This land is your land, this land is my land
From California to the New York island,
From the redwood forest to the Gulf Stream waters;
This land was made for you and me.

That Guthrie song, with its heartfelt words, offered conflicting images of a nation’s greatness and the great strife of its people – the never-ending tension between grander and affliction. The power of his lyrics – with verses too conveniently edited out to make the song a patriotic hymnal rather than the composer’s original intent – is a call to social consciousness. The classic 1940s folk song was written to spark a social impact edge to address the needs of overlooked citizens.  The poverty Guthrie saw as he crisscrossed America’s dustbowl states continues. The reasons may be different; however, the suffering remains.

In a recent New York Times opinion piece, Tony Pipa, a senior fellow at the Center for Sustainable Development at the Brookings Institution, who leads the Reimagining Rural Policy Initiative, working to transform U.S. policy to enable equitable and sustainable development across rural America, writes:

“Too often policymakers mistake agricultural policy for rural policy. Farming now accounts for just 7 percent of rural employment. Service jobs, retailing, manufacturing and government employment all outweigh agriculture. And while $163 million of the relief the Trump administration distributed during the peak of the trade war with China went to high-income farmers making more than $900,000 annually, small-scale and family farmers are increasingly taking off-farm jobs just to get by.”

Today, more than 46 million Americans live in rural communities.  On average, rural locales lag behind non-rural communities on every measure of prosperity, from poverty rates to employment opportunities. This land may have been “made for you and me,” yet, when it comes to access to care, rural Americans live hours away from basic medical care, emergency services, and specialist providers.  Their well-being – survival – often hangs on a limited broadband connection. The system to address their needs is usually based on urban and suburban expectations.

Rural community populations trend older than urban and suburban regions, and while age is an invitation to health risks, rural areas have 20 percent fewer primary care physicians. Rural counties often do not have a psychiatrist to deal with mental health needs, and 81 percent do not have a psychiatric nurse practitioner.

LOSE THE IMAGE OF A WHITE FARMER ON A TRACTOR

Rural America’s needs are a bi-partisan issue impacting blue and red states. Congress has prioritized the rural communities’ needs for many good reasons.  People of color – often the most vulnerable in the health system – comprise 24 percent of the rural population. This includes rural Indigenous Americans and more than half of impoverished Black Americans. That compares with 18 percent of rural whites.

While politicians look for fixes to the problem, physicians, payers, private citizens and retailers are stepping forward to help address the care in access and quality gap.

Earlier this year, Walmart and Medscape released Healthcare Professionals’ Perspectives on Healthcare in Rural America, the most extensive survey to assess barriers and solutions to care delivery from the perspectives of professionals on the front lines of health care in rural and non-rural communities. More than 10,000 primary care health care professionals (HCPs) shared opinions that quality care is the most significant concern in their day-to-day efforts for their communities, particularly for people with chronic care and mental health concerns.

FORGET TECH – THE GAP IS ABOUT QUALITY CARE

Rural healthcare professionals are already utilizing telehealth and tapping into electronic medical records to improve quality care delivery. While there is plenty of buzz about remote patient monitoring and digital health technologies as tools that will enhance access to care, the biggest concern among physicians on the frontlines of addressing patient needs is clinical training and financial assistance to keep community hospitals operating. 

Physicians cite building on what they already utilize to care for their remote patients: state-of-the-art medical equipment, 5G internet service, and expanding use of electronic health records to guide their patients on self-care strategies. While technology helps with a care connection, it can only measure and monitor the substandard status quo.

PHYSICIANS IN RURAL AMERICA SEEK UPSKILLING

“We have known the systematic problems within the current health care system for decades. The Walmart-Medscape report emphasizes how health care professionals, like their patients, are most concerned about the quality of care, and we can no longer wait for old models to work,” said John Whyte, Chief Medical Officer at WebMD and Medscape and a Medika Life contributor. “This underscores the need for innovative solutions that look beyond the walls of the doctor’s office, similar to how Walmart is innovating in the space, driven by those who live and work in communities they serve.”

Often people in rural communities want to be cared for by people they know and trust and understand their local challenges and needs where they live and work. Experts addressing rural health needs know that staying well requires additional components beyond a physician visit.  The advocates seek to tackle social determinants of health, improved clinical care, and environmental factors.

