Focus on Rural Health Care and Disparities
Historically, new medical treatments are initiated through development and testing around a majority population -- white males from urban and suburban areas. In 2019 and 2022, the United States Food and Drug Administration (FDA) called for new guidelines emphasizing greater diversity in clinical trials to understand better a new treatment's risks and benefits among a more comprehensive set of individuals.
"Rural" has become a buzzword in advancing new healthcare technologies and clinical innovations in the past decade. A key component in developing and advancing the field is the recruitment and availability of the correct patient populations for new drugs and devices that can make a global impact. One in five Americans is now redefined as "rural" according to expanded guidelines of the United States Census Bureau and Office of Management and Budget (OMB).
What does a rural population entail that makes it different from the typical population that is more likely to be involved in developing current healthcare advancements? Rural patients are generally older, lower socioeconomic status, and sicker than their urban counterparts. They live further from advanced medical care and are many times characterized by one or more of the following:
- High incidence of disease or disability
- Increased mortality rate
- Lower life expectancies
- Higher rate of pain and suffering
- Injury
- Smoking
- Misuse of opioids
- Cardiovascular disease
- Cancer
- Suicide
- Death
- Chronic obstructive pulmonary disease (COPD)
- Stroke
- multiple comorbidities
- high BMI/ Diabetes
- Lower socioeconomic status
- Limited access to medical services (including specialists and tertiary care)
- Geographic isolation
- Unreliable transportation
- Limited access to childcare
- Higher rates of risky health behaviors
- Higher rates of uninsured individuals
- Low health literacy
- Financial challenges
Start with the Community
Roanoke’s unique location allows for field study in the City of Roanoke and southwest Virginia's rural health clinics. This immersion emphasizes the impact of the social determinants of health in patient care. A community's zip code often accurately predicts health outcomes due to the social determinants in place. These social determinants of health -- defined as the factors in which individuals live, work and play -- include elements of daily stressors, the built and natural environment, and ease or difficulty in accessing resources. Equity is a factor of health status, and inequity creates health disparity- often for generations to come.
*Besides experiential field learning, Social Determinants of Health is a course included in the fellows’ academic core programming.
Roanoke
Following the Great Depression, New Deal stimuli included provisions for 30-year mortgages, allowing middle-class America to grow through homeownership and improving generational wealth prospects. Unfortunately, redlining excluded many minorities and persons of color from this dream. Redlining is a discriminatory practice that denies financial services to certain areas based on race or ethnicity.
Roanoke was among those original redlined cities on the east coast, perpetuating and intensifying racial inequity and a wealth gap. Though redlining has since been outlawed, we see the effects of generational wealth (or poverty) in communities today. In 2022, Roanoke held a 13-year gap in life expectancy across city zip codes. Interestingly, the disparity in mapping life expectancy is visibly congruent to the disparity in 1930s redlining. Understanding a community's health disparities is crucial to designing solutions that meet patients’ needs.
While this health disparity is valid, Roanoke’s community strengths include its proximity to Carilion Clinic’s flagship hospital and administration. The city’s shift from railroad operations to medical innovation, colloquially referenced as “from train to brain,” is apparent in the growth of various labs, biomedical collaborations and medical start-ups. Such a landscape of innovation is an ideal sandbox for biodesign residents.
Southwest Virginia
Southwest Virginia counties within our program footprint experience more significant health disparities comparable to state averages at-large. Compared to other regions as defined by the Virginia Department of Health, the Far Southwest region experiences a 30% higher death rate, with a 35% higher rate of death attributed to COPD and a 21% higher rate of death attributed to heart disease.
Considering the patient health trifecta (quality, access, affordability), these communities are at a heightened disadvantage of access sheerly by the isolation of rurality. Many Virginians in these communities travel long distances for treatment across the continuum of care. Furthermore, these communities are also at a heightened risk of experiencing poverty, providing a helpful landscape for biodesign through telehealth or other innovation to reduce or alleviate these disparities.
