By Liz Carey
Daily life there
For the first time in 20 years, mental health and substance abuse are more pressing health problems than access to basic health care, according to a survey of rural stakeholders.
Rural Healthy People 2030, published by the Southwestern 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, social services and other fields.
In 2010 and 2020, the top issue in the survey was access to health care.
Although access to health care remains one of the top five issues according to survey respondents, researchers said the growing impact of mental health and substance abuse ranks first and second on the list, regardless of age, race, region or profession.
“Over the past two decades, access to health care has been, by far, the most important topic, no matter how we reduce the data,” said Timothy Callaghan, one of the authors of investigation. “The fact that mental health and addiction are ahead of access to health care this time around…certainly surprised us, but when you start to think about the context of the last decade and the context of the pandemic in which you launched the investigation, the results are a little less surprising.
Callaghan said the rise of the opioid epidemic before 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 it. But changes to health care through the Affordable Care Act may have improved access to health care, putting other issues at the top of the list, Callaghan said.
Nearly 20 million people signed up for insurance under the Affordable Care Act during open enrollment last year, according to the U.S. Department of Health and Human Services. In 2022, 35 million people signed up for insurance during the open enrollment period, 21 million of whom were part of Medicaid expansions.
Still, it’s striking that mental health and substance abuse topped every category, he said.
“You’re going to see small changes in characteristics over decades,” he said. “But the extent to which mental health and substance abuse have increased and been so systematically cherry-picked by stakeholders demonstrates the true scale of these problems.”
Stakeholders may have focused on the most pressing needs of the moment, Callaghan said. The survey was presented to stakeholders in 2021. In partnership with rural health organizations such as 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 links to the survey and asked stakeholders to comment. Additionally, the center sent the survey to people who had responded to the survey in previous decades and asked stakeholders to identify others who they thought could provide insight.
According to the Pew Research Center, an estimated 40% of American adults have suffered increased mental health issues during the pandemic. A survey by the Kaiser Family Foundation and CNN found that 90% of the U.S. population believed the country was facing a mental health crisis. Adults across the country have reported increased symptoms of anxiety, depression, hopelessness, sadness and suicidal ideation during the pandemic, as well as increased drug and alcohol use.
A total of 1,291 respondents answered at least one of the questions between July 2021 and February 14, 2022.
“I think part of (the ranking) might be because many participating rural stakeholders understood that we are looking at 10-year trends,” he said. “Our data did not allow us to identify precisely why, for example, vaccination is not in the top 20, although we might have expected it, due to the pandemic.”
Besides access to health care, the top concerns in previous surveys included heart disease and stroke, diabetes and nutrition.
Callaghan said as a country we have made significant progress in these areas. A report from the research center to the federal Office of Rural Health Policy found that rural America has made progress in combating some leading causes of death.
“We’ve seen pretty dramatic gains in deaths from heart disease,” Callaghan said. “We still have a gap between urban and rural America, but quite considerable progress has been made.”
Callaghan said it’s unclear whether this is because rural health care providers are better at managing disease or educating patients about illnesses, or if other topics have simply become more important.
For now, Callaghan said, the study reveals where rural health systems should focus, according to rural health stakeholders.
“We now have a better idea of the areas that particularly need investment in rural health,” he said.
“We now know that addressing substance abuse and mental health issues have become increasingly important to rural experts over the past decade and, while access to health care remains important… we must nonetheless start prioritizing the most important issues, namely addiction and mental health. .”
