Chapter 24 Rural and Migrant Health Flashcards
Economic base is shifting
Poverty (a key health determinant) continues to be greater in rural America than in urban areas - lower income and below poverty line
Trends: aging-in-place (older pop tends stay), out-migration of young adults, and immigration of older persons from metro areas present challenges to already stressed communities that must provide adequate health care, housing, transportation, and other human services - presents challenges, diff to get them to appts, meds; older, younger people move to pursue opportunities (more people moving out and left with low income indivs less tax dollars to spend on resources) - need money to get things need
Distance is a prob
Emergency: someone has come get you: not have community hospital and if do may be distance; need consider emergency services
Greater ethnic diversity among residents: because a country of immigrants historically and today
Rural population in gen more likely to be older, less educated (resources and opportunities because not great educational resources for kids there - may need support fams by working on farms), live in poverty, lack health insurance, and experience a lack of available health care providers and access to health care
Only 10% of U.S. physicians practice in rural areas - not enough PCP in US and fewer to work in rural areas, healthcare is an issue; not have access to healthcare otherwise
Ratio of physicians in rural population is 36:100,000 (nearly double in urban settings)
More often assess their health as fair or poor
Have more disability days resulting from acute conditions than their urban counterparts
More problems related to negative health behaviors (untreated mental illness, obesity, alcohol, tobacco, and drug use) that contributes to excess deaths and chronic disease and disability rates - based on numbers: older pop (65+) did not acknowledge have mental illnesses or go seek treatment
Highest death rates for children and young adults in rural counties
Rural Residents are twice as likely to die from unintentional injuries, including motor vehicle accidents, than urban residents - lot due to farm equipment; grown up on farms and know what doing and patch self up and may lead to an infection
Motor vehicle accidents drive sooner than urban indivs - often driving a tractor so drive younger (by parents) and more likely get into more accidents
Rural US
In US rural pop, economic base is shifting
Not all living in rural doing agriculture - affect our community
Agriculture is the “food and fiber system” despite shrinking number of farms
All aspects of agriculture (core materials to wholesale and retail and food service sectors) are included
Affect us and communities; want people there and part of agriculture
Despite the shrinking number of family farms and full-time farmers, agriculture continues to be an important part of the rural and U.S. economy
Economic base is shifting
Definition – “the state or condition of having little or no money, goods, or means of support”
Health and Human Services Poverty Guidelines for 2022 - how determine if lives in poverty; determines poverty line; look at number people in household poverty and determines poverty line
DHHS Guidelines are established by estimating the minimum income level needed by a family or individual to just meet the basic needs of food, shelter, clothing, and other essential goods and services
Used to determine financial eligibility for certain federal programs
Want know if eligible for certain programs in area or refer to other resources
Not account for recent inflation rates
Poverty
Already sparsely populated losing residents causing A downward spiral may exist:
Retirees drawn to lower cost but need pub health and other services provided by counties without tax base to support them
Access to health care (#1 priority in many rural areas)- access to and need to address affordability of care (ask what poverty level is) and resources in area; can do some checks remotely which great for those in rural areas
Rural areas: Primary Care - fewer primary care physicians; lacking
General Health Services - lacking (primary care and health care facilities), especially mental health services; places and workers
Health insurance…
Context: health disparities related to place
people leave (Kids want leave so leave; younger fam no reason stay so leave; leaves older community) -> services are lost -> local businesses close -> tax base becomes insufficient -> fewer services are provided including ambulance service -> travel long distances to get health care -> jobs become scarce -> more younger people leave the area -> the cycle continues
Already sparsely populated losing residents causing A downward spiral may exist:
Forces residents to either go without or travel long distances - rough rural roads and dangerous weather
Access health care may become challenge and expensive proposition for elderly who not drive and depend on limited pub transportation
Geography, healthcare costs, lack available resources probs keep many rural adults and children keep them from obtaining needed primary, secondary, tertiary services
General Health Services - lacking (primary care and health care facilities), especially mental health services; places and workers
Varies from state to state and according to race and ethnicity and income and people living in the house; age and residence (rural or urban)
Health disparities in rural Influenced by employment patterns, the percentage of children in the population, state Medicaid policies, and poverty levels; #1 thing is access to affordable healthcare
May create financial barriers to health care
Young people more likely not have health insurance; rural residents more likely lack insurance
Health insurance…
Income and Poverty
Health risk, injury, and death
Vulnerable groups - based on demographic and personal characteristics, generalized and not specific to one person: based on things such as age, education, gender, race, ethnicity, language, and culture are factors that affect health and may block access to existing services; pop elderly expected to double; women achieve poverty level more often
Composition: health disparities r/t persons
Income, education, type employment determine SES; aggregate rural have lower edu levels higher unemployment rates, poverty rates, lower income levels
One of the most important indicators of the health and well-being of all Americans, regardless of where they live - less populated areas not use seatbelts as often and not do preventative screening; rural teens more likely report victims of violent behavior, to engage in suicide behavior, use drugs; r/f: alcohol use, obesity, phys inactivity, intentional injury against self/another person with firearm
Good indicator of Americans
Rural america: suicide second leading cause of death; unintentional injuries leading cause
Regional differences – persistent poverty highest in the South, followed by the West, and then the Northeast and Midwest
Racial and ethnic minorities—rates among rural racial minorities two to three times higher than for rural whites
Family composition—female-headed household families have highest rates
Children—among the poorest citizens in rural America
Income and Poverty
Adults – use seat belts less often (country road and not many cars so not wear it) and are less likely to use preventative screening (not get to place easily)
Rural teens – are equally likely or more likely to report being victims of violent behavior, to engage in suicide behaviors, and to use drugs
other risk factors – alcohol use, obesity, physical inactivity, suicide (2nd leading cause of death), unintentional injuries
Health risk, injury, and death
Health disparities
Accidents and injuries:
Acute and chronic illnesses:
Specific rural aggregates: agricultural workers/farmers
Migrant and seasonal farmworkers (those that support fruit and vegetable production) have the poorest health of any aggregate and the least access to affordable health care
Health disparities
Working in highly variable environmental conditions associated with higher incidence of accident and fatality with machinery
Nature what doing - high risk occupation; due to equipment and lack availability get help
Geographically isolated areas and often work alone
Use of agricultural machinery (most common cause of fatalities and nonfatal injuries of workers) - most involve lack seatbelts and rollover structures
Accidents and injuries:
Sev farming activities at risk for Acute and chronic respiratory conditions
BIGGEST: Chemical exposure (pesticides, herbicides, other chemicals)
long exposure to grain and dust
Pesticide poisoning
Higher rates of cigarette smoking, hypertension, obesity
Higher rates of poverty, less access to health care, and are less likely to have health insurance
Acute and chronic illnesses:
Migrant – migrates to find work; enter countries variety way and go variety ways to obtain work; not in consistent area/work contributes to health disparities
Seasonal – reside permanently in one place and work locally when farm labor is needed
Health Disparities
Cultural, linguistic, economic, and mobility barriers
Specific rural aggregates: migrant and seasonal farmworkers
