When I was growing up, my cousin, Maureen, came to my house to visit in the summer. In turn, I went back home with her to spend time in Brooklyn. She called my suburban New Jersey hometown “the country,” as if cows grazed in bucolic meadows and daily chores consisted of slopping hogs and feeding chickens. I thought of Brooklyn as “the city,” though when I went there, we wandered the green fields of Prospect Park, probably the biggest wilderness I’d ever experienced.

Over time, Maureen and I learned that city and country were relative terms, and that stereotypes sometimes dominated discussion of the differences. That was long ago, but there are still some misconceptions about rural areas that affect the lives and health of people like us, living in western Kentucky, parts of which are indisputably rural.

A recent workshop in St. Louis, hosted by the Association of Health Care Journalists, focused on the unique and emerging needs of rural areas in terms of health care. After a full day of presentations crammed with information and insights relevant to rural areas, I came back to Murray wanting to share some highlights with Main Street readers.

The workshop began with a question: What drives rural health issues? The answers, though not surprising, were sobering.

Rural areas, for instance, tend to have higher rates of poverty that affect many aspects of health care. Smoking, over-eating, obesity, and lack of access to health care may be by-products of poverty. In rural areas, people may be more likely to be exposed to dumping waste and agricultural pesticides and fungicides, thus leading to medical conditions and maladies. Moreover, rural areas have fewer medical specialists to deal with health problems, with only 9% of physicians in the U.S. practicing in rural areas.

When people in rural areas need medical assistance, they sometimes resist getting treatment because of the potential lack of anonymity. Rural people seeking treatment for AIDS, addictions and mental illness, may avoid getting help because they do not want others in their small communities to know their problems. Even when an individual wants help, access to professionals who treat mental illness and addictions is not the same for rural patients, as compared to their urban counterparts.

Here in our county, we are fortunate to be able to boast some positive statistics about health care. According to the website of the Murray-Calloway County Hospital, we have 75 practicing physicians in the facility, covering 26 medical specialties. Services include a cancer center, an emergency room, hospice, and a center for geriatric behavioral health, among others.

One silent medical problem in rural areas is hunger. Related to that is limited access to nutritional meals.

One of the workshop presenters on this topic, Barrie Hardin, from the Area Agency on Aging of Southeast Arkansas, described dramatic changes affecting food insecurity that have occurred in rural regions over the past fifty years.

“In 1951,” she explained, “most families in our area lived on a farm, with extended family nearby. They raised their own meat and poultry, grew their own vegetables, and went to town once a week for supplies. If you got sick, you called the doctor and he came to you.”

In contrast is today’s situation. The rural population is aging. The kids and grandkids have moved elsewhere, in search of education, jobs, opportunities. The grocery store may be 20 miles away, so an elderly rural person may buy food at a convenience store that is closer to home. Prices are higher, quality lower, and healthy choices limited.

Ms. Hardin emphasized the importance of programs like Meals on Wheels to address these needs, but pointed out how declining government funding is affecting individuals like those she described. Since Meals on Wheels cannot get to every home every day, frozen meals are provided – where possible -- for the weekend. In some domiciles, only one person is eligible for the service, but sometimes meals are shared between two or more. When people are too proud and they wait to apply for help, the delay may have dire results. “We have a waiting list,” Barry Hardin said, “and waiting time can be six months to a year.”

Hunger is not confined to the elderly. When school is out and the kids who receive breakfast and/or lunch at school for free or at a reduced rate are home for the summer, hunger may be the price they pay unless there is some kind of intervention. In Murray, as in other communities, churches and charitable institutions prepare backpacks for these kids, filling them with healthy snack and cereals. Kids Against Hunger Murray LLC is on Facebook.

During the discussion of rural hunger, someone asked, “How politically active is Meals on Wheels?” There was no pat answer. Budget cuts are affected by politics, and in some locations fast food eateries that promote unhealthy eating and add to obesity, diabetes, etc., are given tax breaks.

Children who are hungry do not perform as well in school as children who are not hungry. People who eat right, in general, are healthier than those who do not.

In the end, hunger may cost more than feeding people, but those who are hungry in rural areas, may not fare as well as those in the city.

There were many other topics covered at the St. Louis workshop last week, including the challenges for journalists covering disaster preparation and its aftermath. Future columns will address these issues as they relate to rural areas like ours.

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