Book chapter from ETSU COPH presents the ‘ABCDEs’ of rural health disparities

JOHNSON CITY - Solving the problems associated with rural health disparities will never be as easy as reciting the A-B-Cs, but four experts from the East Tennessee State University College of Public Health are hoping the mnemonic device they have developed - the ABCDEs - will help.

Drs. Randy Wykoff and Robert Pack, dean and associate dean, respectively, of the ETSU College of Public Health, are co-authors of a book chapter that offers a new approach. Another co-author, Dr. Jodi Southerland, recently earned her doctor of public health degree at ETSU, and a fourth, Dr. James Florence, has moved to another university but was a department chair for the college when the chapter was written.

Their chapter in the book "Rural Populations and Health: Determinants, Disparities, and Solutions" is titled "The Depth of Rural Health Disparities in America: The ABCDEs."

The intention, Wykoff said, is to provide a tool that public health practitioners can easily remember and reference when planning a public health intervention in a rural setting.

"The health disparities that exist for rural populations are real and the resulting problems are complex," Wykoff said. "So a mnemonic device could be a useful tool in the field. It assists practitioners in taking a systematic approach to examining public health issues in a community and devising possible solutions."

Each letter of the "ABCDEs" corresponds to common contributing elements of the historic and persistent health disparities that exist in rural America. Those factors for a practitioner to consider fall in the categories of (A) availability and access to health care; (B) behavioral patterns; (C) cultural influences; (D) determinants of socioeconomic origin; and (E) environmental factors affecting health in rural areas.

Understanding the extent and impact of these five characteristics in a community gives the public health professional a quick and focused way to identify the main health challenges. Availability and access to health care, for example, include such variables as a common shortage of health care professionals in rural areas, lack of affordability where health care is concerned and the influence of geography on access.

About 25 percent of the U.S. population lives in areas defined as rural, but less than 10 percent of physicians practice in those areas. As for the ability to afford health care, rural dwellers have historically higher rates of poverty and lower rates of having health care insurance.

"I am pleased and excited that ETSU’s expertise in the area of rural public health has been reflected in this book chapter, and that one of our students was able to make a major contribution to the public health literature so early in her career," Wykoff added.