Originally uploaded at SSRN.


This article was prepared for a live conference, on “The Medicalization of Poverty,” held at the University of Illinois College of Law, and a symposium to be published in the Journal of Law, Medicine & Ethics. My piece focuses on a constellation of challenges for health care delivery and access to care in rural areas. Discussions regarding health and poverty often seem to focus on the admittedly persistent and multilayered problems of the urban poor: unemployment, substandard and unaffordable housing, violent crime, nutrition and “food desserts,” recreation and safe outdoor spaces, and under-resourced public schools, to name a few. While cities certainly constitute population centers for poverty, we should not confine our discussion to that context. Rural poverty and rural health disparities present additional, unique concerns for the medicalization of poverty. Access to medical care is particularly challenging in rural areas for an array of reasons, including financial pressures leading to rural hospital closures, difficulty recruiting physicians and other providers to work rural areas, lack of reliable transportation, inadequate broadband support for telemedicine, insurance premiums under geographic rating areas, and non-expansion of Medicaid. This paper provides a broad-brush survey of issues for rural health care access and strategies being developed to address them.