FRANKFORT, Ky. – More than 46 million Americans live in rural areas, and a new report from the Centers for Disease Control and Prevention says these residents tend to be older and sicker compared with people living in urban areas.

In Kentucky, the report says excess deaths from preventable causes jumped by more than five percentage points in all counties.

Macarena Garcia, a senior health scientist at the CDC, says access to emergency medical services is a major factor.

"So when we talk about unintentional injury, specifically overdose deaths, there are particular reasons why the mortality rate is higher,” she explains. “One has to do with emergency transportation."

The report found a widening gap nationwide in the percentages of preventable deaths between rural and urban counties between 2010 and 2017.

Garcia also points out less access to preventive care and regular checkups mean that high blood pressure and early cancer are more likely to go undetected among rural populations.

"This is really now the critical point,” she stresses. “They have less access to health care, specifically specialized health care, and they are less likely to have health insurance."

Health conditions linked to cigarette smoking also are a contributing factor to early deaths in rural communities.

Garcia says in 2017, more than 57% of deaths from chronic lower respiratory disease in the most rural counties were potentially preventable.

"When we look at the data for chronic lower respiratory disease, that is where we see the biggest gap between urban and rural areas, as far as excess deaths go, and that is also where we see the rate and the trend increasing over time," she states.

Garcia says rural health care providers and public health programs should work to help patients quit smoking, reduce their opioid prescribing and screen earlier for high blood pressure to curb early deaths.


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Open enrollment for health insurance through the Affordable Care Act is already underway, and ends on Jan. 15.

More than 1.3 million Georgians do not have health coverage according to the Kaiser Family Foundation.

Richard Gordon, an independent insurance broker, said it is time to do some research, and find out what your options are. His is one of many small businesses offering community outreach events to help people to sign up for coverage online.

Gordon explained some health plans are more affordable, as Congress extended subsidies to bring down monthly premiums.

"We try to explain what the Affordable Care Act is, how you can qualify for tax-credit subsidies to help pay for insurance, as well as provide some instant quotes for people," Gordon outlined. "They can actually see how affordable it can be, based on their family size, their income, and the ZIP code that they live in."

The Inflation Reduction Act passed by Congress extended the premium subsidies through 2025.

Gordon noted all health care plans are considered "major medical" plans, which means they cover hospitalization, doctor's visits, lab work, imaging, and preventive services. He added some insurers this year have "zero-premium" plans, which means the government subsidy covers the total monthly cost.

"A lot of the plans have low co-payments for the primary care doctor visit and a specialist doctor visit," Gordon pointed out. "We explain to people that their preventative services are provided at no cost to them. So that will be their annual physical, mammograms, colonoscopy, cervical cancer screenings."

He emphasized screenings for diabetes and outpatient surgeries are also covered, but only a few health plans offer dental and vision coverage, so people often buy those as stand-alone policies. He recommended doing some homework now, as the enrollment deadline is seven weeks away.

The American Heart Association has developed a series of videos to educate women about heart disease.

The Red Chair Series is a four-episode series of five-minute conversations about an issue relating to heart disease's effects, specifically on women.

Dr. Yolandra Hancock, a member of the American Heart Association Greater Washington Area Board of Directors, said as someone with a personal and professional connection to heart disease, doing the series was important to her. Since heart disease is a leading killer of women, she explained how it can happen.

"Women's symptoms are usually discounted both by us as women and by the medical community," Hancock pointed out. "A lot of times women experience symptoms a bit differently. We get so busy taking care of others, we may sometimes ignore the symptoms of a heart attack. We may associate it with something else. We may just assume it's indigestion or anxiety."

According to the American Heart Association, heart disease is the number one killer of women, causing one in three deaths each year.

Hancock acknowledged people might see heart health as a challenge, but finds managing heart health can be easier than people think. One way to begin, she suggested, is to be mindful of what changes need to be made, such as better diet and increased exercise. Hancock added people can work with their physician to begin taking control of their heart health.

Hancock stressed one of the bigger challenges working on heart health is symptoms are more prevalent when it is too late to do something about them. Although the first videos are brief, she knows there is an expansive future for the Red Chair Series.

"This particular series is part of a longitudinal information sharing," Hancock emphasized. "We've done the Red Chair Series before, but this, thankfully, was my first time participating as the host. But, we've done them before, and we plan to launch continuous series."

Hancock's favorite part of working on the series was knowing how it could help viewers. She added the videos are timeless for women of all generations and at different phases of their lives.

Maine requires its hospitals to provide medically necessary care to its residents at no charge as a condition of receiving tax-exempt status, but not all eligible patients apply.

Mainers with income up to 150% of the federal poverty level can apply for charity-care funds, but documentation requirements can be tricky for non-English speakers, gig workers and those without reliable internet access.

Kate Ende, policy director at Consumers for Affordable Healthcare, said the funds exist so Mainers can get the health care they need.

"These programs are available to people who are uninsured as well as people who maybe have private insurance but have a really high deductible, or other out-of-pocket costs that are expensive," Ende explained.

Accessing the charity funds can help people avoid the heavy burden of medical debt, Ende pointed out, adding many people would be surprised to learn they qualify, if they would simply apply.

Four in 10 Americans carry medical debt while one in seven adults say they have delayed hospital services due to cost. Yet, charity funds remain underutilized.

A recent Kaiser Family Foundation study shows half of U.S. hospitals reported the cost of providing charity care made up just 1.4% of their operating expenses.

Ende argued people deserve quality health care, and it is OK to ask for help.

"People are avoiding care, cutting pills in half, or not filling a prescription their doctor has prescribed," Ende observed. "We know Mainers are going without the care and medications they need because of costs."

Maine hospitals are required to notify patients of charity-care policies prior to collecting payment, and Ende noted some health care workers, such as anesthesiologists, practice care at hospitals but are not employees and would not be covered under any assistance funds.

Patients can find more information at mainecahc.org or by calling the Consumers for Affordable Healthcare hotline at 1-800-965-7476.