Introduction

Imagine you are a 65-year-old grocery worker, Eleanor, in rural North Carolina. You are presented with a consistent cough, chest pain, and shortness of breath and have recently been coughing up blood. After this pain has been carrying on for a while, you decide to go to the doctor. When you finally get to the doctor, after some tests, they discover that you have lung cancer and ask why you didn’t come in sooner. You say I couldn’t afford it. However, if you had gone earlier, they could have caught the illness, which wouldn’t have gotten this bad. Eleanor is a low-class citizen with very little insurance coverage, which influenced her to wait to seek care. Should this lack of funding affect her care? 

Low socioeconomic class and the effect that cost has on care

Most people in rural communities live in poverty or right above the poverty line, like Eleanor. This economic status affects their ability to provide themselves or their families with good-quality insurance and, therefore, affects their decisions about their health. Urban areas are often more established and well-off economically than rural communities. The article “Overcoming the Triad of Disparities: How Local Culture, Lack of Economic Opportunity, and Geographic Location Instigate Health Disparities” discusses these differences. It states, “The economics of healthcare in rural areas is grim: residents earn less than their urban counterparts; county public health offices have a smaller annual tax base through which to fund health-related programs; and hospitals and primary care providers have larger numbers of Medicare or Medicaid patients and fewer resources to invest in new health-related technology.” This statement connects the reality of rural communities facing more poverty to the worsening health conditions of those in those communities. How can people be in good health when they cannot afford to go to checkups or see a doctor when ill? The costs associated with attending the doctor make it nearly impossible for low-class, impoverished citizens to get the healthcare they deserve.

Mentality surrounding healthcare in rural communities with impoverished citizens

Due to the associated costs of medical care, most people in rural communities rarely go to the doctor. As someone who grew up in a rural community, I know that the stigma around medical care is that “you don’t go to the doctor unless it is serious.” This mentality is a result of medical care being so expensive. Stephanie Atkinson can attest to this, as she stated in her oral interview,

“My first dental experience was the first time that I worked here. I had never been to the dentist. There was a time when I was younger that my parents had planned to take us to the dentist, but something happened with the insurance and the cost, and they were like, ‘Oh, no, we can’t afford it,’ so I never actually went. So I was probably twenty-five or -six or -seven the first time I ever went to the dentist.”

Stephanie demonstrates how rural Americans overlook standard appointments since they can be costly without proper insurance. How many times have you been to the dentist in your lifetime? You will most likely say twice a year for as long as you can remember. The sad reality is that some people cannot experience the luxury of visiting the dentist regularly, if at all. 

Expenses, lack of insurance, and decisions that people are forced to make in regards to their health

Rural citizens do not see dentists and other primary care doctors as necessary; people would save their money on food and other necessities like bills. The article by Michael Stillman and Monalisa Tailor, ‘Dead Man Walking,’ does an excellent job of depicting how economic status influences primary and preventative care. Mr. Davis, a man like most in rural communities, experienced pain and warning symptoms but was hesitant to go to the doctor as he could not afford just the visit since he was uninsured, which caused him not to catch his cancer diagnosis until it was too late. The article states

“A recent study showed that underinsured patients have higher mortality rates after myocardial infarction [heart attack], and it is well documented that our country’s uninsured present with later-stage cancers and more poorly controlled chronic diseases than do patients with insurance. We find it terribly and tragically inhumane that Mr. Davis and tens of thousands of other citizens of this wealthy country will die this year for lack of insurance,”

this is a sad reality of our country. People stay ill every day because they cannot receive proper care when they need it most. How are those with low economic status expected to feel taken care of when one illness can ruin their lives in many days, whether the disease itself kills them or they are in severe medical debt? The issue of medical expenses making care hard for many is an ongoing issue that needs to be addressed by our country and the healthcare system. 

