‘Dismayed, but not surprised:’ Health gap between urban and rural America is on the rise

Thus, when Janice Probst read a report released in March of this year, by the federal Department of Agriculture’s Economic Research Service, that the rural-urban divide in American health is expanding, by a whole lot more in fact, she was shocked but hardly surprised. 
 
The report also noted that from 1999 to 2019, the gap of rural/urban natural deaths for the age group of 25 – 54 years increased from 6% to 43%. It was also identified through the research that the localization has profound relationship with the increment where by the more rural the area the higher the localization. 
 
Until recently, Probst worked as a professor of health services policy and management and as the director at the University of South Carolina Rural & Minority Health Research Center, and her observations on rural health’s general absence from the spotlight are entirely consistent with her specialization. 
 
According to another report that Probst refers to and which was published recently by the Revenue and Fiscal Affairs Office of the state of South Carolina, while the population of the state is increasing at a rate of 2. 52% per annum, which makes it the fasted growing state in the country, most of this will be in the urban areas. At the same time, 25 of the 46 counties of the state are expected to experience a population shrinkage. Farm communities are getting depopulated, there is a dozen rural counties that will have less than 20,000 people by 2042. 
 
This dwindling of rural communities is a reality reflected across rural America, and it doesn’t bode well for the health of the residents of those communities: this is unlikely even poorer access to such basic necessities as health care as well as other forms of services and comforts. Or for that of the community as a body: most of them having had reduced participations in decisions that are made at the state and federal levels. 
 
But, Probst also pointed out, the rural folks of the Palmetto State aren’t sitting idly by. South Carolina has an Implementation Plan of the Office of Rural Health is a strategic roadmap that includes health, education, housing, employment sectors – for the creation of a healthier rural environment is more than merely periodic health check – and people are planning and building their future. 
 
Making connections 
 
The people at the University of Wisconsin Population Health Institute’s County Health Rankings & Roadmaps have been giving much consideration to civic infrastructure and civic engagement. 
 
civic infrastructure, according to Michael Stevenson, the program’s co-director, they mean places “where people engage, where they come together to engage, share information, and how that leads to engagement in the community. 
 
This infrastructure includes many things: recreation grounds; learning institutions; information centers; the information, materials, and services that promote health. 
 
The institute’s researchers said that the comparatively less developed civil neighborhood infrastructure is in the Black Belt region in the southeast, Appalachia, along the border with Mexico, and American Indian and Alaska Native tribal areas which take the blow of different types of disinvestment and structural racism. 
 
The researched case is an organisation named Family Solutions in Orangeburg County of South Carolina. 
 
Orangeburg County is in South Carolina Low Country region. It is within the Black Belt; the town of Orangeburg is roughly 75 percent Black. The county faces the same challenges as so many rural communities: , limited health care access, very limited opportunity to secure well paid employment and inadequate and expensive accommodation in certain local areas and lack of access to adequate transport facilities. 
 
The researchers on exploring the factors behind the deteriorating mortality rates in rural areas identified by the USDA report say that one factor is extension of life expectancy rates for rural women dying of conditions that could be prevented or treated. In the counties where the town population does not exceed 10,000, the number of women’s natural deaths in the 25-54 years old group has increased by 18%, and the number of males’ by 3%. 
 
Family Solutions is one of the state Office of Rural Health programs with the goal to decrease the infant mortality and morbidity and to enhance health and quality of life of children, women and families. It’s taken a leadership role in addressing unacceptable health outcomes in five rural counties: Companies’ locations are as follow Allendale, Bamberg both of which are in low per capita income in the state also Barnwell, Hampton and Orangeburg are other south Carolina counties which comes among the bottom fifteen per capita income count. 
 
Despite working in the area of providing maternal health, the Family Solutions team understands that if one has to work towards enhancing the health indicators and saving lives, then it’s a process that has to take place in the community. 
 
Hope: A ‘powerful thing’ 
 
According to the Office of Rural Health’s CEO Graham Adams, Lamikka Samuel, and her team are as effective as they are, because they are of this community, many born and raised, some of them were in this agency/center as clients and suffering from mental illness. 
 
Thus, if the original hired people from home office of Columbia, “I just don’t think we would have had the ability to get the same results; we wouldn’t have had the trust. ” Moreover, it did not happen in short time period “It took years and today; We are 27 years old. ” 
 
It is much about partnership, networking, utilising equipment. It’s about respect. 
 
“We’re not coming in trying to force you to do anything,” the smoothly persuasive voice of Samuel came. Instead, “we are informing you of what is best for you, in terms of your health. ” 
 
Lack of trust is one of the big factors as to why most women in her community will not rush to hospital to seek a check-up as soon as they feel that they have a health problem, Samuel noted. 
 
