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Chronic Condition Rates Highest Among Rural Teens

 |  By Alexandra Wilson Pecci  
   November 02, 2011

A report from the Health Resources and Services Administration (HRSA) shows that compared to children in urban areas, children in rural areas have less access to care. The "National Survey of Children's Health (NSCH):  The Health and Well-Being of Children in Rural Areas: A Portrait of the Nation in 2007" also finds that the percentage of children with chronic conditions such as obesity, asthma, and diabetes is highest among teenagers living in small rural areas.

"The primary challenge is a shortage of providers," Tom Morris, associate administrator of the Office of Rural Health Policy, tells HealthLeaders via e-mail. "There are not enough primary care providers compared to urban areas.  Approximately 60% of primary care health professional shortage areas are rural."

But the access problem goes beyond the lack of primary care providers. According to Morris, "there are shortages of pediatricians and also challenges in terms of access to specialized pediatric providers for both primary care, but also in terms of mental and oral health services."

Although children's overall health status didn't vary much by location, other indicators showed significant differences among children living in rural areas. 

"These findings highlight the heterogeneous nature of the pediatric rural population and suggest areas where targeted approaches may be needed to address disparities," Reem M. Ghandour,DrPH, MPA, a public health analyst with HRSA, tells HealthLeaders via e-mail.

For example, Ghandour highlights the following findings:

  • Children in rural areas were more likely to be living in poverty than children in urban areas.  Almost one-quarter of children in both large and small rural areas had household incomes below the federal poverty level compared to 17.4% of urban children. 
  • More than one-third of rural children had public health insurance coverage compared to 27.3% of urban children. 
  • Among children aged 10-17 years, about 35% of rural children were overweight or obese compared to 30.9% of urban children. Rates were highest among poor children in all locations.
  • More than one-third of children in rural areas (33.1% in large rural areas and 35.0% in small rural areas) lived with a smoker compared to one-quarter of urban children.     
  • Urban children were significantly more likely to have ever been breastfed (77%) compared to children in both large and small rural areas (67.6% and 69.8%, respectively).

Although there are rural disparities in some cases, the report showed that in other cases, urban children were worse off. For example, care coordination is a greater challenge for children with special healthcare needs in urban areas, with 58.5% reporting that they received effective care coordination services, compared to 64.2% of those in small rural areas.

Despite the complexity of the issue, when asked what rural hospitals and clinics can do to improve the health of children in their region, Morris' answer was relatively basic.

"Any focus on improving diet and increasing activity can help reduce child obesity and the related diseases such as diabetes," says Morris.

Morris also points to several programs that can help reduce rural disparities.

"The National Health Service Corps, a network of medical, dental and behavioral health professionals in medically underserved areas, tripled in size in the last three years with funding from the Affordable Care Act," he says. He also adds that the CDC just provided funding for the Community Transformation Grant program, which supports community efforts to reduce chronic diseases. 

"This program has a 20% rural funding set-aside in the state awards, and could play a key role in addressing some of the health care challenges facing rural children," he says.

The children's health report, which is published every four years,examined the overall health of rural children in the United States from birth to 17 years. The data comes from the 2007 National Survey of Children's Health, which collected information from parents between April 2007 and July 2008 about more than 91,000 children.

Alexandra Wilson Pecci is an editor for HealthLeaders.

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