In the United States, some populations suffer from far greater disparities in health than others. Those disparities are caused not only by fundamental differences in health status across segments of the population, but also because of inequities in factors that impact health status, so-called determinants of health. Only part of an individual's health status depends on his or her behavior and choice; community-wide problems like poverty, unemployment, poor education, inadequate housing, poor public transportation, interpersonal violence, and decaying neighborhoods also contribute to health inequities, as well as the historic and ongoing interplay of structures, policies, and norms that shape lives. When these factors are not optimal in a community, it does not mean they are intractable: such inequities can be mitigated by social policies that can shape health in powerful ways. Communities in Action: Pathways to Health Equity seeks to delineate the causes of and the solutions to health inequities in the United States. This report focuses on what communities can do to promote health equity, what actions are needed by the many and varied stakeholders that are part of communities or support them, as well as the root causes and structural barriers that need to be overcome.

In 1996, the Institute of Medicine (IOM) released its report Telemedicine: A Guide to Assessing Telecommunications for Health Care. In that report, the IOM Committee on Evaluating Clinical Applications of Telemedicine found telemedicine is similar in most respects to other technologies for which better evidence of effectiveness is also being demanded. Telemedicine, however, has some special characteristics-shared with information technologies generally-that warrant particular notice from evaluators and decision makers. Since that time, attention to telehealth has continued to grow in both the public and private sectors. Peer-reviewed journals and professional societies are devoted to telehealth, the federal government provides grant funding to promote the use of telehealth, and the private technology industry continues to develop new applications for telehealth. However, barriers remain to the use of telehealth modalities, including issues related to reimbursement, licensure, workforce, and costs. Also, some areas of telehealth have developed a stronger evidence base than others. The Health Resources and Service Administration (HRSA) sponsored the IOM in holding a workshop in Washington, DC, on August 8-9 2012, to examine how the use of telehealth technology can fit into the U.S. health care system. HRSA asked the IOM to focus on the potential for telehealth to serve geographically isolated individuals and extend the reach of scarce resources while also emphasizing the quality and value in the delivery of health care services. This workshop summary discusses the evolution of telehealth since 1996, including the increasing role of the private sector, policies that have promoted or delayed the use of telehealth, and consumer acceptance of telehealth. The Role of Telehealth in an Evolving Health Care Environment: Workshop Summary discusses the current evidence base for telehealth, including available data and gaps in data; discuss how technological developments, including mobile telehealth, electronic intensive care units, remote monitoring, social networking, and wearable devices, in conjunction with the push for electronic health records, is changing the delivery of health care in rural and urban environments. This report also summarizes actions that the U.S. Department of Health and Human Services (HHS) can undertake to further the use of telehealth to improve health care outcomes while controlling costs in the current health care environment.

Accompanying CD-Rom has same title as book.

Klugman and Dalinis initiate a much-needed conversation about the ethical and policy concerns facing health care providers in the rural United States. This volume initiates a much-needed conversation about the ethical and policy concerns facing health care providers in the rural United States. Although 21 percent of the population lives in rural areas, only 11 percent of physicians practice there. What challenges do health care workers face in remote locations? What are the differences between rural and urban health care practices? What particular ethical issues arise in treating residents of small communities? Craig M. Klugman and Pamela M. Dalinis gather philosophers, lawyers, physicians, nurses, and researchers to discuss these and other questions, offering a multidisciplinary overview of rural health care in the United States. Rural practitioners often practice within small, tight-knit communities, socializing with their patients outside the examination room. The residents are more likely to have limited finances and to lack health insurance. Physicians may have insufficient resources to treat their patients, who often have to travel great distances to see a doctor. The first part of the book analyzes the differences between rural and urban cultures and discusses the difficulties in treating patients in rural settings. The second part features the personal narratives of rural health care providers, who share their experiences and insights. The last part introduces unique ethical challenges facing rural health care providers and proposes innovative solutions to those problems. This volume is a useful resource for bioethicists, members of rural bioethics committees and networks, policy makers, teachers of health care providers, and rural practitioners themselves.

Rural counties make up about 80 percent of the land area of the United States, but they contain less than 20 percent of the U.S. population. The relative sparseness of the population in rural areas is one of many factors that influence the health and well-being of rural Americans. Rural areas have histories, economies, and cultures that differ from those of cities and from one rural area to another. Understanding these differences is critical to taking steps to improve health and well-being in rural areas and to reduce health disparities among rural populations. To explore the impacts of economic, demographic, and social issues in rural communities and to learn about asset-based approaches to addressing the associated challenges, the National Academies of Sciences, Engineering, and Medicine held a workshop on June 13, 2017. This publication summarizes the presentations and discussions from the workshop.

