Beyond Access and Infrastructure

Mental Health Policy Development in the States: The Piecemeal Nature of Transformational Change

Unhealthy diets contribute to one in every five deaths in the United States, yet federal policy action to improve dietary quality has been limited. We argue that researchers and advocates should engage in state and local food policymaking, which offers an important complementary avenue for creating healthier food environments and improving diet quality. We outline key questions researchers can address to inform local and state policymaking and provide practical tips on how they can engage with the policy process. Finally, we present a case study of researcher engagement with the New York City Sweet Truth Act policy process.

Changing the health care workforce: lessons from foundation-sponsored programs.

Addressing the health information needs of diverse, multiethnic, and multilingual communities can be both a challenge and an opportunity for libraries. The Vera P. Shiffman Medical Library at Wayne State University in Detroit, Michigan, is the only academic medical library in the Detroit area open to the public. The library provides services to many communities in southeastern Michigan. The diverse geographic area served by the library includes the nation's highest concentration of Arab Americans [1]. A review of the literature reveals that limited research has addressed how libraries can meet the health information needs of this target community [2]. An understanding of the health information needs of Arab Americans in Michigan, and in the United States, will be increasingly important for libraries responsible for providing library services for and developing resources to meet the needs of Arab American health consumers and to improve the quality of information available to health professionals serving these communities. Chief among the concerns of the library was to increase the relevance and usability of information for health professionals providing health-related services to local Arab, Muslim, and Chaldean American communities in Michigan. A key strategy of this initiative was to establish relationships with organizations that served this target population. The Urban Health Partners program, begun in 2003 and continuing through the present, was launched by establishing partnerships with a health department and a community-based organization serving these communities. The program described here is an important building block for achieving a greater understanding of how information is needed and used in different settings and by different groups of people.

Inadequate access to anesthesia and surgical services is often considered to be a problem of low- and middle-income countries. However, affluent nations, including Canada, Australia, and the United States, also face shortages of anesthesia and surgical care in rural and remote communities. Inadequate services often disproportionately affect indigenous populations. A lack of anesthesia care providers has been identified as a major contributing factor to the shortfall of surgical and obstetrical care in rural and remote areas of these countries. This report summarizes the challenges facing the provision of anesthesia services in rural and remote regions. The current landscape of anesthesia providers and their training is described. We also explore innovative strategies and emerging technologies that could better support physician-led anesthesia care teams working in rural and remote areas. Ultimately, we believe that it is the responsibility of specialist anesthesiologists and academic health sciences centers to facilitate access to high-quality care through partnership with other stakeholders. Professional medical organizations also play an important role in ensuring the quality of care and continuing professional development. Enhanced collaboration between academic anesthesiologists and other stakeholders is required to meet the challenge issued by the World Health Organization to ensure access to essential anesthesia and surgical services for all.

Health and healthcare are increasingly dependent on internet and digital solutions. Medically underserved communities that experience health disparities are often those who are burdened by digital disparities. While digital equity and digital health equity are national priorities, there is limited evidence about how community-based organizations (CBOs) consider and develop interventions. We conducted key informant interviews in 2022 purposively recruiting from health and welfare organizations engaged in digital equity work. Nineteen individuals from 13 organizations serving rural and/or urban communities from the local to national level participated in semi-structured interviews via Zoom regarding their perspectives on digital health equity interventions. Directed content analysis of verbatim interview transcripts was conducted to identify themes. Themes emerged at individual, organizational, and societal levels. Individual level themes included potential benefits from digital health equity, internet access challenges, and the need for access to devices and digital literacy. Organizational level themes included leveraging community assets, promising organizational practices and challenges. For the societal level, the shifting complexity of the digital equity ecosystem, policy issues, and data for needs assessment and evaluation were described. Several example case studies describing these themes were provided. Digital health equity interventions are complex, multi-level endeavors. Clear elucidation of the individual, organizational, and societal level factors that may impact digital health equity interventions are necessary to understanding if and how CBOs participate in such initiatives. This study presents unique perspectives directly from CBOs driving programs in this new arena of digital health equity.

