Healthcare in the United States has proven to have many flaws. In 2021 alone, “27.5 million non-elderly individuals were uninsured,” with “64% of uninsured adults saying that they were uninsured because the cost of coverage was too high” (Tolbert & Drake 2023). Out of the millions of uninsured Americans, the highest percentage comes from low-income families with at least one worker in the family (Rural Health Information Hub 2022). But healthcare disparities in the U.S. do not only originate from financial barriers. Rural populations are particularly put at a disadvantage in the American healthcare system as there are many physical and systemic barriers that keep these specific populations away from medical centers. Rural residents typically have less “means to reach and use [medical] services,” a greater lack of “the ability to take paid time off of work to use such service,” and a “lower confidence in their ability to communicate with healthcare providers” in comparison to urban communities (Rural Health Information Hub 2022).
Rural towns in North Carolina, such as Clinton, Dunn, and Rocky Mount are home to individuals who have experienced various struggles with access to medical care. Through the Stories to Save Lives Project, Janette Godwin, Nellene Richardson, and Stephanie Atkinson bring intriguing stories of hardship with healthcare in rural North Carolina that help explain the pitfalls of healthcare access in rural communities. Through the struggles illustrated by these interviewees, we can see how a lack of access to healthcare access in rural North Carolina has forced individuals to use other means of alternative care and medicine.
The Lack of Health Insurance Coverage in Rural NC
In the United States, there are two main forms of insurance: private and public. Private insurance is granted through employers and the health insurance market and public insurance is given by the government. In 2021, around 229 million Americans were insured, but 28 million had no private or public coverage. Of these 28 million, residents in rural communities lacked insurance at higher rates than those in urban areas (Tolbert & Drake 2023). With the tenth-highest uninsured rate in the country, North Carolina is home to over 1 million citizens who lack the financial assistance to gain access to modern healthcare (North Carolina Center for Justice 2020). Out of the large population of uninsured individuals in NC, rural counties face this problem to the greatest extent, with countries such as Swain, Duplin, and Robeson presenting uninsured rates of over 18% each (North Carolina Center for Justice 2020).
In the Stories to Save Lives Project, interviewee Janette Godwin, a 34-year-old nurse from Dunn, North Carolina treats many residents in her rural county who face financial barriers to healthcare access. Godwin works at Harnett Health, a Harnett County hospital serving a highly uninsured and indigent patient population. Through her years of work in the healthcare field in Dunn, she states that she has always seen patients that
“can’t afford insulin, can’t afford to manage chronic diseases or have diseases they don’t know what it is” in a “country [that] doesn’t have the money or means to find out what’s wrong with them” (Godwin 0:07:50-0:08:02).
In her interview, Godwin also states that because of the financial barriers to healthcare access, her town functions more through a “community-based caring environment” than a biomedical hospital environment. In another interview, Nellene Richardson, a 65-year-old healthcare worker and pastor from Rocky Mount discussed similar struggles that residents faced in her community, as she stated that in Rocky Mount,
“there are a lot of people that do not have insurance…[which] means when you go to the hospital…they’re not going to keep you. They’re going to put a Band-Aid on it and discharge you” (Richardson 0:55:03-0:55:10).
The struggles associated with uninsurance in rural towns such as Dunn and Rocky Mount show one of rural NC’s largest and most prominent barriers to healthcare access. Because of the financial constraints that keep many from modern treatment options in clinics and hospitals, uninsured individuals and families are often forced to turn to other means of care in times of illness, which is often seen through community, religious, and familial support and the use of home remedies.
Additional Barriers to Healthcare Access in Rural NC
In addition to the financial boundaries that prohibit many Americans from gaining access to healthcare, physical, geographical, and systemic barriers factor into the issues that rural North Carolinians with and without health insurance face. These issues are magnified for residents in lower-income rural communities with a general lack of medical centers due to “difficulties with their up-keep due to low patient volumes, limited numbers of providers, and unfavorable economies of scale” (Nesbitt et. al. 2006). Within these rural towns and counties, citizens such as Stephanie Atkinson, a 42-year-old woman from Clinton, have experienced issues with many of these barriers to healthcare access due to her rural county’s geographical and economic circumstances. In her interview, Atkinson said that one of the things she remembers about her childhood was that she did not go to the doctor often. She states that “as far as if you had a stomach ache or were nauseous when you woke up… you just [had] to make an executive decision to stay home,” because they did not have many doctor’s officers nearby (Atkinson 0:14:52-0:15:01). Later in her adulthood when it was time for her mother to have hip surgery, she discussed the limited healthcare options due to her rural home, stating that
“in Clinton, there’s only one orthopedic doctor. There are no options to shop around” (Atkinson 0:09:55-0:10:07).
The lack of hospitals and clinics in rural communities becomes even more detrimental when considering variables such as transportation, clinician retention, and patient income. Even in the areas of rural North Carolina with hospitals and clinics, there is an overwhelming amount of instances of lack of transportation to and from medical centers, issues with staff recruitment and retention in low-income areas, and lower pay rates for doctors who work in rural medical centers (Rural Health Information Hub 2022). These issues, compounded with the lack of medical centers in rural North Carolina, create barriers to healthcare access for all residents, whether they are insured or not.
Lack of Healthcare Access and Alternative Medicine
Due to the overwhelming lack of access to healthcare in rural North Carolina due to financial, geographical, and systemic boundaries, many individuals, families, and communities are forced to use other means of care in place of traditional biomedical treatment. Residents of rural communities in North Carolina often turn to forms of familial, community, and religious support and/or home remedies to recover in times of illness, as their government has failed to assist them in meeting their medical needs. Heavily-relied-on forms of alternative care in rural communities have been sufficient for generations of residents, but would not be needed if it weren’t for the immense amount of barriers placed in their way of accessing modern healthcare options.
References
Atkinson, Stephanie. Interview with Maddy Kameny. 25 June 2018 (Y-0003). Southern Oral History Program Collection (#4007), Southern Historical Collection, Wilson Library, University of North Carolina at Chapel Hill.
Godwin, Janette. Interview with Maddy Kameny. 26 June 2018 (Y-0025). Southern Oral History Program Collection (#4007), Southern Historical Collection, Wilson Library, University of North Carolina at Chapel Hill.
Jennifer Tolbert, Patrick Drake. “Key Facts about the Uninsured Population.” KFF, 7 Feb. 2023, https://www.kff.org/uninsured/issue-brief/key-facts-about-the-uninsured-population/#:~:text=How%20many%20people%20are%20uninsured,nearly%201.5%20million%20from%202019.
Nesbitt TS, Marcin JP, Daschbach MM, Cole SL. Perceptions of local health care quality in 7 rural communities with telemedicine. J Rural Health. 2005 Winter;21(1):79-85. doi: https://doi.org/10.1111/j.1748-0361.2005.tb00066.x
“Rural Health Information Hub.” Healthcare Access in Rural Communities Overview, 2022, https://www.ruralhealthinfo.org/topics/healthcare-access.
Richardson, Nellene. Interview with Lauren Frey. 05 June 2019 (Y-0122). Southern Oral History Program Collection (#4007), Southern Historical Collection, Wilson Library, University of North Carolina at Chapel Hill.
“Uninsured in North Carolina.” North Carolina Justice Center, 13 May 2020, https://www.ncjustice.org/projects/health-advocacy-project/medicaid-expansion/uninsured-in-north-carolina/.