Ronald Yee, M.D.
Chief Medical Officer, National Association of Community Health Centers (NACHC)
Overall life expectancy rates have held steady in the United States for several years, but in many rural pockets, progress on that front is stalled or even declining.
Health experts now note a widening gap of almost three years in life expectancy between people living in rural and urban areas. Rural residents are more likely to have lower income, be older, and suffer from preventable chronic illnesses. A major cause of this disparity is simply that rural residents have difficulty getting care.
Problems in rural America
From my own experience as a community health center physician, many patients live with debilitating health problems because traveling long distances to a doctor’s office poses a challenge. Too often, health conditions that could have been prevented are left unaddressed.
Unfortunately, this is becoming even more commonplace; some 250 rural counties across the nation don’t have healthcare providers, leaving 62 million Americans (many of whom have health insurance) living in areas that have few or no options for primary care.
An alarming trend of rural hospital shutdowns is compounding the scarcity. Nearly 90 U.S. rural hospitals have closed since 2010 and just over 21 percent of those still operating are on the brink of closure due to financial insolvency.
An alarming link
Among the environmental factors at the root cause of illness — clean water, jobs, nutrition, and safe housing — access to primary care is a pivotal driver of determining how long one will live.
U.S. counties with a sufficient supply of primary care providers have lower mortality rates, according to a recent study published in the Journal of the American Medical Association-Internal Medicine. The same study noted that for every 10 additional primary care physicians per 100,000 people, there was a 51.5-day increase in life expectancy.
The link between mortality and access to care has been a focus of research before. University of Michigan researchers examined data from when health centers were first funded from 1965-1974 and found that mortality rates dropped 7-13 percent among people aged 50 and older. The most significant reductions were deaths linked to cardiovascular problems.
Access among the “haves and have nots” is certainly not new in healthcare. Community health centers sprang into existence over 50 years ago because of growing evidence that putting doctors in poor communities was a powerful weapon against poverty and ill-health. Today, these centers provide care to more than 28 million people nationwide.
Building a better healthcare system
Nearly half of our health centers are located in rural communities, where the nearest doctor or hospital could be as far as 50 miles or more. It is in these, and more remote frontiers, where community health centers are creating effective, cutting-edge strategies to address complex health issues, such as opioid use disorders, mental illness, chronic pain, and maternal mortality.
They are integrating behavioral health services with primary care. They are applying technology, such as electronic health records and telemedicine, to expand needed services. They are providing support services — such as pain management, casework, home visits or counseling, alongside medication-assisted treatment, to address the cycle of addiction in communities. They are also increasingly addressing the needs of veterans with important services such as oral and behavioral health.
The work community health centers do to extend and improve lives cuts costs across the U.S. healthcare system, but the total return on investment depends on long-term support. Congress needs to commit secure and sustained health center funding for the people and communities they represent — and there is certainly bipartisan support for such a move.
The nation must also invest in programs critical to building a pipeline of the primary care workforce needed for today and tomorrow, such as the National Health Service Corps and the Teaching Health Centers program. Community Health Centers cannot bridge the life expectancy gap on their own.
Ronald Yee, M.D., Chief Medical Officer, National Association of Community Health Centers (NACHC), [email protected]