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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.
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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.
At the turn of the millennium, the disparities between rural and urban livelihoods, underdevelopment and administrative shortcomings in the Chinese countryside were increasingly seen as posing a manifest threat to social harmony and economic and political stability. At that time the term "three rural problems" (sannong wenti) was coined which defined the main issues of rural life that needed to be targeted by government action: agriculture (nongye), villages (nongcun) and farmers (nongmin). In turn, with the launch of the 11th Five-Year Plan in 2006, a pledge was made to shift the focus of developmental efforts to the long-neglected countryside, which is still home to half of the Chinese population. This book presents an analysis of adaptive local policy implementation in China in the context of the "Building of a New Socialist Countryside" (BNSC) policy framework. Based on intensive field work in four counties in Fujian, Jiangxi, Shaanxi and Zhejiang Provinces between 2008 and 2011, it offers detailed analyses of the form and impact of county governments’ strategic agency at certain stages and within certain fields of the implementation process (for example, the design of local BNSC programs, the steering of project funding, implementation and evaluation, the establishment of model villages and the management of public participation). Further, this study illustrates that BNSC is far more than the ‘empty slogan’ described by many observers when it was launched in 2005/2006. Instead, it has already brought about considerable shifts in terms of the process and outcomes of rural policy implementation. Altogether, the results of this research challenge existing paradigms by showing how, against the background of contemporary approaches to rural development and recent reforms initiated by the central state, local bureaucracies’ strategic agency can actually push forward effective – albeit not necessarily optimal – policy implementation to some extent, which serves the interests of central authorities, local implementors and rural residents. By tying into the larger debates on China's state capacity and authoritarian adaptability, this book enriches our understanding of the inner workings of the Chinese political system. As such, it will prove invaluable to students and scholars of Chinese politics, public policy and development studies more generally.
This book investigates the role of wealth in achieving sustainable rural economic development. The authors define wealth as all assets net of liabilities that can contribute to well-being, and they provide examples of many forms of capital – physical, financial, human, natural, social, and others. They propose a conceptual framework for rural wealth creation that considers how multiple forms of wealth provide opportunities for rural development, and how development strategies affect the dynamics of wealth. They also provide a new accounting framework for measuring wealth stocks and flows. These conceptual frameworks are employed in case study chapters on measuring rural wealth and on rural wealth creation strategies. Rural Wealth Creation makes numerous contributions to research on sustainable rural development. Important distinctions are drawn to help guide wealth measurement, such as the difference between the wealth located within a region and the wealth owned by residents of a region, and privately owned versus publicly owned wealth. Case study chapters illustrate these distinctions and demonstrate how different forms of wealth can be measured. Several key hypotheses are proposed about the process of rural wealth creation, and these are investigated by case study chapters assessing common rural development strategies, such as promoting rural energy industries and amenity-based development. Based on these case studies, a typology of rural wealth creation strategies is proposed and an approach to mapping the potential of such strategies in different contexts is demonstrated. This book will be relevant to students, researchers, and policy makers looking at rural community development, sustainable economic development, and wealth measurement.
America's rural areas have always held a disproportionate share of the nation's poorest populations. Rural Poverty in the United States examines why. What is it about the geography, demography, and history of rural communities that keeps them poor? In a comprehensive analysis that extends from the Civil War to the present, Rural Poverty in the United States looks at access to human and social capital; food security; healthcare and the environment; homelessness; gender roles and relations; racial inequalities; and immigration trends to isolate the underlying causes of persistent rural poverty. Contributors to this volume incorporate approaches from multiple disciplines, including sociology, economics, demography, race and gender studies, public health, education, criminal justice, social welfare, and other social science fields. They take a hard look at current and past programs to alleviate rural poverty and use their failures to suggest alternatives that could improve the well-being of rural Americans for years to come. These essays work hard to define rural poverty's specific metrics and markers, a critical step for building better policy and practice. Considering gender, race, and immigration, the book appreciates the overlooked structural and institutional dimensions of ongoing rural poverty and its larger social consequences.
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.