Former surgeon general urges COVID outreach to rural U.S.: "America is more than just the cities and the coasts"

Former Surgeon General Dr. Jerome Adams says he's hoping the Biden White House remembers America is "more than just the cities and the coasts" as rural communities are being decimated by the ongoing coronavirus pandemic. 

In his first conversation since leaving his post as the "Nation's Doctor," the health advocate and longtime physician explained to "Face the Nation" moderator Margaret Brennan that rural America has been hit "just as hard by the pandemic as urban ones- albeit in different ways."

Research from the Kaiser Family Foundation shows that rural communities face unique challenges in responding to the pandemic due to medical workforce shortages, fewer hospital beds per capita, limited access to telehealth and populations at elevated risk for COVID-19-related deaths because of age or chronic disease. Rural residents are also among the most vaccine hesitant groups.

"Demographic data isn't just about race — it's about gender and geography and religion, and language," Adams contends. "One of the things I'm hoping the new administration does is remember that America is more than just the cities and the coasts. Most of America, and over half of minorities, live in the South and middle America. It can't be urban vs rural or red vs blue. COVID-19 affects all."

A 2019 Pew Research analysis found that the South and Southwest of the United States hold most of the counties where Hispanic, black or indigenous people make up a majority of residents.

Adams notes that these more rural communities were also already hard hit by the devastating opioid epidemic and substance misuse issues that rattled the prior administration pre-pandemic. "We were making progress, but much of it was erased due to the isolation from services, but also from each other, of the pandemic."

Adams' comments come amid new findings by the U.S. Government Accountability Office that concluded more than a quarter of rural hospitals faced significant financial distress even before the pandemic, forcing them to potentially pull back on offering health care services or even to close down. 

Executives at rural hospitals that have managed to stayed afloat since the coronavirus struck credit their survival to federal support and other financial aid that has enabled them to continue operating.   

"Equality isn't equity"

As the federal government makes a full court press to minority communities to get more Americans access to a COVID-19 vaccine, Adams says the nation now has an opportunity to change the trajectory of life expectancy for Black and Hispanic communities, but that we "must first understand not everyone has the same opportunities for health- equality isn't equity."

Shortly after COVID-19 was first identified in the United States, disparities in testing, cases, hospitalizations and mortality began to emerge. Inequities were quickly evident by race, ethnicity, geography, disability, sexual orientation, gender identity and other factors.

In response, the Biden administration has since pushed ahead with a national strategy focused on ensuring an equitable response to the pandemic, including President Biden's executive order signed shortly after taking office creating a task force to address COVID-19 related health and social inequities. 

As only the second Black male to ever hold the position of surgeon general, Adams has focused on the links between community health and economic prosperity.

"I'm convinced we have a once in a generation opportunity to address systemic flaws that can help beyond COVID-19," he says. A key component to achieving equity is not just adequate access to physicians and treatments, he says, but stable social conditions.

"We talk about social determinants of health — things like transportation and housing and a good paying job. All of these things are just as important. Studies actually show them to be more important in many cases as access to doctors or medicines," Adams says.

"We must talk about racial bias and its impact on cancer, high blood pressures, maternal and infant mortality and more," Adams added. "Systemic racism is a determinant of health. And being a part of it doesn't make you a bad person. It's about flawed systems, not flawed people."

In an effort to expand outreach to traditionally underserved communities, the Biden administration will begin shipping COVID-19 vaccine doses directly to federally qualified community health centers. But some governors have been critical of that plan, claiming that diverting portions of the vaccine supply will only create further confusion, and asking the White House to work through state distribution channels instead.

Adams parted ways with many health experts on how to navigate better distribution efforts, suggesting a focus on state and local partners – as opposed to the federal level – is critical to better outreach.

"Public health experts always knew this was going to be the hardest vaccine distribution in history. And we need to understand that while federal planning and funding/support are critical, most of the work happens at the state and local level. I used to run a state health department. You absolutely cannot bypass the state or you will have chaos. But you also have to recognize that not all states have the local partnerships in place to reach the most vulnerable communities," says Adams. 

The physician pointed to bolstering partnerships with local pharmacies as a means to reach directly to more vulnerable consumers as the federal government doubled down on its pledge to deliver 200 million more doses of vaccines directly to pharmacies. "Many people go to and trust their pharmacy more than a hospital or the government. Local partnerships are key," he says. 

In:
• COVID-19