Development of a Development of a Rural Typology GIS for Rural Typology GIS for

Policy MakersPolicy MakersMichael ShambaughMichael Shambaugh--Miller, Ph.D.Miller, Ph.D.

RUPRI Center for Rural Health Policy AnalysisRUPRI Center for Rural Health Policy AnalysisCollege of Public HealthCollege of Public Health

University of Nebraska Medical CenterUniversity of Nebraska Medical Center

66thth Quadrennial Conference of Quadrennial Conference of British British –– Canadian Canadian –– American Rural Geographers American Rural Geographers

July 15 July 15 –– 20, 200720, 2007Spokane, WASpokane, WA

The Current ProblemThe Current ProblemThere is no single, universally preferred There is no single, universally preferred definition of rural that serves all policy definition of rural that serves all policy purposes. purposes. –– More than 15 definitions of rural are currently used More than 15 definitions of rural are currently used

by federal health programs.by federal health programs.–– There are over 50 definitions of rural for all federal There are over 50 definitions of rural for all federal

programs.programs.–– 30 million Census Bureau30 million Census Bureau--defined rural people live defined rural people live

in OMBin OMB--defined metropolitan areas.defined metropolitan areas.–– 20 million Census Bureau20 million Census Bureau--defined urban people live defined urban people live

in OMBin OMB--defined nonmetropolitan areas.defined nonmetropolitan areas.

The Policy ConsiderationsThe Policy Considerations

The choice of rural definition affects who The choice of rural definition affects who benefits from a policy and who does not. benefits from a policy and who does not.

Key considerations for understanding the Key considerations for understanding the policy implications of different rural policy implications of different rural definitions include the following: definitions include the following:

The Policy ConsiderationsThe Policy Considerations

Rural definitions can be built on different units of Rural definitions can be built on different units of geography, each of which has distinct geography, each of which has distinct advantages and disadvantages.advantages and disadvantages.The two most commonly used classification The two most commonly used classification systems, those of the Census Bureau and the systems, those of the Census Bureau and the Office of Management and Budget, result in very Office of Management and Budget, result in very different sets of places defined as rural.different sets of places defined as rural.Policies and programs can be targeted when Policies and programs can be targeted when rural definitions are combined with key rural definitions are combined with key demographic, economic, or health care provider demographic, economic, or health care provider characteristics. characteristics.

The Policy ConsiderationsThe Policy Considerations

Rural designations can change with shifts Rural designations can change with shifts in population distribution or commuting in population distribution or commuting patterns, or as a result of changes in patterns, or as a result of changes in geographic boundaries.geographic boundaries.Data availability is essential to support the Data availability is essential to support the application of the rural definition.application of the rural definition.There are many resources that can help There are many resources that can help with understanding the complexities of with understanding the complexities of rural definitions. rural definitions.

What are the potential unintended consequences of What are the potential unintended consequences of relying on commonly used, easily understood relying on commonly used, easily understood definitions, such as those for nonmetropolitan definitions, such as those for nonmetropolitan

counties?counties?

Differences between definitions, such as Differences between definitions, such as those of OMB and Census Bureau, must be those of OMB and Census Bureau, must be clearly understood to anticipate potential clearly understood to anticipate potential unintended consequences.unintended consequences.OMBOMB’’s definition of counties as metropolitan s definition of counties as metropolitan or nonmetropolitan is often used as a proxy or nonmetropolitan is often used as a proxy for urban and rural. for urban and rural.

Should the selected rural definition be Should the selected rural definition be narrowly targeted or widely inclusive?narrowly targeted or widely inclusive?

While targeted, narrowlyWhile targeted, narrowly--defined definitions defined definitions can direct resources to specific populations, can direct resources to specific populations, they also have the potential consequence of they also have the potential consequence of eliminating from policy or program eligibility eliminating from policy or program eligibility places or providers that should be covered. places or providers that should be covered. Conversely, more broadly defined definitions Conversely, more broadly defined definitions might result in the inclusion of areas with might result in the inclusion of areas with less need, with possible budgetary less need, with possible budgetary consequences. consequences.