"[A] welcome addition to the rural health care practitioner's tool kit. It will energize those interested in vulnerable rural residents and their unique characteristics through a public health perspective... Highly recommended."--CHOICE: Current Reviews for Academic Libraries "This call to action for healthcare providers is a comprehensive review of issues in rural healthcare, including both obstacles and ways to begin to overcome them. It is easy to read... This enjoyable book encourages healthcare providers working or considering working in rural healthcare with clear direction."--Doody's Medical Reviews "The Warren & Smalley book is an excellent look at the challenges while also presenting solutions and hope. It recognizes the medical challenges that are present and the cost of bring medical care to these communities... There is so much in this book that will be refreshing and encouraging. The book needs to be read. It is also a book that needs to be placed in the hands of the movers and shakers, as well other interested parties who are in a position to 'make this happen.'" -- Illness, Crisis & Loss Rural residents face distinct health challenges due to economic conditions, cultural/behavioral factors, and health provider shortages that combine to impose striking disparities in health outcomes among rural populations. This comprehensive text about the issues of rural public health is the only book to focus on rural health from the perspectives of public health and prevention. It covers specific diseases and disorders faced by rural populations, service delivery challenges, practitioner shortfalls in rural areas, and promising community health approaches and preventive measures. The text also addresses rural health care ethics and international perspectives. Nearly all chapters offer best practice recommendations and evidence-based prevention programs. This book is a cohesive, centralized resource for researchers, public health practitioners, health organizations, and graduate education programs that focus on the public health of rural populations. Key Features: Comprises the only text to address rural health from the perspectives of public health and prevention Includes best practice recommendations and evidence-based prevention programs in each chapter Presents a cohesive, expansive synthesis of current research and practice Addresses specific diseases and disorders of rural populations, service delivery problems, and practitioner shortfalls in rural areas Discusses promising community health approaches and preventative measures

Rural Health: A Framework for Understanding the Issues and Their Impact on Rural Populations examines the factors that affect health care access and health status of individuals who live in rural areas. The text employs a unique structure called the Rural Health Framework, a methodology created by the authors during their years of teaching rural health at the undergraduate and graduate level. This framework challenges students to collect data and facts about rural areas to help them better understand rural health issues. The book emphasizes the complexity of rural health, the interprofessional nature of rural health care, and the importance of appropriate health care interventions for rural populations. The opening chapter provides readers with an overview of rural health terms and concepts. Additional chapters explore how geographic, economic, sociocultural, demographic, and support factors can impact heath status, access, and outcomes. The final chapter features an array of rural health case assessments to help students connect theory to real-world practice. Offering students an innovative and essential approach, Rural Health is an exemplary resource for courses in nursing, public health, medicine, social work, nutrition, and allied health.

The Social Security Administration (SSA) administers two programs that provide benefits based on disability: the Social Security Disability Insurance (SSDI) program and the Supplemental Security Income (SSI) program. This report analyzes health care utilizations as they relate to impairment severity and SSA's definition of disability. Health Care Utilization as a Proxy in Disability Determination identifies types of utilizations that might be good proxies for "listing-level" severity; that is, what represents an impairment, or combination of impairments, that are severe enough to prevent a person from doing any gainful activity, regardless of age, education, or work experience.

Building on the innovative Institute of Medicine reports To Err Is Human and Crossing the Quality Chasm, Quality Through Collaboration: The Future of Rural Health offers a strategy to address the quality challenges in rural communities. Rural America is a vital, diverse component of the American community, representing nearly 20% of the population of the United States. Rural communities are heterogeneous and differ in population density, remoteness from urban areas, and the cultural norms of the regions of which they are a part. As a result, rural communities range in their demographics and environmental, economic, and social characteristics. These differences influence the magnitude and types of health problems these communities face. Quality Through Collaboration: The Future of Rural Health assesses the quality of health care in rural areas and provides a framework for core set of services and essential infrastructure to deliver those services to rural communities. The book recommends: Adopting an integrated approach to addressing both personal and population health needs Establishing a stronger health care quality improvement support structure to assist rural health systems and professionals Enhancing the human resource capacity of health care professionals in rural communities and expanding the preparedness of rural residents to actively engage in improving their health and health care Assuring that rural health care systems are financially stable Investing in an information and communications technology infrastructure It is critical that existing and new resources be deployed strategically, recognizing the need to improve both the quality of individual-level care and the health of rural communities and populations.

Many of the 61 million people who live in rural America have limited access to health care. Almost a quarter of the nation's population lives in rural places yet only an eighth of our doctors work there. Sponsored by the U.S. Office of Rural Health Policy, this unique book provides the facts about this imbalance and interprets them in the context of government programs that promote the placement of doctors and the operation of hospitals in rural places while paying them less to treat Medicare and Medicaid beneficiaries. The authors' comprehensive analysis of rural health care delivery shows where there are differences in rates of death and disease between rural areas using maps, graphs, and plain-English descriptions. The book provides a thorough look at health care in rural America, giving a snapshot of how doctors, hospitals, and technology are unevenly distributed outside the nation's metropolitan areas.