Rural Health: Issues and Solutions for Rural Communities
嚜燎ural Health: Issues and Solutions
for Rural Communities
Common and Chronic Health Care Management 589
Advanced Nursing Education
University of Mary
March 26, 2018
Bismarck, ND
GoTo Webinar
Presented by: Brad Gibbens, Deputy Director
and Assistant Professor
? Established in 1980, at The University of North Dakota (UND) School of Medicine
and Health Sciences in Grand Forks, ND
? One of the country*s most experienced state rural health offices
? UND Center of Excellence in Research, Scholarship, and Creative Activity
? Home to seven national programs
? Recipient of the UND Award for Departmental Excellence in Research
Focus on
每 Educating and Informing
每 Policy
每 Research and Evaluation
每 Working with Communities
每 American Indians
每 Health Workforce
每 Hospitals and Facilities
ruralhealth.und.edu
2
1
Today*s Objectives/Questions
? How do Values play a Role?
? How do we define ※rural health§?
? What are the Cultural, Social, Economic, and Demographic
Differences between Rural and Urban Communities
? What is Rural Health Equity? Disparity?
? What is the Relationship between the ※Rural§ Community
and ※Rural§ Health?
? What are the Primary Rural Health Issues and Needs?
? What are Barriers and Facilitators to Access in Rural Health?
? What is the environment for Rural Hospitals?
? What are some Options or Models for Positive Change?
Ultimately Our Values Guide Our Perceptions Toward
Health, Health Care, and Public Policy
※It is not what we have that will make us a great nation. It is
how we decide to use it.§
Theodore Roosevelt
※Vision is the art of seeing things invisible§
Jonathan Swift?
※Americans can always be relied upon to do the right
thing#after they have exhausted
all the other possibilities§
Sir Winston Churchill
2
How Do We Define Rural Health
5
What is Rural Health
? Rural health focuses on population health and improving health status
o ※Health outcomes of a group of individuals, including the distribution of such
outcomes within the group§ Dr. David Kindig, What is Population Health?
o Rely on social determinants of health and their impact on the population
(Health care system, Health Behaviors, Socio-Economic factors, Physical
Environment) 每 ※drivers§ of health policy (Better Health, Better Care,
and Lowered Cost 每 Three Aims)
? Historically, rural health has focused more on infrastructure: facilities,
providers, services, and programs available to the public (all with quality,
access, and cost implications) 每 In the ACA world more emphasis on
population health, but infrastructure is still critical as it is the pathway
to achieve better population health.
o
o
o
o
HRSA (ORHP, SORH, Flex, NHSC) 每 Federal bureaucracy orientation
Infrastructure improvement- health orgs, systems, payment structures
More and more health networks 每 independence with collaboration
Delivery systems: CAH, clinics, public health, EMS, nursing homes/aging
services, home health, mental health, dental, pharmacy, and others
3
What is Rural Health?
? Rural health is not urban health in a rural or frontier area
o Social determinants of health vary between urban and rural
(economics/income, education, health systems, environmental conditions)
o Rural is older, poorer, less insured, and has a higher level of morbidity for a
number of conditions
o Rural culture, relationships, how we do things are distinct
? Rural health needs effective health policy, and health policy needs to
rely on competent research
o
o
o
o
Policy process that is reflective of rural health needs
Policy advocacy that tends to be bipartisan
Varity of advocacy groups
Rural health research community
7
What is Rural Health?
∫Philosophy: rural people have the same right to expect healthy lives and
access to care as do urban people 每 fairness frame
? Access essential services locally or regionally
?
?
?
?
Access to specialty services through network arrangements
Health outcomes should be comparable
Quality of care on par with urban
Availability of technology
∫ Rural health is very community focused 每 interdependence frame
? Integral part of what a community is and how people see themselves
?
?
Community engagement 每 public input is fundamental
Sectors: Economic/business, public/government, education, faith/church, and
health/human services
? Direct services provided to the public and secondary impact for other sectors
? Major employer
4
What are the Cultural, Social, Economic,
Demographic Differences between
Rural and Urban Communities?
9
Rural and Urban Strengths and Weaknesses
Rural
Urban
Strengths
Strengths
?Strong informal support network
?Fundraising
?Cohesive
?Established interdependence
?Collaboration
?More stable/diversified economy
?Availability of resources
?Availability of professionals
?Growing and diverse population
?Change is natural
Weaknesses
Weaknesses
?Lack of cohesiveness
?Limited informal support
?Competition among providers
?Competition for fundraising
?More contentious-fractions
?Less sense of "community"
?Skewed population demographics
?Fluctuating economy
?Resistance to change
?Shortage of professionals
?Lack of resources
?Over-tapped staff
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