Retailers like Walmart are partnering with health plans, advocacy groups, and third-party health associations like the American Heart Association to fill these gaps. Major retail pharmacies such as Walgreens are showing commitment by investing in efforts to address health drivers such as food insecurity, maternal and infant health, diabetes and hypertension solutions to reduce health disparities.

PRIVATE CITIZENS SEEK TO TRANSFORM RURAL COMMUNITIES

“Challenges to rural Americans cause suffering, which drives despair and feeds discord. Dialogue that elevates awareness of people’s difficulties is an important step in providing a remedy, and communication is the first step in providing viable solutions,” said Peter Finn, who founded, with his wife Sara Finn, a Foundation to address the pressing needs within his Upper New York State community of Hunter. Finn taps communication and creativity to make a difference and transform rural communities.

“I have been a long-time resident of Hunter, one of the far too many rural communities struggling in Upstate New York. The town was economically depressed and quickly deteriorating, but rather than abandon Hunter and shut our eyes to what was happening. We chose to get involved by raising awareness and mobilizing others to create the Catskill Mountain Foundation,” he adds. 

The Foundation calls upon the arts – music, creativity and dance – to draw people into the community all year round. Today, Hunter’s streets are lined with inns, restaurants, antique shops, and art galleries. Visitors come to enjoy the fall foliage, hike, and ski. The example of Hunter, New York, and other living laboratories proves how volunteering spirit, creativity and caring about rural community needs can shift the tide of events.

Others are contributing their talents to give voice to the diverse challenges rural Americans face.  “Living in the heartland has become increasingly difficult for Americans, and with this unprecedented narrative podcast documentary, we will present noted policy, community, and industry leaders working to change this reality,” reflects Matthew Zachary, co-founder and executive producer of the award-winning podcast network of OffScrip Health. 

Zachary, who is no stranger to tackling life-threatening issues, is looking to create the first audio documentary on the struggles of rural Americans, tapping into the network of companies, rural community leaders and government leaders who want to share how they are shifting from rehashing old issues to rolling-up their sleeves to solve problems.

CONFRONTING STIGMA – MENTAL HEALTH IN RURAL AMERICA

People with mental health needs face stigma.  That remains among the biggest hurdles to seeking care – the thought of “What will people think?” For people in rural communities, anticipating the negative reactions of family and community is an added emotional challenge that keeps people from seeking the care needed. Like any illness with progressive influence, failure to treat mental illness has life-threatening possibilities. Suicide rates increase as population density decreases. According to the Centers for Disease Control, suicide rates among people living in rural areas are as much as 68 percent higher than in large urban areas.

Jeff Winton is the Founder and Chairman of Rural Minds, a nonprofit organization working to end the suffering, silence and stigma surrounding mental illness in rural America. He is a part of the multigenerational farm Wall Street Dairy, LLC — a working dairy farm in Chautauqua County, New York – and founder of a major communications firm that addresses health issues.

In his opinion piece appearing on the National Alliance on Mental Illness (NAMI) website, Winton writes:

“Increasing awareness that mental illness is a health condition — just like cancer, heart disease, or diabetes — is one way to help overcome the stigma in rural communities. In addition, talking openly with others about lived experiences with mental health challenges helps to normalize the conversation and diffuse the stigma surrounding mental illness. The simple act of sharing stories can be an important first step for people to seek help for their own mental health challenges and encourage others to admit that they are struggling.”

The physical and mental health challenges to rural Americans cause suffering, which drives despair and feeds discord. Dialogue that elevates awareness of people’s difficulties is essential in providing a remedy, and awareness is a crucial step toward viable solutions.

OVERCOMING DESPAIR, DISEASE AND DEATH

Apathy and poverty double team are the domino of rural health killers. Walmart and Walgreen, and other major retailers are engaged.  Individuals with passion are leaning into the challenge and inviting others to join in their efforts.  Health organizations such as the American Heart Association, American Telemedicine Association, Blue Cross Blue Shield, National Rural Health Association, and many others have joined the effort to raise quality and ensure access to care.

