The Role of Public Health in COVID-19 Emergency Response Efforts From a Rural Health Perspective

Sandra C. Melvin, DrPH, MPH; Corey Wiggins, PhD, MSPH; Nakeitra Burse, DrPH, MS; Erica Thompson, MD, MPH; Mauda Monger, PhD, MPH

Disclosures

Prev Chronic Dis. 2020;17(7):e70 

In This Article

Abstract and Introduction

Abstract

As the country responds to coronavirus disease 2019 (COVID-19), the role of public health in ensuring the delivery of equitable health care in rural communities has not been fully appreciated. The impact of such crises is exacerbated in rural racial/ethnic minority communities. Various elements contribute to the problems identified in rural areas, including a declining population; economic stagnation; shortages of physicians and other health care providers; a disproportionate number of older, poor, and underinsured residents; and high rates of chronic illness. This commentary describes the challenges faced by rural communities in addressing COVID-19, with a focus on the issues faced by southeastern US states. The commentary will also address how the COVID-19 Community Vulnerability Index may be used as a tool to identify communities at heightened risk for COVID-19 on the basis of 6 clearly defined indicators.

Introduction

Rural communities are heterogeneous. In 2010, 19.3% of the US population resided in rural areas, compared with 54.4% in 1910, with the highest concentration being in the southeastern United States. The southeastern region includes Alabama, Arkansas, Florida, Georgia, Louisiana, Mississippi, North Carolina, South Carolina, and Texas, and racial and ethnic minorities make up 19% of the entire rural population.[1] Socioeconomic characteristics influence the risk of infection with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). For example, in Mississippi, approximately 20% of the population lives in poverty.[2] In 2019, Mississippi, Louisiana, Arkansas, and Alabama were ranked as the country's least healthy states.[2] This statistic is important, because the less healthy the population, the more likely the epidemic is to have fatal consequences. In addition, the weaker the health system, the harder it is to contain the virus.

Most of the states that make up the southeastern United States are rural (Table 1). Rural communities face a unique set of challenges in the face of the coronavirus disease 2019 (COVID-19) pandemic. They are often areas already affected by high levels of poverty, lower levels of access to quality health care, lower levels of health literacy, and social stigma. Many elements contribute to these problems, including a declining population; economic stagnation; shortages of physicians and other health care professionals; a disproportionate number of older, poor, and underinsured residents; and high rates of chronic illness. This commentary will describe the challenges and issues faced by rural communities in addressing the COVID-19 pandemic. It will also show how the COVID-19 Community Vulnerability Index (CCVI)[4] may be used as a tool to identify communities at highest risk for COVID-19 on the basis of 6 clearly defined indicators (Table 2).

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