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Leveraging Assets to Improve Health and Equity in Rural Communities

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This presentation was delivered at NADO's Annual Training Conference, held in Anchorage, Alaska on September 9-12, 2017.

A growing body of research shows that people living in rural communities experience inequities in health and well-being compared to their urban counterparts. The NORC Walsh Center for Rural Health Analysis, with funding from the Robert Wood Johnson Foundation, is conducting formative research to explore opportunities to improve health
and equity in rural communities using an asset-based community development approach. This session will provide an overview of rural health disparities data, followed by preliminary findings and key recommendations to strengthen rural communities
based on an enhanced understanding of culture and history, priorities, assets, partners, and promising strategies unique to and common across rural communities and regions.

Michael Meit, MS, MPH, Co-Director, NORC Walsh Center for Rural Health Analysis, NORC at the University of Chicago, Bethesda, MD

Published in: Government & Nonprofit
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Leveraging Assets to Improve Health and Equity in Rural Communities

  1. 1. 1 Leveraging Assets to Improve Health and Equity in Rural Communities
  2. 2. Rural Health Disparities
  3. 3. Source: Singh and Siahpush, Widening Rural-Urban Disparities in Life Expectancy, U.S., 1969-2009. American Journal of Preventive Medicine, 2014; 46(2):e19-e29.
  4. 4. 4 All-Cause Mortality: US vs. Appalachia ‡Rates are presented as deaths per 100,000 population. Rates are age adjusted. *In all years except 1999, the Appalachian rate is significantly different from the non- Appalachian U.S. rate, p ≤ 0.05 Source: Mortality Rates and Standard Errors provided by Centers for Disease Control and Prevention, National Center for Health Statistics. Accessed at http://wonder.cdc.gov/mcd-icd10.html Diseases of despair annual mortality rates, ages 15-64, by region (1999-2015)‡* All-cause annual mortality rates, ages 15-64, by region (1999-2015)‡* ‡Rates are presented as deaths per 100,000 population. Rates are age adjusted. *For all years, the Appalachian rates is significantly different from the non- Appalachian U.S. rate, p ≤ 0.05 Source: Mortality Rates and Standard Errors provided by Centers for Disease Control and Prevention, National Center for Health Statistics. Accessed at http://wonder.cdc.gov/mcd-icd10.html
  5. 5. 6 Overdose Deaths: Appalachia ‡Rates are presented as deaths per 100,000 population. Rates are age adjusted. *Appalachian rates are significantly different from the non-Appalachian U.S. rate for the same age group, p ≤ 0.05 Source: Mortality Rates and Standard Errors provided by Centers for Disease Control and Prevention, National Center for Health Statistics. Accessed at http://wonder.cdc.gov/mcd-icd10.html Overdose mortality rates for males, ages 15-64, by age group and region (2015)‡ Overdose mortality rates for females, ages 15- 64, by age group and region (2015)‡* ‡Rates are presented as deaths per 100,000 population. Rates are age adjusted. *For all age groups, Appalachian rates is significantly different from the non- Appalachian U.S. rate, p ≤ 0.05 Source: Mortality Rates and Standard Errors provided by Centers for Disease Control and Prevention, National Center for Health Statistics. Accessed at http://wonder.cdc.gov/mcd-icd10.html
  6. 6. 7 The social determinants can be classified into five domains: 1) Economic stability • Poverty, employment, food security, housing stability 2) Education • High school graduation, enrollment in higher education, language and literacy, early childhood education and development 3) Social and community context • Social cohesion, civic participation, perceptions of discrimination and equity, incarceration/institutionalization 4) Health and health care • Access to health care, access to primary care, health literacy 5) Neighborhood and built environment • Access to healthy foods, quality of housing, crime and violence, environmental conditions Social Determinants of Health Healthy People 2020 Framework. http://www.healthypeople.gov/2020/topics-objectives/topic/social-determinants-health
  7. 7. 8 Social Determinants of Health Rural residents tend to be poorer than urban residents • Average median household income is $42,628 for rural counties ($52,204 for urban counties) (2013) • The average percentage of children living (ages 0-17) living in poverty is 26% in rural counties (21% urban) (2013) Source: http://www.ers.usda.gov/data-products/state-fact-sheets/state-data.aspx#.VFpOS_nF91Y
  8. 8. 9 Social Determinants of Health Rural residents’ educational attainment (2009-2013) - Averaged across counties 16.5% have < high school education (14.7% urban) 36.3% have only a high school diploma (31.9% urban) 17.4% have a Bachelor’s degree or higher (24% urban) Source: http://www.ers.usda.gov/data-products/state-fact-sheets/state-data.aspx#.VFpOS_nF91Y
  9. 9. 10 Examination of Trends in Rural and Urban Health: Establishing a Baseline for Health Reform CDC published Health United States, 2001 With Urban and Rural Health Chartbook No urban/rural data update since 2001 Purpose of this study: Update of rural health status ten years later to understand trends Provide baseline of rural/urban differences in health status and access to care prior to ACA implementation
  10. 10. 11 Methods Replicated analyses conducted in 2001 using most recent data available (2006-2011) Used same data source, when possible: National Vital Statistics System Area Resource File (HRSA) U.S. Census Bureau National Health Interview Survey (NCHS) National Hospital Discharge Survey (NCHS) National Survey on Drug Use and Health (SAMHSA) Treatment Episode Data Set (SAMHSA) Applied same geographic definitions, although classifications may have changed since 2001: Metropolitan Counties: large central, large fringe, small Nonmetropolitan Counties: with a city ≥ 10,000 population, without a city ≥ 10,000 population