What Can the Impact of What Can the Impact of a Definition Be?a Definition Be?

A recent example is the use of the TRICARE definition of rural fA recent example is the use of the TRICARE definition of rural for applying or applying access standards for Medicare Part D. access standards for Medicare Part D.

Policy makers sought a broad, inclusive rural definition in hopePolicy makers sought a broad, inclusive rural definition in hopes of ensuring s of ensuring Part D pharmacist availability across wide areas of rural AmericPart D pharmacist availability across wide areas of rural America. a.

The TRICARE definition defined rural so broadly that only centraThe TRICARE definition defined rural so broadly that only central cities were l cities were excluded from the rural definition. excluded from the rural definition.

Policy makers then mandated that pharmacies be available within Policy makers then mandated that pharmacies be available within 15 miles 15 miles of 70% of the TRICAREof 70% of the TRICARE--defined rural population. defined rural population.

By including areas most people would consider suburban in the ruBy including areas most people would consider suburban in the rural ral category, the residual 30% of the TRICAREcategory, the residual 30% of the TRICARE--defined rural population not defined rural population not protected by the access standards is a number equal to the entirprotected by the access standards is a number equal to the entire rural e rural population under the mostpopulation under the most--used definition. used definition.

Figure 1: Rural Areas as Defined by the TRICARE Retail Pharmacy Program

Note: Alaska and Hawaii not to scale

Source: ZIP Code population classifications from #MDA906-03-R-0002, DoD, 2003. Population data from U.S. Census, 2000. ZIP code spatial files based on U.S. Census ZIP Code Tabulation Areas, 2000.Cartogrraphy: RUPRI Center for Rural Health Policy Analysis, 2004.

Classifications by Person per Square Mile (ppsm)Rural - less than 1,000 ppsm

Suburban - 1,000 to 2,999 ppsm

Urban - more than 3,000 pppsm

Classifications by Person per Square Mile (ppsm)

Most Common DefinitionsMost Common DefinitionsThe most commonly used definitions of rural are based on either The most commonly used definitions of rural are based on either the Census Bureau Urbanized Area categorization of census blocksthe Census Bureau Urbanized Area categorization of census blocksand block groups or the Office of Management and Budget (OMB) and block groups or the Office of Management and Budget (OMB) characterization of counties. characterization of counties.

The Census Bureau intentionally creates a definition of rural byThe Census Bureau intentionally creates a definition of rural bydesignating census blocks and block groups as urban based on totdesignating census blocks and block groups as urban based on total al population and population density, with all other areas being rupopulation and population density, with all other areas being rural. ral.

The OMB classifies counties as The OMB classifies counties as metropolitanmetropolitan, when one or more , when one or more county is the county is the ““corecore”” and other counties are included based on and other counties are included based on commuting patterns into the core. commuting patterns into the core.

The OMB The OMB metropolitan metropolitan classification was not designed to create a classification was not designed to create a definition of rural. However, many federal programs use the definition of rural. However, many federal programs use the metropolitan designation to declare all other counties rural. metropolitan designation to declare all other counties rural.

The Building Blocks for Defining The Building Blocks for Defining RuralRural

Rural definitions are aggregations of one Rural definitions are aggregations of one or more of the following units of or more of the following units of geography:geography:–– CountiesCounties–– ZIP code areasZIP code areas–– Census tractsCensus tracts

Blocks and Block Groups Blocks and Block Groups

CountiesCounties

Advantages:Advantages: County boundaries represent County boundaries represent political jurisdictions and remain stable political jurisdictions and remain stable over time.over time.

Disadvantages: County size varies Disadvantages: County size varies substantially across the United States, and substantially across the United States, and larger counties include both urban and larger counties include both urban and rural areas.rural areas.

ZIP CodesZIP Codes

Advantages:Advantages: ZIP code areas are easy to ZIP code areas are easy to implement with programs that rely on implement with programs that rely on provider or beneficiary address.provider or beneficiary address.

Disadvantages: Because ZIP codes areas Disadvantages: Because ZIP codes areas are designed for postal purposes, ZIP are designed for postal purposes, ZIP codes change frequently from year to codes change frequently from year to year.year.

