennsylvania births that occur in rural counties, less than one percent of mothers did not receive prenatal care, although 41 percent of the births were to mothers receiving WIC services. The uninsured rate in 2014 was six percent for rural children and 12 percent for working adults. Nearly 20 percent of residents are eligible for the state’s Medicaid program, Medical Assistance. Employer-sponsored insurance is less common, and despite the use of the federal health insurance exchange, rural residents are enrolled at a lower rate than their urban counterparts.

Illicit Drug Abuse and Overdose Deaths in Rural Pennsylvania

One of the most urgent problems facing rural Pennsylvania youth and young adults is the rapid growth of illicit drug use, particularly heroin and opioids. In 2015, Pennsylvania had the eighth highest overdose deaths in the country. Toxicology tests reported heroin in more than half of the drug-related overdose deaths. Twelve of Pennsylvania’s rural counties were among the top 20 counties for rate of drug-related deaths, and 14 rural counties ranked among the top 20 for largest increase in rate of drug-related overdose deaths, according to 2014 data.

Health Care Challenges for Seniors and the Elderly in Pennsylvania

Pennsylvania is ranked sixth highest in the nation for percentage of elderly residents. Challenges with accessing health care services can lead to undiagnosed and untreated conditions, causing delays in care until they have to resort to expensive emergency care. Almost 65 percent have difficulty completing activities of daily living, and 23 percent have cognitive difficulties or difficulties with independent living. Because of this, placement in a nursing home is often inevitable, and complications with malnutrition, loneliness, and depression are compounded. Personal care and assisted living for Seniors tend not to be viable options due to a lack of government subsidies.

Rural Health Care Challenges and Mortality in Pennsylvania

Reliance on Medicare and Medical Assistance, along with the high costs of a disproportionately elderly population, puts financial strain on providers. Combined with the shortage of rural health professionals, access to care is limited. There is only one physician per 586 rural residents, and travel to tertiary and specialty care is both lengthy in distance and infeasible for many. Public transportation in rural areas is virtually non-existent, and services within a reasonable distance may have difficulty keeping their doors open due to costs of technology, wages, and costs of obtaining highly educated workers. In 2014, rural hospital closures across the nation were greater than in the previous 15 years combined.

Twenty-two percent of Pennsylvania’s population live in federally-designated Health Professional Shortage Areas which include 26 percent of Pennsylvania’s rural residents, as opposed to 1.7 percent of urban residents. Two-thirds of Pennsylvania’s primary care physicians practice in the five most populated counties, and 30 percent of the physicians who do practice in rural counties say they plan to leave their position in under five years. Due to the professional isolation, limited options for coverage, and lack of access to continuing education, it is difficult to attract new physicians to rural areas to replace those who leave.
It is especially challenging for rural hospitals to staff emergency departments and retain private Emergency Medical Service (EMS) units. Mortality due to injury is 40 percent higher in rural areas, specifically in motor vehicle crashes. Because of long delays in the discovery of the crash and difficulty of travel, the average transport time for a patient injured in a rural county to a trauma center is 113 minutes – well beyond the recommended 60-minute “Golden Hour.” Rural areas also experience a shortage of mental health and substance abuse centers and professionals. Only five psychiatric and substance abuse hospitals are located in rural areas of the state, leading to potentially more hospitalizations, excessive use of emergency rooms, homelessness, and family violence.

Increased Access to Health Care in Rural Pennsylvania

Several remedies have been applied to the issue of access. Pennsylvania is a prominent employer of physician assistants and nurse practitioners, who provide high-quality health care in rural areas. Designated Rural Health Clinics are able to receive special Medicare and Medicaid reimbursement, and Critical Access Hospitals (CAHs) provide acute care and outpatient care while referring more complex conditions to larger hospitals, all with cost-based reimbursement from Medicare instead of standard fixed rates. The use of telemedicine and electronic medical records may provide greater communication and access to providers and medical information.

Why Choose Rural?

There is a lot of work to do to improve the health of rural Pennsylvania, and at times it can seem like an insurmountable challenge. Yet, rural Pennsylvanians are no strangers to hard work. Communities and individuals may be isolated geographically, but they are surrounded by residents who would offer help at the drop of a dime. “Next door” is a relative term – often quite literally. Neighbors might live a couple miles or more down the road, but they are still very neighborly, and might even be a brother, aunt, or second-cousin. Rural Pennsylvania is home to 3.4 million people, and many wouldn’t want to live anywhere else.