Disparities in HIV prevalence reflect multiple disparities in the social determinants of health that affect rural Southern populations. This presentation will review residence and racial/ethnic inequities in education, income and access to care that culminate in differing health outcomes

Crouch, Elizabeth

English

Georgia Southern University: Digital Commons@Georgia Southern

Georgia Southern UniversityDigital Commons@Georgia Southern7th Annual Rural HIV Research and TrainingConferenceSep 21st, 1:40 PM - 2:25 PMThe Status of Rural Health in the Southeast UnitedStatesElizabeth CrouchFollow this and additional works at: https://digitalcommons.georgiasouthern.edu/ruralhivThis presentation (open access) is brought to you for free and open access by the Conferences & Events at Digital Commons@Georgia Southern. It hasbeen accepted for inclusion in 7th Annual Rural HIV Research and Training Conference by an authorized administrator of Digital Commons@GeorgiaSouthern. For more information, please contact digitalcommons@georgiasouthern.edu.Recommended CitationCrouch, Elizabeth, "The Status of Rural Health in the Southeast United States" (2018). 7th Annual Rural HIV Research and TrainingConference. 18.https://digitalcommons.georgiasouthern.edu/ruralhiv/2018/2018/18South CarolinaRural Health Research CenterRural Health in the Southeast U.S.Elizabeth Crouch, PhDDeputy DirectorSouth Carolina Rural Health Research CenterSeptember 2018 Rural Health Research CenterSouthCarolinaSouth Carolina Rural Health Research Center Competitively funded research program of the Federal Ofice of Rural Health Policy, HRSA Focus on rural vulnerable populations and problemsRural Health Research CenterSouth CarolinaHIV+ Prevalence, 2015Source: https://www.ruralhealthinfo.org/data-explorer?id=193• The Rural SE is a high-prevalence area• Nationally, HIV prevalence is higher in metro (379/100K) than rural (152/100K) counties.• In SC, the rural rate (439) exceeds the urban (373).• In FL, rates almost equal (rural 604, urban 609)Rural Health Research CenterSouthCarolinaTakeaways for today HIV is transmited and treated in a specific social and health care context In the rural South, that context includes chalengesPersonal resourcesPersonal behaviorsAccess to care   Good change, bad change are both possible Rural Health Research CenterSouth CarolinaRural and urban countieshttps://www.ers.usda.gov/webdocs/charts/37405_micrononcorepng/micrononcore.png?v=41404Rural Health Research CenterSouthCarolinaCommon to al definitions Rural = more space with fewer people And, coincidentaly:Fewer physicians Fewer nursesFewer hospitals (etc)Rural Health Research CenterSouthCarolinaExamining the social determinants of health Poverty Education DebtRural Health Research CenterSouth CarolinaRural Southeast marked by povertyRural Health Research CenterSouth CarolinaPersistent poverty Rural Health Research CenterSouth CarolinaChild poverty Rural Health Research CenterSouth CarolinaRural America: lagging recoveryRural Health Research CenterSouth CarolinaEducational disparities affect health literacy Rural Health Research CenterSouth CarolinaRestricted upward mobilitySource: https://www.vividmaps.com/2018/01/geography-upward-mobility-u-s.htmlRural Health Research CenterSouth CarolinaMany lack health insurancehttps://nccd.cdc.gov/DHDSPAtlas/Reports.aspxPercent of persons under age 65 without Health Insurance, 2015 Rural Health Research CenterSouth CarolinaHouseholds with debt in collectionsAny debt:27% white45% nonwhitehttps://apps.urban.org/features/debt-interactive-map/Rural Health Research CenterSouth CarolinaHouseholds with medical debtNationally:16% white21% nonwhiteLocally:Tennessee:24% white26% TN nonwhiteGeorgia:20% white28% nonwhitehttps://apps.urban.org/features/debt-interactive-map/Rural Health Research CenterSouth CarolinaMedicaid expansionRural Health Research CenterSouthCarolinaUniquely rural barriers Distance Absence of providers Absence of privacyRural Health Research CenterSouth CarolinaShortages of health professionalsRural Health Research CenterSouthCarolinaLack of privacy The flip side of “everybody knows your name” Stigmatized diagnoses and care-seeking are dificulty to concealHIVMental health issuesRural Health Research CenterSouthCarolinaPersonal behaviors Generaly risk behaviorsA mixed picture –some protective, some advance risk Indicators of sexualy risk behaviorsNot mixedRural Health Research CenterSouth CarolinaSmoking:  Higher in the regionRural Health Research CenterSouth CarolinaBinge drinking: lower than averageRural Health Research CenterSouth CarolinaPhysical inactivity, 2013Rural Health Research CenterSouth CarolinaObesity, 2013Rural Health Research CenterSouth CarolinaAccess to opioids - moderatehttps://www.cdc.gov/vitalsigns/opioids/infographic.html#graphic-bRural Health Research CenterSouth CarolinaHealth outcomesRural Health Research CenterSouth CarolinaTeen births common in the SEhttps://www.cdc.gov/teenpregnancy/about/alt-text/map-county-text.htmTeen births per 1,000 females ages 15 – 19, US, 2015Rural Health Research CenterSouth CarolinaHigh GC rates in the SERural Health Research CenterSouth CarolinaSimilarly high syphilis ratesSource: https://gis.cdc.gov/grasp/nchhstpatlas/maps.htmlRural Health Research CenterSouth CarolinaDrug mortality high in parts of SE https://www.nytimes.com/interactive/2016/01/07/us/drug-overdose-deaths-in-the-us.htmlRural Health Research CenterSouth CarolinaLife expectancy at birth (2014)JAMA Intern Med. 2017;177(7):1003-1011. doi:10.1001/jamainternmed.2017.0918Rural Health Research CenterSouth CarolinaBut I promised a ray of hope…Rural Health Research CenterSouth CarolinaThe SE does have practitioners….Rural Health Research CenterSouth CarolinaWorking together might be an optionRural Health Research CenterSouth CarolinaNew rural toolkitThere are information resources for rural communitiesRural Health Research CenterSouthCarolinaFederal Ofice of Rural Health Policy Substance Abuse Treatment Telehealth Grant Program Rural Health Opioid Program Delta Region Community Health Systems Development Rural Health Network Program grants Planning and implementation grants, including a series specific to the Delta StatesTend to run on a 3-year cycleRural Health Research CenterSouth CarolinaAdditional source of infoRural Health Research CenterSouthCarolinaThanks! Our core funder:Federal Ofice of Rural Health Policy, Health Resources and Services Administration, USDHHS Our website: rhr.sph.sc.edu My contact info: jprobst@sc.edu

The Status of Rural Health in the Southeast United States

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The Status of Rural Health in the Southeast United States

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