Population Health in Rural America in 2020 Proceedings of a Workshop (2021) / Chapter Skim
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3 Rural Health Vital Signs
3 Rural Health Vital Signs
Pages 21-44
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ongoing Healthy People and Rural Healthy People initiatives. The session was moderated by Alana Knudson from the Walsh Center for Rural Health Analysis at NORC at the University of Chicago.
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Drivers of Higher Mortality in Nonmetro Areas Holmes described how specific drivers of higher mortality may account for divergent mortality trends in metro versus nonmetro areas. An analysis of the trends in metro and nonmetro mortality data from 1980 to 2010 found that county demographics, economics, and geographic distribution in each decade explained the growing rural–urban health gap (Spencer et al., 2018)
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compressed mortality data (2013 Metro Status) ; see https://wonder.cdc.gov (accessed 23 August 3, 2020)
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Between 2010 and 2014, 171 rural hospitals closed in the United States; these closures were concentrated in the American South, a region widely affected by rural health issues.2 Variation in Causes of Death Holmes explained that the increasing rural–urban mortality gap is being driven by certain conditions, including heart disease, unintentional injury, suicide, cirrhosis, COPD, lung cancer, and stroke (Singh and Siahpush, 2014)
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Holmes added that COVID-19 trends in the South have been consistent with the expectation that cases and deaths would rise first in more urbanized areas and then spread across less urbanized and rural areas. TRIBAL HEALTH PERSPECTIVE Valerie Nurr'araaluk Davidson, president of Alaska Pacific University, offered a tribal health perspective framed with the tenet "nothing about us without us." She described the Alaska Tribal Health System (ATHS)
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Alaska Pacific University is a member of the University of the Arctic and has a strategic affiliation with the Alaska Native Tribal Health Consortium, a statewide tribal health organization providing services to all 229 federally recognized tribes in Alaska and services formerly provided by the federal government through the Indian Health Service. This strategic affiliation allows Alaska Pacific University to focus on tribally driven and culturally responsive research, to support Indigenous researchers and scholars, and to focus on rural workforce issues.
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Nurr'araaluk Davidson provided an overview of ATHS, which is a voluntary affiliation of tribes and tribal organizers providing health services to Alaska Native and American Indian people. The ATHS is governed by the Alaska Tribal Health Compact, which is negotiated annually with the Secretary of HHS.
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2015. Testimony of the Alaska Native Tribal Health Consortium.
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An overarching goal of Healthy People 2020 has been to achieve health equity and eliminate disparities, including rural health disparities. For instance, one of the initiative's objectives is to increase the proportion of persons with medical insurance.
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Yaemsiri suggested that these trends and the disparities in progress toward Healthy People 2020 targets between rural and urban areas is related to the notion of structural urbanism discussed by Janice Probst. Challenges and Opportunities in Tracking Rural Health Data Yaemsiri outlined some of the challenges encountered in efforts by the Heathy People 2020 initiative to track mortality in rural areas.
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RURAL HEALTHY PEOPLE INITIATIVE: PROCESSES AND RURAL HEALTH INDICATORS Alva Ferdinand from the Southwest Rural Health Research Center at Texas A&M University discussed the development of the Rural Healthy People initiative, presented findings from Rural Healthy People surveys and publications, and described current and future plans to further advance the initiative's aims. Ferdinand explained that the Rural Healthy People initiative was commissioned by the Federal Office of Rural Health Policy in 2002 to complement HHS's Healthy People 2010 initiative.
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The advisory board included representatives from funding partners, rural health care providers, state rural health agencies, and national rural health agencies. The aims were to prioritize the objectives of the Healthy People initiative in terms of the needs of rural America and to engage with those working in the field to identify models and programs that were showing promise in rural settings.
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providers, state and municipal agencies, public health offices, and federal agencies, as well as volunteer and indigent clinics. Rural Healthy People: Past, Present, and Future Ferdinand highlighted some of the key features of the Rural Healthy People initiative thus far and described efforts under way for Rural Healthy People 2030.
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Rural and Minority Health Research Center. SOURCE: Eberth presentation, June 24, 2020.
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Both iterations of Rural Healthy People reflected a great need for additional model programs and practices that have been shown to be effective in rural settings, along with the need for new targeted prevention and care models for rural areas. Rural Healthy People 2030 will continue to seek the input and involvement of rural stakeholders, with the following aims: • identifying objectives within priority areas for targeted attention between 2020 and 2030, • identifying successful or promising programs developed in rural America that will help achieve those objectives, • identifying and advocating for data sources that will help track the progress of rural America toward Healthy People targets, and • keeping rural health disparities at the forefront of policy makers' and advocates' minds.
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. Regardless of metro/nonmetro designation, Asian and Pacific Islander populations have the lowest mortality rates for all three of these causes of death, Black populations have the highest rates of mortality caused by cancer and cardiovascular disease, and American Indian and Alaska Native populations have the highest rates of mortality caused by unintentional injuries.
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. She added that similar data showing racial and ethnic differences and childhood mortality can be found in the Health Affairs 2019 special issue on rural health.12 Eberth noted that in addition to mortality, morbidity is also a key indicator of population health that often differs by race and ethnicity in metro versus nonmetro populations.
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. Rural residents who are Black, Hispanic, and American Indian or Alaska Native are more likely 15 The SDOH include neighborhoods and the built environment, health and health care, social and community context, education, and economic stability.
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To successfully effect real improvement in rural health, she added, policies should focus on SDOH and macro-level factors across multiple sectors beyond an exclusive focus on the health care system. DISCUSSION Disseminating Rural Health Data to Rural Communities Knudson started the discussion and asked how to best distribute data to rural communities so they can address their own local issues.
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Existing data resources should also be used in more flexible ways in order to present rural health estimates at the regional level or aggregate data by year, which can be used to evaluate progress in rural areas over time. She noted that in addition to rural populations, these strategies can benefit small population groups -- such as the Native Hawaiian and other Pacific Islander, American Indian, and Alaska Native populations -- for which obtaining reliable data may require aggregating over geographic areas or 17 More information about CDC WONDER online databases is available at https:// wonder.cdc.gov (accessed July 9, 2020)
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They have also observed correlations between adverse childhood experiences and health status in tribal communities. She noted that the Special Diabetes Program for Indians has brought about substantial improvements because the program offers latitude for tribes and tribal health organizations to tailor diabetes programs to the needs of local populations with services such as nutrition classes, ensuring that fresh vegetables are available, and encouraging residents to harvest natural foods.
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Subsequent iterations of Rural Healthy People will have the opportunity to unpack the SDOH and engage with stakeholders to determine where they fall in priority among rural health priorities, she added. Acceleration of Telehealth in Response to COVID-19: Implications for Rural Health Probst asked whether the transition to telehealth accelerated by the COVID-19 pandemic has served as an effective mechanism for improving infrastructure for rural areas.
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RURAL HEALTH VITAL SIGNS 43 issues in rural Alaska, people can now visit many village health clinics to access telehealth services from providers that would otherwise be inaccessible. Eberth added that the COVID-19 pandemic has also brought about positive regulatory changes, with certain long-standing rules loosened to facilitate the rapid acceleration of telehealth.
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