1. Rural Health - The Forgotten Minority 23rd Annual Minority Health Conference February 16, 2001 Yvette McMiller, MPH NC Office of Rural Health

2. Rural Health n State of Rural Health in NC n Availability of Services n Distribution of Providers n Programs/Assets in NC n Challenges n Future Emphasis in Rural Health

3. The State of Rural North Carolina n Older- 15% rural residents are older than 65 (vs. 11% urban) n Poorer- –16.5% rural residents live in poverty (vs. 11.1% urban) –~1 in 4 rural children live in poverty (vs. 1 in 7 urban) –~1 in 4 rural elderly live in poverty (vs. 1 in 6 urban) n Less likely to be insured (those < 65) n Travel Distances, Limited Transportation, Fewer Health Care Providers...

4. NC’s “Most Distressed” North Carolina’s “Most Distressed” Counties. NC Dept. of Commerce

5. Rural Areas tend to have fewer and less funded health care services. n Smaller tax base n Limited resources n Fewer providers n Lower volume

6. Sources: Public School Forum, NC DHHS, NC Dept of Commerce, NC Assoc of County Commissioners Inequities in NC county wealth Some counties lack the ability to finance basic services, as illustrated in comparison of selected 1998 data.

7. 1998 Comparison of Distribution of Population and Primary Care Providers between 18 Urban and 82 Rural Counties in NC Total Population Primary Care Physicians* Nurse PractitionersPhysician Assistants *FP, IM, GM, Ped, Ob/Gyn

8. NC Assets in Rural Health n NCORH since 1973 –Established 80+ Practices –Recruited 1,800 providers –T.A. to hospitals, practices, Health Dept. n 87 Public Health Departments n NC AHEC System n 21 Federally funded Health Centers serving 41 communities n Foundations, NCHA, NC Medical Society n Teaching Institutions n Tertiary Care Centers n Independent Free Clinics

9. Source: Cecil G. Sheps Center for Health Services Research, Chapel Hill, NC

10. Make Services Accessible & Acceptable Element n Community as decision makers n Staff and employ community members n Provider seen as integral part and committed Challenge n Small pool of available leaders n Confidentiality n Turnover   

11. Future Emphasis for Rural Health n Partnerships share resources –What breeds commitment and collaboration? –Agencies working together for the good of the whole - networks n Sustained funding of services –Advocacy for policy that helps sustain and strengthen resources in rural areas