By Molly O'Toole, Reuters
Rural Americans are more likely to suffer from chronic health conditions such as diabetes, heart problems and cancer, and face greater difficulty accessing quality healthcare than urban counterparts, according to a report released on Wednesday.
The challenges facing healthcare providers for rural areas could be compounded by recent healthcare legislation, according to the UnitedHealth Center for Health & Reform Modernization.
"This is kind of an opportunity," UnitedHealth chair and report author Simon Stevens told Reuters. "Expanding coverage will mean that more people will have the ability to access care than before, but it's also a wake-up call."
The Center projects that around 8 million more rural residents will join Medicaid, state and government-subsidized insurance plans in the national coverage expansions than would have otherwise -- a net expansion of some 5 million people.
The paper found that there are only 65 primary care physicians per 100,000 rural Americans -- 40 less than the 105 per 100,000 urban and suburban Americans.
Already five million rural residents live in "shortage areas" defined by the federal government as counties with less than 33 primary care physicians per 100,000 residents. The number is continuing to decrease.
Per capita in rural areas there is less than half the number of surgeons and other specialists.
A survey that was part of the study found that among roughly 3,000 patients and primary physicians queried nationwide, those from rural areas were more likely to respond that drug abuse and teen pregnancy are major concerns than were those from urban areas.
Those from rural areas also generally thought the quality of care was lower in their communities than in urban ones.
UnitedHealth confirmed this "equality deficit" is supported by data showing that in 70 percent of markets, rural quality of care was measurably worse than in urban areas.
Though the rural population is aging, placing pressure on public programs like Medicare and Medicaid, UnitedHealth projects rural areas could see higher growth in their non-elderly insured population than urban areas, with increases of over 20 percent in the South and West.
RURAL RESPONSE TO GROWTH
Rural primary care physicians are 15 percent more likely to accept new Medicaid patients as of 2014 than their urban counterparts. Already, urban doctors receive a greater share of their income from public programs than urban doctors.
The report's "roadmap toward a 21st-century health care system," includes a bigger role for nurse practitioners, mobile health clinics, faster uptake of electronic record technology, designing insurance market and public program regulation to meet the needs of rural areas, and engaging more rural consumers in improving their health.
Telemedicine technologies, which use tools such as broadband connectivity to facilitate communication between patients and providers, are crucial to rural areas where distance and low patient and provider density contribute to these health care challenges, according to the report.
UnitedHealth calls for a coordinated effort by patients, providers, private and public sectors to ensure that coverage expansions do not make existing problems worse.
"The next few years will be times of considerable stress on rural health care," the conclusions state, "but also times of great opportunity."
By Susan Hundertmark, Seaforth Huron Expositor
Wednesday, October 27, 2010 9:53:53 EDT AM
As municipalities and some health units in Ontario continue to call for an independent health study on industrial wind turbines, Dr. Claudio Munoz, research director of Gateway Rural Health Research Institute, says he is part of a team looking for funding to conduct such a study after approaching the Ministry of the Environment in November of 2009.
Munoz says he and a team of researchers from Kingston's health unit and Queen's University have collaborated on a study proposal that would look at communities where local residents are being exposed to wind turbines and communities where wind turbines are not in place yet.
Munoz says the group sent a letter of intent to Minister of the Environment John Gerretsen on Nov. 2, 2009 and received a response in January, 2010.
Dr. Paul Masotti, of the Kingston, Frontenac, and Lennox and Addington (KFL and A) Health Unit and Queen's University, says the letter's intent was to inform the province that someone is prepared to do a research study on wind turbines in Ontario and Gerretsen referred the group to other possible funders. Masotti met Munoz at a conference in Kingston where Masotti was giving a presentation on wind turbines.
"He's (Gerretsen is) not a funder and we didn't ask him for funding. But we told him we're in a position to do the study," says Masotti, the lead researcher in the study proposal. He adds that a full proposal hasn't yet been developed or submitted for funding.
