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Health Care Disparities and Health Care Policy PaperKathryn FoxFerris State UniversityApril 2nd, 2013AbstractRural populations have been identified as an underserved population with increased health disparities influenced by social determinants. The rural population’s social determinants including socioeconomic status, access to health care, and social behaviors are explored. Social determinants effects on health disparities including increased chronic disease, mortality are cancer rates are analyzed. The Affordable Care Act will implement many changes that positively affect rural populations’ access to health services, insurance coverage, and health outcomes. The importance of policy makers and healthcare professionals identifying underlying beliefs and values that affect the health outcomes of rural Americans is great. Doing so will allow them to create programs and initiatives that are more successful in decreasing health disparities. Health Care Disparities and Health Care Policy PaperRural areas have been defined as an area high in social determinants and health disparities. A rural area can be geographically designated based on land use, administrative, or economic concepts (Harkness & DeMarco, 2012). Categorizing an area as rural, metropolitan, or nonmetropolitan is important because it affects the amount of government tax credits, financial backing, and personnel that are given to a defined area (Harkness & DeMarco, 2012). Through this paper the health disparities and social determinants affecting the health disparities of rural populations with be explored. The impact of the Affordable Care Act on rural populations will also be discussed. Rural areas suffer from many health disparities. Eberhardt and Pamuk’s article in the American Journal of Public Health (2004) found that premature mortality rates were greater among rural areas in comparison to suburban ones. Unintentional death rates from suicide and chronic obstructive pulmonary disease also ranked higher than urbanized areas (Eberhardt & Pamuk, 2004). While geographical location varied by population demographics, rural areas generally showed higher rates of edentulism (tooth loss), cardiovascular disease, type 2 diabetes, hypertension, and certain cancers. (Eberhardt & Pamuk, 2004, Harkness & DeMarco, 2012). Social DeterminantsSocial determinants of health are defined by the World Health Organization (WHO) (2011) as, “the conditions in which people are born, grow, live, work and age, including the health system” (para 1). These social determinants largely affect health disparities and inequalities. Social determinants that affect rural populations include access to health care, social behaviors, and socioeconomic status. Access to Health CareRural populations have decreased access to health care services and providers, and according to Harkness & DeMarco (2012), “rural residents have greater transportation difficulties reaching healthcare providers, often traveling great distances to reach a doctor or a hospital” (p. 340). Lack of access to health care is one of the largest social determinants identified. Barriers to access include lack of public transportation in rural areas, inclement weather, and physical distance to health care services. In medical emergencies like myocardial infarction and cerebrovascular accidents time is of the essence, and this lack of access in rural areas is positively related to the higher post acute myocardial infarction death rates in rural hospitals when compared to urban ones (Harkness & DeMarco, 2012). Many rural residents depend on small rural hospitals that do not have the medical expertise that a large urban medical center houses. Most rural hospitals average 25 beds and the case mix widely varies, creating unique challenges for these hospitals (United States Department of Health and Human Services, 2011). Only 11% of physicians in the United States practice in rural locations, despite having 19% of the American population residing there (United States Department of Health and Human Services, 2011). Social BehaviorsSocial behaviors are another factor that influence the health status of rural populations. Rates of cigarette smoking are higher among rural areas; especially among adolescents (Eberhardt & Pamuk, 2004, Hartley, 2004). This higher incidence of smoking can be directly related to higher rates of cancers and chronic obstructive pulmonary disease in rural areas. Prevalence of obesity and lack of physical exercise are higher among rural areas when compared to suburban counterparts (Eberhardt & Pamuk, 2004, Hartley, 2004). Obesity and physical inactivity are known contributors to hypertension, diabetes, and cardiovascular disease. Unintentional injuries have higher prevalence’s in rural areas, and according to Harkness & DeMarco (2012), “rural residents are nearly twice more likely to die from unintentional injuries other than motor vehicle accidents than are urban residents” (p. 340). Reckless and irresponsible behavior, including driving under the influence is more common in rural areas as well, in fact, “40% of rural 12th graders reported using alcohol while driving compared with 25% of their urban counterparts” (Harkness & DeMarco, 2012, p. 340). Suicide rates among males in rural areas are significantly higher when compared to their urban counterparts. These higher suicide rates may have a positive relationship with the lack of access to health care including mental health services. Harkness & DeMarco (2012) found that, “20% of nonmetropolitan counties lack mental health services versus 5% of metropolitan counties” (p. 340). Socioeconomic StatusRural citizens suffer from many different health disparities due to low socioeconomic status. In the Agency for Health Care Research and Quality’s (AHRQ) report (2011) of healthcare disparities, they found that when compared to urban residents, rural citizens were more likely to be poor and of older age. Harkness and DeMarco (2012) found that rural populations are more likely to have higher high school dropout rates, less college education, and lower incomes. Low socioeconomic status is positively related to lack of health insurance coverage and unhealthy lifestyles, and according to Hartley (2004), “behavioral disparities are correlated with income and education, and efforts to change unhealthy behaviors have often proven less effective among low-income, less-educated