Rural hospital closures will have an immediate effect on community health, from both a financial and a medical perspective ("Will Rural Community Hospitals Survive?" September).

With no operational hospitals, local providers will be challenged to maintain the level of service needed to provide adequate care. Because a lack of available health care does not attract new families or businesses to an area, employment opportunities will be limited.

Populations in rural areas will decline owing to a lack of employment and health care, with people relocating to areas that provide for the needs of the community. As the population and employment base declines, so will local businesses that provide health care equipment, home health, medications, adequate nutritional food, and education.

The effects of hospital closures are immediate and begin a cascade of community challenges that will result in difficulties accessing care for everyone, but especially for the elderly and lower-income patients. If we want to preserve health and promote wellness, we have to make rural health and health care access a priority.

Terri Brame, RN

Rougemont, NC