How do we define Rural versus Urban, and what does the data tell us about the difference in health indicators for Rural versus Urban?
How can geography help us to better understand causes and outcomes, demographics and the social determinants of health, disparities and inequalities?
What are the multiple factors that affect behavioral health in the community, and how can they be modified to improve community health?
When we assess the needs and assets of ALL the people in each of our counties or communities, do we come to the same conclusions as when we look only at the patient populations, programs and priorities of the local healthcare provider systems?
THANK YOU FOR EXPLORING THE ANSWERS TOGETHER.
THIS IS A LIVING DOCUMENT AND WILL CONTINUE TO EVOLVE WITH YOUR INPUT. A FINAL VERSION WILL BE PRESENTED AT THE STATEWIDE FORUM IN EARLY 2018.
As you scroll through the presentation, you can interact with the maps (zoom in or out, click to see a pop-up with information) or select links to other web pages with detailed explanations of these issues.
Depending on which of many definitions is used to define Rural and Urban, comparisons of health disparities can vary substantially. As the map below illustrates, there are many 'flavors' of Rural: for example, the Rural-Urban Continuum Codes (RUCC) system uses 9 categories of counties (7 found in our state).
An alternate, 4-category method for exploring Rural versus Urban indicators is found here: New Mexico Rural-Urban Counties Comparison Tables
Defining Rural at the SUB-County level (for example, Census Tracts or Zip Codes) is an even more complex process that merits careful consideration as we go forward exploring these issues. EXPLORE Working Definitions of Rural with a map illustrating 6 ways to classify Rural geographies.
For present purposes, we will use the simplified 2-way definition of 7 Urban and 26 Rural counties.
The population size of our counties varies greatly. Bernalillo County and surrounding areas hold nearly half the state population, while we also have 8 counties with less than 5000 people each.
In Rural counties, the percent of people unemployed (5.9%) is significantly higher than in Urban counties (5.2%). But the percent of families below the poverty level is slightly lower (Rural = 14.9%; Urban = 15.8%). 21% of households in Rural counties receive retirement income, versus 19.5% in Urban counties.
Do the following maps of behavioral health outcomes reveal Rural-Urban disparities? What are the causes of these differences?
Cognitive difficulty: Because of a physical, mental, or emotional problem, having difficulty remembering, concentrating, or making decisions.
The above maps display population-wide measures: in other words, measurements of outcomes in the general population of all persons of all ages, or in the general population of children or adolescents. They are not based on sub-populations served by one medical provider system.
The determinants of population health include personal factors such as medical care, public health interventions, genetics and individual behavior.
Within the broad categories of social determinants listed below, what would be the more important factors to measure in order to better understand Behavioral Health determinants in Rural communities? Some examples and links are provided for you:
INCOME: __________________________________________________________
EDUCATION: ______________________________________________________
EMPLOYMENT: ____________________________________________________
CULTURE: _________________________________________________________
FAMILY: ___________________________________________________________
Children Cared for by Grandparents
COMMUNITY CONNECTION: ______________________________________
SAFETY: ___________________________________________________________
HOUSING: _________________________________________________________
TRANSPORTATION: ________________________________________________
This map compares the increases in Medicaid enrollment. CLICK on a County to see the data.
The Affordable Care Act also resulted in greater improvement in the number of rural patients able to access hospital services for the first time thanks to their Medicaid benefits:
Conversely, repeal of the ACA would negatively impact rural patients to a greater degree. For a more in-depth look at this issue see The Role of Medicaid in Rural America .
The 519 active Medicare service providers and 12,600 inpatient beds in New Mexico are distributed in an equitable manner across the rural-urban continuum. Rural counties contain 50% of facilities and 40% of inpatient beds. Click on the points on the above map to see information about each of them.
With the exception of parts of three urban counties, every county and census tract in the state of New Mexico is classified as a Mental Health Professional Shortage Area. Click on the map to see other health professional shortage classifications:
(SAMHSA certified facilities, outpatient and inpatient. Click on a STAR to see info.)
Over the previous 10 years, the number of person over 18 reporting poor mental health has grown 3 1/2 times faster in rural counties:
Rural counties have 3.28 behavior health providers per 1000 population. Urban counties have 5.05 per 1000, a 54% greater rate.
The Patient Protection and Affordable Care Act requires hospitals claiming tax-exempt status conduct a community health needs assessment every three years and develop a strategy to address the needs identified. Hospital and their provider systems must report on what they are doing to address the needs identified in the community health needs assessment. In addition, they must describe any needs not being addressed and explain why they are not being addressed.
2015 Community Health Needs Assessment and Implementation Plan, Gerald Champion Regional Medical Center, Alamogordo, NM: http://www.gcrmc.org/upload/docs/Community%20Needs%20Assessment%202015.pdf
2013 Community Health Needs Assessment and Implementation Plan, Holy Cross Hospital, Taos, NM: http://taoshospital.org/uploads/files/HCH-CHNA_Report_5-15-13.pdf
2016 Community Health Needs Assessment and Implementation Strategy, Cibola General Hospital, Grants, NM: http://www.cibolahospital.com/docs/6_21_2016_-_CHNA_FINAL_-_Cibola.pdf
Community Health Needs Assessment Collection, Presbyterian Healthcare Services, Multiple Sites, NM: https://www.phs.org/community/committed-to-community-health/Pages/default.aspx
At times, the strategies promoted are more focused on improving care within a system of eligible patients, rather than across an entire population. AthenaHealth has developed the following interactive to promote strategies related to the patient-centered medical home model: improving the patient experience, improving health-care outcomes, and reducing costs:
THIS INTERACTIVE STORY MAP WAS DEVELOPED BY THE NEW MEXICO COMMUNITY DATA COLLABORATIVE UTILIZING MATERIALS FROM ITS ONLINE COLLECTION OF NEIGHBORHOOD DATA
THOMAS SCHARMEN
&
HARVEY LICHT
Thanks to:
Susan Wilger, Cathleen Wilging, Alisha Herrick and the NMPHI Forum Planning Committee
YOUR FEEDBACK, COMMENTS, SUGGESTIONS ARE WELCOME: aherrick@swchi.org OR thomas.scharmen@state.nm.us
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