# Presentation: 314949

## Rural Public Health

- Heather Reed
- State Office of Rural Health
- Ohio Department of Health

## Key Concepts

- If you’ve seen one rural community, you’ve seen one rural community
- Rural public health must be viewed in the context of the entire system of health care
- Health care and economic development are integrally linked in rural areas

## Function of Public Health

- Preventing epidemics
- Protecting against environmental hazards
- Preventing injuries
- Promoting healthy behaviors
- Responding to disasters
- Assuring quality and accessibility of health care for underserved populations

## Rural Public Health Issues

- Rural people die of the same diseases as urban people, but often at higher rates
- Deaths from accidents more prevalent in rural areas
- Fewer resources to support public health initiatives in rural areas
- Health promotion/disease prevention a “tough sell” in rural areas

## Rural Health vs. Public Health Policy

- Rural health policy development focuses heavily on access issues
- Public health policy generally doesn’t draw a distinction rural vs. urban
- Public health is integral to ensuring the health of rural populations and access to both public health and primary care professionals is critically important

## Potential Threats to the Rural Public Health Infrastructure

- Leadership
- Workforce Preparedness
- Safety Net Provider Support
- Managed Care Impact
- Telecommunications
- Funding

## Leadership

- Diminishing rural representation
- No single organization for advocacy
- Public misperception of public health’s role
- Fragmentation of public health programs across federal agencies

## Workforce Preparedness

- Nationally 4 out of 5 public health employees have no degree, certificate, or formal education in public health
- Rural health departments face a continuing problem of attracting and retaining the proper mix of public health professionals

## Safety Net Provider Support

- Rural public health agencies caught between conflicting demands for population-based services and supporting a safety net of personal health services
- In urban areas there are more likely to be other safety net providers to provide those services if public health agencies do not
- Philosophical divide in public health between safety net role versus population-based services

## Public Health “Push” & “Pull”

- Provision of indigent care
- Dilemma more pronounced in rural
- Providing clinical services detracts from prevention mission
- If we don’t, who will?

## Impact of Managed Care

- Variable impact in rural areas
- Has potential to alter existing funding mechanisms
- Delivery systems appropriate for urban areas may not be appropriate for rural areas

## Telecommunications

- Rural communities most in need of telecommunications technology are often those least equipped to take advantage of it
- Stabilizing public health in many rural communities requires starting with very basic equipment

## Funding

- Public health funding is unstable
- Rural public health departments are likely to receive federal, state, and local funds, all with their own requirements, criteria, and expectations
- These dollars not necessarily tied to need

## Current Rural Health Trends

- Increasing health care costs
- Chronic shortages of providers
- Closure of some rural facilities
- Decreasing federal and state subsidies
- Aging of rural population
- Rural consumers going “urban” for services

## Access Barriers

- Financial
- Geographic
- Organizational/Availability
- Sociological/Acceptability

## Rural Health Care Delivery Challenges

- Poverty
- Inadequate Transportation
- Distance
- Aging Population
- Rural Economic Decline

## Economic Development and Rural Health

- Kellogg Foundation Survey found...
- Broad consensus among lawmakers about problems facing rural America, but...
- Rural economic development and health care taking a back seat to current state fiscal woes

## Economic Development and Rural Health

- Potential Strategies...
- Linking rural development and health care improvement
- Using economic development to strengthen the rural health (including public health) workforce
- Finding models to improving financial access

## The Rural Health Exodus

- What if 50% of rural parents sent their kids to city schools?
- State subsidies would decrease since enrollment down
- More difficult to recruit teachers
- No money for new books, computers...
- Parents would feel local schools of poor quality

## The Rural Health Exodus

- This is what is happening in rural health care across the country!!!

## Economic Impact of the Health Care Sector in Rural Ohio

- Study commissioned by the ODH State Office of Rural Health
- Conducted by the Institute for Local Government Administration and Rural Development at Ohio University
- Utilized IMPLAN data as basis for study which incorporates employment and income as well as direct and indirect impacts of health care system

## Health Care Sub-Sectors

- Hospitals
- Doctors, dentists, and other medical professionals
- Nursing and protective care
- Other medical and health services (e.g. home health, public health)
- Pharmacies

## Cautionary Notes

- 1999 data utilized
- May not reflect current situation in county
- Retail sales and sales tax methodology may not fully transfer
- Large data sets inherently miss some local providers

## County Level Results

- In rural Ohio, health sector directly employed 103,375 employees
- Total payroll generated was $2.8 billion
- Direct and indirect impact was 158,748 jobs and $4.2 billion in earned income
- Health care sector responsible for 11.5% of rural county employment and 11.6% of income in 1999

## Why is this Important?

- Health care is often overlooked as a significant source of employment in rural communities
- The more health care services are provided within rural Ohio, the greater the share of these dollars that stay in the local economies of these counties

## Using the Economic Impact Data

- At the state level this data can be used to stimulate the development of sound rural health policy
- At the local level it provides a common language between health, economic development, and local elected officials

## Economic Impact and Rural Public Health

- Why is this important to rural public health?
- Public health departments are an integral piece of the rural health care infrastructure
- Rural public health departments can and should take the lead in conducting community needs assessment planning processes that includes an analysis of the economics of the rural health care system

## For More Information

- Heather Reed, Administrator
- Rural Health Section
- Ohio Department of Health
- 246 North High Street, 6th Floor
- Columbus, OH 43215
- (614) 752-8935 Phone
- (614) 995-4235 Fax
- _[hreed@gw.odh.state.oh.us](mailto:hreed@gw.odh.state.oh.us)_