By David R. Shorey(link is external), East County Program Manager, Institute for Public Strategies
June 11, 2023 (San Diego) -- If you’re looking for medical attention in the East County’s backcountry, chances are you have about a 30 to 60-minute drive ahead of you to get the help you need. While the challenges of rural health care are not new, the topic got more attention during the COVID-19 pandemic. Vaccination rates in the region were lower than anywhere else in the county. That could have been because of the lack of trust by some rural residents, disinformation spreading by word of mouth, and isolation, among several other reasons. The rural backcountry stretches from the east side of Alpine to the County line and from the border to the south side of Julian. Rural healthcare challenges are not limited to East County.
“It’s a national discussion, it’s a state discussion and it’s a local discussion,” Grossmont Healthcare District CEO Christian Wallis said. “It is a community that is deeply underserved and we can no longer turn our back on these communities.”
That’s where the East County Rural Health Coalition comes in. I was invited to join the coalition as part of my job at the Institute for Public Strategies. The coalition comprises local schools, Cal Fire, the San Diego County Health and Human Services Agency, the office of District 2 Supervisor Joel Anderson, the Hospital Association of San Diego/Imperial Counties and the Southern Indian Health Council.
Our number one concern is to get access to primary, behavioral and specialty care to residents in the rural stretches of the county. Social services and community-based organizations don’t operate much in rural communities. A lot of it has to do with the return on investment. It takes a lot of infrastructure and capital to provide these services, so coverage pretty much stops in Alpine. If a community-based organization offers a social service program and it can only get to a few patients in the rural community, the cost versus the benefit may not be feasible if it’s already financially constrained.
Rural Health Challenges
Another challenge facing rural residents is that because they are so isolated, there is less of a chance for neighbors to provide support. They are either seeking that remote lifestyle or it’s where they ended up due to financial reasons and the area’s affordability. Regardless of why residents are there, we still need to provide services to them. Cal Fire has done a wonderful job reaching out to the rural community. San Ysidro Health has a mobile clinic that will reach rural communities. Live Well San Diego vans carry primary preventative education to communities throughout San Diego. Each community has a different need and we aim to focus our health and wellness programs on each community.
It may seem counterintuitive, but there’s little to no community space to unwind in the backcountry. There are no walking trails, biking lanes, community spaces like parks to unwind and get control of your thoughts and feelings. Nowhere to host a community garden or yoga classes. The lack of these services can lead to depression, substance use disorders and problems with drugs and alcohol. Transportation is the first solution. We need better bus routes, more frequently and reoccurring to get patients to the places they need to be if they are going to get and stay healthier. Broadband is another solution. More reliable internet services could allow patients access telemedicine. There is no broadband access in a lot of the rural communities. Broadband providers are looking for grant opportunities and return on investment. The underserved areas begin just past Alpine, where service gets spotty.
Camp Lockett near Campo is an area for community space that can be utilized for public use. The former military housing could be renovated to help professionals move out to the area to be closer to the clientele they serve. The camp could be used as a health and wellness center for nutrition classes, yoga, hiking trails, and other outdoor recreation. We have to find more ways to get social services from county and community-based organizations to provide for residents in the rural area. The Southern Indian Health Council already includes access to pediatricians, but other specialty care is problematic. They deal with primary care. The Freedom Ranch in Campo is a substance abuse facility for men. That’s a start.
Cardiovascular diseases in rural areas are typically significantly higher than anywhere else in the county due to lack of exercise, lack of good nutrition, and food insecurity. Smoking and second-hand smoke are also contributing factors. While we don’t have hard data yet, we are studying the likelihood that there is more substance misuse and alcoholism in rural areas.
Health Discharge Program
The brand-new Rural Health Discharge Follow-up Program is where a public health nurse from the county will go to the hospital with Cal Fire and follow up at the patient’s home. That’s where they will check that the patient has access to the proper medication and nutrition, make sure there are no trip hazards, confirm the presence of working fire alarms, and make sure there are no other public safety concerns in the home. They will check for social service needs of the patient. Plus, the Cal Fire paramedic can help size up the living conditions to determine the likelihood of potential substance misuse.
“I think things are looking better for the rural communities than they ever have,” Wallis said. “We have multiple organizations, both health and non-health related trying to solve rural issues.”
IPS works alongside communities to build power, challenge systems of inequity, protect health and improve quality of life. IPS has a vision for safe, secure, vibrant and healthy communities where everyone can thrive. To learn more about IPS East County, follow us on our social media platforms: IPS East County Facebook(link is external), IPS East County Twitter(link is external), and East County Youth Coalition Instagram(link is external). Our website is at IPSEast.org(link is external). Resources and services are available to assist with screening, treatment, and recovery for individuals with a substance use disorder.