Shannon Monnat defines “spatial disparities in health” as inequalities in political, economic, and social conditions that increase vulnerability to and risk of poor health. And she wants to get to the bottom of them.
Looking at prescription painkiller and heroin addiction as just one example, Shannon has found that rural communities that have experienced decades of employment loss, economic deprivation, and out-migration are places where conditions are ripe for addiction.
“Opioid addiction is certainly a national epidemic, but when you look at a map of this problem, you see that there are spatial clusters where overdose deaths are highest,” she explains.
From rural upstate New York, Shannon is driven by her memories of people in her community who struggled with health disparities because of where they lived.
“Many people living in cities don’t think that people living in rural areas have the same issues with drug abuse,” Shannon states.
Yet a forthcoming article in the Journal of Rural Health, coauthored with New Connections network member Khary Rigg, shows that rural adolescents actually are more likely than their urban peers to abuse prescription painkillers, due largely to greater use of emergency department treatment and lower perceptions of risk about the harmfulness of illegal drugs.
In addition to opioid research, Shannon has looked at many other drivers of health disparities, including employment and income, race/ethnicity and citizenship status, health insurance coverage, physical activity opportunities in schools, and adverse childhood experiences. In all of these efforts, she hopes to better articulate the types of communities that facilitate good health.
Currently, for her New Connections grant, Shannon is looking at the drivers of health care access and utilization disparities among Hispanics in new and established destinations along the rural-urban continuum.
“The U.S. Hispanic population has grown at an unprecedented rate, dispersing to rural areas with small or non-existent Hispanic populations in the past,” Shannon explains. “Yet there is almost no research on health disparities between Hispanics living in these new rural destinations versus traditional gateways. It turns out, Hispanics in rural new destinations are experiencing tremendous difficulties in accessing health care.”
To Shannon, we will only achieve integrated health services and systems when we start seeing well-being as something that goes beyond utilization of health services.
“Good health has to do with opportunities to eat healthy, engage in physical activities, build strong relationships, and pursue positive mental health,” she explains. “Even though we all make our own choices about our health, those choices and opportunities occur within a larger social structure that’s affected by economic, social, and political conditions.”