Challenges for Elders in Rural Areas
Elders in rural areas face a range of problems that include lack of access to healthcare, distance, lack of transportation, social stigma and privacy issues, and poor health literacy. Lack of access to care mainly attributed to lack of health insurance coverage (Warren & Smalley, 2014). A June 2016 ASPE issue brief noted that 43.3% of uninsured rural residents say they do not have access to care and 26.5% did not receive care in the previous year because of cost-related issues (Avery, Finegold, & Xiao, 2016). This shows that affordability of care is a major concern for rural residents, especially the elderly. Another barrier to access is distance and transportation. Rural areas not only have fewer transport infrastructure but also fewer means of travel, and distance to nearby healthcare center may be considerably long, particularly in cases of emergency. What is more, social stigma and privacy issues can act as barriers to access to healthcare because rural areas are characterized by little anonymity and privacy concerns. Individuals may be reluctant to seek care for issues like substance abuse, mental health, sexual health, and even common chronic illnesses. Lastly, poor health literacy is a primary concern in rural communities where residents attain lower educational levels.
Health problems of primary concern with the reservation-based American Indian population
Four major health problems of primary concern are diabetes, injuries, tuberculosis, and suicide. The American Indian community records the highest rates of diabetes in any group (American Diabetes Association, 2018). In fact, the Pima Indians of Arizona have the highest rates in the world. This is attributed to poverty and lack of access to healthy food. CDC statistics indicate that Native American Indians die by injury by age 44 more than any other cause. Compared to whites, they are more likely to die in a car crash, by fire, as a pedestrian, or by drowning. Tuberculosis is another problem that ravages reservation-based American Indians. Rates of TB have risen in the last 50 years although disparities between communities exist (Jay Paulsen, 1987). Lastly, suicide is an epidemic among American Indians as they are more likely to kill themselves compared to any other group (Woodard, S.2012). Suicide is associated with other issues like substance abuse, sexual assault, joblessness, isolation, and limited mental health services.
Gaps in service that are likely exist
Poverty, distance to emergency care, long distance to health centers, and lack of mental health and emergency services are four likely gaps in with reservation-based American Indian population (Sarche & Spicer, 2008). The prevalence of diabetes due to lack of access to healthy foods is an indicator that the population is needy. High rates of death due to injury indicate that there may be a lack of access to emergency services probably as a result of the rural locality in which many families live. Lastly, the high incidence of suicide shows that the community has a deficiency when it comes to mental health services.
Policy Recommendations
To curb the aforementioned gaps, the community should:
- Establish emergency transportation systems and centers within the area. Transportations systems should be able to support elderly residents as well as those without a basic means of transportation.
- Deliver health education to the residents.
- Increase funding to boost health in the region.
- Schedule health screening for residents.
References
American Diabetes Association. (2018). American Indian/Alaska Native Programs. [online] Available at: http://www.diabetes.org/in-my-community/awareness-programs/american-indian-programs/ [Accessed 14 Jul. 2018].
Avery, K., Finegold, K., & Xiao, X. (2016). Impact of the Affordable Care Act coverage expansion on rural and urban populations. Department of Health and Human Services, Office of the Assistant Secretary for Planning and Evaluation.
H. Jay Paulsen. (1987). Tuberculosis in the Native American: Indigenous or Introduced? Reviews of Infectious Diseases, 9(6), 1180-1186. Retrieved from http://www.jstor.org/stable/4454264
Sarche, M., & Spicer, P. (2008). Poverty and health disparities for American Indian and Alaska Native children. Annals of the New York Academy of Sciences, 1136(1), 126-136.
Warren, J., & Smalley, K. B. (Eds.). (2014). Rural public health: Best practices and preventive models. Springer Publishing Company.Woodard, S. (2012). Suicide is epidemic for American Indian youth: What more can be done?. [online] NBC Investigations. Available at: http://investigations.nbcnews.com/_news/2012/10/10/14340090-suicide-is-epidemic-for-american-indian-youth-what-more-can-be-done?lite [Accessed 14 Jul. 2018].
