Study highlights transit barriers to care

Poor are more than five times as likely to go without health care

Paul Mann, Humboldt State University
9/8/09

Arcata

The Redwood Coast’s poor people, non-whites and thinly populated areas suffer disproportionately from transportation problems that diminish their access to health care, according to data drawn from the four-county region by the California Center for Rural Policy (CCRP) at Humboldt State University.

The center has published a new research brief, one of a series, that documents transportation disparities among 43 communities surveyed in Del Norte, Humboldt, Mendocino and Trinity Counties. Those canvassed who have transportation problems were 2.6 times more likely to go without the health care they needed for themselves and their children, versus respondents free of transit obstacles.

Redwood residents below the federal poverty level ($20,444 for a family of two adults and two children in 2006) were 5.2 times more likely to do without health care and 11 times more likely to report no vehicle in the household.

Native Americans and non-whites were 1.7 times more likely to miss out on care and 2.5 times more likely to have no vehicle compared to white respondents. Other transportation obstacles included unreliable vehicles, lack of a driver’s license or telephone, no public transportation, insurmountable distances and weather and road conditions.

Survey respondents in low population areas—fewer than 50 people per square mile—were 1.6 times more likely to encounter transportation problems in obtaining care. One respondent said, “Can’t afford the gas, road trips are very rough on me and [the] baby at times, there is no public transportation and no babysitter.” Another said, “[I have to] travel to Santa Rosa (two tough hours) to get good quality specialty care.” A third commented, “Can’t afford to keep up on registration, insurance and gas.”

Rural residents usually must travel longer distances than urban populations to get treatment and the rural elderly are particularly hard hit, according to the CCRP’s brief, which was drawn from extensive findings of the Rural Health Information Survey that the CCRP conducted in the fall of 2006. Transportation shortages were long known to block access to health care, but the 2006 survey will enable political leaders, planners and policy makers to quantify the extent of the problem and pinpoint those populations and communities most in need.

The research brief says that in dealing with unmet transit needs, community leaders will have to balance the advantages of expanded availability—better access not only to health care, but also to jobs, goods, services and education—with drawbacks: vehicular accidents, noise, air pollution and lack of physical activity.

As the population ages, the brief states, innovative ways will have to be found to improve rural transportation and delivery of services, “since the elderly have the greatest difficulty with personal transportation and have the greatest need for frequent health care visits.”

The report recommends better coordination between transportation planners and health care facilities. It cites Indian health care systems, including Mendocino County’s Consolidated Tribal Health Clinic, which is financed through general funds from an eight-tribe alliance that provides trips to its clinic in Ukiah, Calif., to the Stanford Medical Center in Palo Alto, Calif., and to the University of California Medical Centers in San Francisco.

CCRP research data are available at www.humboldt.edu/~ccrp.