Rural Health in Ohio: Issues and Trends
Heather Reed, Administrator
Primary Care and Rural Health Program
Ohio Department of Health
Learning Objectives
Understand the uniqueness of rural Ohio as it relates to health status and health care access
Identify at least five rural-specific health status or health care access issues
Describe successful collaborative interventions to address rural health needs in Ohio
What is Rural?
Definitions of Rural
U.S. Census Bureau Urban = 50,000 people
Office of Management and Budget Metro areas + economic ties to core counties
Economic Research Service (USDA) Gaining popularity – combines Census Bureau
data with commuting patterns
Rural Ohio
Lawrence
Henry
Putnam
Coshocton
Holmes
Scioto
Highland
FayettePickaway
Greene
BelmontMuskingum
Monroe
Guernsey
Portage
Harrison
Jeffer- son
Richland
Seneca
Hardin
Sandusky
Licking
Delaware
Madison
Franklin
ChampaignMiami
Darke
Preble Mont-gomery
Carroll
Brown
Huron
Erie
Tus-carawas
Ash- landWyandot Crawford Wayne
Cuyahoga
Lorain
Summit
Lake Ashtabula
Trumbull
Geauga
Mahoning
ColumbianaStark
Noble
Gallia
ClintonWarrenButler
Shelby
Williams
Mercer
Allen
Auglaize
Hancock
Van Wert
Defiance
FultonLucas
Wood
Ottawa
Logan
Union
Clark
Hamilton
Paulding
MarionMorrow
Knox
Medina
Ross
Hocking
Jackson
Vinton
Morgan
Perry
Washington
Fairfield
Athens
MeigsPike
Adams
Clermont
Source: Counties designated as rural, partially rural, or urban under the definition used by the federal Office of Rural Health Policy, 9/2009
Rural County
Partially Rural County
Urban County
Appalachia
Rural Ohio
72 of Ohio’s 88 counties are considered rural or partially rural
32 counties in southeast Ohio make up the state’s Appalachian region
Approximately 24% of Ohio’s residents live in rural areas and the remaining 76% reside in urban areas
Why Define Rural?
Eligibility for federal rural grant programs
Implementation of programs and/or laws
Research purposes to allow for statistical consistency
Regional Comparison Rural Health Grants Ohio - $22,653,160 Michigan - $72,315,051 Pennsylvania - $18,973,046 Indiana - $12,301,109 West Virginia - $28,616,136 Kentucky - $30,531,145
Health Status and Health Care Access
Rural Populations and Chronic Disease Rural populations have higher rates of:
Hypertension Heart disease Cancer Stroke
Health Risk Factors
Rural populations report higher rates of:
Cigarette smoking Obesity Physical inactivity
Rural Health Access Issues
Chronic shortages of providers Aging population Increased reliance on Medicare and Medicaid Inadequate transportation Poverty/rural economic decline Rural consumers going “urban” for health care
services
HARRISON
BUTLER
CUYAHOGA
2C
MARION
4HAMILTON
FRANKLIN
3
3
h
WILLIAMS FULTON
HENRY WOODDEFIANCE
PUTNAM HANCOCK
WYANDOT CRAWFORDVAN WERT
MERCER AUGLAIZE
LOGANSHELBY
DARKE
UNIONDELAWARE
KNOX
LICKING
FAIRFIELD
MADISON
CLARK
CHAMPAIGNMIAMI
CLINTONWARREN
BROWN
ROSS
GALLIA
WASHINGTON
NOBLE
MUSKINGUM
TUSCARAWAS
STARK
WAYNE COLUMBIANA
PORTAGE
SUMMITMEDINA
GEAUGA
LAKE
LORAIN
ASHTABULA
ERIE
HURON
OTTAWA
BELMONT
MEIGS
HOCKING
JACKSON
SCIOTO
PIKE
ADAMS
HIGHLAND
PICKAWAYFAYETTE
HOLMES
LAWRENCE
VINTON
MORGAN
PERRY MONROE
JEF
FE
RS
ON
PAULDING
PREBLE
HARDIN
SANDUSKY
SENECA
MORROW
RIC
HL
AN
D
AS
HLA
ND
COSHOCTON
ATHENS
CARROLL
C
GUERNSEY
C
MONT-GOMERY
MAHONING
TRUMBULL
LUCAS
ALLEN
HARRISON
6
GREENE
2C
C
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106
Ohio HPSA Map
= Geographic HPSA
= Special Population HPSA
= Facility HPSA
= Correctional Facility HPSA
C
Source: Ohio Department of Health, Primary Care Office, Sept. 2010
CLERMONT
Rural Access Barriers
Financial
Geographic
Organizational/Availability
Sociological/Acceptability
Rural Health System Plays Major Economic Role
Not only do rural health systems have an important role in health care delivery, they also have an important economic role
Health sector often largest employer in rural counties
However, most rural residents have little idea of the importance of the health sector to the economy
Health care
safety net
Urban vs. Rural “Safety Net”
Safety Net: Web of health care professionals and institutions that provide care to the poor and uninsured, regardless of ability to pay
Urban systems: Often depend heavily on teaching hospitals and
professional educational programs that use trainees to care for low-income patients
Also include health centers and homeless centers
Rural systems: Generally do not have these types of resources
Rural Safety Net
Instead, the rural safety net depends upon a variety of different individual providers and provider types:
Rural hospitals Rural Health Clinics Community Health Centers (e.g. FQHCs) Public health departments Private practitioners
Ohio’s CAHs, FQHCs, and RHCs
Source: Ohio Department of Health, State Office of Rural Health, July 2010
Successful Collaborations
Galion Community Hospital Needs assessment with broad community
support and involvement
CAO of Scioto County Health Clinic Expanded services for low-income women
Knox County Health Department Maintenance of a community-wide wellness
coalition
Additional Resources
Federal Office of Rural Health Policy, HRSA www.ruralhealth.hrsa.gov
Rural Assistance Center www.raconline.org
National Rural Health Resource Center www.ruralcenter.org
For More Information
Heather Reed, AdministratorPrimary Care and Rural Health ProgramOhio Department of Health 246 North High Street, 6th FloorColumbus, OH 43215(614) 752-8935 Phone(614) 995-4235 [email protected]