NewPublicHealth Q&A: Michael Meit Speaks on Public Health in Rural Communities
Michael Meit, M.A., M.P.H., Program Area Director, Public Health Research Department, National Opinion Research Center (NORC) at the University of Chicago, led a session at the recent National Association of County and City Health Officials annual conference on areas under-served by local public health departments, with a focus on rural communities.
NewPublicHealth spoke with Michael Meit, who also serves as the Co-Director of the NORC Walsh Center for Rural Health Analysis, on how to address public health challenges for rural communities, including infrastructure issues, budget concerns and sheer distance between residents and services.
NewPublicHealth: How complete a picture do we have on the rural public health infrastructure?
Michael Meit: I think it’s helpful to understand the historical perspective behind the development of health departments. In rural jurisdictions, they developed about 100 years later than they did in urban jurisdictions and perhaps because of that late start many communities never fully developed and many communities were left with areas of under-service.
And when we talk about that under-service, we’re talking about fewer available dollars, fewer staff, less training, less technological capacity, and typically, a smaller array of public health services that are provided. The main data source that we have to compare rural health departments to non-rural health departments is the NACCHO National Profile of Local Health Departments [a survey of the nation’s nearly 3,000 local health departments on how they operate and what services they provide]. The report shows very clearly that rural health departments as a whole have less capacity – but it’s important to remember that the NACCHO profile looks at areas that have local health departments, while there are many communities that really don’t. The profile is the good news – the positive story about public health. But many areas that don’t have local health departments probably are doing worse than those communities in the NACCHO profile.
NPH: What are some of the key challenges that rural communities face in providing public health services?
Michael Meit: It’s hard to do strong epidemiological work when you have small numbers and it’s hard to track diseases. Of course, there are often distance challenges – we see that on the access to health care side, but we also see that on the public health side where it’s harder for people to access services and it’s harder for the public health staff to be able to get out into the community. They’re not able to see as many people and they have less exposure within their community. All of that also ties into reimbursement challenges. It’s also important to recognize that rural communities tend to have very well-documented health disparities. There are higher rates of smoking, higher rates of obesity, higher death rates due to injury, and many other conditions, including higher overall death rates. When you dig a little deeper and look at social determinants, you’ll see that a lot of the factors that probably underlie a lot of health disparities are more prevalent in rural communities. Rural residents have less income and they tend to have less education, which can be factors in poorer health.
NPH: Are rural health disparities easily defined, or are they more complex than that?
Michael Meit: You have rural versus urban geographic disparities but you also have several areas of the nation that face their own disparities such as the Appalachian region, the Delta region, the U.S./Mexico region, and down in the southern states you have a lot of rural disparities that overlay with racial disparities. All of us in public health firmly believe that every resident should have access to high quality services to address and eliminate those disparities, and to the extent that it’s more challenging to do that in rural communities, I think we need to have a dedicated focus on how we deliver high quality accessible public health work to rural residents.
NPH: What are some of the innovative strategies and ideas you’ve seen?
Michael Meit: Shared services is one. I think that’s a particularly potent strategy in many rural communities where they may not be able to support a full-time epidemiologist or a full-time public health nurse. If they can pool resources and share some of these staff positions across communities they may be more likely to be able to provide some of those services, and we’ve seen some of that happening in communities around the country. One example is from a few years ago when Nebraska used funding from the Robert Wood Johnson Foundation to re-establish a regional public health infrastructure by combining multiple counties into regional health departments that were locally governed and providing a lot of services to the local residents.
And one that we’ve seen most recently is in Maine where they’ve taken on a ten-year initiative to really build public health at the local level, starting by building community coalitions to look at, identify, and address public health issues. Over the years they have added governmental components to support the community-based efforts. Recently, they created a state staff position and that person works on a regional basis with those community coalitions to supplement and strengthen the grassroots infrastructure that they’ve been developing.
NPH: Can telemedicine help improve public health services in rural communities?
Michael Meit: Yes. I think that’s a very good approach and there have been a lot of successes on the healthcare delivery side through telemedicine. We need to be exploring that more on the public health side. There are some technological challenges in rural communities related to broadband access that limits some of those capabilities. Certainly, funding is always a challenge when trying to address those kinds of capacities. I think that’s something that definitely needs to be explored more.