Health Statistics

The statistics regarding health care aren’t encouraging for rural Americans in general or for rural North Dakotans specifically.

Population density statistics combined with mileage and travel time factors indicate that 48 of 53 counties in ND – 91% – are not only considered rural, but frontier counties. (areas with 6 or fewer people per square mile are defined as “frontier”).

Studies show that a higher proportion of rural residents are without comprehensive health insurance coverage and that chronic conditions are more prevalent in rural than in urban areas. According the Robert Wood Johnson Foundation State of the State Report 2002, there are approximately 67,000 uninsured North Dakotans. Almost 15,000 children are uninsured in the state. When compared with insured children, uninsured children are:

• Up to six times more likely to have gone without needed medical, dental or other health care.
  
• Twice as likely not to have been seen by a physician during the previous year
  
• Up to four times as likely to delay seeking care
  
• Up to ten times less likely to have a regular source of care.

A study of more than 4,600 breast cancer patients found that uninsured women had a 49 percent greater chance of dying after diagnosis than women with private insurance.

Forty percent (40%) of rural populations in the United States live in either Health Professional Shortage Areas (HPSA) or Medically Underserved Areas (MUA). In North Dakota, 47 of 53 counties (89%) are fully or partially designated as either HPSA, MUA, or both.

Despite the prevailing belief that life is more “relaxed” in rural areas, evidence to the contrary shows that the prevalence of mental health problem including anxiety and stress-related disorders is virtually equal between rural and urban populations. According to data compiled by the North Dakota Adolescent Suicide Prevention Task Force, the suicide rate among North Dakota’s white teens was 42% higher than the national rate for white teenagers. The suicide rate among Native American teen and young adults 15 –24 years old is 429% higher than the white rate for the same age group. Statistics show that 20.5% of non-metropolitan counties in the U.S. have no mental health services. The North Dakota Department of Health Suicide Prevention Task Force publication documents statistics and makes recommendations at http://www.health.state.nd.us/ndhd/pubs/
PREVENT/SuicidePreventionSeptember2000.pdf

The Rural Mental Health Association provides background on the scope of rural mental health issues and makes a variety of recommendations to address the problems at http://www.nrharural.org/dc/issuepapers/ipaper14.html

Information from the UND Center for Rural Health indicates that the situation for rural Native Americans is even more bleak. Older Native Americans are:

17.7% more likely to have high blood pressure
48% more likely to suffer congestive heart failure
173% more likely to be afflicted by diabetes.

Indian Health Service statistics show that Native Americans in the IHS Aberdeen region, which includes North Dakota, Native populations die

• of accidents a four times the rate of all other Americans.
  
• from alcoholism at 7 times the national rate
  
• from diabetes at six times the national rate
  
• from tuberculosis at ten times the rate of other Americans

According to the Arizona Republic, “The Indian Health Services spends about $1,920 per person annually. That compares with more than $4,390 that private insurance budgets for most American’s health plans, or the federal government’s $3,859 for Medicaid, $5,600 for Medicare and more than $5,700 that veterans receive.”

For in-depth reports regarding medical care issues on the reservation, read the Arizona Republic articles by reporter Judy Nichols at http://www.azcentral.com/news/specials/indianhealth/
0414healthmain.html
http://www.azcentral.com/news/specials/indianhealth/
0721hospital21.html
http://www.azcentral.com/news/specials/indianhealth/
0721heart21.html

“Quality of Life: Reality or Myth?”

Despite the fact that Americans are healthier today than they were 25 years ago, the picture isn't as rosy for those living in rural areas. A recent study from the U.S. Center for Disease Control (CDC) found that rural Americans were less healthy than their urban and suburban counterparts.

The study came as a surprise to many, according to Dr. Mary Wakefield, director of UND's Center for Rural Health. During an interview with a national news syndicate, the reporter expressed astonishment at the CDC's findings. "The person who was interviewing me said 'we always think about rural populations as living in areas where there’s healthy air, there’s less traffic, there’s maybe even less stress--How can this be?'" said Wakefield. "My response to her was 'You know it’s a little bit of a myth that everything about rural living is so bucolic.'"

According to indictors researched in the 2001 CDC study, rural Americans tend to get less preventive care and medical treatment, are less likely to have health insurance, tend to smoke more, lose more teeth, exercise less, and die sooner.

Experts say the high rate of poverty among rural residents and the long distances to drive to medical facilities play a big factor in these numbers and unfortunately, Wakefield says, if the rural health crisis does not improve, these statistics for rural residents will only get worse over time.

"The picture is not a good one that’s painted for rural populations. As a matter of fact, it’s really bleak," said Wakefield. "If a 60-year-old needs to drive 30 miles to get health care, he or she might think twice before they seek out that health care. So, in fact, we see different patterns of utilization. A lot of our rural folks don’t use hospitals, for example, as much as their urban counterparts. They certainly, the data show us, certainly don’t have as many physician visits as their urban older population counterparts—they don’t see docs as frequently."

Among the study's findings:

Even the wealthiest rural residents are less likely to have health insurance than their urban or suburban counterparts. 10.6 percent of the people living in rural areas lack health insurance, compared to 6.6 percent of suburban residents. Only the poorest urban residents had a similarly low rate of health insurance coverage.

Overall, access to health insurance is poor for rural Americans. 21 percent of rural residents under the age of 65 are uninsured, compared with 19.6 percent in urban and 12.2 percent in the suburbs.

Dental health is lower for rural areas, especially among older residents. 37.6 percent of rural residents over 65 had a total loss of all teeth, compared to only 25.7 percent in the suburbs and 26.8 percent in the cities.

Smoking is more prevalent among rural residents, particularly adolescents. 18.9 percent of youngsters age 12 to 17 in the most rural areas were smokers, compared to 11 percent in urban areas and 15.9 percent in suburbs. Rural adults also smoke at a higher rate than urban or suburban adults.

People living in rural areas get less exercise on the whole. 46.5 percent of men and women in the most rural areas did not exercise, play sports or pursue active hobbies, compared with 40.9 percent of urban residents and 31.1 percent of their suburban counterparts.

The only major factor tracked by the study in which rural life scored higher than urban or suburban was a lower rate of death by homicide. However, the death rate for children, adolescents, and adults in rural areas was highest for death from natural causes and accidental injuries.

Suburban populations also have a much lower teen birth rate, around 36 births per 1,000 females compared to 59.6 for urban females and 57.9 for rural females.

Women living in the suburbs have the lowest infant mortality rate—6.1 deaths per 1,000 live births. Women in urban areas are at 7.5 and rural at 7.7 deaths per 1,000 live births.

Additional statistical information can be found at these websites:

Center for Disease Control
Models that Work website – The Models That Work Campaign identifies and promotes the replication of innovative community-based models for the delivery of primary health care to underserved and vulnerable populations. Michigan’s Rural Health Prevention Network is an example of one innovative model that pools the resources of multiple health agencies in a rural four-county area in order to provide greater access to and new services aimed at chronic disease prevention including diabetes, chronic obstructive pulmonary disease, and heart disease. http://www.bphc.hrsa.dhhs.gov/mtw/

State of ND Health Department
Biennial Report 1999-2001
http://www.health.state.nd.us/ndhd/pubs/
bienrpt/BiennialReport9901.pdf

UND Center for Rural Health
http://www.med.und.nodak.edu/depts/rural/

Funding for Life Support is provided by a grant from USDA Rural Development