Rural Reads: On the disparities of rural vs. urban cancer patients

Mar 29, 2013

Every week, KBIA’s Health and Wealth Desk curates the week’s most interesting (or so we think) articles and reports on rural health, wealth and society issues

This week’s topics: guns in rural schools and how low health literacy affects rural cancer patients. 

Rural area in Florida have higher cancer deaths—lack of health literacy?

An in-depth report by The Gainesville Sun’s Kristine Crane highlights some disparities between rural and urban cancer patients. 

“There really is a difference between rural and urban (patients),” said Dr. Laurel Warwicke, an oncologist at the Community Cancer Center of North Florida. Many of Warwicke's patients are from rural communities. “They don't want to go to the doctor. They could have a tumor growing out of their neck and think it will go away,” she said.

“I would say that 70-75 percent of patients come from rural areas, and they have a tendency to be diagnosed at a later stage — either because of lack of medical care or because it takes them some time to get to the office,” said Lucio Gordon, an oncologist at the North Florida Regional Cancer Center.

These anecdotes go hand in hand with what I learned earlier this week at a webinar sponsored by the National Rural Health Association about health literacy and rural patients. Health literacy, by the way, is defined as a patient’s ability to process health information needed to make appropriate health decisions.  University of Wisconsin researcher Julie Halverson led the webinar—she assisted with the study of health literacy of cancer patients at six rural Wisconsin clinics, findings from which will be published in the Journal of Rural Health soon. 

I learned that rural patients have 33 percent higher odds of not being health literate—factors that influence low health literacy, such as poverty, lack of access to medical care and older age, are more concentrated in rural areas. Someone with low health literacy is less likely to be screened for cancer, is more likely to be diagnosed at later stages of cancer and have an increased risk of cancer mortality, like the people described in Crane’s story. Even once they are screened, they are still less likely to comply with treatment plans. 

The researcher who led my webinar said part of the reason of this is misunderstanding between health care providers and patients—providers tend to talk in a level that many patients can’t even understand. Add that to the emotional toll of having cancer—Halverson said stress tend to make patients forget what they’ve been told to do for treatment. 

The non-profit group Health Literacy Missouri has a list of resources for both patients and care providers on how to deal with understanding health information. 

Packing heat in rural schools
In the wake of December’s massacre in Newtown, Conn., the idea of arming teachers and school employees arose as a possible way to prevent yet another deadly school shooting. While the rest of the country are still mulling over the pros and cons of that move, multiple rural schools in the U.S. have actually moved closer this week to let their employees carry guns in schools. 

  • In Missouri, a school district in rural West Plains in Howell County voted this week to allow some employees to carry concealed weapons into school. The district is paying for the employees’ firearm training, but isn’t revealing the employees’ names. 
  • In Southwestern Colorado, the school board of one district in rural Dolores County voted to arm the superintendent and the high school principal with semiautomatic guns.  
  • In Arizona, the House Appropriations Committee this week voted to approve a bill that would allow some employees in remote, rural schools to be armed. The bill has also cleared the Senate, and now heads to the House for a full  debate. 
  • In Western Texas, an independent school district 30 miles outside of Lubbock has approved a policy change to arm school employees. The employees must get superintendent approval and go through concealed-carry training.
  • In Ohio, the school board of rural Montpelier voted in January to arm the district’s janitors. This week, The Columbus Dispatch writes of Ohio teachers going through training to learn tactics to take down a gunman.  

Quick hits: 

  • South Dakota pushes for  more rural lawyers. The state recently became the first in the country to have legislation designed to recruit more attorneys to rural areas. 
  • Rural hospitals in Georgia are struggling. A Kaiser Health News story on why rural hospitals in Georgia are broke. Really broke. The issues facing Georgian rural hospitals listed out here can easily be applied to any other state, really.

As unemployment in the northeast Georgia mountains remains stubbornly high, more of the hospital’s patients have no health insurance.

Among those patients with private coverage, an increasing number have high-deductible policies, which means that patients must pay all or a large portion of the bills out of pocket. And a large share of patients have Medicaid, the federal-state program for low-income people that often doesn’t reimburse enough to cover the cost of services, hospital officials say.