For many in Brownsville, Tennessee, a rural town in the eastern part of the state, Haywood Park Community Hospital was the closest hospital.
Some residents believe that this is how their relatives stayed alive. others in this predominantly black city said they drove to a hospital miles away or the care is omitted altogether. The facility finally closed in 2014 following a decline in patient numbers.
“Despite my bad feelings or experiences in this environment,” said Alma Jean Thomas Carney, who described the hospital’s white staff as unwelcoming, “there are destitute people living in Haywood County who need to go to the nearest available facility.”
According to the Centers for Disease Control and Prevention, people in rural areas are more likely to die earlier than city dwellers from diseases such as heart disease, cancer and stroke. But over the past decade, hospitals have been closing across America, leaving some of the 46 million people who live in these areas with fewer options to the care they need, when they need it.
Advocates, hospital and health clinic administrators and rural residents say changing inequalities in health consequences And Healthcare in rural America must start at the local level – especially in communities of color where there may be a lack of trust in the medical field.
This is already happening in Brownsville, where the hospital fully reopened in 2022; in North Carolina, where mobile clinics care for farm workers who do not have permanent residency status after their working hours; and in California, where Community health workers in the Fresno area go door to door to help Punjabi-Sikh immigrantswho often work on farms or in meat packing plants.
“We have learned that we have to go to the people. We have to go where they are. They will not come to us,” said Mandip Kaur, health director of the nonprofit Jakara Movement.
Rural hospitals at risk
More than a third of the nation’s rural hospitals – about 700 – are at risk of closure due to “severe financial problems,” according to a July analysis by the Center for Healthcare Quality and Payment Reform. Harold Miller, president and CEO of the center, said a hospital closure can impact a rural community.
“If the hospital didn’t exist, there wouldn’t be any doctors there,” Miller said. “There’s no place to go and get lab tests other than that hospital. There might not be a nursing home or a place to get rehab or long-term care other than those hospitals.”
If a hospital stays open in a large rural region where few people live, the facility may not serve the number of patients it would need to operate profitably, says Arrianna Planey, who studies health policy and management at the University of North Carolina.
Brownsville officials tried to find a buyer for the hospital. The county eventually bought it. Braden Health, a private company, then took over the hospital under two conditions set by the county: It must be a full-service hospital with a 24-hour emergency department, and it must hire staff as soon as possible. Local officials say the hospital is just breaking even.
Tennessee is one of 10 states – many of them in the South – that have not expanded Medicaid. Michael Meit, director of the Center for Rural Health Research at East Tennessee State University, believes this would be an obvious solution to the problem of growing health inequalities in rural areas. More people would be insured, Meit says, and hospitals could make more money.
“They provide a lot of uncompensated health care,” he said of rural health systems in those states.
While Miller acknowledged that expanding Medicaid could be helpful, he argued that relying solely on it would “absolve private health insurers of responsibility.”
“In some cases, small hospitals lose more money to private insurance than to Medicaid, which is really remarkable,” he said, “but they get so little … from private health insurers.”
Doulas and mobile health clinics help
Low Medicaid reimbursements play a role in Closure of maternity wards in rural areasalong with labor shortages and declining birth rates. More than half of rural hospitals have suspended maternity services, another recent analysis by the Center for Healthcare Quality and Payment Reform found. This can lead to longer travel times and a higher risk of complications and deathand in the USA Black mothers have the highest maternal mortality rate.
Alexis Ratliff, 29, had few options for prenatal care when she was pregnant with her second child. The hospital in Rocky Mount, Virginia, has no maternity ward, and a hospital about 40 minutes away closed in 2022. Ratliff, who is black, instead drove to Salem — more than an hour away — for every prenatal appointment. She used all of her paid vacation time and had no paid maternity leave.
She did, however, have a doula. The doula is black and her services were covered by Medicaid—a benefit Virginia began offering in 2022.
“I really wanted someone else to help me advocate for myself, especially because death rates are higher for women of color. So I thought to myself, ‘Anything can happen,'” she said. “My family members have never had good experiences up here in these doctor’s offices, even for regular appointments.”
In the southern state, immigration status can make health care difficult. About 150,000 Agricultural workers and their family members live in North Carolina. Many of them speak Spanish, do not have permanent residency status, and are not eligible for Medicaid, meaning they must pay for clinics out of their own pockets or go without medical care.
Some organizations in the state offer mobile health clinics. Campbell University’s Community Care Clinic, in partnership with NC FIELD’s Sembrando Salud, conducted its first public outreach in 2017 and diagnosed 68 people with diabetes. Four of them had very high blood sugar levels, said Dr. Joseph Cacioppo, a clinic volunteer and chair of the Community and Global Health program at Campbell.
“Three of them were lucky; when we found them, there was little or no organ damage,” he said, adding that the fourth had kidney failure and liver damage “because he didn’t know he was diabetic for so many years.”
There’s something else communities should strive for, says Alana Knudson, director of the NORC Walsh Center for Rural Health Analysis: a positive attitude and perspective.
“It’s not all dystopia,” she said.
“I think we’re really trying to change that narrative because that’s the challenge: Who wants to come from an older, poorer, sicker area? It doesn’t matter if you’re from inner-city America or rural America,” Knudson said. “Labeling that kind of thing doesn’t bring out the best in people’s feelings of self.”
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Aallyah Wright with Capital letter BClaudia Boyd Barrett with California Health ReportEmily Schabacker with Cardinal News and Claudia Rivera Cotto with Latino NC Link contributed to this report. This story is part of joint reporting led by the Institute for Nonprofit News’ Rural News Network – with the support of the Walton Family Federation. Light catcher visual support provided.
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The Associated Press Health and Science section receives support from the Robert Wood Johnson Foundation. The AP is solely responsible for all content.
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This article has been corrected to show that there is a hospital in Rocky Mount, Virginia, but it does not have a maternity ward.
