Healing from Within: How Rural Communities Compensate for Inaccessible Healthcare
Since the age of modern medicine, rural communities have always struggled to maintain reliable, high-quality healthcare systems. Whether it be because governments deem rural communities less important than urban communities or a lack of trust in healthcare systems, there is no doubt that rural communities have been fighting a decades-long struggle to gain consistent access to healthcare. Thus, when the traditional healthcare system fails them, these communities step in to help their patients, often resorting to alternative methods of medicine and support. In regards to medicine and support, rural areas embody “community” more so than any other area, because community members step in to take care of each other when healthcare systems cannot.
Rural populations and areas consistently rank poorly on common health indicators. In a 2023 study conducted by Rural and Remote Health, researchers uncovered the various reasons for the lack of quality healthcare in rural communities, as explained by members of those communities. One of these members, from rural Pennsylvania, explained that “there’s a little bit more skepticism of the medical community and educated people among some of the rural, more rural population, they tend to be a little more untrusting of medicine.” Other participants also cited cost and lack of or limited insurance, geographic dispersion, and provider shortage due to burnout as reasons for lack of quality healthcare in rural communities. Since obtaining healthcare from medical providers is challenging, rural communities are forced to turn to other means of support. This often comes in the form of family, friends, and other members of the community. A North Carolina native, Martha Mac Harris described how her family took care of each other when they were sick, saying,
“there were no nurses or doctors…There would be friends and family, neighbors that would come in and sit with the sick and dying… probably there was a lot of prayer back then.”
Harris’ testimony is a direct representation of how social support systems step in to aid the sick and ailing when healthcare systems fail. Because of the barriers put in place—whether intentionally or not— in rural healthcare systems, it is necessary for communities to step up and support each other, as Harris described. Additionally, Harris also explains that in rural areas, referencing her grandparent’s life outside of Wadeville, “there was nothing much that was unexpected, except illness would be the only unexpected thing… illness or storms, nature or illness.” Thus, the lack of trust in and use of rural healthcare systems is not only because of the systemic barriers put in place— like distance, lack of healthcare professionals, and cost— but also because of rural attitudes towards health and healthcare, creating a cycle that cannot help but repeat itself. If members of rural communities do not focus on preventive healthcare, they will not utilize healthcare systems. This resistance to modern medicine makes it harder for healthcare systems to be accessible, which in turn makes it difficult for communities to focus on their health. Therefore, although many of the barriers to rural healthcare are systemic, the presence of rural culture makes it difficult for the problem of inaccessible rural healthcare to be solved.
Additionally, the presence of “rural culture” is a commonly referred to barrier to access to and trust in healthcare systems. Because of the sense of community that accompanies living in rural areas, friends and families often supplement— or replace completely— professional healthcare systems. Instead of going to the doctor or the hospital for an ailment, friends and family would step in with homegrown remedies. For example, Greensboro native Tammy Blackman describes the remedies her grandmother would use when she fell ill, saying,
“I had a bout with bronchitis. I have asthma, and my granny would make these mustard plaster things out of dry mustard and a piece and put it on your chest… things like that, so much better than modern medicine, I think.”
As Blackman describes, part of rural culture is to rely on pre-existing remedies, passed down through generations to supplement the lack of accessible modern medicine in rural areas. Seeing that even though rural areas hold 20% of the United States’ population, but only 11% of the available physicians, it’s not only more convenient, but also necessary for friends and family to supplement the lack of structured healthcare in rural areas. Moreover, Martha Mac Harris also describes her community’s cure to a typhoid epidemic, including,
“cold compresses on the head, warm compresses on the feet, were the big thing…Warm compresses on the feet are supposed to help, but they still didn’t know a lot about germs, and people would sit with them and try to get their fevers down, and the whole point was to get the fever down and hope and pray.”
Medicine evolved at a much faster rate in urban communities, and as a result, rural healthcare has consistently lagged. This has resulted in friends and families helping aid the ailing in rural communities, rather than relying on hospitals and doctors, as urban communities are more likely to do.
Finally, understanding that a “one size fits all” approach to rural healthcare is not the most effective approach is key to aiding and developing rural healthcare systems, so that rural communities not only feel supported by each other, but also by the infrastructure in place. Retired physician George Gould describes his experience working in healthcare in different areas of New York and North Carolina, explaining that “we need something bigger [than ObamaCare] to get people receiving healthcare, good healthcare…the people with insurance have easier access to good healthcare. People who don’t have insurance don’t necessarily get to see the best people, and their healthcare can be delayed or absent.” Thus, it is important to note that the lack of government support for healthcare in rural communities also adds to the strain on rural healthcare systems. Additionally, studies have shown that harnessing the sense of community that is so ingrained in rural communities and using it to develop alternative methods of delivering medicine, like pop-in clinics, helps increase access to healthcare in rural settings. Utilizing the sense of community so prevalent in rural areas is one path that can help spread access to healthcare to struggling communities, rather than imposing an urban infrastructure in an area with a different culture.
All in all, rural healthcare is multifaceted, involving social support systems that step in to help when government infrastructure fails the people who sometimes need it, and simultaneously mistrust it, most. Using these social systems to develop a healthcare system that fits rural communities is vital if we want to see every American with access to quality, reliable, and affordable healthcare.
References
Blackman, Tammy. “Stories to Save Lives.” Southern Oral History Project, June 25, 2018. https://dc.lib.unc.edu/cdm/compoundobject/collection/sohp/id/27936/rec/10
Coughlin, Steven S et al. “Continuing Challenges in Rural Health in the United States.” Journal of environment and health sciences vol. 5,2 (2019): 90-92.
Gould, George. “Stories to Save Lives.” Southern Oral History Project, June 26, 2018. https://dc.lib.unc.edu/cdm/compoundobject/collection/sohp/id/28256/rec/26
Harris, Martha Mac. “Stories to Save Lives.” Southern Oral History Project, June 14, 2018. https://dc.lib.unc.edu/cdm/compoundobject/collection/sohp/id/27897/rec/29
Kenny, Amanda, et al. “Community Participation in Rural Health: A Scoping Review.” BMC Health Services Research, vol. 13, 2013, article 64, https://doi.org/10.1186/1472-6963-13-64.
Maganty, Avinash, Mary E. Byrnes, Megan Hamm, Rachel Wasilko, Lindsay M. Sabik, Benjamin J. Davies, and Bruce L. Jacobs. “Barriers to Rural Health Care from the Provider Perspective.” 2023. Rural and Remote Health, vol. 23, no. 2, James Cook University, 2023, pp. 1–11, https://search.informit.org/doi/10.3316/informit.197516774554362.