Afterschool centers in four rural communities in Michigan

A Comparison of Assertive Community Treatment and Intensive Case Management for Patients in Rural Areas

The 11th Australian Rural and Remote Mental Health Symposium Communiqué.

An unexpected digital divide? A look at internet speeds and socioeconomic groups

Rural regions and communities have changed dramatically over the last decade, affected by increased in-migration, changing age and ethnic composition, and related social and economic restructuring. Such trends encompass all components of demographic change and directly affect employment opportunities, human capital development, land use, and social and economic well-being in rural America. All Americans’ well-being depends upon many things: availability of good-paying jobs; access to critical services, such as education and health care; technology; transportation and communication infrastructure; strong communities; and a healthy natural environment. But the challenges for achieving these goals differ considerably in rural and urban areas (Brown & Swanson, 2003; Center for the Study of Rural America, 2000; Christenson & Flora, 1991; Dillman & Hobbs, 1982; Economic Research Service, 1988, 1995; Southern Rural Development Center, 2003). The research presented in this volume focuses on population change and the diverse needs of rural areas in an effort to further social science research on population and society interdependencies and to provide federal, state, and local policymakers with sound empirical analysis to develop strategies that enhance social and economic opportunities of rural Americans. This chapter summarizes some of the public policy implications of key findings presented in this volume as well as in other recent studies on rural communities. Population change and diversity of need underscore many of the economic, political, and geographic changes occurring in rural America. Declines in agricultural jobs, particularly in the Midwest, have forced many families to leave rural communities to seek new sources of income. Remaining small farmers now rely more on off-farm work than farm work for the largest share of their support. Declining populations and small-scale, low-density settlement patterns have made it more costly for some rural communities and businesses to provide critical services and infrastructure. And changes in the use of natural resources, such as the conversion of farmland to urban activities or the economic development of recreation and high-amenity areas, affect the people who earn a living from these resources,

While the vast majority of residents in cities have access to the internet at home, many remain under-connected due to limited data or speed, cost barriers, insufficient digital devices or lack of tech support or digital skills. This negatively impacts the economic mobility, academic performance and social inclusion of low-income students and families. This chapter provides examples of how six cities in the United States have successfully addressed these challenges. All six cities meet the criteria of a technopolis, and each leveraged the strength offered by a technopolis through the development of innovative local policies and collaborative community action. The chapter also describes how policies developed at the state and national level may support technopolis cities in their efforts to move toward digital equity.

Measuring county-level immigration policy contexts that may influence Latino health in California.

Promoting tobacco control policies in rural tobacco-growing communities presents unique challenges. The purpose of this study was to assess smoke-free coalition cohesiveness in rural communities and identify coalition members' perceived barriers or divisive issues that impede the development of smoke-free policies. A secondary aim was to evaluate differences in coalition cohesiveness between advocates in communities receiving stage-based, tailored policy advocacy assistance versus those without assistance. Tobacco control advocates from 40 rural Kentucky communities were interviewed by telephone during the final wave of a 5-year longitudinal study of community readiness for smoke-free policy. On average, five health advocates per county participated in the 45-min interview. Participants rated coalition cohesiveness as not at all cohesive, somewhat cohesive, or very cohesive, and answered one open-ended question about potentially divisive issues within their coalitions. The mean age of the 186 participants was 48.1 years (SD = 13.3). The sample was predominantly female (83.6%) and Caucasian (99.5%). Divisive concerns ranged from rights issues, member characteristics, type of law, and whether or not to allow certain exemptions. Three of the divisive concerns were significantly associated with their rankings of coalition cohesiveness: raising tobacco in the community, the belief that smoke-free would adversely affect the economy, and government control. Educating coalition members on the economics of smoke-free laws and the actual economic impact on tobacco-growing may promote smoke-free coalition cohesiveness. More resources are needed to support policy advocacy in rural tobacco-growing communities as well as efforts to reduce the divisive concerns reported in this study.

Medicaid can and should play an active role in advancing health equity.