  11. 11. 12 Mortality: Children and Young Adults Death rates for all causes among persons 1–24 years of age by rurality
  12. 12. 13 Mortality: Working-Age Adults Death rates for all causes among persons 25-64 years of age by rurality
  13. 13. 14 Mortality: Seniors Death rates for all causes among persons 65 years of age and over by rurality
  14. 14. 15 Mortality: Chronic Obstructive Pulmonary Diseases Death rates for chronic obstructive pulmonary diseases among persons 20 years of age and over by rurality
  15. 15. 16 Mortality: Suicide Suicide rates among persons 15 years of age and over by rurality
  16. 16. 17 Risk Factors: Adolescent Smoking Cigarette smoking in the past month among adolescents 12-17 years of age by rurality
  17. 17. 18 Risk Factors: Adult Smoking Cigarette smoking among persons 18 years of age and older by rurality
  18. 18. 19 Risk Factors: Obesity Obesity among persons 18 years of age and older by rurality
  19. 19. 20 Regional Mortality Study Purpose: To examine the impact of rurality on mortality and to explore the regional differences in the primary and underlying causes of death.
  20. 20. 21 HHS Regions
  21. 21. Figure 46 Regional Differences in Mortality: Males; 25-64; Region 6 (AR, LA, NM, OK, TX)
  22. 22. Regional Differences in Mortality: Females; 25-64; Delta Source: Centers for Disease Control and Prevention, National Center for Health Statistics, Multiple Cause of Death.
  23. 23. Regional Differences in Mortality: Males; 25-64; Appalachia Michael Meit, Co-Director of the Walsh Center Meit-Michael@norc.org  301-634-9324 Source: Centers for Disease Control and Prevention, National Center for Health Statistics, Multiple Cause of Death.
  24. 24. Health is an economic and community development issue in Rural America 25 Bottom line….
  25. 25. Exploring Strategies to Improve Health and Equity in Rural Communities
  26. 26. • Conduct formative research to identify strengths, assets, and strategies that will accelerate and improve health and well-being in rural communities. • Identify factors and cross-sector partners that can influence health and well-being within rural communities, including why barriers have not been overcome in the past. • Identify opportunities for action and a set of recommendations for diverse rural stakeholders and funders. 27 Project Purpose
  27. 27. 28 RWJF Culture of Health Action Framework
  28. 28. Needs and Deficits Assets and Capacities Opportunities for Action 29 A Shift of Focus
  29. 29. 31 Cross-Sector Strategies Sample of Sectors Represented • Economic Development • Education • Media • Aging • Healthcare • Mental Health • Transportation • Housing • Public Health • Cooperative Extension • Environmental Health/Utilities • Youth Development • Physical Activity • Local Philanthropy • Food Systems • Churches • Community Development • Veterans • Early Childhood
  30. 30. 32 Regional Community Forums
  31. 31. Rural communities are hubs of innovation – a lack of financial resources can help foster creative solutions to local challenges – our problem is knowing where to find this innovation. 33 Key takeaway from regional meetings…
  32. 32. • Roles of RDO’s in strengthening rural communities: • conveners, especially in resource scarce areas • resource connectors, • backbone organizations, • capacity builders, • project managers, • technical assistance providers to help different sectors work together • Strategies that work tend to center around building infrastructure and addressing system-level priorities as opposed to specific programs and interventions 34 Input from the Planning and Development Sector
  33. 33. • Recommendations for the Planning and Development Sector • More time and resources during planning for building shared understanding and community buy-in on social issues • Recommendations for the Health Sector • Once healthcare organizations embrace more population health priorities, they can partner with RDO’s to address upstream issues and collaborate with other sectors 35 Input from the Planning and Development Sector
  34. 34. • Recommendations for national funders • Foundations can play crucial role by funding work that can’t be funded by government • Allow for innovations within regions and support local ideas and solutions • Encourage national associations in different sectors to figure out how they can support the work of other sectors • Find ways to measure success of community work that captures the impact of social, cultural, and intellectual assets on health and wellbeing 36 Input from the Planning and Development Sector
  35. 35. Preliminary Recommendations and Opportunities for Action
  36. 36. • Continued Foundation Learning • Strengthening Community Implementation Capacity • Identifying and Growing Rural Leaders • Community Development/Economic Development • Building the Rural Evidence Base • Fostering Cross-Sector Collaboration • Enhancing Community-Level Evaluation and Measurement • Co-Funding and Utilizing Regional/Local Intermediaries • Finding and Replicating “Rural-Centric” Health Innovation • Rural Specific Communications and Messaging • Fostering Learning Across Communities Preliminary Set of Recommendations
  37. 37. • What is missing? Are there additional recommendations that could be actionable for a large national funder? • Can you offer specific guidance for how recommendations may be implemented? What kinds of support could a large national funder provide? • Do you have real world examples where any of these strategies have worked? 39 Discussion
  38. 38. 40 https://walshcenter.norc.org https://www.ruralhealthinfo.org
  39. 39. Michael Meit, Co-Director NORC Walsh Center for Rural Health Analysis 4350 East West Hwy, Suite 800 Bethesda, MD 20814 301-634-9324 Meit-Michael@norc.org Thank you!

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