Rural and Urban Health Differences, Take 2

Yesterday The Early Show on CBS had a report on health differences between urban, suburban and rural counties, based on the research of the University of Wisconsin Population Health Institute.  (You can read the article and watch the report here.)  The Institute compiles the County Health Rankings, an annual snapshot of health activities and outcomes based on a number of factors, such as smoking and obesity rates and mortality.

Once again, evidence proves that rural residents are significantly less healthy than urban.  The most troubling fact in the report: 48 % of the healthiest counties were urban or suburban, while 84% of the unhealthiest counties were rural.  Obesity, diabetes, high blood pressure and heart disease are generally higher in rural.  I reported on this trend last month in another post, where I outlined some of the differences in behavior and environment that lead to these disparities. Read the rest of this post »

September 9, 2011 · KJacobson · No Comments
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Wisconsin Office of Rural Health Grants

I recently released the guidelines for the Office’s Rural Community Grant program.  We will award up to $12,000 to rural Wisconsin coalitions working on a health care issue in their community or region.  A rural hospital of <50 beds must be an active member of the coalition, i.e., must have an active role in the project.  We’ll award planning and implementation grants, so if you and your partners are still in the preliminary stages, you can apply for funds to help develop your project.  We will award extra points for EMS-related projects, but I encourage you to consider applying regardless of your project.

I hosted a webinar a couple of weeks ago explaining the guidelines and offering some advice on preparing proposals.  That was recorded and is available on our website, along with the accompanying PowerPoint with active links.  On the same page are all the successful proposals from the last several years.  These will give you an idea of what a winning proposal looks like.  Proposals must be in our office by September 28.  Sorry, no late entries.

The Wisconsin Medical Society also has a Community Grant program.  This program “focuses on providing support for physician-led, community-based programs to improve health through education and outreach.”  The site has examples of previously funded projects.  Proposals are due tothe Society October 7.

August 30, 2011 · KJacobson · No Comments
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Food Deserts and Insecurity

Last month First Lady Michelle Obama announced a program with retailers to expand access to healthy, affordable food in “food deserts;” rural or urban areas where healthy, affordable food is difficult to obtain.  This is often a result of food insecurity.  A federal Office of Rural Health Policy report defined this: “the food intake of one or more household residents was reduced and eating patterns disrupted because the household lacked money and other resources for food.”  The lack of accessible food is a primary factor in both instances.  This map illustrates the lack of access by county; in several Wisconsin counties, over 10% of the population lives over a mile from a market and doesn’t have access to a car.  Often these “markets” are convenience stores, which lack reasonably priced healthful food and may not carry any fruits and vegetables.  The White House food desert initiative is an agreement with a number of national and regional retailers, including Wal-Mart and Walgreen’s, to introduce and expand healthful food offerings. Read the rest of this post »

August 29, 2011 · KJacobson · No Comments
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Telemedicine, HIT and Rural Healthcare

I was planning to do a post on telemedicine sometime soon.  Then in the last few days, I’ve seen a number of reports and articles on this subject, especially as it relates to rural healthcare.  My plan started when I came across this post about patients having access to their physicians through a variety of technologies (Skype, email, etc.).  The point of the post was that patient/physician communication in any
form is desirable and is expected to increase (it also discusses reimbursement challenges).  What struck me were the comments.  I assume most or all of the commenters are physicians, several of whom wrote about the additional time burdens these new communication media will place on providers.  What none of them mentions are the opportunities telemedicine will provide to those who don’t have the luxury of face-to-face provider contact.  This is especially true in rural communities who face a growing provider shortage.  Read the rest of this post »

July 29, 2011 · KJacobson · No Comments
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Improving Access to Oral Health Care

Last week the Institute of Medicine released a report on the status of oral health care, Improving Access to Oral Health Care for Vulnerable and Underserved Populations.   (Their July 13 press release provides a recap.)  The report identifies several population groups that lack access to dental care, including seniors, minorities and rural residents.  Over 33 million people live in oral health shortage areas, including over 560,000 here in Wisconsin, almost 10% of the population.  This map illustrates that the vast majority of Wisconsin shortage areas are in rural communities.  The WI Dental Association found last year that the 45 smallest, rural counties in the state had an average population-dentist ratio of 2,700:1, much higher than the recommended ratio of about 1,900:1.  Lower rates of dental care in rural areas are due to several factors, such as the relative lack of dental insurance, but the most significant reason is a shortage of providers.  There are some programs to address this problem, such as the Health Professions Loan Repayment Program (which I manage).  The Office of Rural Health also has a dentist recruiter on staff, Marsh Siik. Read the rest of this post »

