Rural health care disparities likened to biblical tower of Babel | Pennsylvania

(The Center Square) – Rural health care disparities persist because of cultural and structural incompatibility, providers say, leaving residents scattered across the state without access to the most basic services.

“The tower of Babel is real,” said Dr. Jeffery Cohen, of AlphaLab Health. “There’s a lot of smart people in healthcare. Unfortunately, they’re stuck in models they can’t get out of.”

Cohen’s comment references the Biblical story of the tower of Babel, which scholars believe attempted to explain why different languages exist across the world. In the passages from the book of Genesis, when humankind – all of whom spoke the same language – began building a tower into the sky, God forced them to speak different languages.

Their inability to communicate became the undoing of the tower and it was never completed. And, providers recently told the House Agricultural and Rural Affairs Committee, the challenges they face in less-populated, more remote communities draw a lot of parallels. 

According to Dr. Beth Piccione, president of UPMC Horizon and UPMC Jameson – which serve Mercer and Lawrence counties – the state’s rural communities have higher populations over 65 compared to urban and suburban areas.

Among those under 65, there is a higher rate of disability, and more of the population falls below the poverty line.

“In so many areas, we are the sole provider of essential services,” she said. “The challenges to providing these services are very real.”

This is best exemplified by Horizon’s Birth Place, the only childbirth delivery unit servicing two counties with over 200,000 residents, a phenomenon happening across the state.

For these vulnerable populations, traveling 60 or more miles to see a doctor or waiting over 30 minutes for emergency services to arrive at their door can be the difference between life and death.

Fearing that critical care will be further diminished, Piccione spoke against House Bill 106, a measure that would create mandatory staff-to-patient ratios for hospitals and would force understaffed facilities to reduce available beds.

The bill is strongly supported by nurses who have experienced critical levels of burnout and attrition since the pandemic.

Accessibility is even worse for dental care, according to Dr. James Mancini, who drives 86 miles each way to provide care at Meadville Dental Center. He noted that over 2,000 dentists have stopped practicing in Pennsylvania this year, while 39 counties are without access to pediatric dentists.

“There was such a decrease in people reapplying for their license that the Pennsylvania Dental Board didn’t meet their budget,” Mancini said.

While many of the panelists agreed that legislative measures like investing in loan repayment and incentivizing preceptors could help increase the number and efficacy of providers choosing to learn and work in the state, social determinants are a huge indicator of health outcomes.

When it comes to health care, the gap isn’t only in distance, but also in trust. Residents in rural communities are less likely to receive routine care as the availability of services that are covered by major regional hubs and local primary care providers dwindles.

Cohen also pointed out the huge disparity in outcomes for low-income residents throughout the pandemic, further eroding trust.

“Look at the intersection between the economics and the health care outcomes because poor people just don’t do as well,” he said.

For their part, neither do poor medical providers. Pennsylvania has been slow to increase Medicaid reimbursement for dental care. Neighboring West Virginia covers 87% as compared to the commonwealth’s 54%, disincentivizing graduates – now hundreds of thousands of dollars in debt – from working in the state.

Dr. Lynn Williams, of the Southwest Pennsylvania Area Health Education Center, said one often overlooked solution to the challenges faced by doctors and their patients: community health workers.

“As we all struggle to find solutions to decreasing costs of healthcare and improving the lives of each and every person in Pennsylvania, let us consider community health workers as integral members of that team,” she said.

Community health workers build strong relationships within communities and are able to form a bridge between patient and provider, helping to increase health literacy and follow-up care, connecting the dots across systems, Williams added.