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population Affected by Disabilities.

Rural and Migrant Health 

Read chapter 21 and 23 of the class textbook and review the attached PowerPoint presentations.  Once done, answer the following questions.

  1. Mention and discuss the differentiation between the medical model and social construct definitions of disability.
  2. Identify and discuss selected health care and social issues that influence the ability of people with disabilities to live and thrive in the community.
  3. Mention and discuss the characteristics of rural community health nursing practice.
  4. Mention and describe the features of the health care system and population characteristics common to rural aggregates.

As stated in the syllabus present your assignment in an APA format word document, Arial 12 font attached to the forum in the discussion tab of the blackboard titled “Week 8 discussion questions” and the SafeAssign exercise in the assignment tab of the blackboard which is a mandatory requirement.  A minimum of 2 evidence-based references (besides the class textbook) no older than 5 years must be used.  You must post two replies to any of your peers sustained with the proper references no older than 5 years as well and make sure the references are properly quoted in your assignment. The replies must be posted on different dates (to verify attendance), I must see different dates in the replies.  

A minimum of 700 words is required (excluding the first and reference page). Please make sure to follow the instructions as given and use either spell-check or Grammarly before you post your assignment.

Please check your assignment every time you log in because I can ask questions requesting clarification or giving feedback to your assignment.

One more time all assignments posted must be in a word document in both tabs.

· Name

DQ Rubric 2019

· Description

· Rubric Detail

 

Levels of Achievement

Criteria

Proficient

Competent

Novice

Introduction and quality of discussion’s Argument

Weight 60.00%

100.00 %

It is consistent with application in research related to its context. Clarity of ideas. Comprehensive, in-depth and wide ranging.

70.00 %

The topic has a partially weak association to clarity of ideas and related topic. Relevant but not comprehensive.

15.00 %

Unable to address any part of the question and/or topic. Little relevance/some accuracy.

Objectivity of Tone, overall quality & Review of Literature in APA 6th format within past 7 years

Weight 10.00%

100.00 %

Tone is consistent, addressed professionally and objectively. Evidence in literature supports arguments.

70.00 %

The tone is not consistently objective. Some observations, some supportive evidence used.

15.00 %

No objectivity in tone. No evidence of literature review provided. Lacks evidence of critical analysis, poor to no use of supportive evidence.

Grammar / Writing Skills

Weight 7.50%

100.00 %

Excellent mechanics, sentence structure and organization with no grammatical mistakes.

70.00 %

Some grammatical lapses , uses emotional responses in lieu of relevant points.

0.00 %

Poor grammar, weak communication, lack of clarity.

Peer Reply #1

Weight 7.50%

100.00 %

Demonstrates an exceptional ability to analyze and synthesize student work, asks meaningful extending questions.

70.00 %

Some ability to meaningfully comment on other students work and ask meaningful questions.

0.00 %

No peer response

Peer Reply #2

Weight 7.50%

100.00 %

Demonstrates an exceptional ability to analyze and synthesize student work, asks meaningful extending questions.

70.00 %

Some ability to meaningfully comment on other students work and ask meaningful questions.

0.00 %

No Peer response

Overall APA Use

Weight 7.50%

100.00 %

Demonstrates an exceptional ability to apply 6th edition APA standards.

70.00 %

Some ability to to apply 6th edition APA standards. i.e. use of in-text citation, reference structure, quoting,etc.

0.00 %

No adherence to 6th edition APA standards.

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Chapter 21

Populations Affected by Disabilities

Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc.

Most people whose lives do not end abruptly

will experience disability.

– Nies & McEwen (2015)

Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc.

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Doing a Self-Assessment

What comes to mind when you think of someone with a disability?

Picture yourself as a person with a disability.

Imagine yourself as a nurse with a visible disability, or a client receiving care from a nurse with a disability.

Think about living in a family affected by disability.

What is the experience of living with disability within your community?

Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc.

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Definitions for Disability

Disability is the interaction between individuals with a health condition and personal and environmental factors.

– World Health Organization, 2012

Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc.

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WHO International Classification of Functioning, Disability, and Health

Disability is an umbrella term covering impairments, activity limitations, and participation restrictions (individual level).

An impairment is a problem in body function or structure—activity limitation or participation restriction (micro level).

A handicap is a disadvantage resulting from an impairment or disability that prevents fulfillment of an expected role (macro level).

Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc.

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Table 21-1

Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc.