Census GeographyCensus Geography

Advantages:Advantages: Census geography Census geography represents the smallest and most precise represents the smallest and most precise geographic unit.geographic unit.

Disadvantages: Census tract definitions Disadvantages: Census tract definitions can be hard to implement, because census can be hard to implement, because census geography information is not commonly geography information is not commonly used by programs and payers. used by programs and payers.

So What is Out There So What is Out There CurrentlyCurrently

Figure 2: Rural Areas as Defined using the Office of Management and Budget (OMB) Category of Nonmetropolitan, 2003

Note: Alaska and Hawaii not to scale

Source: U.S. Census Bureau, Census 2000 and OMB, 2003.Cartography: RUPRI Center for Rural Health Policy Analysis, 2004

Rural-urban classificationUrban/suburban (metropolitan counties)

Rural (micropolitan and non-core based statistical area counties)

Rural-urban classifications based on OMB categories

0 900 1800 Miles

N

EW

S

Core Based Statistical Areas, 2000

RUPRI Center for Rural Health Policy Analysis, 2005Source: U.S. Bureau of the Census, 2000

CBSANon CBSA County

CBSA County

County Typology

0 900 1800 Miles

N

EW

S

Metropolitan, Micropolitan and Non-Metro Counties, 2000

RUPRI Center for Rural Health Policy Analysis, 2005Source: U.S. Bureau of the Census, 2000

Micropolitan County

Non Micro County

Micro County

Metropolitan County

Metro County

County Typology

0 900 1800 Miles

N

EW

S

Non Core Based Statistical Area Rural Counties, 2000

RUPRI Center for Rural Health Policy Analysis, 2005Source: U.S. Bureau of the Census, 2000

Non CBSA Rural CountyCBSA Metro

CBSA Rural

County Typology

0 900 1800 Miles

N

EW

S

Rural (Including Micropolitan) Counties, 2000

RUPRI Center for Rural Health Policy Analysis, 2005Source: U.S. Bureau of the Census, 2000

Non Metropolitan Rural CountyMetro

Rural

County Typology

0 900 1800 Miles

N

EW

S

Rural by ORHP Outreach Grant Program Definition, 2005

RUPRI Center for Rural Health Policy Analysis, 2005Source: U.S. Bureau of the Census, 2000

Rural areas in goldenrod color.

NOTE: This map is incomplete at this time. The New England area has yet to be completed.

Source: ORHP, 2005

Recent Alternative ProposalsRecent Alternative Proposals

IssermanIsserman’’s proposalss proposals

RUCARUCA’’ss

ESR Rural TypologiesESR Rural Typologies

Recent work by Andrew Isserman, Recent work by Andrew Isserman, University of IllinoisUniversity of Illinois

In the National Interest: Defining Rural and In the National Interest: Defining Rural and Urban Correctly in Research and Public PolicyUrban Correctly in Research and Public Policy(International Regional Science Review, 28, 4:465(International Regional Science Review, 28, 4:465--499 499 (October, 2005)(October, 2005)

Two alternative methods suggested. Most reasonable is a Two alternative methods suggested. Most reasonable is a county level mixture ofcounty level mixture of–– RuralRural–– Rural Urban MixRural Urban Mix–– Urban Rural MixUrban Rural Mix–– URbanURban

The Rural-Urban Density Typology

RUCA CodesRUCA Codeshttp://depts.washington.edu/uwruca/http://depts.washington.edu/uwruca/

RUCAsRUCAs, Rural, Rural--Urban Commuting Area Codes, Urban Commuting Area Codes, are a Census tractare a Census tract--based classification scheme based classification scheme that utilizes the standard Bureau of Census that utilizes the standard Bureau of Census Urbanized Area and Urban Cluster definitions in Urbanized Area and Urban Cluster definitions in combination with work commuting information combination with work commuting information to characterize all of the nation's to characterize all of the nation's Census tractsCensus tractsregarding their rural and urban status and regarding their rural and urban status and relationships. In addition, a ZIP Code RUCA relationships. In addition, a ZIP Code RUCA approximation was developed. approximation was developed.

