By Dr. Marc Babitz
The classic geographic barrier, which is very prominent in Utah is the issue of being in a rural area--literally living somewhere where there aren't health professionals. When we look at physicians, the vast majority of them choose to practice in urban or suburban communities. We have a very small proportion, about 5%, who are practicing in rural America. And yet 20% of our population lives in rural America. In Utah, it's the same ratio. About 20% of our population live in 80% of our state, which is rural or call it the frontier areas of Utah, and there aren't physicians there. I was at a conference one time and I was talking about barriers to health care, and I got to this issue of rural care and this gentleman raised his hand and I said, "Yes, you have a question?" And he said, well Dr. Babitz, I understand that you're concerned about rural barriers to care, but after all, those people choose to live there, and I said, "Yes..." We were actually having lunch at the meeting and so I said, "How's your lunch?" And he looked at me puzzled and he said its fine. I said, "Did you have a good salad?" He said “Yes”. "Did you like your steak?" “Yeah, it was good, the potatoes were great.” I said, "Where do those things come from?" And of course he named a grocery store chain, and I said, "How about before that?" And then he said, well they came from rural America. So I asked him, "Do you think the people who raised our food, mine our coal, produce our raw products... do they deserve to have health care?" Which point he thought well I guess maybe they do, and choosing to work there because that's where their work is, is not the kind of choice that I would think should deny you health care. So that's a rural barrier.
But sadly there are also urban geographical barriers to care. Urban barriers tend to relate more to where is health care located? Salt Lake, for better or for worse, presents a really good example of that. If you were to say start here at the University of Utah and draw a circle with maybe a mile or so radius picking up places like LDS Hospital, the VA Hospital, Primary Children's Medical Center, University of Utah Hospital, Salt Lake Regional Medical Center--all of the big clinics that are here--if you were to capture all of that health care, you'd find a very large percentage of the county's health care located in this northeastern corner of the county. But the question is where are the majority of patients who maybe really need access to health care? And the way I answer my own question, especially when I'm teaching medical students, is I say to the students, "When you're up in the University Health Sciences building in one of the upper floors, I'd like you to look west, and on a clear day you can see the people who need the care that we have here, but they're way over there, and how many bus rides is it to get to the University of Utah or to LDS Hospital, or to Salt Lake Regional? How many transfers? What's the cost to do that, and how do you do that if you have two or three children and one of them is really sick, and does that become a barrier?" Now there are health services on the west side, but not in proportion to the population that we would have in the east bench or the northeast part of the county. Other urban geographical barriers would include things like our health care systems, or doctor's offices or hospitals located on bus routes. Do they have adequate parking? Do they provide for things like childcare so someone can come and have their children cared for while they get health care? Those all become, what I would call geographical access barriers.