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Characteristic Impairment Disability Handicap
Definition Physical deviation from normal structure, function, physical organization, or development May be objective and measurable Not objective or measurable; is an experience related to the responses of others
Measurability Objective and measurable May be objective and measurable Not objective or measurable; is an experience related to the responses of others
Illustrations Spina bifida, spinal cord injury, amputation, and detached retina Cannot walk unassisted; uses crutches and/or a manual or power wheelchair; blindness Reflects physical and psychological characteristics of the person, culture, and specific circumstances
Level of analysis Micro level (e.g., body organ) Individual level (e.g., person) Macro level (e.g., societal)

6

National Agenda for Prevention of Disabilities (NAPD) Model

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Figure 21-1 Reprinted with permission from Pope AM, Tarlov AR, editors: Disability in America: toward a national agenda for prevention, Washington, DC, 1991, Institute of Medicine, National Academy Press. Copyright © 1991 by the National Academy of Sciences. Courtesy National Academy Press, Washington, DC.

Quality of Life Issues

Transportation to a needed service

Cost of care

Appointment challenges

Language barriers

Financial issues

Migrant/noninsured issues

Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc.

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Models for Disability

Medical model—a defect in need of cure through medical intervention

Rehabilitation model—a defect to be treated by a rehabilitation professional

Moral model—connected with sin and shame

Disability model—socially constructed

Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc.

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Disability: A Socially Constructed Issue

Disability is a complex, multifaceted, culturally rich concept that cannot be readily defined, explained, or measured (Mont, 2007).

Whether the inability to perform a certain function is seen as disabling depends on socio-environmental barriers (e.g., attitudinal, architectural, sensory, cognitive, and economic), inadequate support services, and other factors (Kaplan, 2009).

Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc.

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“Medicalization” Issues

Nurse needs to differentiate …

A person who has an illness and becomes disabled secondary to the illness

versus …

A person who has a disability, but may not need treatment

Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc.

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“Medicalization” Issues (Cont.)

Nurse’s interaction with PWD and families

Approach on an eye-to-eye level

Listen to understand

Collaborate with the person/family

Make plans and goals that meet the other’s needs and draw on strengths and improve weaknesses

Empower and affirm the worth and knowledge of the person/family with a disability

Promote self-determination and allow choices

Note: PWD = persons with disabilities

Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc.

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Historical Perspectives

Long history of institutionalization/segregation

Often viewed as sick and helpless

In the 20th century, special interest groups emerged to advocate for PWD (e.g., ARC)

Tragedies include Hitler’s euthanasia program

Deinstitutionalization began in 1960s-1970s

Stereotypical images still common in literature and media; these images influence prevailing perceptions of disability

Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc.

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Historical Context for Disability

Early attitudes toward PWD

Set apart from others

Viewed as different or unusual

Documented in carvings and writings

Infanticide or left to die (not in Jewish culture)

Viewed as unclean and/or sinful

Served as entertainers, circus performers, and sideshow exhibitions

Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc.

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Historical Context

18th and 19th century attitudes

No scientific model for understanding and treating

Disability seen as an irreparable condition caused by supernatural agency

Viewed as sick and helpless

Expected to participate in whatever treatment was deemed necessary to cure or perform

Industrial Revolution stimulated a societal need for increased education

If not third-grade level = feeble-minded

Special schools established in early 1800s

Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc.

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Historical Context (Cont.)

20th century attitudes

Special interest groups were formed

First federal vocational rehabilitation legislation passed in early 1920s

Involuntary sterilization of many with intellectual disabilities

ARC (Association for Retarded Children) began to advocate for children with intellectual disabilities—today is Association for Retarded Citizens

ARC is “world’s largest community-based organization of and for people with intellectual and developmental disabilities” (ARC, 2009)

Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc.

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Historical Context (Cont.)

20th century attitudes

One of the most horrendous tragedies under Hitler’s euthanasia or “good death” program

Killed at least 5000 mentally and physically disabled children by starvation or lethal overdoses

Killed 70,274 adults with disabilities by 1941

Over 200,000 people exterminated because they were “unworthy of life”

Deinstitutionalization movement in 1960s and 1970s

Community-based Independent Living Centers established

Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc.

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Historical Context (Cont.)

Contemporary conceptualization

Stereotypical images remain common in literature and media

Population portrayed as a burden to society or from pity/pathos or heroic “supercrip” perspectives

“just as the paralytic cannot clear his mind of his impairment, society will not let him forget it.” (Murphy, 1990, p. 106)

Societal stigma still exists

Teasing or bullying often occurs in schools

Rehabilitation Act of 1973 and American with Disabilities Act of 1990 prohibit “disability harassment”

Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc.

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Characteristics of Disability

Americans with Disabilities Act (ADA) of 1990 and Rehabilitation Act of 1973 defined disability according to limitations in a person’s ability to carry out a major life activity.

Major life activities: ability to breathe, walk, see, hear, speak, work, care for oneself, perform manual tasks, and learn

U.S. Census Bureau (2006) defines disability as long-lasting physical, mental, or emotional condition that creates a limitation or inability to function according to certain criteria.

Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc.

