A research team led by Augusta University Executive Vice President for Academic Affairs and Provost Neil J. MacKinnon has released a study about health disparities among 11 high-income nations.
Among the Augusta University researchers on the team were Vanessa Emery from the Institute of Public and Preventive Health, Jennifer Waller, Ph.D., and MCG researchers Preshit Ambade, Dr.Ph., from the Department of Population Health Sciences and Brittany Ange, Ph.D. Other researchers on the team included Munira Gunja from the New York-based health care nonprofit Commonwealth Fund, which funded the study, and Emma Watson with the NHS Education for Scotland.
Drawing from data provided by the 2020 Commonwealth Fund International Health Policy (IHP) Survey, the team examined health statuses in Australia, Canada, France, Germany, the Netherlands, New Zealand, Norway, Sweden, the United Kingdom and the U.S., comparing between rural and urban areas.
The team examined more than 22,000 survey respondents, representing a 14-49% response rate, depending on the country, using 10 health indicators across three domains: health status and socioeconomic risk factors, affordability of care and access to care.
“There are three indicators that are under what we call health status… ‘Do you have multiple chronic conditions, what’s your mental health condition and have you experienced material hardship,’” said MacKinnon about the self-reported survey. “We then had three indicators related to affordability of care: ‘Have you skipped needed medical care, have you skipped dental care and have you had serious problems or unable to pay your medical bills?’”
Four of the indicators were related to access to primary care, inquiring whether participants have a regular physician, or can get same-day or after-hours care when needed.
The research yielded some unexpected results, notes MacKinnon, as the scholars had largely assumed that conditions in rural areas would be worse for most, if not all, of the surveyed countries.
There were 21 occurrences of geographic health disparities, 13 in which being in a rural area was a protective factor, and eight of those in which it was a risk factor.
“It was kind of a mixed bag,” MacKinnon said. “In the U.S., for example, there were some cases where the health outcomes actually were better in rural compared to urban [areas], which was a bit surprising, and then some, of course, that were worse.”
The mean number of geographic health disparities in the countries was 1.9. The indicators with the most occurrences of geographic health disparities were in the “access to care” domain.
The U.S. had significant geographic health disparities in five indicators, the most of any country, whereas Canada, Norway and the Netherlands had no significant geographic health disparities.
“One that was worse in rural U.S. was, ‘Did you skip needed dental care, because of cost?’ And we certainly know that rural Georgia is underserved when it comes to dental care,” said MacKinnon. “We have the state’s only federal school here, [Dental College of Georgia], and we know that there’s several rural counties in Georgia that don’t have a single dentist. We know that income levels and insurance levels are also lower in rural residents.”
As the university prepares to open its new School of Public Health, the study provides an opportunity for students and researchers to make an impact on health equity in Georgia, MacKinnon said.
“I think it just shows that one challenge for us across this country, as we think of improving health care for all, regardless of zip code, we need to ensure that people are taken care of and have access to the to the care that they need, as well as being able to afford it,” he said. “It just begs the question, what can we do better as a nation to reduce those differences? Again, some things were worse in urban areas, so it’s not just saying everything is worse in the rural areas. But I think it gives new information that healthcare decision makers can hopefully use to plan better for the entire state of Georgia.”
The study, titled “Mapping Health Disparities in 11 High-Income Nations,” was published by the JAMA Network Open medical journal, free and open to the public, and can be accessed at https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2807053.
Skyler Q. Andrews is a staff reporter for The Augusta Press. Reach him at skyler@theaugustapress.com.