2004 ERS/USDA County Typology Codes2004 ERS/USDA County Typology Codeshttp://www.ers.usda.gov/briefing/rurality/Typology/http://www.ers.usda.gov/briefing/rurality/Typology/

An area's economic and social characteristics An area's economic and social characteristics have significant effects on its development and have significant effects on its development and need for various types of public programs. need for various types of public programs. To provide policyTo provide policy--relevant information about relevant information about diverse county conditions to policymakers, public diverse county conditions to policymakers, public officials, and researchers, ERS has developed a officials, and researchers, ERS has developed a set of set of countycounty--levellevel typology codes that captures typology codes that captures differences in economic and social differences in economic and social characteristics. characteristics.

Economic TypeEconomic TypeCodes and definitions of the categories are Codes and definitions of the categories are

as follows:as follows:

FarmingFarming--dependentdependent (440 total, 403 nonmetro) counties(440 total, 403 nonmetro) counties——either 15 percent or more of average annual labor and either 15 percent or more of average annual labor and proprietors' earnings derived from farming during 1998proprietors' earnings derived from farming during 1998--2000 or 2000 or 15 percent or more of employed residents worked in farm 15 percent or more of employed residents worked in farm occupations in 2000. Note that a few counties have changed occupations in 2000. Note that a few counties have changed farm dependency status from the preliminary group posted in farm dependency status from the preliminary group posted in May 2004. See May 2004. See methods, data sources, and documentationmethods, data sources, and documentation for for an explanation of these changes.an explanation of these changes.MiningMining--dependentdependent (128 total, 113 nonmetro) counties(128 total, 113 nonmetro) counties——15 15 percent or more of average annual labor and proprietors' percent or more of average annual labor and proprietors' earnings derived from mining during 1998earnings derived from mining during 1998--2000. 2000. ManufacturingManufacturing--dependentdependent (905 total, 585 nonmetro) (905 total, 585 nonmetro) countiescounties——25 percent or more of average annual labor and 25 percent or more of average annual labor and proprietors' earnings derived from manufacturing during 1998proprietors' earnings derived from manufacturing during 1998--2000.2000.

Economic TypeEconomic TypeCodes and definitions of the categories are Codes and definitions of the categories are

as follows:as follows:

Federal/State governmentFederal/State government--dependentdependent (381 total, 222 (381 total, 222 nonmetro) countiesnonmetro) counties——15 percent or more of average 15 percent or more of average annual labor and proprietors' earnings derived from annual labor and proprietors' earnings derived from Federal and State government during 1998Federal and State government during 1998--2000.2000.ServicesServices--dependentdependent (340 total, 114 nonmetro) (340 total, 114 nonmetro) countiescounties——45 percent or more of average annual labor and 45 percent or more of average annual labor and proprietors' earnings derived from services (SIC categories proprietors' earnings derived from services (SIC categories of retail trade; finance, insurance, and real estate; and of retail trade; finance, insurance, and real estate; and services) during 1998services) during 1998--2000.2000.NonspecializedNonspecialized (948 total, 615 nonmetro) counties(948 total, 615 nonmetro) counties——did did not meet the dependence threshold for any one of the not meet the dependence threshold for any one of the above industries.above industries.

Policy TypesPolicy TypesThese indicators are not mutually exclusive; These indicators are not mutually exclusive;

definitions of the types are as follows:definitions of the types are as follows:

Housing stressHousing stress (537 total, 302 nonmetro) counties(537 total, 302 nonmetro) counties——30 30 percent or more of households had one or more of these percent or more of households had one or more of these housing conditions in 2000: lacked complete plumbing, lacked housing conditions in 2000: lacked complete plumbing, lacked complete kitchen, paid 30 percent or more of income for owner complete kitchen, paid 30 percent or more of income for owner costs or rent, or had more than 1 person per room. costs or rent, or had more than 1 person per room. LowLow--educationeducation (622 total, 499 nonmetro) counties(622 total, 499 nonmetro) counties——25 25 percent or more of residents 25percent or more of residents 25--64 years old had neither a high 64 years old had neither a high school diploma nor GED in 2000.school diploma nor GED in 2000.LowLow--employmentemployment (460 total, 396 nonmetro) counties(460 total, 396 nonmetro) counties——less less than 65 percent of residents 21than 65 percent of residents 21--64 years old were employed in 64 years old were employed in 2000.2000.Persistent povertyPersistent poverty (386 total, 340 nonmetro) counties(386 total, 340 nonmetro) counties——20 20 percent or more of residents were poor as measured by each of percent or more of residents were poor as measured by each of the last 4 censuses, 1970, 1980, 1990, and 2000.the last 4 censuses, 1970, 1980, 1990, and 2000.