Rural America is vast, with a remarkably diverse population and needs. The biggest problem isn’t decision-makers’ willingness to dedicate money or their readiness to align blue and red forces in bipartisan action to the challenge. The government often seeks big solutions to significant challenges.  However, the image we have long held onto of rural America – the proud and industrious farmer in a ballcap sitting on a tractor – is as outdated as the stoic, proud tiller of the land.  These citizens need our help urgently.  How do we resolve these problems? We start by recognizing that a one-sized solution does not fit all.

Woody Guthrie, while some verses of your ballad were conveniently edited out, we know your question:

As they stood there hungry, I stood there asking,
Is this land made for you and me?

Yes, it is!  Woody, we still remember.

The post Rural America – A Generational Struggle for Health Equality appeared first on Medika Life.

 Only 6.8% of the group in 2017-2018 had what would be considered optimal cardiometabolic health. And the trend is down, substantially. (See the article text for the graphic presentation.)

Let that sink in for a moment. We Americans stack up health wise very poorly.

African Americans and Mexican Americans fared somewhat worse than whites as did men compared to women, less educated vs more educated, and less affluent than more so participants.

But for you well-educated, affluent whites, be aware, you still did poorly.

Equally important, the trend is down in every category over the almost twenty years of this survey.

It is notable that the survey criteria used here did not include measurements of exercise (most Americans are deficient,) diet (most Americans eat an unhealthy diet,) stress (most are chronically stressed,) or sleep (most are sleep deprived.) Add these in along with tobacco usage (fortunately now down below 15%) and excessive alcohol consumption and we are a woeful group wondering why we develop diabetes, angina, a heart attack or a stroke, cancer, kidney disease or Alzheimer’s.

The authors of the study made the obvious conclusion that “the findings inform the need for nationwide clinical and public health interventions to improve cardiometabolic health and health equity.”

In an accompanying editorial, Failing Cardiovascular Health: A Population Code Blue^∗ in the Journal of Cardiology, the authors observe, “The reported findings of secular trends of stalling and worsening cardiometabolic profile should not be a surprise as the obesogenic lifestyle—unhealthy dietary patterns that feature foods and beverages high in saturated fat, sugar, salt, and calories; little or no physical activity; alcohol; too much or too little sleep; and hours of screen time—seems to be the norm for many Americans and other populations. These obesogenic behaviors are promoted by increasing opportunities for screen time, a snack food industry [the link will bring you to an interesting short article] that uses science to craft products that are tasty and addictive yet neither satisfying nor filling, and community designs that favor travel by automobile and discourage walking and bicycling. We are particularly concerned about the potential for the developing metaverse to decrease physical activity and increase obesity.

“Regaining the momentum toward positive cardiovascular health will not occur spontaneously. It will require the engagement of every physician and every public health policy with action at 3 levels—personal, clinical, and community.”

My last article in this series on our dysfunctional healthcare delivery system was titled “Follow the Money in Healthcare – It Will Lead You to Chronic Diseases.”

In a reader’s comment, with only the first two paragraphs copied here, Jo Lis wrote, “Prevention of chronic disease is as a practical matter, for most people; eat sensibly, exercise, don’t smoke, don’t drink excessively, get enough sleep, time outdoors, etc. We all know this, and yet only some of us check a few of those boxes regularly. Food is the key to all of this, and it is the most misunderstood ingredient in preventative care. The big #1 one principle is to eat sensibly. Most of us don’t even know what that means anymore. Consuming whole foods is the point. But that is not profitable for the big food companies, so we get told lies to make us buy processed foods that end up causing preventable chronic disease. You see the vicious circle there? … Follow the money, as usual.”

Since industry and government probably will not help much, it is incumbent upon us to take the first steps. In this regard, the American Heart Association (AHA) has set out a set of metrics designed to assist us in determining our health status and watching it into the future. Called “Life’s Essential 8,” it is an update in June 2022 of their earlier “Life’s Simple 7” published in 2010. That was a “a novel construct of cardiovascular health to promote a paradigm shift from a focus solely on disease treatment to one inclusive of positive health promotion and preservation across the life course.” This is an important paradigm shift as the vast majority of the dollars expended today for are for diagnosis and treatment of chronic disease; hardly any goes to disease prevention, wellness maintenance and health preservation.

