Public access to health care has been in the national spotlight for years, but much of the discussion has either focused on urban areas or ignored the issue of place altogether. The provision of health services in rural areas presents difficult challenges, including impoverished patient populations distributed over large geographic areas, insufficient numbers of health care professionals living in rural areas, technological barriers to disseminating information, and disproportionately high rates of drug and alcohol addiction, car accidents, suicide attempts, gunshot wounds, and other threats to health and life. This panel will address the challenges of providing health care in the American rural west, and also explore potential solutions and policy approaches to improving access.
Held March 19, 2016 at the University of Montana in Missoula, MT
Speakers Video unavailable
- Martin Blair, Rural Institute for Inclusive Communities, Moderator
- Tom Seekins, University of Montana, “Rural Health and Disability”
- Kenny Smoker, Fort Peck Tribes and Indian Health Service “Fort Peck HPDP”
- Christiane von Reichert, University of Montana, “Distance to Health Care”
- Gyda Swaney, University of Montana “Psychological and Health Consequences of Historical Trauma”
Often isolated and hours away from a proper hospital, many people in the rural West struggle to receive the same health care services available in more urban areas. Tom Seekins, a professor of psychology and director of the Research and Training Center on Disability in Rural Communities at the University of Montana, gave a glimpse into his work.
Seekins began his talk by posing the question: “What is role of a non-medical school university in contributing to health of population?” During the ensuing presentation, Seekins gave the audience plenty of reason to believe it’s an important one. Inequitable access to health benefits, he observed, leads to disproportionate outcomes in rural health. Rural areas are characterized by low populations over large areas, which conflicts with the market-oriented strategy of our traditional medical delivery systems. This is exacerbated by the fact that people in rural areas are more likely to have chronic health problems, Seekins said. He related the story of St. Patrick’s Hospital in Missoula, which was once identified as having the lowest rate in the nation of re-hospitalizations for cardiac patients. When Seekins and his team delved deeper into this statistic, they found that the reason for the low rate was that many of the patients were dying after their release. Poor discharge planning, which Seekins referred to as the ‘black hole of medicine’, was responsible for low recovery rates among these cardiac patients. Many discharge planners aren’t familiar with the resources available (or lack thereof) for patients returning to small, rural communities. To address this problem, Seekins asserted, a greater focus needs to be placed on developing communications strategies and linkages, and those in bigger cities like Missoula need to work with providers in smaller areas. One alternative, Seekins suggested, was for rural residents to relocate to denser areas for the duration of their follow-up treatment.
Kenneth Smoker’s presentation focused specifically on health care in the reservation setting, especially as it relates to children. He noted that those living on reservations experience an extremely young average age of death by comparison to other parts of the country. Smoker works for the Indian Health Service for the Fort Peck Tribes in Montana, where he started four school-based health centers to serve every child, regardless of their background or ethnicity. These centers care for about 2,600 students, and also create employment opportunities for tribal members (slides). Partners in this effort include Yale, Harvard, Walla Walla University, and the University of Montana. Last year, a survey done by the Indian Health Service discovered that many students did not look forward to going home after school, so Smoker’s current efforts are focused on creating more after-school opportunities for children on the reservation.
Christiane von Weichert is a geographer at the University of Montana who examines rural areas as part of her research. In her presentation, she also highlighted the fact that disability rates are higher in rural areas than in urban ones. She also presented a series of maps illustrating the long distances that separate potential patients from physicians and hospitals in the rural West. A hundred million people who live West of the 100th meridian, von Weichert said, live in a location that is more than one hour away from a clinic. (slides) She also noted an interesting trend referred to as a “rural health bypass.” This term describes the growing tendency of rural residents to bypass nearby health care providers and travel to what they consider to be quality health centers, most commonly in more urban areas.
Gyda Swaney, an associate professor of clinical psychology at the University of Montana, began her talk by describing the valley where the University of Montana, and at that moment all the conference attendees, were situated, a valley that However, the words she used to describe it, from the local Native American dialect, were decidedly unfamiliar. ‘Historical trauma’ was another phrase Swaney introduced to the audience. She points to historical trauma as a lens through which we might better understand the myriad issues facing Native American populations today (slides). Symptoms of such trauma include poverty, poor health status, high disability rates, and lower life expectancy. A paradigm shift, Swaney said, is necessary in order to transition from a single Western perspective of discovery, assimilation, and reinvention to the indigenous perspective of invasion, genocide, resistance, survival, and now, recovery. Along with this shift is recognizing the inherited legacy of many of the challenges faced by Native American reservations and moving away from problematizing Indians.