April 9, 2019: Applying Translational Science to Address Rural Health Disparities

Early in my career, I was privileged to work in an Indian Health Service hospital in Kotzebue, Alaska, that was responsible for the care of the approximately 5,000 people living in the northwest 30,000 square miles of the state. “Ambulance” calls often meant a single-engine plane flight 150 miles to an isolated airstrip; evacuations to the nearest referral hospital meant a two-hour plane flight. Some years later, I worked in a similarly remote hospital in rural Swaziland, where no electricity or running water was available outside the hospital and patients who could not walk often arrived by wheelbarrow. These experiences gave me a deep respect for the challenges of life and health in rural areas, as well as for the health care workers who provide care in these communities.

Today, more than 80 percent of the U.S. population lives in urban areas, squeezed into only about 3 percent of the total land mass; the remaining 20 percent, or 60 million people, occupy the other 97 percent. Rural Americans face health disparities rooted in economic, social, racial, ethnic, geographic and health workforce factors. They experience higher rates of poverty and less access to health care. They are more likely than their urban counterparts to die from heart disease, cancer, chronic lower respiratory disease and stroke. Addiction, drug overdose and suicide have increased dramatically in the last decade in many rural areas.

NCATS is ideally situated to develop new approaches for reducing the burden of disease among rural populations and promote health equity. Our translational science approach emphasizes engagement with patients, community members and nonprofit organizations to develop and broadly disseminate best practices for patient-focused research, and it enables innovative collaborations with scientists at diverse research institutions to develop, demonstrate and disseminate medical interventions that improve health. NCATS’ Clinical and Translational Science Award (CTSA) Program has unmatched nationwide reach and an innovative, collaborative model that includes longstanding engagement with communities and patients. This model is essential to the creation of successful approaches to address rural health disparities.

In fiscal year 2019 appropriations, Congress recognized the role of the CTSA Program in leveraging statewide resources and capabilities to improve rural health outcomes and eliminate health disparities. Earlier this year, NCATS announced an expansion of the program’s efforts to accelerate clinical and translational research to address these needs. Project areas include improving access to clinical trials for rural communities, harnessing technology to deliver effective care that obviates the need for travel to a major medical center to access specialists and specialized equipment, and enhancing rural community outreach.

To identify additional ways we can apply the NCATS paradigm to rural health disparities, we’re building partnerships with other federal agencies and organizations, including the Health Resources and Services Administration and the Indian Health Service. This May, NCATS will participate in the National Rural Health Association’s Annual Rural Health Conference in Atlanta to understand the salient issues and identify opportunities and potential synergies with CTSA Program assets and resources. And just this week, the CTSA Program held the “Un-Meeting” on Rural Health and Health Equity at the University of Florida to brainstorm breakthrough ideas across the translational spectrum to address rural health disparities.

NCATS’ translational science paradigm is successfully tackling many previously intractable issues in the development and implementation of interventions to improve health. We are excited to be ramping up our efforts to bring this paradigm to rural health disparities and help realize the medical and social imperative of health equity for all.

Christopher P. Austin, M.D.
National Center for Advancing Translational Sciences