美国国家公共电台 NPR Poll: Many Rural Americans Struggle With Financial Insecurity, Access To Health Care（在线收听）

STEVE INSKEEP, HOST:

The economy may be strong, but many Americans' finances are not. That's especially true in many rural areas. In a poll of rural Americans by NPR last fall, 55% of those surveyed said their local economy was only poor or fair. A follow-up poll by NPR, the Robert Wood Johnson Foundation and the Harvard T.H. Chan School of Public Health digs deeper. It finds 4 out of 10 rural Americans struggle with routine bills for housing, food and medical care. Half of rural Americans say they could not afford it if they got hit with a surprise $1,000 expense. NPR's Patti Neighmond has more.

PATTI NEIGHMOND, BYLINE: Our new poll was a telephone survey of just over 1,400 adults living in rural areas across the country - areas like Whitesburg, nestled in the mountains of eastern Kentucky coalfields. Seventy-two-year-old Leitha Dollarhyde, a retired caregiver, lives nearby.

LEITHA DOLLARHYDE: Go out of town like you're going toward Hazard, and there's a turnoff there on 931 South. It's within about four miles of where I was born. So...

NEIGHMOND: I asked Dollarhyde the question we asked in our poll - could you afford an unexpected $1,000 bill?

DOLLARHYDE: No. No. There's no way.

NEIGHMOND: Not even a $200 extra bill. What about savings?

DOLLARHYDE: My savings account is zero. I don't even have a savings account.

NEIGHMOND: Dollarhyde worked all her life, but the jobs just didn't pay enough for her to put anything aside. She raised four children. Today, her income - Social Security and Supplemental Security Income - adds up to $790 a month.

DOLLARHYDE: With that income, you watch every penny.

NEIGHMOND: Even so, Dollarhyde just couldn't afford to make it on her own. She recently moved into a two-bedroom trailer with her daughter. Even with the extra money from her daughter, it's still hard. They have no car, and the cost of electricity is barely affordable.

DOLLARHYDE: It was 360-something. And the $200 rent, there's nothing left.

NEIGHMOND: So no movies, no dinners out. The only luxury is cable TV. But Dollarhyde says she's one of the lucky ones. She has Medicare and a state health plan that covers her health costs. That's not the case for many of those in our poll. Harvard professor Robert Blendon.

ROBERT BLENDON: One in 4 reported that they could not get health care recently when they needed it. And the majority said it's either because they couldn't afford it or they had insurance that would not be taken by local health providers.

NEIGHMOND: A serious national concern, says Blendon, even with major improvements in health insurance coverage over the last decade.

BLENDON: These problems are more severe for African American communities and Native Americans.

NEIGHMOND: As well as Latinos. And the future of health care in rural America looks even more grim, says Brock Slabach with the National Rural Health Association. A hundred and six rural hospitals have closed over the past decade, which he says can make timely medical care nearly impossible. Take the town of Tonopah in Nevada. Its hospital closed a few years ago.

BROCK SLABACH: This left the ambulance service to deal with all kinds of medical problems that they're not situated to do. And so when they get on the road to the next nearest hospital, that's a three-hour trip one way.

NEIGHMOND: The hospital is more than 100 miles away.

SLABACH: We know that distance can be a barrier to timely and appropriate access to services. And so, in that context, delayed care can often lead to tragic consequences.

NEIGHMOND: Especially in rural areas where people may not have a car, and public transportation may be unreliable. Bottom line, says Slabach, wealth equals health.

DEE DAVIS: We're poorer, and we're sicker.

NEIGHMOND: Dee Davis is president of the Center for Rural Strategies in Whitesburg.

DAVIS: People in this congressional district have the shortest lifespan in the United States. We also are the poorest.

NEIGHMOND: But one of our big findings was that rural Americans are also optimistic about their communities. Dee Davis.

DAVIS: People may be living more of a hardscrabble existence than folks in the suburbs or a lot of the folks in the cities, but that doesn't mean they're not living a decent life. And most people are pretty happy with it. And they've got friends and neighbors that they rely on, and they're where they want to be.

NEIGHMOND: Community activist Nell Fields says, over the past few weeks when her husband was hospitalized, her neighbors were extraordinary.

NELL FIELDS: My neighbors come and mow my grass, and my neighbors come and feed our cattle. And our neighbors gather the eggs and - every day for the last few weeks. And that says so much to me, makes me feel the emotion now of what it feels like to have such warm, wonderful support. And I know that that's the blessing of living in rural America.

NEIGHMOND: And that's what our poll found - 92% of those surveyed said they had people nearby they could rely on in times of need.

Patti Neighmond, NPR News.

(SOUNDBITE OF MOONCAKE'S "NINE BILLION NAMES... [TO A. CLARKE]")