Masotti says that while he doesn't believe the construction of wind turbines must stop before a study on their health effects is done, there is no definitive evidence yet that wind turbines don't cause health problems.
"There is not enough research to prove they (wind turbines) don't cause problems. Our position is that the quality of the research done so far is not credible enough to document whether wind turbines have an impact or not. More research needs to be done," adds Munoz, continuing that the design of the studies, done mostly in Europe, and the length of the follow-up hasn't been sufficient to determine any long-term effects.
The proposal sent to Gerretsen cites the statistic that 1.88 million Google searches in September, 2009 were looking for information on wind turbines and health, illustrating the dramatic increase in public interest in the topic. On the Internet, searchers can find information about "wind turbine syndrome" and "vibroacoustic disease" whose symptoms are listed as pericardial thickening, respiratory pathology, late onset epilepsy, cardiovascular diseases, respiratory pathology, sleep disturbance, headache, tinnitus, ear pressure, dizziness, vertigo, nausea, visual blurring, tachycardia, irritability, problems with concentration/memory, and panic episodes.
The study proposal points out that the information about health concerns come from anecdotal evidence, creating a "clear need for research."
"The current situation presents problems for government and public health units when responding to public concerns. For example, the typical response is that there is no available evidence that exposure to wind turbines causes ill health and that this suggestion is supported by expert opinion. However, this allows one to argue that there also is no evidence that wind turbines do not cause ill health," says the proposal.
"I have a problem with people relying on things the read on the Internet when they don't know how to judge what's scientific or not," says Masotti.
Munoz says the proposed study would measure noise levels in homes along with the blood pressure and cortisol levels of the people living there, comparing residents of the Kingston area where a number of wind turbines have already been erected with Huron County where wind turbines are in the planning stages. Cortisol is a hormone released in response to stress.
The main research question will be, "Is exposure to wind turbines associated with ill health among residents living within 1.5 km to a wind farm?" The study would identify all the residences within 1.5 km of wind farms or proposed wind farms, measure high and low frequency noise exposure levels in a random sample of residences and all residences with noise complaints and document self-reported quality of life, health status and annoyance along with clinical outcomes such as chronic stress levels and new or increased morbidity levels.
"The trick is designing the study to provide a true answer. It won't be easy," says Munoz, adding that he'd like to see a study that runs for at least five years.
"This would be an opportunity to do a study pre and post wind turbines. That's the interesting part," says Munoz.
In communities with planned wind farms, baseline data will be collected before the turbines are erected. In the Wolf Island area near Kingston, more than 80 wind turbines are operating.
Experts would include medical doctors, PhD researchers, health unit professionals, a health geographer and an acoustician to plot the wind turbines and residents using GIS (geographical information system) and make sound measurements.
Munoz says current literature says the No. 1 effect of wind turbines on health is increased annoyance levels, a phenomenon that has been documented whenever new technology, such as trains, cars and airplanes, develops.
"Over time, the level of annoyance phases out and the same thing may happen with wind turbines," he says.
He adds that it will be difficult to determine if wind turbines lead to problems with high blood pressure and stroke since the statistics on heart disease and stroke are already so high in Huron County.
As well, he says it will be difficult to avoid bias in the study when the issue has been so politicized.
"We'll need a control group to bring answers to our questions. It will require a long term follow-up and long term funding and it will be a struggle to get that," he says, adding that they will keep developing their proposal.
Munoz says they also sent the proposal to the Canadian Institute of Health Research but came ninth when eight grant proposals were funded.
Masotti says work is still being done to create a more comprehensive study proposal on wind turbines, which he hopes will eventually find funding.
"My interest level is still high," he says.
By Celia Milne, The Globe and Mail
Published Wednesday, May 26, 2010 5:11PM EDT
Last updated Thursday, Aug. 23, 2012 3:31PM EDT
You know the drill: You go to the doctor. The doctor checks your pulse, your blood pressure, your cholesterol. If you are at risk, he or she scribbles out a prescription. Take two tablets twice a day with food.
