A weekly roundup of public health news
Millions of rural Americans lack access to primary care
Rural America is facing a growing shortage of primary care providers, according to a new analysis from the Commonwealth Fund. About 43 million rural Americans live in areas with too few primary care providers, hindering their access to timely, appropriate care.
As serious as the shortages are now, the problem is expected to worsen. By 2027, the supply of primary care physicians in rural areas is projected to meet only 68% of demand, according to the issue brief.
The challenges to access translate to heavy reliance on emergency departments, with nearly 40% of rural adults using EDs for health issues that are better handled in a primary care setting.
People who have a regular source of primary care are more likely to receive preventive services, have better support managing chronic conditions and to be diagnosed for serious health problems sooner.
Rural residents also have problems accessing care when they need it, with only about 40% of working-age rural adults able to secure same-day or next-day appointments, and a third able to easily obtain after-hours care. Nearly half of rural residents lack health insurance or are covered by Medicaid or Medicare.
The provider shortage varies by region, the brief said. In the South and West, 97% of rural counties are either partially or fully designated as primary care health professional shortage areas by the federal government, compared with 84% of such counties in the Midwest. On average, there is one rural physician per 3,400 residents in the South, versus one per 2,000 in the Northeast.
Many Americans fear they can’t afford needed health care
Anxiety over health care costs has reached a new high in the U.S., with nearly half of adults concerned they may not be able to afford the care they need in the coming year, new findings from West Health and Gallup show.
Researchers surveyed almost 20,000 adults across all 50 states and Washington, D.C., asking about cost, access and quality of care. They found some states are providing better experiences with health care than others.
Iowa, Massachusetts and the District of Columbia ranked highest overall, with residents more likely to say they could get care when they needed it and afford their prescriptions. In contrast, Alaska, Nevada, New Mexico and Texas ranked lowest, with far more people reporting they had delayed or skipped care due to cost.
Differences between states were stark. In the highest-ranked states, about 15% of adults said they had recently been unable to pay for medicines, while in the lowest-ranked states, that number rose to 29%. Avoiding a recommended test or medical procedure due to cost was also roughly twice as common in the hardest-hit states.
Financial barriers are rising, researchers found, with 20% of all survey respondents reporting they or someone in their household recently could not pay for a prescribed medication.
Most countries that test drugs can’t access them years after U.S. approves them
While countries around the world play host to major clinical trials of pharmaceuticals used in the U.S., those same nations don’t always gain access to the drugs, a new study finds.
Researchers at Yale School of Medicine reviewed more than 170 medicines approved by the U.S. Food and Drug Administration and tracked whether they later became available in the countries that hosted their testing sites. Despite helping to generate the clinical evidence needed for approval, most host nations did not gain timely access to the therapies after they reached the U.S. market.
Only 24% of U.S.-approved medications tested between 2015 and 2018 were accessible for patients in the five years after approval in the nearly 90 countries where they were studied on residents, according to the study in JAMA Internal Medicine.
While more than 30% of medicines tested in high-income nations became available within five years, access was far lower in countries with fewer economic resources. In Western Europe, more than 80% of tested medicines became available within five years, compared with less than 30% in Africa.
Access also varied within regions. In Peru, where 19 drugs were tested during the study period, only about 20% became available within five years, while in Chile, where 24 drugs were tested, nearly 90% reached the nation’s patients.
The five leading trial-host countries outside the U.S. were Germany, Spain, the U.K., Canada and France, where roughly two-thirds of the approved medicines were tested.
Millions exposed to arsenic could benefit from safer drinking water
Lowering arsenic levels in drinking water dramatically reduces the risk of dying, even after years of exposure, a major new study finds.
Researchers followed nearly 11,000 adults in Bangladesh for about 20 years. Many of them had been drinking well water with high levels of arsenic, which can come from natural deposits in the ground. Over time, people who switched to safer water had a much lower risk of dying from cancer, heart disease and other chronic illnesses, according to the study in the Journal of the American Medical Association.
People who lowered their exposure to arsenic were up to 50% less likely to die during the study period than people who continued drinking contaminated water. Those who made the biggest improvements saw the biggest benefits.
The study measured arsenic levels in people’s bodies by testing their urine over many years. Over 20 years of efforts to reduce arsenic in drinking water in Bangladesh, where the chemical is widely present in well water, community workers were able to reduce exposure by 70%.
As many as 200 million people around the world, including the U.S., are estimated to be exposed to high levels of arsenic through groundwater. While the chemical is naturally present in the earth’s crust, arsenic can also reach drinking water sources through human activities such as mining, coal-fired power plants and metal smelting.
Other recent public health news of note:
• Farmland in California is sprayed with an average of 2.5 million pounds of pesticides containing per- and polyfluoroalkyl substances each year, an analysis by the Environmental Working Group shows. Between 2018 and 2023, nearly 15 million pounds of “forever chemicals” were used on crops in the state, including almonds, pistachios, wine grapes and tomatoes, the research estimated.
• Cesarean births are disproportionately increasing for Black mothers, a new study in JAMA Network Open says. Researchers found Black mothers had a 12% higher risk of primary cesarean delivery in 2012 compared with other racial and ethnic groups, climbing to 17% higher by 2021. The increase occurred even as the nation’s rate of overall cesarean births decreased.
• Older workers face growing risks of harm from extreme heat, recent findings in Generations report. Threats for workers over age 50 are highest for Black, Hispanic and low-income people in outdoor jobs or poorly cooled indoor settings such as kitchens and warehouses. Men, immigrants and people with lower socioeconomic status are more likely to hold such jobs, researchers noted.
The Watch is written by Michele Late, who has more than two decades of experience as a public health journalist.