On Cancer, Health Reform, and Rural

According to the AP wire for September 19, Congresswoman Sue Wyrick, R-NC, recently spoke out in opposition to health care reform. She cited her own case, which she described as requiring “six doctors, three mammograms and one ultrasound” as taking “only a few weeks.” She asserted that in Canada and the UK, she might have had to wait “more than a month.” [1]

Leaving aside the question of whether there is a substantive difference between “a few weeks” and “more than a month,” and acknowledging the traumatic nature of breast cancer for any woman, the lawmaker could still use some education regarding health care in the US.

- All women do not have equal access to mammograms, and thus to the quick treatment received by Rep. Wyrick. Among age-appropriate women (over age 40), rural women are less likely to receive timely mammograms than their urban sisters (71% versus 78%). Among uninsured rural women, only 51% get screened. [2] That means barely above a coin flip that cancer will be detected among these women.

- For women who are not receiving routine screening and must wait till they detect a suspicious lump to seek out free screening for the uninsured, the clock starts a lot later than “more than a month.” This has real consequences: uninsured women are more than twice as likely to have advanced stage cancer when they first seek treatment (18% for uninsured versus 8% for privately insured women). [3] At that point, they likely would have traded "more than a month" waits to have had their cancer detected at Stage I.

The health care reform debate is not trivial for folks living “outside the Beltway.” We need lawmakers who are both passionate and informed about rural.

References:

[1] “GOP lawmaker warns of dangers in health overhaul” http://www.thestate.com/nationalpolitics/story/949479.html

[2] SCRHRC Health Disparities Chartbook, http://rhr.sph.sc.edu/index.php

[3] Halpern et al, Cancer July 15, 2007, p 395-402.

Reform and Rural

The SCRHRC was fortunate enough to be a participant at the ORHP Grantee Partnership meeting in DC last week. An overwhelming message on the part of participants: let the wonks sort out the details, but let's have a beginning to health care reform now. We can tweak later.

The LA Times published an interesting analysis of the health reform paradox: rural states (South and West) would be the biggest "winners" if health care reform makes care more accessible, but residents in these areas are most likely to oppose change of any kind [http://www.latimes.com/news/nationworld/nation/healthcare/la-na-uninsured-rural2-2009sep02,0,1307203.story]. If it is difficult to bring change in good times, it may be even more challenging to effect change in bad times.

Lest We Forget

Arriving in DC for the ORHP Grantee Partnerships Meeting, I was fortunate enough to encounter the events pictured. USAirways flies WWII vets to DC, free of charge, to visit the WWII memorial. An honor guard of vets from subsequent wars was present to escort their brothers and sisters to the memorial.

Planning the future of rural research

The National Center for Minority Health Disparities (NCMHD) and the Office of Rural Health Policy (ORHP) convened a terriric meeting in DC July 30 and 31, in which the SCRHRC participated. The overall purpose of the meeting, in the words of the pre-meeting materials, was to “provide NCMHD and ORHP with more insight into the best practices, research gaps, and innovation opportunities in addressing and eliminating rural health disparities.” About 30 rural health researchers and representatives of significant rural population groups met to work on defining research opportunities that NCMHD may wish to pursue to reduce disparities experienced by rural (not necessarily minority) populations.

This was a working meeting, not a listening meeting. Participants were divided into three groups, and each group spent the day brainstorming research recommendations for the three areas outlined: best practices, research gaps, and innovation opportunities. The task was harder than it sounds. First, “research gaps” kept sneaking into every discussion. As the rural community has been saying for years, we lack data and quality research on so many aspects of rural: disease burden, health behavior, health care systems operation, and outcomes. Second, it’s hard to keep “best practices” from sneaking into innovation. We know a good thing when we see it. At least, we think it’s a good thing; research is needed to confirm that a cool idea is a best practice. But it’s hard to sit around a table at a hotel in DC and predict the next new thing! Back in the day, I bought a Betamax (kids, ask your parents), so I definitely don’t set myself up as an innovation predictor.

By 5:00 Thursday afternoon, the participants were all drooping slightly from the effort of expending so much creativity. During the Friday summary presentations and discussion, it was clear that most of us agreed on some issues: need for rural data, workforce as a lasting issue, the need for partnerships. The list of topics in all areas was fairly deep and extensive. The proceedings should make a very interesting document.

Rural Faculty Network at AUPHA

   In Chicago last week, the Association of University Programs of Health Administration introduced its new “faculty networks,” scheduled to be implemented in the fall.  These networks will expand the previous loosely configured interest groups into ongoing networks dedicated to sharing resources and expanding teaching in their topic areas. Richard Vallone of Adams State College in Colorado (rvallone@adams.edu) is the current Chair of the Rural Faculty Network; Jan Probst of the SCRHRC is Chair-Elect. 

   Attendance at the first Rural Faculty Network meeting was a tad thin:  There were seven of us in the room.   Along with the Chair & Chair-elect, this included Armando Valdez of Adams State; David Cockley of James Madison University;  Gary Filerman of Georgetown University; Gerald Ledlow of Georgia Southern University; and Warren McDonald of Methodist University.  Discussion at the session was wide-ranging, from the interests of the Veterans Administration in rural workforce, to the need to establish what schools are currently doing to prepare students for the challenges of rural healthcare management.  A key point:  the line between viability and death is a lot thinner for rural hospitals and clinics, with slim margins and limited staff resources, than it is for their urban cousins.

   Got any ideas?  Send ‘em to any of the folks listed above.  We know that there must be lots of rural hospital administrators out there who can tell us “… if only I had known about [insert challenge here], I would have been better prepared.” We hope to develop a charter for our network, so that we can enlist other leaders, teachers and researchers who can help us pool, share, and grow.

SCRHRC in Chicago

 Like Miami, Chicago is a far piece from rural.  That didn't stop us from presenting several abstracts at AcademyHealth.  Along the way, we met up with Wendy from North Dakota, and visited "Taste of Chicago" to see what the big city folks eat.  It appears that they eat SC State Fair food.  Not a veggie in sight.




   

SCRHRC Party

At the beginning of summer in South Carolina, there is a brief, wonderful time when the weather's nice and warm and the outdoors hasn't yet become a steam room.  So Center faculty & staff partied at Jan's house. 

Jihong & Jessica

Medha and her lake-loving spouse
Robert & daughter

Jeff & Teddy