Infrastructure is so poor that medicine is delivered by drones. Foreign doctors are encouraged to build temporary practices because the shortage of local practitioners is so severe. Life expectancy declines even as people from developed countries often expect to live to 80. Thousands flock to pop-up hospitals to receive necessary healthcare.
Welcome to rural Appalachia, here in the United States of America.
The Appalachian region is an enormous part of the United States, with metropolitan areas along the fringes of the mountains and extremely rural areas in between cities. The Appalachian Mountains stretch from east Mississippi into western Pennsylvania and southern New York state. This area encompasses all of West Virginia and large portions of twelve other states, nearly 740,000 square miles, or almost a quarter of the contiguous United States. In such a massive area, the geography can vary widely; included in the region are the urban areas of Pittsburgh, Knoxville, and Birmingham, even as other areas are nearly impossible to reach except by air. For many residents, that’s the appeal – unique cultures and tight-knit communities are spread across the more rural areas.
To give a brief history of how a large portion of America became poverty-stricken to this degree, the economy of much of the region has historically been based in coal-mining and farming. However, the coal and fertile land have both been running out. In addition, the geography of the mountains often presents massive obstacles to the construction of infrastructure, and the dying economy presents no compelling financial reason to overcome the challenges involved. As a result, of the 25 million people in 420 counties, many live entirely off the grid in very literal ways. The poorest and most rural areas can lack electricity or even indoor plumbing, despite the best efforts of the government and many charities.
Government aid has an enormous impact on the Appalachian area. Medicaid and the Affordable Care Act have had the most obvious effect on healthcare, allowing the poorest to receive healthcare if they can access a clinic. The SNAP program, a.k.a. “food stamps,” hugely affects the ability of impoverished Appalachians to improve their health. However, it is often spent on junk foods- not necessarily because of a desire for Twinkies and potato chips, but because they take much longer to spoil, are usually cheaper, and are often more easily accessible in areas with poor infrastructure.
Finally, there is the specially created Appalachian Regional Commission (ARC), which focuses on job creation and infrastructure development through federal grants, provided through the budget approved by Congress. The existence of this organization shows the dire situation, as its sole purpose is to assist the poorest regions in America. However, President Trump has attempted to eliminate the ARC’s funding entirely while debating the last two federal budgets. Both times, it was only representatives of Appalachian states that prevented the ARC from being eradicated.
Problems Faced Today
Economically speaking, rural Appalachia faces a great deal of uncertainty as the resources that once drove a booming economy run out and many face unemployment. This leads to several specific health problems that are often associated with poverty. Obesity is a common issue, caused by junk food diets, unemployment leading to a sedentary lifestyle, and lack of health education. Rural Appalachia is the most obese part of America. For the same reasons, rural Appalachia faces the highest rates of diabetes. To make matters worse, insulin is often difficult to transport to the people who need it, and the same lack of health education can delay diagnosis. Parents often have to drive hours to pick up insulin for diabetic children, and some practitioners have made efforts to help parents stockpile insulin for longer periods, or find different treatments.
In the entire United States, the opioid epidemic is worst in rural Appalachia. Prescriptions were pushed harder in these areas, poverty led to illegal use and people turning to the black market for cheaper substitutes, and substance abuse in general is higher in these areas. Due to the lack of roads and clinics, in many cases illegal drugs are the only ones that are available. These are people who end up taking heroin instead of aspirin, because it’s cheaper than the oxycodone that was originally prescribed to them.
Dentistry is a major issue in the most rural areas, as it is perhaps the least accessible of common medical practices. As a result, many in rural Appalachia face abysmal oral hygiene, even leading to death in the most severe cases. It’s common for people in these areas to have only a fraction of their teeth by the time they’re middle-aged.
These issues and the shortage of doctors causes rural Appalachia to continue to lag behind the rest of the U.S. in both life expectancy and infant mortality rates. The trend is upward, but not near where they should be compared to the country as a whole.
In rural communities, a doctor is often not available at all. In many cases, a physician assistant is the highest medical authority available. Legally, a physician assistant must have 30-minute access to an MD, but that availability can include a telephone call, meaning that the MD is often in another state altogether.
However, plenty of communities lack even that much medical assistance. Alternative methods of providing medical assistance are sometimes employed – charities or the government may provide pop-up clinics that assist thousands of people if infrastructure is available.
In the worst cases, it is sometimes possible to deliver medicine by drones in a sort of micro-airdrop. This is a relatively new method, but has been able to help thousands of people already. If these areas are not able to build up infrastructure in the coming years, it is possible that they will still have access to medicine because of drone deliveries.
Things in Appalachia have been getting better, but they’re not getting better at the same pace as the rest of America, and they’re already starting at a huge disadvantage. An optimist might look at the development of workarounds for poor infrastructure such as drones as portents of an acceleration in improvement. A pessimist might see the budget cuts and slower-paced growth as the beginning of a progression towards an increasing gap in wealth and, therefore, access to healthcare. If we stop trying to hamstring the programs already in place and maintain our development of infrastructure alternatives like drone networks, the area should at least start looking more like the rest of America. At the very least, the people of rural Appalachia should find themselves with more access to the healthcare they need.