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Examples of Disabilities

Physical disabilities

Sensory disabilities

Intellectual disabilities

Serious emotional disturbances

Learning disabilities

Significant chemical and environmental sensitivities

Health problems

Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc.

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Measurement of Disability

Survey of Income and Program Participation (SIPP)

Functional activities

Activities of daily living (ADLs)

Instrumental activities of daily living (IADLs)

American Community Survey (ACS)

Surveys for disability limitation in six areas that affect function or activity (sensory, physical, mental/emotional, self-care, ability to go outside the home, employment)

Other organizations also collect disability data

Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc.

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Prevalence of Disability

In 2010, approximately 18.7% of civilian noninstitutional population aged 5 years and older had a long-lasting condition or disability.

Of those with a disability, 12.6% had a “severe” disability.

Prevalence varies by race, age, and gender.

It is important for health care policymakers and health care providers to recognize that the prevalence of disability is increasing.

Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc.

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Prevalence of Disability in Children

Approximately 15.2% of households with children have at least one child with a special health care need (disabling condition).

– National Survey of Children with

Special Health Care Needs (2009/2010)

A disability is defined by a communication-related difficulty, mental or emotional condition, difficulty with regular schoolwork, difficulty getting along with other children, difficulty walking or running, use of some assistive device, and/or difficulty with ADLs

Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc.

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Recommendation for the Nurse

Listen to parental concerns

“Something is not right”

Establishes an important bond with parents

Nurse can serve as an intermediary

Regularly assess for key developmental milestones

Compare with predicted values

Work with team of resource providers on IEP

Be cognizant of disability within the context of culture and aging

Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc.

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Legislation Affecting People with Disabilities

Individuals with Disabilities Education Act (IDEA) (1975); reauthorized in 1997, 2004

Ensured a free appropriate public education (FAPE) in the least-restrictive setting to children with disabilities based on their needs

Parents, students, and professionals join together to develop an Individualized Education Program (IEP), including measurable special educational goals and related services for the child.

Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc.

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Americans with Disabilities Act of 1990 and ADA Amendments Act of 2008

ADA: Landmark civil rights legislation that prohibits discrimination toward people with disabilities in everyday activities

Guarantees equal opportunities for people with disabilities related to employment, transportation, public accommodations, public services, and telecommunications

Provides protections to people with disabilities similar to those provided to any person on basis of race, color, sex, national origin, age, and religion

Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc.

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ADA (Cont.)

Refers to a “qualified individual” with a disability as a person with a physical or mental impairment that substantially limits one or more major life activities or bodily functions, a person with a record of such an impairment, or a person who is regarded as having such an impairment.

Qualifying organizations must provide reasonable accommodations unless they can demonstrate that the accommodation will cause significant difficulty or expense, producing an undue hardship.

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Americans with Disabilities Act of 1990 and ADA Amendments Act of 2008 (Cont.)

Ticket to Work and Work Incentives Improvement Act (TWWIIA)

Increases access to vocational services; provides new methods for retaining health insurance after returning to work

Increases available choices when obtaining employment services, vocational rehabilitation services, and other support services needed to get or keep a job

Became law in 1999, amended in 2008

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Public Assistance Programs

Cash assistance

Supplemental Security Income—SSI

Social Security Disability Insurance—SSDI

Food stamps

Public/subsidized housing

Costs associated with disability

Gaps in employment, income, education, access to transportation, attendance at religious services

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Health Disparities in Quality and Access

Disparities are caused by …

Differences in access to care

Provider biases

Poor provider-patient communication

Poor health literacy

Persons with disabilities experience …

Higher rates of chronic illness

Increased risks for medical, physical, social, emotional, and/or spiritual secondary issues

People with intellectual disabilities are

Undervalued and disadvantaged

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Systems of Support for People With Disabilities

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Figure 21-2

The Experience of Disability

PWD may be largest minority group in the United States

Different experiences, depending on …

Temporary disability

Permanent disability from accident or disease

Disability from progressive decline of a chronic illness

Benchmark event is acceptance of the label of “disabled”

Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc.

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Children With Disabilities (CWD)

Family and caregiver responses

Redefine image and expectations for child and self

Sibling response influenced by age, coping, peer relationships, parents, impact on family

Levels of parental adjustment

The ostrich phase

Special designation

Normalization

Self-actualization

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Family Research Outcomes

Established various benefits, amid challenges

Families with satisfying emotional support experience fewer potentially negative effects of unplanned or distressing events.

Parents may grieve the loss of idealized or expected child over time.

Supportive relationship is needed.

Empowerment and enabling decision making on behalf of CWD is important.

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Knowledgeable Client

A person who lives with a disability commonly becomes an expert at knowing what works best for his or her body.

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The nurse who has information about the disability and the available community and governmental resources.

