Achieving Rural Health Equity and Well-Being Proceedings of a Workshop (2018) / Chapter Skim
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5 Equitable Access to Health and Health Care
5 Equitable Access to Health and Health Care
Pages 45-58
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From page 45... ...
(Sabo) • Community health workers can help create a common voice of action, engage community members in advocacy, change their own organizations to better meet the needs of popula tions, and engage at the civic level.
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From page 46... ...
"Interestingly, the African American population nationally has a lower mortality rate than the white population here in Alabama," said Quinney, adding that "we have a very unhealthy population in this state." One sign of an unhealthy population is a lack of population growth. Of the 67 counties in Alabama, 24, all of which are rural, had a smaller population in 2010 than they had had 100 years earlier in 1910.
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From page 47... ...
In a previous position with the Center for Health Statistics in Alabama, Quinney helped develop the publication Selected Health Status Indicators: Alabama's Caucasian and African-American Populations, which compares the African American and white populations in Alabama and the United States on approximately 90 health-related indicators ( labama Department of Public Health, 2013)
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From page 48... ...
Finally, the Alabama Rural Health Association is working with the Alabama Department of Public Health to establish county health coalitions that bring together hospitals, clinics, government agencies, physicians, nurses, mental health providers, public health officials, emergency medical services, the clergy, educators, and law enforcement officers to identify health care–related problems and possible solutions. Such coalitions can generate more funding from local, state, and national sources, said Quinney.
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From page 49... ...
In addition, Sabo pointed to six factors that together make the border unique: • Ethnicity • Growth • Poverty • Youth • Shared infrastructure in health, education, commerce, and the environment • Militarization As an example, Sabo mentioned medical tourism, explaining that "when your tooth hurts, oftentimes it is cheaper to go down to the border and get your tooth fixed than it is to go to a dentist in this country." Another example is that Texas offers in-state tuition for Mexican nationals, creating substantial educational exchanges. Such exchanges can be expected to continue as the border population continues to grow, since at current growth rates, the combined population of the border counties in the United States and the municipios in Mexico will double in about 35 years.
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From page 50... ...
About 30 percent self-reported having poor mental health in the past 30 days, with smaller percentages reporting diagnosed depression or depressive symptoms. With any type of immigration-related mistreatment, whether experienced personally or witnessed, the risk of stress increased twofold.
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From page 51... ...
"Community health workers change the conditions within their communities," Sabo observed. They can "engage in various levels to take the voice of the people to the top." Sabo closed by citing a phrase from a migrant shelter mural that she admired: "If we don't think differently, everything will remain the same." THE CLOSURE OF RURAL HOSPITALS The North Carolina Rural Health Research Program at the University of North Carolina's Cecil G
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From page 52... ...
. Other studies of hospital health facilities have shown that closure of trauma centers, emergency departments, and public urban hospitals disproportionately burdens racial and ethnic minorities and Medicaid beneficiaries, Thomas reported.
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From page 53... ...
The implication is that rural hospital closures disproportionately affect African Americans and Hispanics, as has been demonstrated in other studies of health facilities. These results raise important questions about racial segregation and political power, health outcomes after hospital closures, and other methods of health care delivery, Thomas observed.
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From page 54... ...
Children's Health Fund programs in Florida and Nevada also provide health care in rural communities. These programs are informed by an adaptive learning process, said Johnson, with recognition and understanding of the full range and aggregate effect of factors that define the frame of health access in underserved communities.
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From page 55... ...
It creates missed opportunities for immunizations and routine well-child care, increases the incidence of untreated chronic illnesses, increases the use of emergency rooms and ambulances for nonemergency care, and increases preventable hospitalizations. Medical transportation provider organizations must be committed to being part of the health care team to create a more seamless system and improve health access, Johnson said.
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From page 56... ...
Partnerships with hospitals, community health centers, and other human services providers could improve care, as could outreach to and engagement of state transportation officials in a meaningful cross-sector dialogue that fosters and enhances collaborative planning to better serve community needs. Involving local independent contractors, community colleges, and small businesses is good for communities and for people who need better access to health care.
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From page 57... ...
Community health workers are one way to address the longer-term root causes of health issues. But many members of those communities are dealing with basic survival strategies rather than focusing on long-term issues.
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From page 58... ...
58 ACHIEVING RURAL HEALTH EQUITY AND WELL-BEING Senator Grassley has the REACH Act that is out there that is looking at different models of health delivery in rural areas, different ways to reim burse those facilities so that they can have the freedom to innovate and design a program that works specifically for their community, because it is not going to be the same for every rural community. Innovations can also help manage the delivery of health care to the relatively small percentage of people who incur a large portion of health care costs while "maintaining our focus on the broader public health questions and commitment that we need to have to ensure that the public's health continues to improve," Thomas said.
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