Health Equity from a Rural Health Lens 1 Source: Singh and - - PowerPoint PPT Presentation

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Health Equity from a Rural Health Lens

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.

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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

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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

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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.

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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

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HHS Regions

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

Source: Centers for Disease Control and Prevention, National Center for Health Statistics, Multiple Cause of Death.

Michael Meit, Co-Director of the Walsh Center Meit-Michael@norc.org  301-634-9324

Other Opiates and Synthetics

Admissions Aged 12 and Over for Primary Abuse of Other Opiates/Synthetics, TEDS 2000 - 2004 1 2 3 4 5 6 7 8 2000 2001 2002 2003 2004 Percentage of All TEDS Admissions 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 2 4 6 8 10 12 14 16 18 2000 2001 2002 2003 2004 Percentage of All TEDS Admissions 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 2 4 6 8 10 12 14 16 18 2000 2001 2002 2003 2004 Percentage of All TEDS Admissions 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

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American Health Values Survey – Rural Findings American Health Values 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.

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12.8% 14.0% 15.5% 18.3% 18.4% 21.0% 15.4% 16.3% 17.4% 13.6% 12.8% 24.5% 0.0% 5.0% 10.0% 15.0% 20.0% 25.0% 30.0% Private-sector Champions Self-reliant Individuals Disinterested Skeptics Committed Activists Equity Advocates Health Egalitarians Urban n=8,836 Rural n=1,738

American Health Values Survey – Rural Findings American Health Values Survey – Rural Findings

More likely to support active role for government Less likely to support active role for government

Typology Size by Rural/Urban Status and Typology Classification

Measure Question Whole Sample Urban n=8,836 Rural n=1,738 P- Value Importance of Personal Health 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%*** Great deal of effort spent on: Limiting portion size 24% 20%*** Great deal of effort spent on: Weight management 30% 26%*** 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%** Equity/Social Solidarity General opportunity to succeed: Strongly agree that country should do whatever necessary to make sure equal opportunity to succeed 46% 42%*** Health equity: Country should do whatever necessary to make sure equal access to be healthy 56% 53%** Beliefs about Health Care Disparities 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%*** Compared to whites: Latinos have harder access 33% 24%*** 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 the rural and urban proportions are statistically significant at α=0.01.

Table 1 Questions that had a significant difference between the answers of Rural and Urban respondents

American Health Values Survey – Rural Findings

Measure Question Whole Sample Urban n=8,836 Rural n=1,738 P- Value Social Determinants Health is strongly affected by: Quality of food available 52% 49%** Health is strongly affected by: Community safety 33% 29%*** Health is strongly affected by: Housing quality 29% 27%** Beliefs about the role of government in health 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 responsible 52% 45%*** Making sure that healthy, affordable foods are available should be top/high priority: Private sector should be responsible 27% 31%*** Making sure that healthy, affordable foods are available should be top/high priority: Gov't (or both) should be responsible 45% 41%*** 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 sector should be responsible 15% 19%*** Making sure that safe outdoor places to walk and be active are available should be top/high priority: Gov't (or both) should be responsible 57% 47%*** 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 the rural and urban proportions are statistically significant at α=0.01.

Table 1 (con’t) Questions that had a significant difference between the answers of Rural and Urban respondents

American Health Values Survey – Rural Findings

And I think the greatest asset that we have in Appalachia is people and their identification with their culture and their

• home. --- Community member

Thank You!

Michael Meit, MA, MPH NORC at the University of Chicago 4350 East West Hwy, Suite 800 Bethesda, MD 20814 301-634-9324 meit-michael@norc.org