“They do not go out to get help from other persons, from other households, from the large neighborhood, the neighbors, the outside world,” she added, because each time they try it, “they are not listened to; they are not esteemed. ” 
 
The team requisites company to the women appointments, so that they can ‘explain the language’ to them, according to Samuel. 
 
“If the person you are targeting has such an attitude of mistrust towards the medical system, the clinical community to start off with it, the time they take just to be able to get to that appointment, then frustration may set in for that particular person and he comes to a conclusion that if this is how he or she is going to be treated after all this, then they will not be coming back again. ” 
 
“Yes we can try to reduce some of those problems,” responded Samuel. It is about being there for them and explaining why they need to take the medicine in the first place, “not because I, Dr. So-and-so, asked you to, but because this may help deal with whatever it is that you are facing. ” 

While engaged with providers the team assists them to understand their patients and the difficulties they observe as well as prepare the nursing students at the local community college what it might be like to practice in the rural setting. 
 
There are some classes such as childbirth classes and availability of a doula. “We are going into their homes, monthly we are doing the education on maternal and infant health,” explained senior program manager Tracy Golden. 
 
“We are relating the dads,” Golden said. The male involvement coordinator, Kelvin Gadson, champions talks in the local barbershops something that they are handling. 
 
Adams mentioned that the first statewide federal funding for Family Solutions funding was in 1997 but a county where the program now operates has the highest rates of infant mortality on the country. 
 
But he said this state still contends with issues of infant mortality, not to mention maternal mortality. “However, there has been many a year that program participants in the counties served by the organization have not experienced any infant mortality. ” 
 
Romaine Stephens is the community engagement coordinator of Family Solutions. She recently got pregnant in what could be regarded as the age bracket of child-bearing that is stretched to the limit. She was scared. That was really if, in my opinion, brought to the realization of how crucial this work is. 
 
“In the words, ‘I don’t want to die pregnant’; nobody should have to feel like that,” Stephens said. “Having all this for them — a therapist for them, all these resources for them — and if you could lift a little of stress from someone, to give them hope – I believe hope is a powerful antidote. ” 
 
‘Come in’ 

One of the new services that is being offered by the Family Solutions is referred to as Resource Center out of numerous others across the state, each of which is created to address the need of a given community. 
 
“This is our community arm,” Samuel went on, “This is the resource that is available to anybody. ” “This is for those who are in the community if there is something that you need which is available here you are free to come. ” 
 
Services offered are; Legal services, Money matters and insurance, fatherhood classes and reproductive health classes, classes on sewing and wreath making. 
 
Thus, the South Carolina Infant Mental Health Association is willing to help. It is not clear what services are offered but hope health offer HIV tests, Hepatitis B tests. Diabetes Free SC is yet another partner to the program. Their application is a beneficial thing for the residents of the state although sometimes they may need the assistance of the state Department of Social Services especially for those who are applying for Temporary Assistance for Needy Families. 
 
Families can also give a free household supplies or diapers for their families. plus there is a provision for children’s playing area for the other attendants to take their services. 
 
‘Shouting from the hilltops’ 
 
“The issue which I have been crying out for years,” Janet Probst said, “is that rural hospitals and rural health care needs to be funded like this is a necessary commodity, not like a beauty product that we’d probably like but we don’t necessarily require. ” 
 
In her view, this means that health care should be delivered like electricity is, “where it reaches every house because even though it requires more resources to get it some houses than for others. ” 
 
But Probst also acknowledges there lies the question of what it will take to maintain not only individuals’ health, but the community as a whole – the foundation or social and physical capital for creating and sustaining a healthy community. 
 
The rural societies are not sitting and hoping for a string of external support. Probst referred to the Federal Reserve Bank of St. Louis saying only 6. 9% of all charitable dollars go to rural agencies. And she wanted to know that, as she found out there are many federal grants that rural communities can apply for? including through the USDA but they are quite complicated. 
 
(There is, it must be noted, a very substantial chunk of federal funding available that the South Carolina state legislature has thus far declined: South Carolina is one of the 10 states that have not expanded Medicaid as provided by the Affordable Care Act known as Obamacare. The working poor, Probst said, are less likely to seek an early checkup when they have a health concern or be as severely impacted. 
 
Solutions are within. This paper, authored by Michael Stevenson and his co-workers, establishes that those places which have ‘worship’ as a form of infrastructure are more likely to vote, unionise, conduct census. Their opinions appear more often of being listened or considered. They are more likely to suggest a way out more so when it comes to solving that complex scenario. 
 
“With all the chances that can be given to express any concern regarding what is going on in rural South Carolina,” – as Lamikka Samuel has stated – “we seize those moments. ” 
 
“Sometimes, ‘We wish they would shut up those two again,’ say I,” she continued. That will not go without them being heard Their voice will be aired.