July 22, 2011 · KJacobson · No Comments
Tags: , , , , ,  · Posted in: Grant Advice, Provider Loan Repayment, Reports and Studies

Rural and Urban Health Differences

A reporter in the Wall St. Journal last week asked the question, who is healthier, rural or urban residents?  (You can read a recap in The Rural Blog)  Despite the image many of us have of a healthy rural environment (Produce all around you!  Fresh air! Lots of opportunities for outdoor exercise!) urban and suburban residents are living longer, healthier lives than those in rural areas.  The statistics are pretty stark.  Two thirds of all fatal traffic accidents are in rural, even though only about 25% of us live there. Where, by the way, only 10% of physicians live.  35% of rural children are overweight compared with 30% of urban.  Rural residents are less likely to have health insurance, see a dentist regularly or have prescription drug coverage than urban and suburban.  Rural residents are also more likely to engage in unhealthy behavior, like smoking, drinking (40% of rural and 25% of urban teens report drinking and driving) and poor diets (rural children consume on average 80 grams of fat each day; urban, 73 grams).

This reporting was based in large part on the work of the UW Population Health Institute.  Each year they update their County Rankings, which examines a number of health factors (activities and influences on health, like smoking and education) and health outcomes, like premature death rates.  Wisconsin rankings are on their website.   Read the rest of this post »

July 20, 2011 · KJacobson · No Comments
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Are Rural Hospitals Living Up To Expectations?

I just got back in the office after spending the first half of the week in Portland, ME at the National Conference of State Flex Programs.  Flex is a federally funded program that provides various types of assistance to rural health care providers, including hospitals, clinics and EMS.  There was a lot of buzz about a recent article in the Journal of American Medical Association (JAMA) on rural hospitals “Quality of Care and Patient Outcomes in Critical Access Rural Hospitals”.  The authors found that “Compared with non-CAHs [critical access hospitals], CAHs had fewer clinical capabilities, worse measured processes of care, and higher mortality rates for patients with AMI, CHF, or pneumonia.”  That’s pretty blunt; the authors seem to believe that a program that was implemented to improve care in rural communities isn’t achieving it’s purpose.  However, as I heard several people say at the conference and from other articles I’ve seen, there’s more to this story. Read the rest of this post »

July 14, 2011 · KJacobson · One Comment
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Obama’s Rural Policies

President Obama recently created the White House Rural Council through an executive order.  The Council “will focus on job creation and economic development by increasing the flow of capital to rural areas, promoting innovation, expanding digital and physical networks, and celebrating opportunity through America’s natural resources.”  The Council will address a number of key issues that affect rural communities (jobs, education) including healthcare, with a goal to “improve access to quality health care through expansion of health technology systems.”  There doesn’t seem to be a website yet.

One of my favorite rural blogs, Daily Yonder, greeted news of the Council with some healthy skepticism.  It’s a great sign the White House seems dedicated to identifying the challenges and opportunities in rural America, but as the DY says, it’s unclear what the Council’s responsibility is and what they will do.  They note that there will be no staff hired and no Congressional committee was assigned oversight.  Time will tell how effective the Council will be.

A DY article from earlier this week describes one of those challenges; demographics.  In 2010, ¼ of all counties had more deaths than births.  As you can imagine, most of these are rural counties.  In fact, more than 90% of these counties, 750, are rural.  We’ve seen demographic trends in rural communities for years—young people leave due to few prospects leaving older residents to age in place.  This has obvious social and economic impact.  Health care needs, for one, will only increase as populations age.  But many rural communities lack access to health care—the proverbial vicious circle. Read the rest of this post »

July 6, 2011 · KJacobson · No Comments
Tags: , ,  · Posted in: Reports and Studies