I was reading about how Spain has promised its rural residents that they will have the same access to essential services as people living in the city. I laughed a little, thinking of tiny Spain offering this reassurance. How far can you be from services if you’re in Spain?!
Spain is less than 500 thousand square kilometers. That’s 20 times smaller than Canada. And Spain has over 12 million more residents than Canada. It seems ridiculous for Spain to struggle with rural healthcare in the same ways that Canada does.
The issue is that I’m conflating rural and remote healthcare. I’ve gotten used to conversations about the geographic struggles of providing medical care when they refer to communities that are far beyond the reach of big box stores and big cities. No one in Spain takes a sea plane to make a grocery run.
Then I came across information on US rural health care in the CAP newsletter:
“a 2018 report by Pew Research Center found that the average time to drive to a hospital in rural communities was 17 minutes, nearly 65 percent longer than the average drive in urban communities.”
Does anyone else think 17 minutes sounds unbelievably fast? In Brooklyn it’d seem fast if I only waited 17 minutes for the bus that goes to the hospital. It’d be fast to only circle around looking for parking for 17 minutes.
This is where the average skews things, since driving across the US demonstrates that there are long stretches of the country where you’re more than 17 minutes from anything, never mind a hospital. Still, the data shows most Americans are within 30 minutes of a hospital.
Reports on access to medical care emphasize access to emergency services.
I find myself imagining the mind numbing routine of driving back and forth between hospital and home for ongoing treatment. The back and forth to visit someone in the hospital, bringing them things from home, making sure they’re eating. I think of going to one location to see the GP, then another for lab work, another for scans, then back to the GP, then on to a slew of specialists. I think of the times an appointment is cancelled after I’ve been in the waiting room for an hour because pre-approval did not come through or test results weren’t forwarded on correctly.
That’s a lot of time in the car.
As someone who lives in the city, I’m continually baffled by what people consider reasonable distances to drive. It’s normal, because in most of Canada things are very far apart. So it came as a shock to read in Pubmed that “The median aerial distance to the nearest hospital facility in Canada was less than 3 km, while the mean distance was about 6 km.”
Of course, that’s all of Canada, not just rural or remote Canada. Around 80% of Canadians live in cities. That other 20% of the population is incredibly spread out.
While my apartment is 1km to a hospital (and there are six hospitals total within a brisk 15 minute walk), “22.5% of Canadian live more than one hour driving distance by road from either a level I or level II trauma centre.” The average rural hospital in Canada has 18 beds.
Australia is even less densely populated than Canada. Australia has 3 people per square kilometer, compared to Canada’s 4…and Spain’s 93. Rural Spain still has 14 people per square kilometer.
As much as it strikes me as a little bit funny to imagine a tiny country struggling with ensuring access to medical care in rural areas, I have no doubt that it’s a real struggle that’s keeping a lot of people busy to address.
It goes to show that no matter how different our situations are, we can find ourselves facing similar challenges. There are a lot of people around the world working to ensure we all have access to medical care, no matter where we are.