Population Health, Health Access and Health Status Improvement: A Rural Regional Perspective

1
Population Health, Health Access and Health
Status Improvement A Rural Regional Perspective

• Michael Beachler, Program Director
• Robert Wood Johnson Foundations
• Southern Rural Access Program
• Workshop on the Future of Rural Health A Quality
  Focus
• Institute of Medicine Committee of the Future of
  Health Care
• March 1, 2004 Washington, D.C.

2
Focus of Presentation

• How can we allocate resources in a way that
  targets high need rural populations?
• How can we most effectively reduce disparities in
  health status, health risk factors and minority
  health issues of rural populations?
• What needs to be in place to improve the overall
  health status of rural populations?

3
How can we allocate resources in a way that
targets high need rural populations?With Great
Difficulty

• Barriers
• Realities of political decision making in both
  public and private sector
• Competitive nature of funding often rewards high
  capacity high prestige places
• Geographic biases of certain funders the
  advantage of familiarity

4
Factors That Drove the Development of a Targeted
Regional Program Southern Rural Access Program

• Need Targeted states with large rural
  populations with
• - Most significant health access barriers
• - Most significant health status problems
• Level the playing field Target states where
  RWJF had not committed many resources
• Healthy Futures Program - Previous positive
  experience with a regional program Regional
  Learning Factor

5
Robert Wood Johnson FoundationsSouthern Rural
Access Program(1998 2006) - 32.8 million

• Goal Improve access to basic healthcare and
  strengthen capacity in eight of the most
  underserved states
• Eight states AL, AR, GA, LA, MS, SC, East TX, WV
• Original design Also targeted Great Plains
  states cutting room floor because of complexity
  and resource issues

6
Major Program Components

• Build rural leaders pipeline
• Improve provider recruitment and retention
• Develop rural health networks
• Revolving loan funds improving access to
  capital
• 21st Century Challenge Fund-matching grant program

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Description of Southern Rural Access Program
(Continued)

• Health coverage not included because of other
  RWJF programs
• Increased health system capacity needed before an
  effort to improve health status

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Southern Rural Access ProgramLead Agencies

• Alabama Primary Care Association
• Arkansas Center for Health Improvement/College
  of Public Health
• Georgia Department of Community Health/Office
  of Rural Health
• Louisiana State University Health Sciences Center
• Mississippi Primary Health Care Association
• South Carolina Office of Rural Health
• East Texas Area Health Education Center
• West Virginia Center for Rural Health Development
  Inc
• 4 of 7 loan fund grants to economic development
  intermediaries not health agencies

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Lessons LearnedAccomplishments and Successes

• Productivity of loan funds
• Catalytic role in stimulating rural health
  networks in the Southeast
• Promising/practical recruitment and retention
  efforts
• Funding partnerships with multiple state federal,
  state, and local agencies
• Partnerships with philanthropies

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Lesson Learned - Challenges

• Limited scale of rural health leaders component
• Variable and shifting policy environments in
  states
• Some sites stronger than others
• Program scale relative to the access problem of
  states

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Potential/Anticipated Contribution to the Field

• States will sustain many/most interventions by
  2006
• Gumbo nature of loan funds Economic
  development/health agency intermediaries
• Practice management assistance as a retention
  tool
• Silo busting nature of program
• Confirmation of the value of regional efforts

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Southern Health Improvement Consortium

• Regional collaborative Owned and Developed by
  the lead agencies/states
• RWJF 600K start-up South Carolina Office of
  Rural Health lead agency
• Focus on both health access and health status
  improvement issues

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Regional Health Improvement Efforts

• Can help the system to target resources to needy
  populations
• Communities/states with similar values, health
  systems better learn from each other
• Regional commissions/authorities an important
  idea to build on and adapt (Appalachian Border,
  Delta, Denali Great Plains)
• Not-for-profit vs. government agency models

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What Needs to be Done to Reduce Health
Disparities of Rural Populations A Few Ideas

• A much greater national commitment
• Long term commitments from federal, state
  philanthropic funders on health workforce issues
• Greater investments in community colleges as a
  health workforce strategy
• Greater interest from healthcare consumers
  (Mixed results of RWJF funded survey on support
  (54) for legislation allowing for the collection
  of racial and ethnic data) www.rwjf.org
• Focused efforts to reduce health
  literacy/communication caps between providers and
  patients

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What needs to be place to enhance health status
of rural populations?A Few Thoughts

• Continued emphasis on improving rural economies
  and educational systems
• Reduction of tobacco, alcohol and illegal drug
  use in rural areas. Needs much greater emphasis
• Reduction of obesity/increase in physical
  activities in rural America needs much greater
  attention

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Good News on Tobacco Use/Tobacco Control

• Since 1995 Tobacco prevalence in this nation
  declined 12.6 for adults and 18 for youth
• Increased tobacco taxes in 31 states in last two
  years
• States of Delaware, New York, Connecticut and
  Maine have gone smoke-free

17
Bad News on Tobacco Use/Tobacco Control in Many
Rural States

• Of SRAP states, only Texas is below national
  median in smoking prevalence
• Virtually no SRAP state has increased tobacco
  taxes since 1994 (W. Virginia/Arkansas small
  modest increases)
• Is this a grower state issue?
• Role of rugged individualist orientation of
  rural consumers/policy makers?

18
Binge Alcohol Use Rates High in Great Plains
States

• Nebraska is the only Great Plains state with
  binge alcohol use rates below the national
  average
• Of SRAP states, only Louisiana and Texas have
  binge alcohol use rates above the national average

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Physical Inactivity/Obesity Rates Very High in
Southern and Great Plains States

• Of SRAP states, only Georgia and South Carolina
  are below national median on obesity rates
• Of SRAP states, only Georgia and Texas are below
  national median regarding physical inactivity
  rates
• Nebraska, South Dakota, North Dakota, Iowa,
  Kansas are all above national median regarding
  obesity rates. Same for physical inactivity
  rates except for North Dakota

20
Future Opportunities to Work on Obesity
Reduction/Physical Activity

• Much greater media attention and consumer
  recognition that the obesity epidemic is a major
  national health issue
• Reducing obesity among is an emerging priority of
  health grant makers
• New federal legislation on obesity reduction
  considered in 2004

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Final Thoughts

• To improve health status, rural agenda needs to
  move beyond its primary focus of increasing
  services/resources
• Rural Advocates need to concentrate more focus on
  rural population health issues