PowerPoint Presentation

Rural Disparities

Rural vs. Urban

Rural Services CommissionRole of the CommissionCore entity charged with examining the challenges of low- to moderate-income individuals living in rural areasDeveloping recommendations for strengthening services and service delivery to rural residents.Met weekly to:Identify the key issues in rural areasShare experiencesGather input from other states experiencesDiscuss the changes needed to strengthen services in Massachusetts

Rural CommunitiesFor the purpose of this study, the definition of rural areas is communities that have population densities of less than 500 people per square mile (MacDougall and Campbell, 1995). There are 14 counties in Massachusetts, consisting of 351 communities total, of which 172 can be classified as rural.

Food Deserts

The opiate crisis1) greater opioid prescription in rural areas, creating availability from which illegal markets can arise

(2) an out-migration of young adults

(3) greater rural social and kinship network connections, which may facilitate drug diversion and distribution

(4) economic stressors that may create vulnerability to drug use more generally.Rural Domestic and Sexual Violence

In rural Massachusetts, domestic and sexual violence continue to be leading health problems exacerbated by social and geographic isolation and the lack of public transportation, housing, employment, child care, anonymity and accessible health and human services. Although domestic and sexual violence crosses all socioeconomic lines, the overwhelming poverty of many rural communities in Massachusetts further limits the choices of victims there, preventing escape and access to assistance. Only about ten percent of physicians practice in rural America despite the fact that nearly one-fourth of the population lives in these areas.There are 60 dentists per 100,000 population in urban areas versus 40 per 100,000 in rural areas**Hypertension was also higher in rural than urban areas (101 in metro areas vs. 129 in rural areas)Medicare payments to rural hospitals and physicians are dramatically less than those to their urban counterparts for equivalent services. This correlates closely with the fact that more than 470 rural hospitals have closed in the past 25 years.

Whats Different About Rural Health?The suicide rate among rural men is significantly higher than in urban areas, particularly among adult men and youth.The suicide rate among rural women is escalating rapidly and is approaching that of men.

Whats Different About Rural Health?Although only one-third of all motor vehicle accidents occur in rural areas, two-thirds of the deaths attributed to these accidents occur on rural roads.Anywhere from 57 to 90 percent of first responders in rural areas are volunteers.

Whats Different About Rural Health?Medicare payments to rural hospitals and physicians are dramatically less than those to their urban counterparts for equivalent services. This correlates closely with the fact that more than 470 rural hospitals have closed in the past 25 years.

From RAC

On average, rural populations are older than populations in other parts of the country. Populations of older adults increase by level of rurality:

Trends in Substance AbuseHeroin use in the United States increased 63% from 2002 through 2013. This increase occurred among a broad range of demographics, including men and women, most age groups, and all income levels. The highest rate of growth has been in rural areas.

Trends in Substance AbuseAs heroin use, abuse, and dependence have increased, so have heroin-related overdose deaths. From 2002 through 2013, the rate of heroin-related overdose deaths nearly quadrupled. Persons often use heroin with other substances, including marijuana, cocaine, alcohol, and opioid pain relievers. This practice is especially dangerous.

Trends in Substance Abuse Groups with an increased risk for heroin abuse or dependence include men, persons aged 1825 years, non-Hispanic whites, persons with annual household income less than $20,000, Medicaid recipients, and the uninsured

GOALS FOR RURAL MASSACHUSETTSThe Rural Access Commission identified and constructed goals for the commission to guide its study and the recommendations set forth in this report. The goals of the commissions recommendations intend to:

Strengthen the overall infrastructure of the service delivery system in rural areas;Engage and support rural service providers through improved policy and planning on rural services delivery;Align access policies across state agencies;Support workforce planning;Improve access to services and improve service coordination;Support improvements to information availability;Strengthen the states options for responding to housing issues and homelessness; and Leverage best practices from other jurisdictions regarding servicing rural communities.

RECOMMENDATIONS FOR IMPROVEMENTRecommendations for improvement were centered on five priority areas: Access, Policy, Workforce Planning, Technology, and Service Delivery.

Access

Expand transportation options for rural residents

Strengthen Information and Referral services available

Increase access to subsidized child care Key Recommendations are as follows:

Policy

Review agency polices that require clients to travel to agencies

Review rate models for rural providers

Support rural appropriate models of health care

Establish ongoing Commission on Rural Services

Improve the ability of state agencies to reach and serve those in rural communitiesWorkforce Planning

Develop an enhanced and coordinated state infrastructure that identify and address rural workforce needs

Implement data-driven and evidenced based strategies to address health care worker shortage in rural communities

Address Family Child Care Provider shortage for children in state funded slotsTechnology

Expand broadband access to rural communities and service providers

Strengthen communications options

Improve outreach and service delivery through use of smart phone technology

Support data-sharing

Expand the use of telemedicine and health information technologyService Delivery

Integrate eligibility processes

Support service availability and a more comprehensive service experience in rural areas

Establish service access centers The Good News.Quality of life

Outdoor and environmental resources

Increased interpersonal connections

Supportive infrastructure for advocacyBe Part of the Solution.Every voice makes a differenceNeighbors helping neighborsSee something, say somethingStop the stigma