War and Rural Health

James E. Rohrer, Ph.D., Professor and Chair, Department of Health Services, Research and Management, Texas Tech University Health Sciences Center, Lubbock, Texas

Residents of rural areas sometimes pride themselves on not following national and world events. Why should they care what happens in some big city far away? If a pollster came to the farm house door and asked this question: "Does federal policy improve the lives of average people living in rural places?" a typical answer might be: "Not so's you'd notice."

The situation has changed. Ingrained dislike for city people, including New Yorkers, has given way to horrified sympathy laced with icy dread. Urban and rural folk alike are frightened, with adverse consequences for our travel plans, our economy, and our mental health. But before we can start to deal with the consequences of fear, we must ask whether or not fear is justified.

The terrorists targeted large cities. Epidemics, should they occur, will be most immediately devastating in cities. Rural areas contain some targets of strategic value, however, and this includes not only military bases and power plants, but also agricultural targets that could be used to poison the food supply. Furthermore, if the national economy sours dramatically, then our fragile local economies could begin to suffer quickly.

A fair assessment of the relative risk is that while rural areas might face less risk, they are not risk free.

Some actions can be taken, however. Vigilance is warranted. If watchfulness leads to watching out for your neighbor, then we can be happy about that. Education is needed for children and adults alike regarding what to watch for and what to do if you see behavior suggestive of terrorist activity. Unusual physical symptoms may call for prompt medical care. Prevention strategies may require development and dissemination. Health care personnel may require additional training.

An important issue, from the perspective of your Editor, is that the field of public health offers the best defense against bio-terrorism, but the public is generally not aware of this. Public health grew out of the need to control epidemics, after all. Before the germ theory of disease was developed, public health workers were able to stymie the spread of deadly diseases. This should be reassuring, because it means that we don't need to have all the scientific facts sorted out before we can begin containment, surveillance, and investigation of outbreaks. Unfortunately, most people think all public health is doing during the current crisis is swabbing noses in Florida.

Defensive actions can be taken and that should reduce anxieties somewhat. However, many people are suffering deeply though silently from war worries. Generalized anxieties are exacerbated by the world situation. People are losing sleep and avoiding travel that would allow them the comfort of distant family members. What is happening to anxious people who have hypertension or other chronic diseases that may be influenced by psychological factors? Some people should be encouraged to seek help in the form of support groups, counseling, or medical visits. Yet, many rural communities lack these resources.

As our rural communities plan their defenses against terrorism, they should keep in mind the full range of services required. These include enhanced public health capabilities (possibly in coordination with regional health science centers), health education, and health promotion designed to control stress. These are community-wide responses rather than actions individuals can take alone. In times of crisis, rural communities know how to pull together, and this is the time to dust off those skills.