Nov. 20 is National Rural Health Day™, an opportunity to bring attention to and honor the efforts of rural healthcare providers, communities and others dedicated to addressing the unique healthcare  needs of rural America. It also provides an opportunity to consider the unique challenges that living in rural communities poses to managing health. NRHD is sponsored by the National Organization of State Offices of Rural Health (NOSORH).

According to the National Rural Health Day, Rural Health Information Hub, the National Institutes of Health, and multiple CDC reports, despite the many positives of living and working in rural communities, rural Americans are more likely to die prematurely from heart disease, cancer, lung disease and stroke, as well as having greater risks of fatality from road crashes, suicide, and drug overdose. Coincidentally, the third Thursday of November is also the American Cancer Society’s annual Great American Smokeout® event, which they have hosted for almost 50 years.
What is it about rural areas that results in poor health and poor health outcomes?

Geography

• Long distances to healthcare providers and limited public transportation options may mean people are not going to the doctor for regular check-ups or preventive screenings when they need to be;

• longer response times for emergency services because of farther distances to reach patients or scenes of accidents result in worse outcomes;

• lack of accessible recreational activities for youth and seniors contribute to social isolation and worse mental health;

• limited access to stores carrying fresh food contribute to eating processed, high sugar/sodium foods;

• the energy and agriculture industries are among the top 10 most dangerous jobs in the US, according to the OSHA Education Center.

Shortage of healthcare services

• Fewer providers, especially of specialty medicine, addiction and cancer care and high turnover of providers in rural areas may mean lack of continuity of care so people may become frustrated with having to start a new relationship with a provider more frequently;

• lack of funding for community hospitals to stay open, and generally smaller hospitals with fewer beds also means critical services are not available locally and increase the time to receive life-saving care;

• limited broadband service may not support telehealth options that would otherwise be able to meet some of the needs for chronic disease management and mental/behavioral health services including addiction treatment.

A culture of independence and stoicism

Especially when it comes to mental health, but also around public health issues such as wearing seatbelts or getting immunized, many rural people don’t like to ask for help or be told what to do, even if it’s in their best interest, and still subscribe to the old warning of not “airing dirty laundry,” and the “cowboy up” ethos.

Other challenges to rural health include an aging population with complex health needs, lack of affordable health insurance options, high use of tobacco, especially among youth, and unsafe driving habits.

There are risk factors for cancers and chronic diseases like diabetes we cannot control, like genetics, or past history of environmental exposure or personal health habits. With all of these challenges, what steps can we take to improve our own health outcomes while enjoying the positives of living in rural northeast Colorado?

Get to know your health insurance

Most health insurance plans cover annual wellness/check-ups and preventive care/screenings. Don’t leave those benefits on the table – preventive care and screening can mean the difference between catching a serious illness early enough to manage it or finding out late when treatment options are limited and costly. If you do not have employer-provided insurance, the NCHD Equity & Outreach team are certified Assisters for Connect For Health Colorado, the health insurance marketplace, and can help you find the right plan for you and your family so you can maintain your best health. When transportation is the barrier to care, options are available through Northeast Colorado Association of Local Governments (NECALG), and through the Health First Colorado (Medicaid) non-emergent medical transportation (NEMT) program.

Reduce your risk factors:

• Through diet and exercise — maintaining a healthy weight isn’t about how we look, but how we feel, and excessive weight contributes to worse outcomes for diabetes and heart disease, among other chronic conditions. NCHD offers a free Diabetes Prevention Program to help you make the lifestyle changes that will let you live your best life now.

• Stop using tobacco — tobacco use damages the lungs and contributes to long-term diseases like chronic obstructive pulmonary disease (COPD), makes conditions like asthma worse, worsens infections like pneumonia and tuberculosis, AND contributes to more than 10 cancers that affect every part of the body. We also have a vibrant Tobacco Cessation program that can provide the resources to make your quit journey more successful.

• Practice safe driving — slow down, pay attention, always wear seat belts, and have children in the right size safety seat, correctly installed. The Colorado State Patrol in northeast Colorado has estimated that up to 90% of child passenger safety seats are installed wrong — have them checked at a State Patrol office or by an NCHD certified safety seat inspector.

Support your mental wellness

Lack of transportation and recreational activities, especially for youth and elders, combined with social stigma about seeking help, means the isolation of living in rural areas can leave people without the tools to manage their behaviors, relationships, and emotions. You can find program information on our webpage Behavioral and Mental Health – including the LifeSource Project which can help pay for mental health therapy for youth up to age 19. Last year NCHD introduced the online tool CredibleMind, which is now also available in Spanish, to support residents of all ages in managing their own mental wellbeing. CredibleMind provides confidential access to thousands of assessments, articles, videos, podcasts, reading recommendations, and wellness practices that address over 100 topics related to mental wellbeing. The platform is free and can be used completely anonymously or you can create a log in to track your assessments and save your favorite resources. Local community resources and services in the six-county district are also included on the website nchd.crediblemind.com.

Whether you are a multigenerational rural resident, or a relative newcomer to the region, you can take charge of your health in spite of the challenges that exist here.

Linked sources:

• National Rural Health Day powerofrural.org/key-messages-data-points/

• Rural Health Information Hub www.ruralhealthinfo.org/topics/rural-health-disparities

• News in Health newsinhealth.nih.gov/2022/03/health-rural-america

• OSHA Education Center www.oshaeducationcenter.com/dangerous-jobs-in-united-states/

• NECALG Transportation www.necalg.org/transportation

• Colorado Medicaid Transportation hcpf.colorado.gov/nemtlist

• NCHD Behavioral and Mental Health nchd.org/behavioral-and-mental-health

• NCHD LifeSource nchd.org/programs/behavioral-and-mental-health/lifesource-project/

• NCHD CredibleMind nchd.crediblemind.com