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by Michael E. Samuels, DrPH, Janice
Probst, PhD, and Saundra Glover, PhD
A new report on rural minority poverty by the
South Carolina Rural Health Research Center stresses that individual
poverty (low incomes) and community poverty (limited economic resources
overall) work together to limit economic opportunity and health
care access. Policymakers must understand this reality in order
to devise well-tailored solutions.
Public perception often tends to associate rural
poverty with whites and urban poverty with minority populations,
particularly African Americans and Hispanics. In reality, African
Americans, Hispanics, and Native Americans who live in rural areas
are not only more likely than rural whites to be poor but also more
likely to live in communities that have tighter constraints on total
economic resources.
Understanding this combination of individual and
regional poverty is absolutely critical, according to a new report
by the South Carolina Rural Health Research Center at the University
of South Carolina in Columbia. The report, "Minorities in Rural
America: An Overview of Population Characteristics," which is the
first offering in a series that will address minority health issues,
was prepared with the help of a grant from the Federal Office of
Rural Health Policy.
Using existing data sources to create a profile
of rural minority populations, the authors report that total community
economic resources are more constrained when minority groups represent
over half of the population. Counties with high concentrations of
minorities typically have income and assets that are two-thirds
of the national average. This suggests how difficult it is for rural
communities to improve their economic status--and that it is nearly
impossible for individual residents to improve their own status
without leaving their communities.
Rural Minorities: Limited Economic and Health
Care Resources
The report notes that, with the exception of Asian/Pacific
Islanders, rural minorities are geographically concentrated in certain
areas of the country: African Americans in the South, Hispanics
in southwestern States, and Native Americans in the western States.
Poverty is a more prevalent problem for these three groups than
it is for whites.
While 13 percent of the rural white population
is poor, the numbers are two to almost three times higher for rural
minority populations: 34 percent for African Americans, 25 percent
for Hispanics, and 34 percent for Native Americans. (Asian/Pacific
Islanders are an exception to this trend.) Furthermore, in counties
where minorities make up more than half the population, economic
resources are more constrained. For example:
- African Americans: When African Americans
are the majority population, average total county income is 67
percent of the national value, and bank deposits average 56 percent
of the value for majority white counties.
- Hispanics: In majority Hispanic counties,
the average total county income is 66 percent of the average for
all rural counties, and total bank deposits are 56.2 percent of
the average for these counties.
- Native Americans: When Native Americans
are the majority, total county income is 48 percent of the average
for all rural counties, and total bank deposits are less than
a quarter (24 percent) of the average for these counties. This
is the greatest disparity in resources that the researchers observed.
The authors also looked at disparities in access
to health care resources, again finding that the minority populations,
with the exception of Asian/Pacific Islanders, are more severely
affected. They report that three of five rural white Americans live
in Health Professional Shortage Areas (HPSAs), while roughly three
out of four rural minority Americans do (71 percent of African Americans,
76 percent of Hispanics, and 73 percent of Native Americans). In
fact, counties where minorities make up the majority population
are more likely to be HPSAs than majority white counties.
Furthermore, African Americans, Hispanics, and
Native Americans are more likely than whites to live in counties
that fall into the bottom quartile for physician-to-population ratio,
and less likely to live in counties with the highest physician-to-population
ratios. Whereas 12.2 percent and 43.6 percent of rural whites live
in counties in the bottom and top quartiles, respectively, the numbers
for rural minorities are worse: 14.8 percent and 38 percent for
African Americans; 15.5 percent and 32.8 percent for Hispanics;
and 17.6 percent and 34.5 percent for Native Americans. While bed-to-population
ratios tend to favor minority counties, the researchers note that,
without providers, it is likely that the bed capacity remains unused.
Thus, rural minorities are not only more likely
to be affected by individual poverty and community-wide economic
constraints but also to have more limited access to health care
resources. According to the report, "poverty and health care are
intertwined: persons without resources cannot afford health services,
and communities without resources have difficulty attracting and
retaining health care providers."
Implications for Policy and Planning
The report's authors assert that policymakers
and government programs must understand that rural minority poverty
is both an individual and a regional problem. It is very difficult
for an individual to improve his or her economic status in a community
that faces severe economic constraints--just as it is difficult
to get adequate health care.
The authors also point to the results of a U.S.
Department of Agriculture analysis which showed that while rural
counties tend to exceed metropolitan counties in funds received
for income security (such as Social Security, public assistance,
and medical benefits), funding for community resource development--business
assistance, community and regional development--flows principally
to metropolitan counties. The authors note that this trend will
have to change if rural communities and rural health infrastructures
are to survive, and they make a number of recommendations to assist
in meeting the needs of these communities and their residents.
To receive a copy of "Minorities in Rural America:
An Overview of Population Characteristics," contact the South Carolina
Rural Health Research Center at (803) 251-6317.
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