The reality of socioeconomic class affecting health and care

Like Mr. Davis’ instance, poverty and the economic status effect of rural Americans negatively affect their health. ‘Aging Well in Rural America- the Role and Status of Healthcare’ states, “Rural Americans are more impoverished and rely more heavily on government health insurance programs than urban people. In 2016, the rural poverty rate for people 65 and older was 10 percent, compared to a non-metropolitan rate of 9.1 percent (Economic Research Service, 2019). Poverty is both a cause and a consequence of poor health (Health Poverty Action, 2019).” Further explaining the statistical evidence of the inequality in healthcare amongst socioeconomic classes and areas. Many people in these rural areas rely on Medicaid or no insurance at all and hope that they won’t get any serious illness that will put them more in a financially difficult situation. Unfortunately, that isn’t the case for some people. Laura, a woman from Caswell County, North Carolina, discusses her experience with healthcare, the discussion she felt in labor due to her class, and the trauma she felt through this and the death of her first husband. At one point in her interview, she discussed the challenges she faced trying to get her first husband the care he needed, “I had gone to DSS [Department of Social Services] and just begged for—you know, I can’t get him into a neurologist because I can’t get him on Medicaid, that he has no insurance, and so I can’t get him in.” She got him into a less knowledgeable neurologist but knew her husband needed more. Sadly, he was unable to survive. Was this the first time someone’s socioeconomic class caused their medical care to sink? Unfortunately, no. Not being able to afford frequent checkups or care in general will severely affect people’s health in the long run. People will start settling for a lower quality of care to save money, which puts their health at risk for more complications.  

Possible Solutions 

These instances are a part of the tragic reality of socioeconomic class and healthcare. Listening to and hearing these stories from people makes one wonder how to help with this disparity. As discussed in Dead Man Walking, knowledge is essential to solving this issue. Educating your patients on Medicare and preventive medicine will help reduce mortality rates in these communities. People also need to learn about the laws in their states regarding Medicaid and other government-funded medical programs. The Southern Oral interview of Amy, a clinical social worker and addiction specialist, discusses her experience in these fields and the economic barriers that prevent people from seeking care. She states,

“If I have to choose between food, you know, if I have to choose between food and medical care, I’m going to choose food, and so is everyone else…I think if we had in North Carolina, if we expanded Medicaid, that would benefit people. And in the long run, we know—there is evidence, there is science, there is research—that it will cost our system less and fewer dollars if folks have the medical care that they need regularly and can access support from both physicians or medical providers and behavioral health providers.”

Allowing more people to gain access to insurance will decrease the probability of people in these areas falling ill with life-threatening illnesses. If people had insurance of any kind, they would be able to see a doctor regularly, not just when their symptoms are bad enough to cause worry. 

Conclusion

Healthcare inequality due to socioeconomic status has been an issue in our country for years, especially in rural communities. Many people do not receive the care they deserve because they cannot afford it due to a lack of insurance or coverage. This medical care issue cannot be solved overnight, but change is possible by educating the public on these issues in medical care, not just those in these communities. Along with educating people, working towards Medicaid expansion will help combat this inequality. Socioeconomic class should not play a role in people’s medical care decisions when their lives are on the line. 

 

References:

Thomas, Tami L., et al. “Overcoming the Triad of Rural Health Disparities: How Local Culture, Lack of Economic Opportunity, and Geographic Location Instigate Health Disparities.” Health Education Journal, vol. 73, no. 3, Feb. 2013, pp. 285–94,

Atkinson, Stephanie, “Y-0003”, Southern Oral History Program, 25 June 2018.

Stillman, M. & Tailor M., “Dead Man Walking”, New England Journal of Medicine, vol. 369 no. 20, 14 November 2013

MacKinney, A. C., Dennis Dudley, and George Schoephoerster. “Aging Well in Rural America-the Role and Status of Healthcare.” Generations Journal, vol. 43, no. 2, 2019, pp. 46-54. ProQuest,

“Laura”, “Y-0114”, Southern Oral History Program, 18 October 2018.

“Amy”, “Y-0095”, Southern Oral History Program, 27 July 2019.