“Life’s Essential 8,” by the American Heart Association. Each of the four health behaviors and four health factors are graded on a scale of 1-10. Those summarize as a composite score shown on the Overall scale at the top which, in this example, gives a score of 68. See text for details.

The new AHA metrics recognize that social determinants and psychological health are important determinants of cardiovascular (and all) health. The Life’s Essential 8 include health behaviors of diet, physical activity, tobacco (including vaping and chews), sleep, and health factors of BMI (body mass index), blood lipids (non-high density lipoprotein cholesterol), blood glucose (sugar, as also measured by hemoglobin A1c), and blood pressure.

As the authors point out, “numerous studies have shown strong, stepwise, inverse associations between the number of ideal CVH [cardiovascular health] metrics or overall CVH score and total cardiovascular disease (CVD) and CVD mortality” but also “all-cause mortality and a wide variety of non-CVD outcomes.”

In other words, measuring cardiovascular health status is an excellent guide toward health in general. This suggests that using the Life’s Essential 8 methodology can be an excellent guide to developing effective wellness preservation and chronic disease prevention approaches.

The Life’s Essential 8 emphasizes the importance of social and economic conditions that impact ultimate CVH. Community resources such as education, agriculture, employment, water and sanitation, housing, etc. are foundational to good health overall and CVH in particular. So too are a person’s psychological health where anxiety, depression and pessimism detract from health whereas psychological well-being, gratitude, optimism and a sense of life’s purpose all benefit good health. These factors have consistently been shown to improve longevity and “healthspan,” i.e., life lived without disease.

Obviously, the community resources group are dependent on government actions whereas the psychosocial are closely related to community status and issues but still are largely in the preview of the individual and his or her family and counsellors.

Sleep has been ignored until recently but new science has shown its importance to overall health and to cardiovascular health. Sleep is important to manage stress and inflammation, two interconnected conditions that are extremely important in the development of most all chronic diseases including coronary artery damage and plaque buildup.

Unfortunately, with just food alone, the cards are stacked against us in many ways. Nevertheless, we each need to assume responsibility for our health status. We also need help from the industrial agriculture and manufacturers of food industries, the food purveyors, insurers and governments at all levels. So far, except for tobacco, efforts have been minimal. And it is unlikely to change. There is just too much money being reaped that any attempts to push back is always met with strong resistance. Lobbyists keep Congress under control and marketing encourages us to eat more and more unhealthy processed foods.

So, it is up to you and you alone. If you would like to augment your and your loved one’s lives toward better health and a longer health lifespan, I encourage you to focus on at least some of the elements of healthy living. Read the AHA’s article in full. In later articles I will review the key concepts as outlined in the books noted below in my bio sketch.

Veal, squash, broccoli, salad, iced tea. Author’s image.

The authors of the newly released study from the CDC referred to at the top of this article also note that the prevalence of an ideal diet among all age groups of Americans is “negligible (<1%).” So, for now, focus on what you eat. That will be a great place to start. You don’t have to be perfect, just a bit better than yesterday. Each day you can make added headway.

Cut way down on sugar (soda, candies, ice cream) and white flour products (white bread, pastries, muffins, most cereals, even pizza.) Those are the “Nos.” Instead focus on fresh fruits and vegetables, whole grains, seeds and nuts, olives and olive oil, fatty fin fish like salmon, mackerel, or sardines, plus some dairy, poultry (preferably free range), and a limited amount of red meat, again preferably free range, grass fed. Look at the image above; do not think of this as unpleasant. Instead, make it a tasty, enjoyable meal preferably shared with a friend or two.

This will be an excellent start. You will feel better and then you can address some of the other key steps including exercise, stress management, and enhanced sleep. Follow the money; you will save dollars, not only now but big dollars in a future of lessened chronic illnesses. Your health will stack up way better than most.

Stephen C Schimpff, MD, MACP, is a quasi-retired internist, professor of medicine, former CEO of the University of Maryland Medical Center and author of Longevity Decoded – The 7 Keys to Healthy Aging and his co-authored book with Dr Harry Oken BOOM — Boost Our Own Metabolism

The post How Do We Americans Stack up Healthwise? Very Poorly! appeared first on Medika Life.