populations” (p. 1676). Health Care Policies The Affordable Care Act (ACA) put into place in 2010 by President Barack Obama will have a positive impact on rural populations. The ACA will increase coverage, access, and programs to rural populations.Increased CoverageWhile the ACA will increase coverage for many Americans, it’s important to understand that since rural persons have higher uninsured rates than their urban counterparts the impact of the ACA provisions will be disproportionately more important for rural populations (Coburn, Lundblad, MacKinney, McBride, & Meuller, 2010). Many rural Americans are small business owners, and under the ACA insurance premiums will be lowered for small business owners making insurance for employees and owners more accessible (Department of Health & Human Services, 2010). Purchasing individual health insurance will also become easier, under the ACA patients with pre-existing conditions, that may have been previously denied coverage, will now be eligible (Department of Health & Human Services, 2010). Since rural populations have higher rates of chronic disease this change will greatly affect them. Increased Access to Health CareLack of access to health care providers and programs is one of the largest determinants to rural populations. The ACA will allow for increased resources placed on training health care professionals that will work in rural areas (Coburn, et al, 2010). There will also be incentives for providers to practice in rural areas including scholarships, loan repayments, and Medicare reimbursements (Department of Health & Human Services, 2010). Community health centers in rural areas will have increased funding to expand and modernize to better meet rural population needs (Department of Health & Human Services, 2010). Contributing FactorsRural populations have many different beliefs and values that may affect health outcomes. Lower socioeconomic status and education level may create unhealthy eating and lifestyle habits that are accepted by neighborhoods and families. These habits ultimately become tradition after being passed on from generation to generation. Rural populations have several barriers in place that affect living. Fewer resources are available to them when compared to urban populations. Public health departments are often far away and transportation to supermarkets, pharmacies, and other necessities may prove more difficult. Traditionally, men work hard at their jobs to provide for their families, and there is decreased focus on relaxation and self indulgence. I think rural jobs are typically more likely to be labor intensive, high stress, and pay less than someone living and working in an urban area. This high stress environment increases the likelihood of negative habits like smoking, eating unhealthy foods, and lack of physical activity. I believe that these barriers for rural populations often hinder the value of healthy living, and therefore affect health outcomes. In my opinion, policy makers recognize the health disparities that rural populations face, but look at the problem on a larger scale. They place higher value on economic and fiscal efficiency. Placing value on the dollar amount may cause them to overlook what underlying factors impact health outcomes for populations. ConclusionRural areas suffer from many health disparities that are affected by social determinants. The ACA will positively impact rural populations by increasing access to health services, insurance coverage, and the number of providers practicing in rural areas. It’s important to recognize what values and beliefs affect health outcomes of populations. Doing so allows policy makers and health care professionals to better identify the needs of rural populations. ReferencesCoburn, A. F., Lundblad, J. P., MacKinney, A. C., McBride, T. D., & Mueller, K. J. (2010). The patient protection and affordable care act of 2010: Impacts on rural people, places, and providers. Rural Policy Research Institute, 1-28. Retrieved from of Health and Human Services. (2010, November). The patient protection and affordable care act of 2010: Impacts on rural people, places, and providers. Retrieved from , M. S., & Pamuk, E. R. (2004). The importance of place of residence: Examining health in rural and nonrural areas. American Journal of Public Health, 94(10), 1682-1686. Retrieved from , D. (2004). Rural health disparities, population health, and rural culture. American Journal of Public Health, 94(10), 1675-1678. doi: 10.2105/AJPH.94.10.1675National Advisory Committee on Rural Health and Human Services (2011, December). Reducing health disparities in rural america: Key provisions in the affordable care act. Retrieved from . Department of Health and Human Services, (2011). National healthcare disparities report. Retrieved from Agency for Healthcare Research and Quality website: Health Organization. (2011). Social determinants of health. Retrieved from Name: Kathryn FoxN340 ~ Health Care Disparities and Health Care Policy Paper RubricSectionGuidelinesPossiblePointsEarnedPointsPopulation and disparity defined? Clearly defines the population under consideration? Describes the health disparity(ies)experienced by this population.? Supports all data with reliable resources.10%10Review of social determinants?What social determinants ar erelevant to the identified disparity?? The connection between the social determinants and the disparity is clearly explained.? Support the data, explain the reasoning.30%30Policies contributing to disparities? Identify policies that negatively or positivelyaffect the disparities and the social determinants. Source the policies? Make the connection between the policies and the outcomes on health.30%30Contributing factors? What underlying beliefs or values mightcontribute to the disparities? This is the tough critical thinking part.? What values held by those in power might influence the health status ofa particular population.? Clarify your thinking.30%30Content Grade100%100WritingFINAL GRADE less Deductions: DEDUCTION OFUP TO 30 points (-30%) will be made forAPA/writing/grammatical/punctuation errors.-30%-3Total100%97Comments: Good job. All areas were covered well in your paper. A few minor spelling/ APA/citation errors were noted. See comments within paper. This is an important population group that we all need to assist with their special needs. ................
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