Knowledgeable Nurse

Strategies for the CH Nurse

Do not assume anything.

Adopt the client’s perspective.

Listen to and learn from client. Gather data from the perspective of the client and family.

Care for the client and family, not for the disability.

Be well informed about community resources.

Become a powerful advocate.

Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc.

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Dealing With Ethical Issues

Spiritual perspectives

Quality of life (QOL) and justice perspectives

Proper use of scientific advances

Self-determination, deinstitutionalization, and disability rights

Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc.

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When the Nurse Has a Disability

Education programs and employers must provide reasonable accommodations for qualified students and nurses.

Technical aspects of nursing tend to discriminate; nursing should emphasize “humanistic” capacities.

Type of setting influences functionability.

Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc.

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Nurses Can …

… become familiar with a variety of ethical frameworks for decision making.

… help the patient and family access needed information to make informed decisions.

… help educate the public on health care issues.

… participate in the development of institutional policies and procedures related to disability.

… take a position on an ethical issue.

… work to influence government policies and laws.

Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc.

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Chapter 23

Rural and Migrant Health

Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc.

Rural Populations

The largest rural population in history of United States is now.

75% of counties are classified as rural; they contain only 20% of the U.S. population

Number/size of rural counties are highest …

in the South (35%)

in the Midwest and West (23%)

in the Northeast (19%)

Census data

20% of nation’s children under 18

15% of nation’s elderly

More than 50% of nation’s poor

Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc.

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Rural Populations (Cont.)

Economic base is shifting

Agriculture is the “food and fiber system”

All aspects of agriculture (core materials to wholesale and retail and food service sectors) are included

Poverty in rural areas greater than in urban areas

Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc.

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Rural Populations (Cont.)

Poverty continues to be greater in rural America than in urban areas.

Aging-in-place, out-migration of young adults, and immigration of older persons from metro areas.

Greater diversity among residents: a country of immigrants historically and today.

Health disparities exist—rural population more likely to be older, less educated, live in poverty, lack health insurance, and experience a lack of available health care providers and access to health care

Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc.

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Health Disparities Among Rural Americans

Only 10% of U.S. physicians practice in rural areas

Ratio of physicians in rural population is 36:100,000 (nearly double in urban settings)

More often assess their health as fair or poor

More disability days resulting from acute conditions

More negative health behaviors (untreated mental illness, obesity, alcohol, tobacco, and drug use) that contribute to excess deaths and chronic disease and disability rates

Higher number of unintentional injuries

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Defining Rural Populations

Population size

Rural = towns with population of less than 2500 or in open country [farm/nonfarm]

Density

Rural = fewer than 45 persons per square mile

Frontier = less than 6 people per square mile

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Defining Rural Populations (Cont.)

The Rural-Urban Continuum uses population and adjacency to metropolitan areas

Core Based Statistical Areas (CBSAs)

Metropolitan areas = county with at least one urbanized area of 50,000 or more people

Micropolitan area = area contains a cluster of 10,000 to 50,000 persons

Outside CBSAs = noncare areas

Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc.

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Describing Rural Health and Populations

Differ in complex geographical, social, and economic areas

Disparities include key indicators of health:

Employment

Income

Education

Health insurance

Mortality

Morbidity

Access to care

Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc.

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Rural Health Disparities: Context and Composition

Context: characteristics of places of residence

Geography, environment, political, social, and economic institutions

Composition: collective health effects that result from a concentration of persons with certain characteristics

Age, education, income, ethnicity, and health behaviors

– Braveman (2010)

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Context: Health Disparities Related to Place

A downward spiral may exist:

people leave  services are lost  tax base becomes insufficient  fewer services are provided  long distances to get health care  jobs become scarce and more people leave  the cycle continues

Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc.

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Context: Health Disparities Related to Place (Cont.)

Access to health care (#1 priority)

Fewer primary care physicians

General health services lacking

Health insurance coverage …

Varies according to race and ethnicity; age and residence (rural or urban)

Influences health patterns

May create financial barriers to health care

Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc.

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Composition: Health Disparities Related to Persons

Income and Poverty

One of the most important indicators of the health and well-being of all Americans, regardless of where they live.

Regional differences—highest in the South

Racial and ethnic minorities—rates among rural racial minorities two to three times higher than for rural whites

Family composition—female-headed families have highest rates

Children—among the poorest citizens in rural America

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Composition: Health Disparities Related to Persons (Cont.)

Health risk, injury, and death

Higher rates of obesity, smoking, sedentary lifestyles, alcohol use, firearms usage, suicide, vehicular accidents; lower rates of seat belt use

Risk factors

Age, education, gender, race, ethnicity, language, and culture

Education and employment

Occupational health risks

Perceptions of health (gender, race, ethnicity)

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Agricultural