June 13, 2022. By Ben Succop. UNC Vital Signs.

An abbreviated version of this op-ed was published August 10, 2022 in NC Voices which is a feature that runs on the Opinion page in the Charlotte Observer, Raleigh News & Observer and Durham Herald-Sun.

Studies have shown rural Americans have an increased risk of infection and death from COVID and are less likely than urban community members to be vaccinated. It would be easy to drop the conversation here and blame politics and personal choice for why COVID is disproportionately damaging our rural communities, and many, particularly those who do not live or work in rural areas, do exactly that. However, this assumption ignores the long-acting forces that left rural communities vulnerable in the first place.

Rural America is often criticized for a monolithic culture, politics, and populace, which makes it easy to stereotype and blame for its pandemic related problems. Heart disease, diabetes, cancer, drug overdose, all of these and more are increased in mortality by simple virtue of geography. It is no coincidence that the NC Rural Health Research Program recently revealed that 80 rural hospitals across 26 U.S. states have closed in the past decade and that rural communities are 15,000 physicians short of receiving the same care per capita as their urban counterparts. Nor is it surprising that, according to Pew research, the average travel time to a hospital is nearly double that of metropolitan areas, and these rural hospitals have less than half the percent of emergency funding compared to their metropolitan counterparts, which the difficulties of the pandemic have all too starkly illuminated. Indeed, rural America is unified most not by a single political view or ethnic background, but by a lack of healthcare access.

I have witnessed the consequence of this lack of healthcare access working as clinic co-coordinator and social needs navigator for the free, student run Bloomer Hill People’s clinic in rural Whitakers, NC. In our clinic, many of our patients struggle with affording medication, getting transportation to and from appointments, and finding an accessible primary care doctor. For many, having the means, time, and place to obtain a vaccine is a luxury that cannot be afforded even if the desire is there. Still others fear the vaccine and virus both will exacerbate the chronic illnesses they have to deal with, which have gone undertreated and undereducated due to the lack of regular medical care. As a NC Schweitzer Fellow, my partner and I developed a referral resource network to connect community members to help track and fill gaps in healthcare access. However, grassroots efforts like this are a small bandage on the gaping wound of rural healthcare needs. 

Lacking the desire or opportunity to live in a city should not jeopardize a person’s life, yet in North Carolina and the broader United States, the disparity is a stark reality. This disparity that is not eliminated, but magnified when considering the effects of racial discrimination, poverty, citizenship status, and other health outcome determinants, and it is reflected directly in the decades-long decline in rural healthcare resources. Communities have been left to struggle against this unequal allocation of resources largely alone, to the detriment of the quality of life and health outcomes for people who live there. It’s no wonder that vaccine hesitancy, regardless of political affiliation, is higher in rural communities—why trust institutions that have abandoned you? So yes, our rural community health centers need vaccines and need advocates convincing people to take them. They also need doctors. And nurses. And technicians. And hospitals. And mental health professionals. And social workers. And emergency funds. And the understanding that problems years in the making take time and resources to solve. We must on a policy level invest in rural health facilities and healthcare staff. That’s what gives us the best chance to end this pandemic and the pandemics yet to come: ensuring all our healthcare systems, not just in population centers but across the furthest regions of the state, are equipped to care for their communities.

Ben Succop

UNC School of Medicine

2021-22 NC Schweitzer Fellow