Rural Public Health

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Rural Public Health

• Heather Reed
• State Office of Rural Health
• Ohio Department of Health

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Key Concepts

• If youve seen one rural community, youve seen
  one rural community
• Rural public health must be viewed in the context
  of the entire system of health care
• Health care and economic development are
  integrally linked in rural areas

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Function of Public Health

• Preventing epidemics
• Protecting against environmental hazards
• Preventing injuries
• Promoting healthy behaviors
• Responding to disasters
• Assuring quality and accessibility of health care
  for underserved populations

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Rural Public Health Issues

• Rural people die of the same diseases as urban
  people, but often at higher rates
• Deaths from accidents more prevalent in rural
  areas
• Fewer resources to support public health
  initiatives in rural areas
• Health promotion/disease prevention a tough
  sell in rural areas

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Rural Health vs. Public Health Policy

• Rural health policy development focuses heavily
  on access issues
• Public health policy generally doesnt draw a
  distinction rural vs. urban
• Public health is integral to ensuring the health
  of rural populations and access to both public
  health and primary care professionals is
  critically important

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Potential Threats to the Rural Public Health
Infrastructure

• Leadership
• Workforce Preparedness
• Safety Net Provider Support
• Managed Care Impact
• Telecommunications
• Funding

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Leadership

• Diminishing rural representation
• No single organization for advocacy
• Public misperception of public healths role
• Fragmentation of public health programs across
  federal agencies

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Workforce Preparedness

• Nationally 4 out of 5 public health employees
  have no degree, certificate, or formal education
  in public health
• Rural health departments face a continuing
  problem of attracting and retaining the proper
  mix of public health professionals

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Safety Net Provider Support

• Rural public health agencies caught between
  conflicting demands for population-based services
  and supporting a safety net of personal health
  services
• In urban areas there are more likely to be other
  safety net providers to provide those services if
  public health agencies do not
• Philosophical divide in public health between
  safety net role versus population-based services

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Public Health Push Pull

• Provision of indigent care
• Dilemma more pronounced in rural
• Providing clinical services detracts from
  prevention mission
• If we dont, who will?

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Impact of Managed Care

• Variable impact in rural areas
• Has potential to alter existing funding
  mechanisms
• Delivery systems appropriate for urban areas may
  not be appropriate for rural areas

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Telecommunications

• Rural communities most in need of
  telecommunications technology are often those
  least equipped to take advantage of it
• Stabilizing public health in many rural
  communities requires starting with very basic
  equipment

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Funding

• Public health funding is unstable
• Rural public health departments are likely to
  receive federal, state, and local funds, all with
  their own requirements, criteria, and
  expectations
• These dollars not necessarily tied to need

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Current Rural Health Trends

• Increasing health care costs
• Chronic shortages of providers
• Closure of some rural facilities
• Decreasing federal and state subsidies
• Aging of rural population
• Rural consumers going urban for services

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Access Barriers

• Financial
• Geographic
• Organizational/Availability
• Sociological/Acceptability

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Rural Health Care Delivery Challenges

• Poverty
• Inadequate Transportation
• Distance
• Aging Population
• Rural Economic Decline

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Economic Development and Rural Health

• Kellogg Foundation Survey found
• Broad consensus among lawmakers about problems
  facing rural America, but
• Rural economic development and health care taking
  a back seat to current state fiscal woes

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Economic Development and Rural Health

• Potential Strategies
• Linking rural development and health care
  improvement
• Using economic development to strengthen the
  rural health (including public health) workforce
• Finding models to improving financial access

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The Rural Health Exodus

• What if 50 of rural parents sent their kids to
  city schools?
• State subsidies would decrease since enrollment
  down
• More difficult to recruit teachers
• No money for new books, computers
• Parents would feel local schools of poor quality

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The Rural Health Exodus

• This is what is happening in rural health care
  across the country!!!

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Economic Impact of the Health Care Sector in
Rural Ohio

• Study commissioned by the ODH State Office of
  Rural Health
• Conducted by the Institute for Local Government
  Administration and Rural Development at Ohio
  University
• Utilized IMPLAN data as basis for study which
  incorporates employment and income as well as
  direct and indirect impacts of health care system

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Health Care Sub-Sectors

• Hospitals
• Doctors, dentists, and other medical
  professionals
• Nursing and protective care
• Other medical and health services (e.g. home
  health, public health)
• Pharmacies

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Cautionary Notes

• 1999 data utilized
• May not reflect current situation in county
• Retail sales and sales tax methodology may not
  fully transfer
• Large data sets inherently miss some local
  providers

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County Level Results

• In rural Ohio, health sector directly employed
  103,375 employees
• Total payroll generated was 2.8 billion
• Direct and indirect impact was 158,748 jobs and
  4.2 billion in earned income
• Health care sector responsible for 11.5 of rural
  county employment and 11.6 of income in 1999

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Why is this Important?

• Health care is often overlooked as a significant
  source of employment in rural communities
• The more health care services are provided within
  rural Ohio, the greater the share of these
  dollars that stay in the local economies of these
  counties

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Using the Economic Impact Data

• At the state level this data can be used to
  stimulate the development of sound rural health
  policy
• At the local level it provides a common language
  between health, economic development, and local
  elected officials

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Economic Impact and Rural Public Health

• Why is this important to rural public health?
• Public health departments are an integral piece
  of the rural health care infrastructure
• Rural public health departments can and should
  take the lead in conducting community needs
  assessment planning processes that includes an
  analysis of the economics of the rural health
  care system

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For More Information

• Heather Reed, Administrator
• Rural Health Section
• Ohio Department of Health
• 246 North High Street, 6th Floor
• Columbus, OH 43215
• [phone] Phone
• [phone] Fax
• hreed_at_gw.odh.state.oh.us