1. HEALTH INEQUITIES EXPERIENCED IN RURAL V URBAN Alicia Haywood Policy & Advocacy Manager

2.  Colorado Rural Health Center  Definition of “rural”  Coverage  Health factors and outcomes  Mental health  Workforce  Social determinants  Opportunities for change  Resources Overview

3.  Non-profit membership organization  State Office of Rural Health  Programs & Services o Rural Health Clinics (52) o Critical Access Hospitals (29) o Provider Recruitment and Retention o Grant Programs o Community Development o Policy and Advocacy Colorado Rural Health Center

4. What is Rural?

5.  Over 20 definitions of “rural” used by federal government in regards to healthcare  One common definition is from the Office on Management and Budget – uses US Census data to describe “urban”  Frontier = Less than or equal to six persons per square mile What is Rural?

7. “The demographics of rural America have a direct impact on many factors of healthcare delivery and outcomes, including rural residents’ health status, health insurance status, access to healthcare providers, and their communities’ economic viability.” -2008 report from the National Advisory Committee on Rural Health and Human Services

8. Population Change

9. Lower Income and Higher Rates of Poverty

10. Avg. rate uninsured for rural is 23% as compared to 18% in urban  Higher unemployment  Self-employers and small businesses less likely to offer health insurance  Hard to afford health insurance in rural (geographic rating)  Limited availability of plans Coverage

14.  Higher rates of suicide  High rates of tobacco and alcohol use o Higher DUI rates o Higher methamphetamine and prescription drug use  Concerns about privacy and confidentiality in counseling  Shortage of mental health providers  Lack of tele-health options Mental and Behavioral Challenges

15. Mental Health Counselors

16.  Disparities greater for rural minorities o 15% of rural population  Poverty rate for rural African Americans and Native Americans is 3x higher than Whites  Rural minorities are more likely to engage in binge drinking, heavy drinking, and driving under the influence than urban youth (particularly in small rural towns <10,000) Rural Minority Disparities

18.  56 counties were either fully or partially designated as a primary care HPSA  20% of Colorado’s healthcare workforce is over the age of 55  2 rural counties did not have an active licensed physician  9 rural counties did not have an active licensed dentist and 12 did not have a dental hygienist  7 rural counties did not have an active licensed pharmacist Workforce Shortages

19. Other Social Determinants  Limited public transportation  Travel time is longer for rural patients to get care  1/3 rd of all motor vehicle accidents occur in rural: 2/3 rds of vehicular deaths Higher levels of education enables better job opportunities and higher incomes AND Greater levels of understanding about health and healthy behaviors

21. Federal  Affordable Care Act State  Role of nurse practitioners, physician assistants, dental hygienists  Medicaid expansion  Oral health benefit in Medicaid  Mental health options  Marketplace subsidies and new insurance options Opportunities

22. References and Resources  Department of Local Affairs Department of Local Affairs  Robert Wood Johnson – County Health Rankings Robert Wood Johnson – County Health Rankings  Livewell Colorado Livewell Colorado  Department of Public Health & Environment Department of Public Health & Environment  Colorado Health Institute Colorado Health Institute  Colorado Rural Health Center Colorado Rural Health Center  National Rural Health Association National Rural Health Association  2013 Snapshot of Rural Health in Colorado 2013 Snapshot of Rural Health in Colorado

23. Alicia Haywood ah@coruralhealth.org 720.248.2748 coruralhealth.org Contact