Rural Bioethics: The Alaska Context
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Rural Bioethics: The Alaska Context Fritz Allhoff1 · Luke Golemon2
© Springer Nature B.V. 2019
Abstract With by far the lowest population density in the United States, myriad challenges attach to healthcare delivery in Alaska. In the “Size, Population, and (In)Accessibility” section, we characterize this geographic context, including how it is exacerbated by lack of infrastructure. In the “Distributing Healthcare” section, we turn to healthcare economics and staffing, showing how these bear on delivery—and are exacerbated by geography. In the “Health Care in Rural Alaska” section, we turn to rural care, exploring in more depth what healthcare delivery looks like outside of Alaska’s major cities. This discussion continues in the “Alaska’s Native Villages” section, which specifically analyzes healthcare in Alaska’s indigenous villages, some of the smallest and most isolated communities in the United States. Though many of the ways we could improve Alaskan health care for Alaskan residents are limited by its unique features, the “Justice and Healthcare Delivery” and “Technology and Telemedicine” sections consider ways in which certain policies and technology—including telemedicine—could mitigate the challenges developed in previous sections. Keywords Alaska · Rural healthcare · Indigenous health · Bioethics
Size, Population, and (In)Accessibility Alaska has fewer than 800,000 residents, making it 47th population-wise in the United States—only North Dakota, Vermont, and Wyoming have fewer (United States Census Bureau 2018). At the same time, though, it is the largest state, spanning over 650,000 square miles (United States Census Bureau 2010b, p. 41). To put this in context, it is more than double the size of the second-largest state, Texas (United States Census
* Fritz Allhoff [email protected] 1
Western Michigan University, Kalamazoo, USA
2
University of Arizona, Tucson, AZ, USA
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Bureau 2010b, p. 41).1 While these statistics might be surprising, it is their combination that gets interesting: Alaska has the lowest population density in the county, by far. At approximately 1.3 residents per square mile, it not only ranks lowest, but is less than 25% that of second-lowest Wyoming, and only .06% that of New Jersey, the nation’s highest (United States Census Bureau 2010b, p. 41).2 In other words, it is not just that Alaska is sparsely populated, or that it is huge, it is that it is both. We can press further. Almost half of Alaska’s population is in Anchorage and another 10% live in Juneau or Fairbanks (Alaska Department of Labor and Workforce Development 2017). Taking out those cities, there are some 200,000 residents living in a geographical area over half the size of the “lower 48” (Alaska Department of Labor and Workforce Development 2017; United States Census Bureau 2010b). To further complicate things, over 86% of Alaska municipalities are unconnected to a major road system (Alaska Department of Labor and Workforce Development 2017, p. 48); Anchorage to Fairb
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