Rural Health in Ohio:
Issues and Trends
Heather Reed, Administrator
Primary Care and Rural Health Program
Ohio Department of Health
Learning Objectives
 Understand the uniqueness of rural Ohio as it
relates to health status and health care
access
 Identify at least five rural-specific health
status or health care access issues
 Describe successful collaborative
interventions to address rural health needs in
Ohio
What is Rural?
Definitions of Rural
 U.S. Census Bureau

Urban = 50,000 people
 Office of Management and Budget

Metro areas + economic ties to core counties
 Economic Research Service (USDA)

Gaining popularity – combines Census Bureau
data with commuting patterns
Rural Ohio
Williams
Lake
Lucas
Fulton
Ashtabula
Ottawa
Geauga
Cuyahoga
Defiance
Henry
Wood
Sandusky
Erie
Seneca
Huron
Paulding
Putnam
Medina
Wyandot Crawford
Richland
Hardin
Ashland
Wayne
Marion
Auglaize
Holmes
Morrow
Logan
Knox
Shelby
Union
Champaign
Licking
Muskingum
Franklin
Clark
Montgomery
Fairfield
Greene
Warren
Jefferson
Harrison
Guernsey
Belmont
Hocking
Pike
Adams
Washington
Athens
Vinton
Highland
Clermont
Monroe
Morgan
Ross
Brown
Carroll
Tuscarawas
Noble
Perry
Pickaway
Clinton
Hamilton
Columbiana
Madison
Fayette
Butler
Stark
Coshocton
Delaware
Miami
Preble
Summit Portage
Mahoning
Allen
Darke
Trumbull
Hancock
Van Wert
Mercer
Lorain
Scioto
Meigs
Jackson
Gallia
Lawrence
Source: Counties designated as rural, partially rural, or urban
under the definition used by the federal Office of Rural Health Policy, 9/2009
Rural County
Partially Rural County
Urban County
Appalachia
Rural Ohio
 72 of Ohio’s 88 counties are considered rural
or partially rural
 32 counties in southeast Ohio make up the
state’s Appalachian region
 Approximately 24% of Ohio’s residents live in
rural areas and the remaining 76% reside in
urban areas
Why Define Rural?
 Eligibility for federal rural grant programs
 Implementation of programs and/or laws
 Research purposes to allow for statistical
consistency
Regional Comparison Rural Health
Grants
 Ohio - $22,653,160
 Michigan - $72,315,051
 Pennsylvania - $18,973,046
 Indiana - $12,301,109
 West Virginia - $28,616,136
 Kentucky - $30,531,145
Health Status and
Health Care Access
Rural Populations and Chronic
Disease
 Rural populations have higher rates of:




Hypertension
Heart disease
Cancer
Stroke
Health Risk Factors
 Rural populations report higher rates of:



Cigarette smoking
Obesity
Physical inactivity
Rural Health Access Issues






Chronic shortages of providers
Aging population
Increased reliance on Medicare and Medicaid
Inadequate transportation
Poverty/rural economic decline
Rural consumers going “urban” for health care
services
Ohio HPSA Map
3
C
6
10
ASHTABULA
LAKE
LUCAS
FULTON
3
OTTAWA
WOOD
HENRY
SANDUSKY
PAULDING
PORTAGE
MEDINA
ASHLAND
CRAWFORD
WYANDOT
HARDIN
STARK
C
2C
HOLMES
MORROW
CARROLL
TUSCARAWAS
KNOX
LOGAN
UNION
HARRISON
HARRISON
COSHOCTON
DELAWARE
CHAMPAIGN
MIAMI
FRANKLIN
LICKING
MUSKINGUM
C
MADISON
MONTGOMERY
NOBLE
PERRY
FAIRFIELD
PICKAWAY
MORGAN
HOCKING
BUTLER
CLINTON
ROSS
2C
HAMILTON
MONROE
C
GREENE
FAYETTE
WARREN
BELMONT
GUERNSEY
CLARK
4
COLUMBIANA
WAYNE
MARION
AUGLAIZE
DARKE
PREBLE
SUMMIT
MAHONING
ALLEN
SHELBY
TRUMBULL
HANCOCK
VAN WERT
MERCER
LORAIN
HURON
SENECA
PUTNAM
CUYAHOGA
ERIE
RICHLAND
DEFIANCE
GEAUGA
JEFFERSON
WILLIAMS
WASHINGTON
ATHENS
VINTON
HIGHLAND
CLERMONT
PIKE
6
BROWN
h
ADAMS
SCIOTO
= Geographic HPSA
MEIGS
JACKSON
= Special Population HPSA
GALLIA
C
C
= Facility HPSA
LAWRENCE
Source: Ohio Department of Health,
Primary Care Office, Sept. 2010
= Correctional Facility HPSA
Rural Access Barriers
 Financial
 Geographic
 Organizational/Availability
 Sociological/Acceptability
Rural Health System Plays Major
Economic Role
 Not only do rural health systems have an
important role in health care delivery, they
also have an important economic role
 Health sector often largest employer in
rural counties
 However, most rural residents have little idea
of the importance of the health sector to the
economy
Health care
safety net
Urban vs. Rural “Safety Net”
 Safety Net: Web of health care professionals and
institutions that provide care to the poor and
uninsured, regardless of ability to pay
 Urban systems:


Often depend heavily on teaching hospitals and
professional educational programs that use
trainees to care for low-income patients
Also include health centers and homeless centers
 Rural systems:

Generally do not have these types of resources
Rural Safety Net
 Instead, the rural safety net depends upon a
variety of different individual providers and
provider types:
Rural hospitals
 Rural Health Clinics
 Community Health Centers (e.g. FQHCs)
 Public health departments
 Private practitioners

Ohio’s CAHs, FQHCs, and RHCs
Source: Ohio Department of Health,
State Office of Rural Health, July 2010
Successful Collaborations
 Galion Community Hospital

Needs assessment with broad community
support and involvement
 CAO of Scioto County Health Clinic

Expanded services for low-income women
 Knox County Health Department

Maintenance of a community-wide wellness
coalition
Additional Resources
 Federal Office of Rural Health Policy, HRSA

www.ruralhealth.hrsa.gov
 Rural Assistance Center

www.raconline.org
 National Rural Health Resource Center
 www.ruralcenter.org
For More Information
Heather Reed, Administrator
Primary Care and Rural Health Program
Ohio Department of Health
246 North High Street, 6th Floor
Columbus, OH 43215
(614) 752-8935 Phone
(614) 995-4235 Fax
heather.reed@odh.ohio.gov