Rethinking Healthcare Models: Addressing Systemic Barriers to Healthcare in Rural America

Gadsden, Alabama—The City of Champions as Gadsden natives call it. Once home to the world’s largest tire manufacturing plant, Gadsden has thrived on the hard labor of generations of blue-collar workers. However, beneath the surface of this resilient community lies a growing concern for well-being. As industries have declined, the tire factory now shut down, and resources have become more limited, there has been an increasing gap in access to an essential service: healthcare. The healthcare system was once able to meet basic needs, but with a growing population and greater demand for preventative services, it is now strained and under-resourced. This decline in preventative services has left Gadsden residents riddled with chronic illness. The growing gap in healthcare has become one of the town’s most pressing issues.

I have spent every summer for the past 4 years in Gadsden scribing for physicians and experiencing the city’s dynamic firsthand. This summer, an elderly patient with a hiatal hernia came to the rural clinic. Lacking the resources for her care, the clinic had to refer her to a hospital miles away—a journey she couldn’t make alone, as she lived by herself and had no transportation. How could she possibly make the drive to Birmingham and return home? As patients continued to enter with similar situations, my heart sank: a single mother of two, a son who is the sole caretaker for his mother, a father covered in soot from working in a nearby factory. One man had even entered the intensive care unit after drinking 12 beers in one sitting, leaving his 9-year-old daughter under the care of his elderly mother. Quality medical care in these areas goes beyond individual rehabilitation; it restores careers, mends relationships, and revitalizes entire communities. The cases detailed above represent two major flaws with healthcare in rural communities: access and prevention.

Access to medical care is hindered by three noticeable factors: geographic isolation, limited transportation options, and a shortage of physicians in the area. According to a study conducted on the effects of spatial behavior on healthcare utilization in rural North Carolina, “distance to care was important in determining the number of regular healthcare visits a person had in a year, with greater distance resulting in fewer regular check-up visits” (Arcury et al., 2005). Essentially, the further someone lived from a healthcare facility, the less frequently they scheduled regular checkups. This finding highlights a major flaw in healthcare accessibility in rural communities. To many people, the inconvenience of transportation outweighs the perceived benefits of receiving care. Especially for the impoverished and elderly, transportation to the nearest facility is almost out of the cards. This leads to the exacerbation of health conditions, which could have been prevented with proactive care. Compounding this issue, clinics are overburdened, with patients often waiting months for appointments due to a shortage of physicians (Nielson et al., 2017). These delays discourage patients from scheduling appointments which exacerbates chronic conditions, creating a cycle of worsening health, and lowering life expectancy and quality of life for the rural residents (Arredondo et al., 2023). During my time in Gadsden, I recall many patients having to wait months for even the most basic checkups. This is far too long to live without treatment, especially with chronic health conditions like diabetes, hypertension, etc. The longer patients go without care, the further their conditions progress, leading to severe, and oftentimes irreversible health complications (Loftus et al., 2018). Access to care isn’t just about health; it keeps people working, children learning, and families together, strengthening the community as a whole.

Preventative care is the key to a healthy community, yet it remains an overlooked aspect in rural healthcare. Without access to primary care physicians in the area, rural residents lack the opportunities to prevent the onset of illness. As a result, illnesses that could have been prevented with proactive care are now at the mercy of medicinal interventions (Natarajan et al., 2023). What could have been prevented with regular screenings and checkups now becomes a health crisis, further burdening the healthcare system. Over my years in Gadsden, I have come to learn that a holistic approach to healthcare is the answer to solving many issues of public health. Preventative care and proper education would substantially decrease the number of smoking, drinking, and eating issues leading to hospitalization. Studies have shown that “interventions to improve self-care have led to documented improvements in self-efficacy” (Paterick et al., 2017) hinting toward a correlation between adequate patient education and the frequency of illness in the population. By equipping residents with knowledge and access to preventative care, rural communities can decrease demand for healthcare systems and individuals can foster long-term well-being.

Imagine Gadsden where clinics are filled with proactive screenings instead of emergency cases, where parents no longer fear a missed paycheck due to illness, and children run freely, their futures unburdened by preventable health crises. Access to healthcare is more than a medical necessity—it shapes communities and changes everyone's lifestyle and way of living. It enables parents to work, children to thrive in school, and families to stay connected and whole. To truly address rural healthcare challenges, policymakers must invest in local healthcare infrastructure, support preventive programs, and explore creative solutions like mobile health units to bring care closer to those who need it most. After all, the ability to maintain health can be the difference between living and just getting by.