Health Disparities in Missouri
Health disparities contribute significantly to Missouri’s poor health statistics. Hypertension (41% vs. 33.9%) and diabetes (14.1% vs. 10.2%) affect African Americans more often than Caucasians, respectively. Obesity is higher in African American (40.4%) compared to Caucasian (29.3%) Missourians. Asthma is a significant epidemic in adults and adolescents. Missouri’s disparity in asthma diagnosis is most apparent among African American adolescents (22.6% vs. 16% in 38 other states). Missourians report at least one major depressive episode during the last year (slightly higher rates than the national average). The Senior Report noted that 6% of Missourians receiving in-home long-term care suffer from major depression; 19% suffer from lesser depression and 40% were persistently depressed over one year.3 Age, the prevalence of chronic health conditions, and social determinants (high poverty rates and decreased education attainment) coupled with a lack of access to primary care providers place rural Missourians at increased risk for poor health outcomes.
Local Nursing and Primary Care Workforce Needs
Missouri ranks 44 of 50 states with regard to persons living in an MUA, with 21.8% of the population living in a MUA.4 Approximately 80% of Missouri is in HPSAs, leaving only 1 in 5 Missourians with adequate access to primary care. Of Missouri’s 114 Counties and the City of St. Louis, only 6 Counties are not an HPSA. The MAPP model currently includes partners representing five community hospitals, 1 inpatient psychiatric facility, 12 PCMHs (not including SSM clinics), 2 corrections facilities, and a city health department. Most are designated as HPSAs. Of the approximately 46 Missouri Counties within the MAPP catchment area, only 7 have no MUA designations. 2
Availability of health care services is important. Over one-third (37%) of Missouri’s population resides in a rural area and are more likely to live in poverty and have lower education than those in urban areas. Missouri’s rural poverty rate (18%) exceeds its urban poverty rate (14.5%), with rural youth (26.3%) experiencing significantly greater poverty than urban youth (19.9%). Youth poverty in 8 rural Missouri counties had rates higher than 40%. Rural Missourians are older and less likely to have a college degree compared to urban counterparts.5
The number of primary care providers lags behind specialists (46.1 primary care physicians versus 65.5 specialists /100,000 population).6 Missouri’s average of 37 primary care physicians per 100,000 population is below the national average. Of the 14,848 physicians in Missouri, only 1,402 practice in rural areas. NPs are proposed as a solution to the primary care shortage. Of Missouri’s 7,280 APRNs, about 50% are in a primary care population focus (Adult, Gerontology, Family, Pediatric and Women’s Health NPs, or Certified Nurse Midwives.) Missouri’s urban counties have a 1 APRN per 911 residents7 and 1 APRN per 1,495 residents in rural areas.
Tools to Help Providers Understand Rural Health Care
Dr. Beth Merwin prepared the two presentations below as a rural health consultant to a Health Resources and Services Administration grant to the University of Missouri – St. Louis. Dr. Merwin is a Professor Emerita of Nursing at the University of Virginia (UVA) and is currently a Professor and Executive Vice-Dean of the Duke University School of Nursing. She is an accomplished nursing and health services researcher whose work has focused on improving care for underserved and rural populations, particularly those in rural communities and minority populations.