Bridging the Gap: Addressing Rural Disparities for Equitable Care

Author: Ashley Smith

Introduction:

Diabetes affects around 3.8 million people in Canada, making it one of the most common chronic diseases to be diagnosed (Government of Canada, 2024). However, is everyone diagnosed equally? Is the distribution of diabetes diagnoses the same across all communities, provinces, and territories? The answer is no. So, why is there a difference? Why do diabetes prevalence and treatment vary between urban and rural communities?

The Statistics:

Diabetes is more common in rural areas, with 10% of adults in rural areas being diagnosed with diabetes, compared to 8% in urban areas (CDC, 2024a; Gupta et al., 2022). Despite an increase in diagnoses, there is also a change in diabetes-related avoidable hospitalization (DRAH) rates. It has been found that residents living in rural areas are 50% more likely to experience a DRAH than those living in urban areas (CDC, 2024a; Gupta et al., 2022). This can be attributed to fewer outpatient visits for diabetes care, as well as fewer endocrinology visits in rural communities, with the percentages differing: 5.5% in rural areas and 9.3% in urban communities (CDC, 2024a; Gupta et al., 2022).

The Reason Why:

Even though there is a clear difference in diabetes diagnoses, adverse hospital events, and treatments between rural and urban communities (CDC, 2024a; Gupta et al., 2022), the reasons why are multifactorial and contribute to the social determinants of health. It has been found that poverty is more prevalent in rural communities than in urban communities, with 15.4% of people living in rural areas having an income below the federal poverty line, compared to 11.9% in urban communities (Bujph, 2024; ​​Foss et al., 2023).

The increased prevalence of poverty further makes it difficult to buy healthy foods. In rural areas, there are more likely to be “food deserts,” which describe areas where food is difficult to afford or where good quality food is inaccessible. This pushes people in poverty to turn to fast food options due to the uncertainty of when they will have access to fresh foods (Bujph, 2024; ​​Foss et al., 2023). However, more interestingly, not only is the poverty rate higher in rural areas, but it is also noted that rural residents remain in poverty longer than people in urban areas. Urban residents are more likely to rise out of poverty and less likely to fall back into poverty, which further creates a barrier for people in rural areas (Bujph, 2024; ​​Foss et al., 2023).

Likewise, it is also evident that people living in rural areas have less access to quality healthcare and health information due to insufficient public transport, staffing shortages, and poor availability of internet service (Bujph, 2024; ​​Foss et al., 2023). This further results in rural residents having lower health literacy and less access to health information from primary care providers, specialized physicians, blogs, or internet search engines (Bujph, 2024; ​​Foss et al., 2023).

Proposed Interventions:

Due to the multilayered aspect of the social determinants of health, a multilevel approach is also needed to help address the effects of diabetes in rural areas. Starting at the community level, efforts to address poverty and food insecurity should include expanding fresh food initiatives, such as Meals on Wheels, to rural areas to help residents access healthy food (CDC, 2024b; Bujph, 2024). Likewise, telecommunication should be addressed to increase access to healthcare providers. When in-person access is not possible due to staffing shortages, telehealth interventions should become a priority to help residents receive healthcare from their own homes (CDC, 2024b; Bujph, 2024).

At the federal level, policy changes are needed to increase funding for rural areas, improve access to transportation services, and support the development of transportation infrastructure (CDC, 2024b; Bujph, 2024). This will allow residents living in rural areas to have better access to going to healthcare providers. Additionally, health literacy needs to be addressed within school education. The federal government can implement a standardized public education system to better prepare students in rural communities, enhance health literacy, and ultimately improve diabetes management (CDC, 2024b; Bujph, 2024).

Conclusion:

Rural communities face disparities in diabetes diagnosis, management, and treatment, which is unfair, inequitable, and needs to change. The proposed interventions are powerful agents for change, as they address both community and federal levels to help rural communities. However, in order to implement these interventions, we must listen to one another and create policies that will bring these proposed solutions to life. The time is now to not only advocate, but also listen to the voices of those in rural communities to create meaningful and lasting changes for more equitable care.

References:

Bujph. (2024, March 29). Social determinants of type 2 diabetes in rural vs. Urban Communities. Brown Undergraduate Journal of Public Health. https://sites.brown.edu/publichealthjournal/2024/03/29/social-determinants-of-type-2-diabetes-in-rural-vs-urban-communities/ 

CDC. (2024a, May 15). Diabetes is more common in rural areas. https://www.cdc.gov/diabetes/communication-resources/diabetes-common-rural-areas.html 

CDC. (2024b, July 24). Diabetes self-management: Rural policy brief. https://www.cdc.gov/rural-health/php/policy-briefs/diabetes-policy-brief.html 

Government of Canada. (2024, October 23). Diabetes: Overview. Canada.ca. https://www.canada.ca/en/public-health/services/chronic-diseases/diabetes.html 

Gupta, N., Crouse, D. L., Miah, P., & Takaro, T. (2022, December 21). The role of neighbourhood environments in hospitalization risk for diabetes and related conditions: A population-based cohort analysis by remoteness and deprivation indices. https://www150.statcan.gc.ca/n1/pub/82-003-x/2022012/article/00001-eng.htm 

​​Foss, R., Fischer, K., Lampman, M. A., Laabs, S., Halasy, M., Allen, S. V., Garrison, G. M., Sobolik, G., Bernard, M., Sosso, J., & Thacher, T. D. (2023). Disparities in diabetes care: Differences between rural and urban patients within a large health system. The Annals of Family Medicine, 21(3), 234–239. https://doi.org/10.1370/afm.2962