But imagine a check-up with a different kind of prescription: Walk briskly; do some push-ups and lunges. Repeat.
It's called an exercise prescription. "It's very similar to any prescription. It's a specific dose of exercise, individualized to the patient and signed off by the doctor," says Dr. Robert Petrella, assistant director of the Lawson Health Research Institute and a University of Western Ontario professor who holds chairs in aging and health.
Dr. Petrella's research reveals that the exercise prescription is a powerful and effective way to improve people's health. "We know it is effective. We've proven it using sophisticated measures of cardiovascular health," he says.
Mary and Tony Vanden Hengel received an exercise prescription last September: Walk at least 10,000 steps a day (measured using a pedometer) and add higher intensity at intervals to get your heart rate up to 23 beats per 10 seconds. Gradually work toward 60 minutes of exercise a day.
Mary is 52-years-old and says she is overweight, with high blood pressure that fluctuates. Her husband, Tony, is 61 and also overweight, with high cholesterol. They live in Seaforth, Ont., where they are both real estate agents. The Vanden Hengels received their exercise prescription when they enrolled in the ARTEMIS study, an international randomized trial led by Dr. Petrella that is assessing the effects of exercise on health.
"We are walking from 5,000 to 12,000 steps a day. We have a stationary bike, which we use two to three times a week. The pedometer motivates us to step more because we know exactly how many steps we have taken in a day. So by 7 p.m., if we have only stepped 4,000 steps, it gives us a good reason for a walk after supper," says Mary.
In only six months since they received their exercise prescription, Tony has lost 4.5 kilograms and his cholesterol has gone down 0.7 points. Mary has lost 5.4 kilograms and her blood pressure is more stable. They are not on as much medication as they were before. "We feel we know more about our health and feel confident we are as healthy as we can be," says Mary.
Dr. Petrella is pumped about the amazing health benefits of exercise. "No other treatment we can give can increase health to the same degree as exercise," he says. "No drug, no technology. It's the least amount of effort, and not expensive. There is nothing else like that."
He and colleagues found in a recently completed study of 360 patients at 40 doctors' offices across Canada that following an exercise prescription not only improved factors such as blood pressure, blood glucose and weight, but also blood flow to the heart and brain. The study was published in the May, 2010, issue of Canadian Family Physician.
Right now in Canada, inactivity is an epidemic. Statistics Canada's latest figures show only 21 per cent of adults are physically active. That number dips to 17 per cent in those over 55. A sedentary lifestyle is linked to obesity, heart disease, stroke, diabetes, some types of cancer, and many other diseases.
Most family doctors (85 per cent) do ask patients about their physical activity levels and about 70 per cent provide verbal counselling about exercise.
But a much smaller number actually test fitness levels and only 16 per cent provide an exercise prescription, according to Dr. Petrella's research.
He has found the best advice from doctors is customized and exact. "Patients respond to their physicians but they need very tailored advice. This means physicians providing specific advice about what to do, at what effort and for how long." To get more doctors across the country using exercise assessments and prescriptions requires long-term funding by health ministries and large-scale adoption by local health networks and teams, he says. "That is the next step."
Recognizing that not all Canadians have a family doctor and not all family doctors prescribe exercise, Dr. Petrella and his team are piloting a project in rural Ontario using smart phones to deliver exercise prescriptions to folks who are at risk for diabetes and heart disease. "We are experimenting with remote technology so that patients can receive input wherever and whenever from their health team."
The program is interactive. Patients receive advice; they measure their activity levels using a pedometer and input their results; the health team then tells them what to work toward next. The project is funded by the Canadian Institutes of Health Research, the Canadian Diabetes Association and the Heart and Stroke Foundation. Results are due next year.
Until more of us receive personalized advice on physical activity, we asked Dr. Petrella for an exercise prescription generalized to the entire population. "In an ideal world," he answered, "Exercise three or more times per week, for 30 or more minutes a day. Make it something you enjoy, at an intensity that challenges you. Come back in three months."