Rural and Migrant Health – Ace Star Tutors

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Chapter 23

Rural and Migrant Health

Rural Populations

The largest rural population in history of United States is now.

75% of counties are classified as rural; they contain only 20% of the U.S. population

Number/size of rural counties are highest …

in the South (35%)

in the Midwest and West (23%)

in the Northeast (19%)

Census data

20% of nation’s children under 18

15% of nation’s elderly

More than 50% of nation’s poor

Rural Populations (Cont.)

Economic base is shifting

Agriculture is the “food and fiber system”

All aspects of agriculture (core materials to wholesale and retail and food service sectors) are included

Poverty in rural areas greater than in urban areas

Rural Populations (Cont.)

Poverty continues to be greater in rural America than in urban areas.

Aging-in-place, out-migration of young adults, and immigration of older persons from metro areas.

Greater diversity among residents: a country of immigrants historically and today.

Health disparities exist—rural population more likely to be older, less educated, live in poverty, lack health insurance, and experience a lack of available health care providers and access to health care

Health Disparities Among Rural Americans

Only 10% of U.S. physicians practice in rural areas

Ratio of physicians in rural population is 36:100,000 (nearly double in urban settings)

More often assess their health as fair or poor

More disability days resulting from acute conditions

More negative health behaviors (untreated mental illness, obesity, alcohol, tobacco, and drug use) that contribute to excess deaths and chronic disease and disability rates

Higher number of unintentional injuries

Defining Rural Populations

Population size

Rural = towns with population of less than 2500 or in open country [farm/nonfarm]

Density

Rural = fewer than 45 persons per square mile

Frontier = less than 6 people per square mile

Defining Rural Populations (Cont.)

The Rural-Urban Continuum uses population and adjacency to metropolitan areas

Core Based Statistical Areas (CBSAs)

Metropolitan areas = county with at least one urbanized area of 50,000 or more people

Micropolitan area = area contains a cluster of 10,000 to 50,000 persons

Outside CBSAs = noncare areas

Describing Rural Health and Populations

Differ in complex geographical, social, and economic areas

Disparities include key indicators of health:

Employment

Income

Education

Health insurance

Mortality

Morbidity

Access to care

Rural Health Disparities: Context and Composition

Context: characteristics of places of residence

Geography, environment, political, social, and economic institutions

Composition: collective health effects that result from a concentration of persons with certain characteristics

Age, education, income, ethnicity, and health behaviors

– Braveman (2010)

Context: Health Disparities Related to Place

A downward spiral may exist:

people leave  services are lost  tax base becomes insufficient  fewer services are provided  long distances to get health care  jobs become scarce and more people leave  the cycle continues

Context: Health Disparities Related to Place (Cont.)

Access to health care (#1 priority)

Fewer primary care physicians

General health services lacking

Health insurance coverage …

Varies according to race and ethnicity; age and residence (rural or urban)

Influences health patterns

May create financial barriers to health care

Composition: Health Disparities Related to Persons

Income and Poverty

One of the most important indicators of the health and well-being of all Americans, regardless of where they live.

Regional differences—highest in the South

Racial and ethnic minorities—rates among rural racial minorities two to three times higher than for rural whites

Family composition—female-headed families have highest rates

Children—among the poorest citizens in rural America

Composition: Health Disparities Related to Persons (Cont.)

Health risk, injury, and death

Higher rates of obesity, smoking, sedentary lifestyles, alcohol use, firearms usage, suicide, vehicular accidents; lower rates of seat belt use

Risk factors

Age, education, gender, race, ethnicity, language, and culture

Education and employment

Occupational health risks

Perceptions of health (gender, race, ethnicity)

Agricultural Workers

Accidents and injuries caused by:

Environmental conditions

Geographic isolation and working alone

Use of agricultural machinery

Delayed access to emergency or trauma care

Acute and chronic illnesses:

Musculoskeletal discomfort, acute and chronic respiratory conditions, hearing loss, hypertension

Chemical exposure (pesticides, herbicides, etc.)

Secondary conditions related to demanding farm work

Migrant and Seasonal Farm Workers (MSFW)

Health Disparities

Poorest health and the least access

Low income and migratory status

Cultural, linguistic, economic, and mobility barriers

Minimal or no preventive care

Mobile clinic sites form a central link to health services

Migrant Health Program (MHP) bases services on enumeration of MSFW

Migrant and Seasonal Farm Worker Enumeration Profile Study (MSFWEPS) (2000)

“Thinking Upstream” Concepts applied to Rural Health

Attack community-based problems at their roots

Emphasize the “doing” aspects of health

Maximize the use of informal networks

Rural Health Care Delivery System

Health care provider shortages

Rural shortages likely to become worse

Need to “grow their own”

Telemedicine

Cost-effective alternative to face-to-face care

Telehealth includes telephones, fax machines, email, and remote monitoring

Telemedicine permits two-way, real-time, interactive communication between patient and provider

Rural Health Care Delivery System (Cont.)

Managed care in the rural environment

Possible benefits:

Potential to lower primary care costs

Improve the quality of care

Help stabilize the local rural health care system

Risks

Probable high start-up and administrative costs

Volatile effect of large, urban-based, for-profit managed care companies

Community-Based Care

A myriad of services provided outside the walls of an institution

Home health and hospice care, occupation health programs, community mental health programs, ambulatory care services, school health programs, faith-based care, elder services (adult day care)

Community participation in decisions about health care services

Focus on all three levels of prevention

An understanding that the hospital is no longer the exclusive health care provider

Home Care and Hospice

Nurse case management and development of local resources

Often hospital based in rural areas

Use county extension services as a bridge for outreach services

Improve home care for these patients and provide support for their families

A partnership between the public health nurse and county extension service could provide support, as well as information groups and caregiving classes, for the important informal provider network.

