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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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The thoroughly revised and updated Third Edition of the acclaimed Modern Epidemiology reflects both the conceptual development of this evolving science and the increasingly focal role that epidemiology plays in dealing with public health and medical problems. Coauthored by three leading epidemiologists, with sixteen additional contributors, this Third Edition is the most comprehensive and cohesive text on the principles and methods of epidemiologic research. The book covers a broad range of concepts and methods, such as basic measures of disease frequency and associations, study design, field methods, threats to validity, and assessing precision. It also covers advanced topics in data analysis such as Bayesian analysis, bias analysis, and hierarchical regression. Chapters examine specific areas of research such as disease surveillance, ecologic studies, social epidemiology, infectious disease epidemiology, genetic and molecular epidemiology, nutritional epidemiology, environmental epidemiology, reproductive epidemiology, and clinical epidemiology.
In the last decade, rural development emerged as one of the prominent challenges facing the United States. Strong support for rural development is now found in both major political parties and at federal, state, and local levels. There is little doubt that the development of rural America will become even more important in the future. Despite unprecedented growth, both urban and rural areas in the United States are greatly deficient in many aspects of quality living conditions. The nation’s cities are slowly strangling themselves, jamming together people and industry while spawning pollution, transportation paralysis, housing blight, lack of privacy, and a crime-infested society. Rural areas simultaneously suffer from the other extreme: lack of sufficient employment opportunities, outmigration and depopulation, and too few people to support services and institutions. The migration from rural areas contributes to the problems of both the city and countryside depopulating rural places at the expense of overcrowded cities. This book focuses on rural development processes, problems, and solutions. Seven prominent specialists in the field, including agricultural and regional economists, demographers, and administrators, discuss the development of the open country, small towns, and smaller cities (up t fifty thousand population). They present an integrated approach to rural development problems, not a mere collection of readings. Valuable guidelines for policies to benefit both rural and urban areas are provided. Since rural development involves interdisciplinary scholarship, this book will be of interest to a wide range of social scientists working in rural areas both here and abroad. Economists, sociologists, and political scientists, as well as community leaders and planners, legislators, government officials and interested laymen, will find this volume useful in understanding the rural development effort. Chapters on the following topics are included: the Philosophy and Process of Community Development; The Emergence of Area Development; Demographic Trends of the U.S. Rural Population; The Conditions and Problems of Nonmetropolitan America; Systems Planning for rural Development; Use of Natural Resources in Community Development; and Rural Poverty and Urban Growth, An Economic Critique of Alternative Spatial Growth Patterns
An analysis of the failure of U.S. broadband policy to solve the rural–urban digital divide, with a proposal for a new national rural broadband plan. As much of daily life migrates online, broadband—high-speed internet connectivity—has become a necessity. The widespread lack of broadband in rural America has created a stark urban–rural digital divide. In Farm Fresh Broadband, Christopher Ali analyzes the promise and the failure of national rural broadband policy in the United States and proposes a new national broadband plan. He examines how broadband policies are enacted and implemented, explores business models for broadband providers, surveys the technologies of rural broadband, and offers case studies of broadband use in the rural Midwest. Ali argues that rural broadband policy is both broken and incomplete: broken because it lacks coordinated federal leadership and incomplete because it fails to recognize the important roles of communities, cooperatives, and local providers in broadband access. For example, existing policies favor large telecommunication companies, crowding out smaller, nimbler providers. Lack of competition drives prices up—rural broadband can cost 37 percent more than urban broadband. The federal government subsidizes rural broadband by approximately $6 billion. Where does the money go? Ali proposes democratizing policy architecture for rural broadband, modeling it after the wiring of rural America for electricity and telephony. Subsidies should be equalized, not just going to big companies. The result would be a multistakeholder system, guided by thoughtful public policy and funded by public and private support.
A new framework for assessing the role of information and communication technologies in development that draws on Amartya Sen's capabilities approach. Information and communication technologies (ICTs)--especially the Internet and the mobile phone--have changed the lives of people all over the world. These changes affect not just the affluent populations of income-rich countries but also disadvantaged people in both global North and South, who may use free Internet access in telecenters and public libraries, chat in cybercafes with distant family members, and receive information by text message or email on their mobile phones. Drawing on Amartya Sen's capabilities approach to development--which shifts the focus from economic growth to a more holistic, freedom-based idea of human development--Dorothea Kleine in Technologies of Choice? examines the relationship between ICTs, choice, and development. Kleine proposes a conceptual framework, the Choice Framework, that can be used to analyze the role of technologies in development processes. She applies the Choice Framework to a case study of microentrepreneurs in a rural community in Chile. Kleine combines ethnographic research at the local level with interviews with national policy makers, to contrast the high ambitions of Chile's pioneering ICT policies with the country's complex social and economic realities. She examines three key policies of Chile's groundbreaking Agenda Digital: public access, digital literacy, and an online procurement system. The policy lesson we can learn from Chile's experience, Kleine concludes, is the necessity of measuring ICT policies against a people-centered understanding of development that has individual and collective choice at its heart.
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.
College Aspirations and Access in Working Class Rural Communities: The Mixed Signals, Challenges, and New Language First-Generation Students Encounter explores how a working class, rural environment influences rural students’ opportunities to pursue higher education and engage in the college choice process. Based on a case study with accounts from rural high school students and counselors, this book examines how these communities perceive higher education and what challenges arise for both rural students and counselors. The book addresses how college knowledge and university jargon illustrate the gap between rural cultural capital and higher education cultural capital. Insights about approaches to reduce barriers created by college knowledge and university jargon are shared and strategies for offering rural students pathways to learn academic language and navigate higher education are presented for both secondary and higher education institutions.