For the first time in 20 years, mental health and addiction are more pressing health concerns than getting access to basic healthcare, according to a survey of rural stakeholders.
Rural Healthy People 2030, released by the Southwest Rural Health Resource Center, surveyed a national sample of people “working to improve the lives and health of rural Americans,” to determine the most important issues facing rural residents. Participants included people working in health care, public administration, education, human services, and other fields.
In 2010 and 2020, the biggest issue in the survey was access to health care.
While access to health care remained one of the top five issues according to survey respondents, researchers said, the growing impact of mental health and addiction took the number one and two spots on the list regardless of age, race, region or occupation.
“For the past two decades, health-care access has been, far and away, the most important topic no matter how we cut the data,” said Timothy Callaghan, one of the survey authors. “The fact that mental health and addiction came out ahead of health-care access this time… certainly surprised us, but when you start thinking about the context of the past decade and the context of the pandemic in which you launched the survey, the findings are a bit less surprising.”
Callaghan said the rise of the opioid epidemic prior to the Covid-19 pandemic, and the growing recognition of the lack of mental health resources in rural America since the pandemic may be part of the reason. But changes in health care through the Affordable Care Act may have improved health-care access, bringing other issues to the top of the list, Callaghan said.
According to the U.S. Department of Health and Human Services, nearly 20 million people signed up for insurance as part of the Affordable Care Act during open enrollment this past year. During 2022, 35 million people signed up for insurance during the open enrollment period, 21 million of whom were part of Medicaid expansions.
Still the fact that mental health and addiction rose to the top across all categories was striking, he said.
“You’re going to see small changes in characteristics over the course of decades,” he said. “But the extent to which mental health and addiction have risen and were so consistently selected by stakeholders, demonstrates how big those issues really are.”
Stakeholders may have been focusing on what were the most pressing needs given the moment, Callaghan said. The survey was presented to stakeholders 2021. Partnering with rural health organizations like the National Rural Health Association, the Centers for Disease Control and Prevention, the American Hospital Association, and the National Association of Rural Health Clinics, the research center sent out links to the survey and asked stakeholders to comment. In addition, the center sent the survey to people who had filled out the survey in previous decades and asked stakeholders to identify others they felt may be able to provide insight.
According to the Pew Research Center, an estimated 40% of American adults suffered from increased mental health issues during the pandemic. A survey done by the Kaiser Family Foundation and CNN found that 90% of the American public felt the country was facing a mental health crisis. Adults across the country during the pandemic reported increased symptoms of anxiety, depression, hopelessness and sadness and suicidal ideation, as well as increased drug and alcohol use.
In all, 1,291 respondents answered at least one of the questions between July 2021 and February 14, 2022.
“I think part of (the rankings) could be that a lot of the rural stakeholders participating understood that we’re looking at 10 year trends,” he said. “Our data didn’t allow us to identify specifically why, for example, vaccination isn’t in the top 20 even though we might have expected it to be, due to the pandemic.”
Major concerns besides health-care access in previous surveys included heart disease and stroke, diabetes, and nutrition.
Callaghan said as a country we’ve made significant strides in those areas. A report by the research center to the Federal Office of Rural Health Policy found that rural America has made progress on some leading causes of death.
“We’ve seen some pretty considerable gains in heart disease deaths,” Callaghan said. “We still do have a gap between urban and rural America, but there have been some pretty considerable gains.”
Callaghan said it’s not clear if that is because rural health-care providers are better at managing the disease, or educating patients about the diseases, or if other topics have just become more important.
For now, Callaghan said, the study reveals where the focus of rural health systems should be, according to rural health stakeholders.
“We now have a better sense of the areas that are particularly in need of rural health investment,” he said. “We now know that addressing addiction and addressing mental health issues have become increasingly important to rural experts over the past decade and while health-care access remains important… we nonetheless have to start prioritizing the issues that are most important which are addiction and mental health.”