Faith Communities and Parish Nursing

A strong sense of community, family life, and religious faith

Integrating nursing expertise and faith-based knowledge to provide holistic care to members of congregations

Involved in case management and coordination of services

Collaboration with other organizations to extend limited rural community health resources

Informal Care Systems

Evolve from self-reliance and self-help traits of rural residents

Include people who have assumed the role of caregiver based on their individual qualities, life situations, or social roles

Provide direct help, advice, or information

Need to identify and combine informal services with formal systems

Rural Public Health Departments

Public health nurses are often the core providers of public health services in rural areas.

Collaboration of services is key—need to develop partnerships with other heath provider agencies.

Environmental health, maternal and child health, and communicable disease control are the three highest-priority programs.

Rural Mental Health Care

Lack of specialized mental health providers in rural areas.

Most services provided by primary care providers without adequate preparation or support.

Perceived stigma prevents individuals from seeking mental health services.

Emergency Services

Getting patients from the place of injury to the trauma center within the “golden hour” is frequently not possible because of distance, terrain, climatic conditions, and communication methods.

Emergency Services (Cont.)

Challenges faced by rural EMS systems

Shortage of volunteers and lower levels of training

Training curricula that often do not reflect rural hazards (e.g., farm equipment trauma)

Lack of guidance from physicians

Lack of physician training and orientation to EMS

Also contributing to difficult public access for emergency care:

Low population density

Large, isolated, or inaccessible areas

Sever weather

Poor roads

Lower density of telephone/communication methods

Emergency Preparedness in Rural Communities

Challenges in rural areas:

Resource limitation

Human, financial, and social capital

Separation and remoteness

Longer response times

Low population density

Impacts funding

Communication

Warning systems often absent or neglected in remote areas; burden on individuals

Legislation and Programs Affecting Rural Public Health

Programs that augment health care facilities and services

Community Health Centers (CHC) program

Migrant Health Clinic (MHC) program and the Migrant Health Program (MHP)

Medicare’s Rural Hospital Flexibility (RHF) grant program

Primary care cooperative agreements

Rural Community Health Nursing

“CH nursing along the rural continuum”

Nonmetropolitan Areas

Metropolitan Areas

Rural Nursing …

… is the practice of professional nursing within the physical and sociocultural context of sparsely populated communities. It involves the continual interaction of the rural environment, the nurse, and his or her practice. Rural nursing is the diagnosis and treatment of a diversified population of people of all ages and a variety of human responses to actual (or potential) occupational hazards or actual or potential health problems existent in maternity, pediatric, medical/surgical and emergency nursing in a given rural area.

–– Bigbee (1993), Lee & Winters (2004),

Rosentahl (2005), Williams et al. (2012)

Characteristics of Rural Nursing

Should rural nursing practice be designated as a specialty or subspecialty area because of factors such as isolation, scarce resources, and the need for a wide range of practice skills that must be adapted to social and economic structures?

Characteristics of Rural Nursing (Cont.)

Positive aspects

Ability to provide holistic care

Know everyone well

Develop close relationships with the community and with coworkers

Enjoy rural lifestyle

Autonomy and professional status

Being valued by the agency and community

Negative aspects

Professional isolation

The newcomer practices nursing in a rural setting, unlike the more experienced nurse, who practices rural nursing. Somewhere between these extremes lies the transitional period of events and conditions through which each nurse passes at her or his own pace. It is within this time zone that nurses experience rural reality and move toward becoming professionals who understand that having gone rural, they are not less than they were, but rather, they are more than they expected to be. Some may be conscious of the transition, and others may not, but in the end, a few will say, “I am a rural nurse.”

– Scharff (1998, p. 38)

Rural Health Research

Research agendas must address:

The capacity of rural public health to manage improvements in health

Information technology capacity in rural communities

Developing and monitoring performance standards in rural public health

Developing leadership and public health workforce capacity within rural public health

Interaction and integration of community health systems, managed care, and public health in rural America

– Berkowitz, Ivory, & Morris (2002)

Capacity of Rural Public Health to Manage Improvements in Health

Healthy People 2020 objectives and intervention strategies

Information Technology in Rural Communities

EHR and reimbursement

Preparedness strengthens infrastructure

Continuing education and advanced education

Telehealth impact on public health

Skills via distance learning?

Costs and infrastructure of IT?

Gaps in epidemiology and surveillance capacity?

Performance Standards in Rural Public Health

National Public Health Performance Standards Program (NPHPSP) describe an optimal level of performance by public health systems regardless of location.

Used to improve collaborations among key public health partners, educate participants about public health, strengthen the network of public health partners, identify strengths and weaknesses, and provide benchmarks for public health practice improvements

Leadership and Workforce Capacity for Rural Public Health

IOM report (2003)—preparing public health workforce for 21st century

CDC Public Health Improvement Initiative (2012)—accreditation support

Medicaid impact on interaction and integration of community health systems, managed care, and public health

New models of health care delivery for rural and frontier areas being tested

The post Rural and Migrant Health appeared first on Infinite Essays.

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