Health Equity from a Rural Health Lens 1
Source: Singh and Siahpush, Widening Rural-Urban Disparities in Life Expectancy, U.S., 1969-2009. American Journal of Preventive Medicine, 2014; 46(2):e19-e29.
Social Determinants of Health Rural residents tend to be poorer than urban residents Average median household income is $42,628 for rural counties ($52,204 for urban counties) (2013) Central Appalachia: $35,160 for rural ($42,297 for urban) The average percentage of children living (ages 0-17) living in poverty is 26% in rural counties (21% urban) (2013) Central Appalachia: 33% of children in rural counties live in poverty (26% urban) Unemployment (2014) Nationally, the average unemployment rate in rural counties is 6.4% compared to 6.9% in urban counties However, in central Appalachia: average unemployment rate in rural counties is 8.2% compared to 6.8% in urban counties Source: http://www.ers.usda.gov/data-products/state-fact-sheets/state-data.aspx#.VFpOS_nF91Y 5
Social Determinants of Health Rural residents’ educational attainment (2009 -2013) - Averaged across counties 16.5% have < high school education (14.7% urban) Central Appalachia: 22.7% have < high school education (17.4% urban) 36.3% have only a high school diploma (31.9% urban) Central Appalachia: 39.8% have only a high school diploma (38.4% urban) 17.4 % have a Bachelor’s degree or higher (24% urban) Central Appalachia: 13.4% have a Bachelor’s degree or higher (17.6% urban) Source: http://www.ers.usda.gov/data-products/state-fact-sheets/state-data.aspx#.VFpOS_nF91Y 6
Regional Mortality Study Purpose: To examine the impact of rurality on mortality and to explore the regional differences in the primary and underlying causes of death. 7
Methods Mortality data pulled from National Vital Statistics System (NVSS) Years 2011-2013 Data are Grouped by: 2013 NCHS Urban-Rural Classification Scheme for Counties • (Large Central, Large Fringe, Small/Medium Metro, Micropolitan, Non-core) HHS Regions Age Gender Cause of Death • Top 10 Nation-wide causes of death for each age group 8
HHS Regions 9
Regional Differences in Mortality: Males; 25-64; Appalachia Michael Meit, Co-Director of the Walsh Center Meit-Michael@norc.org 301-634-9324 Source: Centers for Disease Control and Prevention, National Center for Health Statistics, Multiple Cause of Death.
Regional Differences in Mortality: Females; 25-64; Appalachia Michael Meit, Co-Director of the Walsh Center Meit-Michael@norc.org 301-634-9324 Source: Centers for Disease Control and Prevention, National Center for Health Statistics, Multiple Cause of Death.
Other Opiates and Synthetics Admissions Aged 12 and Over for Primary Abuse of Other Opiates/Synthetics, TEDS 2000 - 2004 Percentage of All TEDS Admissions 8 7 6 5 4 3 2 1 0 2000 2001 2002 2003 2004 US Appalachia NOTE: Other Opiates/ Synthetics includes codeine, Dilaudid, morphine, Demerol, opium, oxycodone, and any other drug with morphine-like effects. Excludes methadone. SOURCE: "Treatment Episode Data Set (TEDS) 1 995 - 2005: National Admissions to Substance Abuse Treatment Services." Office of Applied Studies, Substance Abuse and M ental Health Services Administration.
Use of Other Opiates and Synthetics in the Appalachian Coal Mining Region Trends of Other Opiates or Synthetics Use as Primary, Secondary or Tertiary Reason for Treatment, by Coal Mining Status of Patient Location Percentage of All TEDS Admissions 18 16 14 12 10 8 6 4 2 0 2000 2001 2002 2003 2004 Coal Mining Area in Appalachia Other Areas in Appalachia US SOURCE: "Treatment Episode Data Set (TEDS) 2000-2004, National Admissions to Substance Abuse Treatment Services." Office of Applied Studies, Substance Abuse and M ental Health Services Administration.