Policy TypesPolicy TypesThese indicators are not mutually exclusive; These indicators are not mutually exclusive;

definitions of the types are as follows:definitions of the types are as follows:

Population lossPopulation loss (601 total, 532 nonmetro) counties(601 total, 532 nonmetro) counties——number number of residents declined both between the 1980 and 1990 of residents declined both between the 1980 and 1990 censuses and between the 1990 and 2000 censuses.censuses and between the 1990 and 2000 censuses.Nonmetro recreationNonmetro recreation (334 designated nonmetro in either (334 designated nonmetro in either 1993 or 2003, 34 were designated metro in 2003) counties1993 or 2003, 34 were designated metro in 2003) counties——classified using a combination of factors, including share of classified using a combination of factors, including share of employment or share of earnings in recreationemployment or share of earnings in recreation--related related industries in 1999, share of seasonal or occasional use housing industries in 1999, share of seasonal or occasional use housing units in 2000, and per capita receipts from motels and hotels inunits in 2000, and per capita receipts from motels and hotels in1997. See 1997. See methodsmethods for more details.for more details.Retirement destinationRetirement destination (440 total, 277 nonmetro) (440 total, 277 nonmetro) countiescounties——number of residents 60 and older grew by 15 percent number of residents 60 and older grew by 15 percent or more between 1990 and 2000 due to inmigration.or more between 1990 and 2000 due to inmigration.

Tools for Determining Tools for Determining Rurality StatusRurality Status

Additional Research ToolsAdditional Research Tools

Web based GIS system that will allow Web based GIS system that will allow researchers to experiment with the researchers to experiment with the potential impacts of definitions of rural potential impacts of definitions of rural upon their policy and more importantly, upon their policy and more importantly, the people it is intended to serve.the people it is intended to serve.

Contact InformationContact Information

Michael ShambaughMichael Shambaugh--Miller, Ph.D.Miller, Ph.D.–– Project DirectorProject Director–– 402402--559559--78587858–– mdmiller@unmc.edumdmiller@unmc.edu

Keith Mueller, Ph.D.Keith Mueller, Ph.D.–– Primary InvestigatorPrimary Investigator–– 402402--559559--52605260–– kmueller@unmc.edu

RUPRI Center for RUPRI Center for Rural Health Policy Rural Health Policy AnalysisAnalysis–– 402402--559559--52605260–– www.unmc.edu/ruralwww.unmc.edu/rural–– www.rupri.org/healthwww.rupri.org/healthpp

olicyolicy

kmueller@unmc.edu

Rural Policy Research Institute Rural Policy Research Institute Health PanelHealth Panel

www.rupri.org/ruralhealthwww.rupri.org/ruralhealth

Andrew F. Coburn, Andrew F. Coburn, A. Clinton MacKinneyA. Clinton MacKinneyTimothy D. McBrideTimothy D. McBrideKeith J. MuellerKeith J. MuellerRebecca T. SlifkinRebecca T. SlifkinMary K. WakefieldMary K. Wakefield

Organizational InformationOrganizational Information

RUPRI Center for Rural RUPRI Center for Rural Health Policy AnalysisHealth Policy Analysis–– www.rupri.org/healthpolicy/www.rupri.org/healthpolicy/

Nebraska Center for Rural Nebraska Center for Rural Health Research.Health Research.––

Nebraska Center for Rural Health Research

www.unmc.edu/ruralwww.unmc.edu/rural

University of Nebraska University of Nebraska Medical CenterMedical Center–– www.unmc.eduwww.unmc.edu