1. Health On The Range RURAL HEALTH ISSUES AND INFORMATION RESOURCES KATE FLEWELLING 9/17/15 1

2. What comes to mind you think “Rural”? Image: Flickr user longyounglongyoung 2

3. More Than One Way To Slice It Unit needs to be small enough to identify important community differences… But not so small that little data are available 3

4. The Definition Depends… Administrative: Used by rural development programs. Defines urban/rural along municipal or other jurisdictional boundaries. Administrative: Used by rural development programs. Defines urban/rural along municipal or other jurisdictional boundaries. Land-Use: Used by the Census Bureau. Defines urban/rural based on how densely settled the area is (like what you would see from an airplane). Land-Use: Used by the Census Bureau. Defines urban/rural based on how densely settled the area is (like what you would see from an airplane). Economic: Used in most rural research. Recognizes influence of cities on labor, trade, and media markets that extend beyond densely settled cores. Economic: Used in most rural research. Recognizes influence of cities on labor, trade, and media markets that extend beyond densely settled cores. 4

5. Metro and nonmetro counties Image source: USDA 5

6. More Than One Way To Slice It (2) For research projects and economic development programs alike, the appropriate definition of rural will be that which meets the goals of the endeavor. Amber Waves Magazine June 2008 “Defining the ‘Rural’ in Rural America” 6

7. Check Your Location Rural Assistance Center: http://www.raconline.org/amirural http://www.raconline.org/amirural 7

8. Common Attributes of Rural Culture Courage, faith, hope, trust Relational, sense of community Love and respect for life, land and God Independence, self-reliance, individualism 8

9. Common Attributes of Rural Culture (2) Strong work ethic, perseverance Hardships, troubles, afflictions Enduring sense of gratitude 9

10. Hallmarks of Rural America Rural America comprises 75-80% of the nation’s land area Is home to 25% of the U.S. population Of the 3141 counties in the U.S., 2049 (65%) are designated non-metro or rural by the US Census Bureau 10

11. Hallmarks of Rural America (2) Low population density Limited to no services Disproportionate numbers of elderly, low-income/poverty and minorities Social isolation High incidence of chronic illnesses and premature deaths 11

12. Hallmarks of Rural America (3) Rural areas are experiencing a decline in population of individuals under 20 years of age They are also experiencing a corresponding increase – 7.8% - of individuals in the 40-59-year-old age group 12

13. Hallmarks of Rural America (4) Transportation issues ◦Costs are disproportionately higher ◦More dependent on personal vehicles and have to travel longer distances ◦Transportation issues can limit access to healthcare and other services ◦2/3 of deaths from motor vehicle accidents occur in rural areas (National Rural Health Association) 13

14. Rural Disparities Rural Residents Are More Likely To: ◦Have unintentional injuries and injury-related deaths ◦Be living in poverty or on low-income with lower educational attainment ◦Suffer premature death from heart disease, cancer, diabetes and suicide 14

15. Suicide rates in the USA 15

16. Rural Disparities (2) Rural Residents Are More Likely To: ◦Be older and in poorer health with more physical limitations and disabilities ◦Suffer from chronic or serious illnesses and depression ◦On Medicare, uninsured, or under-insured 16

17. Rural Disparities (3) Rural Residents Are More Likely To: ◦Have high incidence of substance abuse and domestic abuse ◦Lack ready access to health screening, health care and home and community-based services 17

18. Rural Disparities (4) Rural Residents Are More Likely To: ◦Lack convenient access to primary care, emergency services or specialty care ◦Not exercise regularly ◦Not use preventive screening services or use seat belts 18

19. Rural Elderly Disproportionate number of elderly living in rural communities ◦Chronic health conditions and disabilities ◦In poorer health than urban counterparts ◦Live in poverty/lower income than urban counterparts ◦Low health literacy 19

20. Environmental Health "Polluted Animas River" by Mor is licensed under CC BY 2.0Polluted Animas RiverMorCC BY 2.0 20

21. What Contributes to Disparities? 21

22. Unique Health Information Needs 22

23. Where To Turn? 23

24. Rural Assistance Center Agricultural Health and Safety Tribal Health and Human Services Border Health Finding Statistics and Data Related to Rural Health Rural Health Disparities Telehealth Use in Rural Healthcare Migrant Health Over 60 Topic Guides! 24

25. State Guides Organizations Funding Opportunities Data and Statistics News Events 25

26. RAC Customized Assistance Identify potential funding opportunities Locate appropriate federal or state agency contacts Find and print electronic documents Locate statistics, data sources and maps Connect to organizations, experts, and colleagues 26

27. MedlinePlus.gov Farm Health and Safety Motor Vehicle Safety Suicide Health Disparities Heart Disease Diabetes Pesticides 27

28. NLM’s Health Services Research Rural Health Page 28

29. ToxTown 29

30. Household Products Database 30

31. ToxMap.nlm.nih.gov 31

32. Health Hotlines (also a mobile app) 32

33. Resources for Under- and Uninsured: Affordable Care Act (ACA) Healthcare.gov 33

34. National-Level Associations and Agencies (Links on your handout) National Rural Health Association Leadership on Rural Health Issues Rural Assistance Center Rural Health and Human Services Information Portal National Rural Health Resource Center Dedicated to sustaining and improving health care in rural areas Federal Office of Rural Health Policy Coordinates activities related to rural health care within HHS 34

35. National-Level Associations and Agencies (Links on your handout) (2) United States Department of Agriculture (USDA) “Home” for the Secretary of Agriculture – many programs USDA Cooperative Extension Centers Granges, 4H for Youth Educational network serving rural areas and other communities Community and Environment in Rural America (CERA) Project on changing social, economic, and environmental factors in different rural parts of the country 35

36. Funding Opportunities 36

37. Search for funding at Rural Assistance Center https://www.raconline.org/funding 37

38. Funding Opportunities (2) Many of the organizations I just mentioned offer funding, especially: Office of Rural Health Policy (HRSA) USDA 38

39. Funding Opportunities (3) There’s also: Robert Wood Johnson Foundation W.G. Kellogg Foundation And many others, including… 39

40. Funding Opportunities (4) Health Information Outreach Projects Focus on under-served, under- represented groups (rural counts!) http://nnlm.gov/funding/ 40

41. Practice Exercise Complete by September 25, 2015 (no extensions) Email to flewkate@pitt.eduflewkate@pitt.edu Subject line: Practice Exercise 41

42. Questions? 42 Photo credit: Kate Flewelling

43. Thank You! This project has been funded in whole or in part with Federal funds from the National Library of Medicine, National Institutes of Health, Department of Health and Human Services, under Contract No. HHS-N-276-2011-00003-C with the University of Pittsburgh, Health Sciences Library System. Kate Flewelling, MLIS National Network of Libraries of Medicine, Middle Atlantic Region http://nnlm.gov/mar/ flewkate@pitt.edu 43