Uncovering Geographic Health Disparities: A Secondary Analysis of the Commonwealth Fund International Health Policy Survey
Abstract
Background: Healthcare delivery faces a myriad of challenges globally with well-documented health inequities between rural and urban populations. Yet, researchers and policy makers have limited understanding of what factors contribute to these inequities.
Methods: We analyzed the 2020 Commonwealth Fund International Health Policy (IHP) Survey—a nationally representative self-reported survey of adults from Australia, Canada, France, Germany, the Netherlands, New Zealand, Norway, Sweden, the United Kingdom, and the United States (US). We compared the association of area type (rural or urban) with ten health indicators across three domains: health status and socioeconomic risk factors, affordability of care, and access to care. Logistic regression was used to determine the associations between countries with area type for each factor, controlling for individual’s age and sex.
Results: The mean number of geographic health disparities in the 11 countries was 1.9, although there was a wide variation among the 11 nations. The US had statistically significant geographic health disparities in five of the ten indicators, the most of any country. Canada, Norway, and the Netherlands had no statistically significant geographic health disparities. In the US, living in a rural area was associated with having lower odds of having mental health conditions [OR=.89], experiencing material hardship [OR=.87] and higher odds of difficulty accessing after hours care [OR=1.29], having an avoidable emergency department visit in the past two years [OR=2.15], and having a regular provider or place of care [OR= 1.32].
Conclusions: This study has identified geographic health disparities across ten indicators in 11 developed nations. Public health policy makers in the US should look to Canada, Norway, and the Netherlands to improve geographic-based health equity.
Keywords: rural health, geography, health disparities, international health
Keywords
rural health, geography, health disparities, international health
Uncovering Geographic Health Disparities: A Secondary Analysis of the Commonwealth Fund International Health Policy Survey
Background: Healthcare delivery faces a myriad of challenges globally with well-documented health inequities between rural and urban populations. Yet, researchers and policy makers have limited understanding of what factors contribute to these inequities.
Methods: We analyzed the 2020 Commonwealth Fund International Health Policy (IHP) Survey—a nationally representative self-reported survey of adults from Australia, Canada, France, Germany, the Netherlands, New Zealand, Norway, Sweden, the United Kingdom, and the United States (US). We compared the association of area type (rural or urban) with ten health indicators across three domains: health status and socioeconomic risk factors, affordability of care, and access to care. Logistic regression was used to determine the associations between countries with area type for each factor, controlling for individual’s age and sex.
Results: The mean number of geographic health disparities in the 11 countries was 1.9, although there was a wide variation among the 11 nations. The US had statistically significant geographic health disparities in five of the ten indicators, the most of any country. Canada, Norway, and the Netherlands had no statistically significant geographic health disparities. In the US, living in a rural area was associated with having lower odds of having mental health conditions [OR=.89], experiencing material hardship [OR=.87] and higher odds of difficulty accessing after hours care [OR=1.29], having an avoidable emergency department visit in the past two years [OR=2.15], and having a regular provider or place of care [OR= 1.32].
Conclusions: This study has identified geographic health disparities across ten indicators in 11 developed nations. Public health policy makers in the US should look to Canada, Norway, and the Netherlands to improve geographic-based health equity.
Keywords: rural health, geography, health disparities, international health
