A National Agenda for Rural Minority Health

An Issue Paper Prepared by the National Rural Health Association -- May 1999

In partnership with President Clinton's Initiative on Race, which has already made a national commitment to eliminate racial and ethnic disparities in six areas of health status for racial and ethnic minority populations by the year 2010, the NRHA in 1997 developed A National Agenda for Rural Minority Health. The purpose of this agenda is to address access gaps and the growing disparities in health status indicators for rural minority populations. The agenda is organized and developed around three priority areas:

• information and data;
• health policy and practices; and
• health delivery systems.

The three priority areas are presented within the agenda as part of a strategic plan of action that includes objectives and implementation strategies. Also included is the process for identifying partners to participate in the agenda's formulation, implementation and evaluation steps, all of which are a necessary part of a national policy or issue of focus. The agenda is intended to serve as a document that can be used in a prescriptive manner by state and local health and health-related agencies for setting priorities and community funding for major rural minority health initiatives. It includes specifically focused vision statements and implementation strategies for use by multigenerational, rural minority communities into the next millennium. In keeping with the President's Initiative on Race, which sets a goal of "One America in the 21st Century," the NRHA believes we must prepare to live as one nation in the coming new century, with equal health status outcomes and expectations.

THE VALUE OF A NATIONAL AGENDA FOR RURAL MINORITY HEALTH

In 1993, a charge was given to the NRHA by the Rural Minority Health Advisory Committee to develop a dynamic document that could be implemented for the next five or more years-however long it takes to bring the changes to fruition. This process resulted in the following overarching values of a health care delivery system on which the agenda is based.

• Community Based. Accessible to the community being served by being within reach during times of need, the community-based health care system is equitably distributed and universally available in all areas.
• Culturally and Linguistically Competent. The culturally competent system is responsive in its staffing, health care delivery and personal interactions with patient groups, using ways that are familiar and comfortable to them. It is also sensitive to cultural differences and modifies practices to incorporate those differences, integrating traditional and western medicine as appropriate. It is flexible, creative and resourceful in providing care within the constraints of limited health care resources and involves patients and families in the decision-making process.
• Comprehensive. The mix of health care modalities, services and personnel must be commensurate with identified needs, health status indicators and demographics of the community being served.
• Creative. New and different solutions will recognize the unique needs, capacities and strengths of different populations, even within the same rural minority group.
• Community Involvement. The development of policies and programs should involve the active participation of rural minority communities and their representatives. Inclusion of community members in the process is necessary to identify emerging needs and health care problems as well as to facilitate the incorporation of traditional and western practices.
• Cost Effective. Access must be affordable through the allocation of funding to pay for reasonable health care services. Further, it must be distributed in ways that are designed to overcome disparities to bring at-risk populations up to a level of health care and quality of life comparable to the population at large.

This value system serves as the framework on which the agenda's three priority areas are structured. These values also will serve to guide the final plan development and implementation process. Strategies that involve resources from sponsoring and funding agencies or interest groups, or administrative, technical and budgetary support to enact this agenda must incorporate these values as well. As we move forward into the 21st century, we must have clearly defined values and goals as well as commonly held ideals that will prepare our country to live as one nation.

THE THREE PRIORITY AREAS OF THE AGENDA

The structures of A National Agenda for Rural Minority Health are linked to three priority areas. This paper summarizes these areas of the agenda.

Information and Data
Currently there are sparse and inconsistent health-related data on rural minority populations. To reduce health disparities, there must be adequate data concerning the health status, health care patterns of utilization, health care financing and health outcomes for all rural and ethnic minority populations. Action steps recommended to facilitate these needs follow.

1. Rural minority communities will routinely participate in the planning of data collection in all aspects concerning health, illness and the health care system.
2. Rural minority communities will actively participate in interpreting and using data to plan changes and make decisions concerning all health-related issues in their communities.
3. Data collection systems will incorporate core data sets and employ uniform definitions for relevant terms to facilitate information sharing and comparisons among and across minority populations and nonminority populations as well.
4. Data analysis and interpretation of findings will reflect sensitivity to the unique cultural attributes of the population on which data are being collected and used.

Health Policy and Practices
The goal is to achieve a system of health care that provides comprehensive health care services for multigenerational, rural minority populations. As part of the President's Initiative on Race, the elimination of health disparities has been formally acknowledged as a policy issue of top priority. The agenda recommends the following.

1. Policies should be developed at the state, local and national levels that ensure access to comprehensive health services regardless of ability to pay or immigration status.
2. Given the higher degree of uninsurance in both rural and minority populations, to improve the health status of these populations it is imperative that all people in America be covered by health insurance.
3. All providers throughout the health care system must practice preventive measures and include wellness concepts by providing health education to all patients. There should be means to ensure adequate funding of health education and other enabling services.
4. Health systems and professionals will focus on prevention and wellness concepts by advocating lifestyle modifications and regular physical checkups.
5. Measurement of comprehensiveness of health services will be provided by monitoring access to essential services as well as the types of services that are affordable to rural minority populations and by evaluating the quality of care being provided.

Health Delivery Systems
It is necessary to view health care as a right, not a privilege. Primary health care delivery systems must be developed that not only eliminate health disparities in six areas of health status for racial and ethnic minority populations, but also substantially improve the health status of these populations. To do so, health care services must be:

1. linguistically and culturally appropriate for the community;
2. based on the assessed needs of the community;
3. responsive to the community's input;
4. linked to other health and community systems;
5. cost effective;
6. accessible to all rural minority populations; and
7. situated within an integrated network of health services and systems.

SUMMARY

The NRHA will work to further develop and implement A National Agenda for Rural Minority Health. Due to the President's Initiative on Race and the national mandate to eliminate health disparities by 2010 in six areas of health among racial and ethnic minority populations, the NRHA believes that now and into the coming 21st century, the time is appropriate to move this agenda forward. Clearly, with such a mandate for change and a national policy issue acting as a guiding force for the nation, A National Agenda for Rural Minority Health that begins to address the question of "how" is an important component in meeting the goal of "One America in the 21st Century."

In August 1998, the NRHA's Rural Minority Health Committee identified health professions as a fourth priority area to be addressed. To more effectively detail A National Agenda for Rural Minority Health, a series of four issue papers focusing on each of the four priority areas of the agenda will be written in the future. These papers are:

• information and data;
• health policy and practices;
• health delivery systems; and
• health professions.