Heroin Use in the Appalachian Coal Mining Region Trends of Heroin Use as Primary, Secondary or Tertiary Reason for Treatment, by Coal Mining Status of Patient Location Percentage of All TEDS Admissions 18 16 14 12 10 8 6 4 2 0 2000 2001 2002 2003 2004 Coal Mining Area in Appalachia Other Areas in Appalachia US SOURCE: "Treatment Episode Data Set (TEDS) 2000-2004, National Admissions to Substance Abuse Treatment Services." Office of Applied Studies, Substance Abuse and M ental Health Services Administration. Michael Meit, Co-Director of the Walsh Center Meit-Michael@norc.org 301-634-9324
American Health Values American Health Values Survey – Rural Findings Survey – Rural Findings Typology Classification: How Groups Vary on two Dimensions Bye, L., Ghirardelli, A., & Fontes, A. (2016). Promoting Health Equity And Population Health: How Americans’ Views Differ. Health Affairs , 35 (11), 1982-1990. 16
American Health Values American Health Values Survey – Rural Findings Survey – Rural Findings Typology Size by Rural/Urban Status and Typology Classification 30.0% More likely to support active role for government 24.5% 25.0% Less likely to support active role for government 21.0% 20.0% 18.4% 18.3% 17.4% 16.3% 15.5% 15.4% 15.0% 14.0% 13.6% 12.8% 12.8% 10.0% 5.0% 0.0% Private-sector Self-reliant Disinterested Committed Activists Equity Advocates Health Egalitarians Champions Individuals Skeptics Urban n=8,836 Rural n=1,738 17
American Health Values Survey – Rural Findings Table 1 Questions that had a significant difference between the answers of Rural and Urban respondents Whole Sample Measure Question Urban Rural P- n=8,836 n=1,738 Value Health as a priority: Makes health a priority almost always in day-to-day life 46% 38%*** Great deal of effort spent on: Exercise in leisure time 21% 15%*** Importance of Great deal of effort spent on: Limiting portion size 24% 20%*** Personal Great deal of effort spent on: Weight management 30% 26%*** Health Great deal of effort spent on: Stress reduction 25% 22%** Getting appropriate preventative services 35% 32%** Great deal of effort spent on: Speaking up about concerns when seeing doctor 40% 36%*** Self-Efficacy About prevention: High confidence: know how to prevent health problems 44% 41%** General opportunity to succeed: Strongly agree that country should do whatever necessary to make sure Equity/Social 46% 42%*** equal opportunity to succeed Solidarity Health equity: Country should do whatever necessary to make sure equal access to be healthy 56% 53%** Compared to whites: African Americans have easier access 8% 12%*** Compared to whites: African Americans have harder access 33% 25%*** Compared to whites: Not much difference 59% 63%*** Compared to whites: Latinos have easier access 12% 17%*** Beliefs about Health Care Compared to whites: Latinos have harder access 33% 24%*** Disparities Compared to whites: Not much difference 55% 59%*** Compared to whites: Low-income Americans have easier access 11% 17%*** Compared to whites: Low-income Americans have harder access 67% 59%*** Compared to whites: Not much difference 22% 24%** **The difference between the rural and urban proportions are statistically significant at α=0.05. ***The difference between t he rural and urban proportions are statistically significant at α=0.01.
American Health Values Survey – Rural Findings Table 1 ( con’t ) Questions that had a significant difference between the answers of Rural and Urban respondents Whole Sample Measure Question Urban Rural P- n=8,836 n=1,738 Value Health is strongly affected by: Quality of food available 52% 49%** Social Health is strongly affected by: Community safety 33% 29%*** Determinants Health is strongly affected by: Housing quality 29% 27%** Improving health of American people should be top federal priority 32% 29%** Role of government generally: Gov't should do more to make sure Americans are healthier 48% 40%*** Making sure that all communities are healthy places should be top/high priority 80% 76%*** Making sure that all communities are healthy places should be top/high priority: Gov't (or both) should be 52% 45%*** responsible Making sure that healthy, affordable foods are available should be top/high priority: Private sector should be 27% 31%*** Beliefs about responsible the role of Making sure that healthy, affordable foods are available should be top/high priority: Gov't (or both) should be 45% 41%*** government responsible in health Making sure that safe outdoor places to walk and be active are available should be top/high priority 78% 73%*** Making sure that safe outdoor places to walk and be active are available should be top/high priority: Private 15% 19%*** sector should be responsible Making sure that safe outdoor places to walk and be active are available should be top/high priority: Gov't (or 57% 47%*** both) should be responsible Making sure that decent housing is available should be top/high priority 79% 77%** Making sure that decent housing is available should be top/high priority: Gov't (or both) should be responsible 57% 52%*** **The difference between the rural and urban proportions are statistically significant at α=0.05. ***The difference between t he rural and urban proportions are statistically significant at α=0.01.
And I think the greatest asset that we have in Appalachia is people and their identification with their culture and their home. --- Community member
Recommend
More recommend
