Many rural Americans are struggling with access to health care, according to a new poll that National Public Radio has done with the Robert Wood Johnson Foundation and the Harvard T.H. Chan School of Public Health. The poll focused on everyday life in rural America, including economic security, but it was the findings on health care that caught our eye. One-quarter of respondents (26 percent) said they have not been able to get health care when they need it, even though 9 in 10 (87 percent) have some kind of health insurance. Of those not able to get health care when they needed it nearly half (45 percent) said they could not afford it, 23 percent said the location was too far and 22 percent said they could not get an appointment during the hours they needed one.

Access to health care, particularly in rural areas, is something Community Health Centers know more than a little about. Nearly half of health centers (44 percent) are located in rural communities, where the nearest doctor or hospital can be as far as 50 miles or more, or in the next county. Despite the fact that health centers have expanded their reach the last few years (they serve 1 in 5 rural residents) there are still many rural frontiers where there are few or even no options for health care. A trend of rural hospital shutdowns is making matters even more difficult. Two-thirds of respondents in the NPR survey (67 percent) agreed that hospital closures are a problem. Nearly 90 rural hospitals have closed since 2010 and just over 21 percent are on the brink of closure due to financial insolvency.

Among the environmental factors at the root cause of illness — clean water, jobs, nutrition and safe housing, access to primary care is a pivotal driver that determines how long one will live.  U.S. counties with a sufficient supply of primary care providers have lower mortality rates, according to a recent study published in the Journal of the American Medical Association- Internal Medicine (JAMA-IM) [see previous blog post on this topic] . Indeed, the same study noted that each 10 additional primary care physicians per 100,000 people was linked to a 51.5 day increase in life expectancy. 

The link between mortality and access to care has been a focus of research before.  University of Michigan researchers examined data from when health centers were first funded from 1965 to 1974 and found that mortality rates dropped 7 to 13 percent among people aged 50 and older.  The most significant reductions were deaths linked to cardiovascular problems. 

We still have a long way to go to expand access to primary care and save more lives. According to the Health Resources and Services Administration (HRSA), the U.S. needs an additional 15,000 primary care physicians to meet current demand.

Related: NPR: The Struggle to Hire and Keep Doctors in Rural Areas Means Patients Go without Care