Fixing the “rural healthcare disadvantage” that caused more infections and deaths in rural communities during the Covid-19 pandemic and beyond will take more than throwing money at healthcare, one advocate said.
A new study from the University of Wisconsin-Madison has found politics, vaccinations, and the health of communities played a role in the high mortality rural communities faced during the Delta-Omicron wave between the fall of 2021 and the spring of 2022.
(The Daily Yonder’s analysis of Covid-19 deaths throughout the first three years of the pandemic showed that the weekly rural death rate first exceeded the urban rate in summer 2020. By January 2021, the weekly rural death rate was about a third higher than the metropolitan rate. Cumulatively through the end of 2023, Covid deaths were a third higher per capita in rural counties than in metropolitan ones, the Daily Yonder found.)
The University of Wisconsin-Madison study attributed this difference to the fact that rural residents were older, sicker, and less vaccinated.
“Although vaccinations were widely available, this (the Delta-Omicron surge in late 2021-early 2022) was the deadliest period to date in the U.S. and the toll was especially high in rural areas, exacerbating an existing rural mortality penalty,” the study said. “Older age composition, worse pre-pandemic population health, lower vaccination rates,… completely explain the rural disadvantage in Covid-19 mortality.”
For rural policy makers and healthcare providers, this is nothing new. Over the past three years, pre-pandemic health conditions, poverty and aging have been a factor in higher Covid mortality rates in rural communities across the country.
The study looked at mortality rates for Covid at the county level across the country. Using data from multiple sources, including state and local health agency reports, they compared mortality rates between rural and urban counties, as defined by the U.S. Department of Agriculture’s rural-urban continuum codes. The study also looked at county level vaccination data from the Centers for Disease Control and Prevention.
What it found was that death rates from Covid generally increased as rurality increased. But, the study said, if pre-existing health conditions, age and vaccinations rates were the same in rural areas as they were in urban ones, rural communities would have had an advantage over their urban counterparts during the fourth Covid wave and seen fewer deaths.
Tim Size, executive director of the Rural Wisconsin Health Cooperative, said what’s important in the study is not what it shows on the surface, but the underlying implications. In his analysis, the study shows that rural communities have lost faith in the healthcare providers they once listened to as neighbors, caregivers and friends.
“Those of us in healthcare, we were beginning to lose some (of the public’s) trust before the pandemic,” he said in an interview with the Daily Yonder. “In rural communities, when the virus came, the response to it became such a wedge issue. We all really accelerated a loss of trust with people who didn’t see it the way we did.”
Size said that rural healthcare providers have to take responsibility for their side of the doctor-patient relationship in order to fix it.
“My wife’s a retired Episcopal priest, and before that a psychiatric nurse,” he said. “Early on in our marriage she would say both parties own a relationship and if something’s not going right, it isn’t the fault of one and not the fault of the other. Both have contributed.”
Throughout the pandemic, and beyond, Size said, there was anger on both sides of the patient-provider relationship. On one side, there were rural practitioners treating community members who refused to get vaccinations, he said.
“A lot of people, we lost to Covid before there was vaccination – we lost healthcare people around the country,” he said. “You can imagine what it felt like to leave work where you were risking your life and then go to a store and be yelled at for masking or for supporting vaccination. That hurt.”
On the other were patients who felt they were being forced to wear masks, get vaccinations and observe social distancing without their views being listened to or respected.
Now, he said, with a little time and space from the pandemic, it’s time to try to mend those fences. Size, who lost two family members to Covid, said the conversation has to start between doctors and nurses and other healthcare professionals about how to turn the conversation around.
“The question we as health care providers have to ask is how do we rebuild that trust and how do we encourage people to become vaccinated?” he said. “Covid’s still out there. In Wisconsin we’ve seen a significant decrease in both influenza vaccination amongst elders and normal traditional childhood vaccination amongst the kids. That’s coming from this relationship and we have to figure out a way to restore it.”
Size said the most successful work in addressing health issues in rural communities has not come from expensive ad campaigns, but from ongoing personal conversations and deep listening.
“I believe deeply that a nurse or doctor who’s committed their life to living and serving in a rural community should have more credibility than an anonymous voice on Facebook,” he said. “But obviously that’s not what a lot of other people think. I’m looking for a way that creates change, that is not about criticizing the people who disagree with me, but finding out how I can contribute to us finding more common ground.”
For now, Size said he’s working to bring people in his state together, hoping to find a way to reframe the conversation. While still in its infancy, he hopes the movement will move from a few head nods to action soon.
This article first appeared on The Daily Yonder and is republished here under a Creative Commons license.
