Rural Health in Ohio: Issues and Trends

1. Rural Health in Ohio: Issues and Trends Heather Reed, Administrator Primary Care and Rural Health Program Ohio Department of Health

2. 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

3. What is Rural?

4. 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

5. Lake Ashtabula Lucas Fulton Williams Ottawa Geauga Cuyahoga Sandusky Erie Defiance Henry Wood Lorain Trumbull Portage Huron Medina Summit Seneca Paulding Putnam Mahoning Hancock Ash- land Van Wert Crawford Wayne Wyandot Stark Columbiana Allen Richland Hardin Marion Auglaize Carroll Mercer Holmes Morrow Tus-carawas Jeffer- son Logan Knox Shelby Harrison Coshocton Union Delaware Champaign Darke Licking Miami Guernsey Belmont Muskingum Franklin Clark Madison Noble Mont- gomery Fairfield Preble Perry Monroe Greene Morgan Pickaway Fayette Hocking Washington Butler Warren Clinton Ross Athens Vinton Hamilton Highland Meigs Clermont Pike Jackson Brown Gallia Adams Scioto Lawrence Rural Ohio Rural County Partially Rural County Urban County Appalachia Source: Counties designated as rural, partially rural, or urban under the definition used by the federal Office of Rural Health Policy, 9/2009

6. 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

7. Why Define Rural? • Eligibility for federal rural grant programs • Implementation of programs and/or laws • Research purposes to allow for statistical consistency

8. 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

9. Health Status and Health Care Access

10. Rural Populations and Chronic Disease • Rural populations have higher rates of: • Hypertension • Heart disease • Cancer • Stroke

11. Health Risk Factors • Rural populations report higher rates of: • Cigarette smoking • Obesity • Physical inactivity

12. 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

13. Ohio HPSA Map 3 C 6 ASHTABULA 10 LAKE 3 LUCAS WILLIAMS FULTON OTTAWA GEAUGA CUYAHOGA WOOD SANDUSKY ERIE DEFIANCE HENRY LORAIN TRUMBULL PORTAGE HURON PAULDING SENECA MEDINA SUMMIT PUTNAM HANCOCK MAHONING STARK VAN WERT COLUMBIANA WAYNE CRAWFORD WYANDOT ASHLAND RICHLAND ALLEN C HARDIN MARION CARROLL MERCER AUGLAIZE HOLMES 2C TUSCARAWAS MORROW KNOX LOGAN JEFFERSON SHELBY HARRISON UNION COSHOCTON DELAWARE HARRISON CHAMPAIGN DARKE MIAMI LICKING MUSKINGUM FRANKLIN BELMONT GUERNSEY CLARK C MADISON NOBLE MONT-GOMERY PREBLE PERRY MONROE FAIRFIELD C GREENE PICKAWAY FAYETTE MORGAN HOCKING BUTLER WASHINGTON WARREN CLINTON ROSS ATHENS 2C VINTON HAMILTON 4 HIGHLAND MEIGS PIKE JACKSON 6 BROWN GALLIA SCIOTO ADAMS h C LAWRENCE = Geographic HPSA = Special Population HPSA = Facility HPSA = Correctional Facility HPSA CLERMONT C Source: Ohio Department of Health, Primary Care Office, Sept. 2010

14. Rural Access Barriers • Financial • Geographic • Organizational/Availability • Sociological/Acceptability

15. 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

16. Health care safety net

17. 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

18. 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

19. Ohio’s CAHs, FQHCs, and RHCs Source: Ohio Department of Health, State Office of Rural Health, July 2010

20. 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

21. 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

22. For More Information Heather Reed, Administrator Primary Care and Rural Health Program Ohio Department of Health 246 North High Street, 6th Floor Columbus, OH 43215 (614) 752-8935 Phone (614) 995-4235 Fax heather.reed@odh.ohio.gov