Rural Health Problems Research Articles

Rural health efforts in the urban-dominated political economy: three Third World examples.

The theme of this paper is to demonstrate that the urban preference in governmental health delivery programs does exists in capitalist and socialist political economies and that efficient rural health programs exist in capitalist and socialist developing countries. The purpose of the article is to determine strategies to promote accessible rural health care by studying 3 examples. In the State of Kerala, India between 1956-1959, land reforms were carried out, and political parties and agrarian cooperatives involving rural people were organized. rural needs were given top priority in this capitalist economy which resulted in agrarian reform, education, and health delivery. In 1971, food production increased to 5.4 million tons. During this period, the nutritional status rose, the mortality rated declined, and the fertility rates decreased. Thus, the health status for the rural population improved. Bolivia's Montero health program was developed in 1975. This case demonstrates the urban/rural conflict in a capitalist economy with preference given to the urban side. This proposed health program resulted in the urban communities receiving greater resources compared to the rural population. This result is attributed to lack of organization within the rural population. The final case examined was Nicaragua which in 1979 was socialist. The National Unified Health System was established by the Sandinistas and had 4 priorities: revolution defense, economy, education, and health. This movement by the Sandinistas addressed rural health problems and challenged the urban medical organization. Health care workers were trained to deliver more curative and preventative services. The Popular Health Councils in Nicaragua is unique; it provides discussion regarding the urban/rural conflict. A change in the Minister of Health also indicated concern for rural health care delivery. Nicaragua's health status also improved as a result of rural organization. From the 3 cases, it was concluded that revolutions, reforms, and education were effective strategies in improving the health status in rural populations.

A Comparative Analysis of Rural and Urban Mortality in Georgia, 1979

This paper examines the relationship between mortality and ruralness in the state of Georgia. In 1979, the rural Standardized Mortality Ratio (SMR) for deaths from all causes was significantly higher than expected when compared to statewide levels, while the urban SMR was significantly lower (p less than 0.01). Of the 13 leading causes of death, 9 had rural SMRs significantly higher than expected, while only homicide had a significantly greater urban SMR (p less than 0.01). Although much of the rural/urban difference in overall mortality is attributed to the fact that the rural population is older, figures adjusted for age and race still reveal that the rural death rate is significantly higher than the urban rate (p less than 0.01). Furthermore, there are several specific differences when analyzed by cause of death, age, and race that remain unexplained. Specific rural health problems include congenital anomalies, motor vehicle and other accidents, heart disease, and cerebrovascular disease. Specific urban health problems include homicides and cancer. In addition to metropolitan status, a second indicator of ruralness, county population size, was used to analyze the data and produced similar results. As county population size increases, the total mortality decreases.

Problems in, and Prospects for, Rural Mental Health Services in the United States

We shall examine current rural mental health services delivery in terms of three issues, or themes: (1) organization and management; (2) recruitment, retention, and staffing; and (3) relationships with the community. In addition, we shall consider some of the future directions and problems faced by rural mental health planners and practitioners in light of the current retrenchment and realignment of federal health and human services programs. Before doing this, however, let us outline some key aspects of rural health and human service problems and population dynamics.

Leptospirosis in Dairy Farmers: Prevention by Vaccination of Cattle

Abstract Extract Sir-The high incidence of leptospirosis in dairy farm workers is an important and continuing rural public health problem in New Zealand.(1) It has been suggested that vaccination of dairy cattle against Leptospira interrogans serovar hardjo and pomona infection will prevent milkers becoming infected.(4) We would like to report on a study of the protective effects on humans of such a vaccination programme in which a statistically significant (P=0.05, Fisher's exact test) effect was demonstrated. We also wish to draw attention to some aspects observed both in this study and in other surveys in the Waikato area conducted by one of us (T.J .R. ) which we consider could lead to unsatisfactory levels of protection.

Swamp rice development, schistosomiasis, and onchocerciasis in Southeast Sierra Leone.

Seventy-four villages in eastern Sierra Leone, West Africa, many having a recently developed rice swamp, were surveyed for the presence of schistosomiasis and onchocerciasis, and their vectors. Prevalence rates for Schistosoma haematobium and S. mansoni were low, although the infections were widespread. There is some evidence that S. mansoni is extending its range in Sierra Leone although this is problematical because of the apparent absence of Biomphalaria pfeifferi, the recognized snail vector, from areas where the disease now occurs. The characteristics of rice swamp environment now being created in Sierra Leone are described and results of snail collections, which were with few exceptions small, are presented. Reasons for the apparent unsuitability of the developed rice swamp as a snail habitat are discussed. Onchocerciasis was found in all villages and the prevalence rate, almost 50%, was high. The rice swamp is not a suitable breeding site for Simulium damnosum s.l., but the study area is crossed by several major rivers and all villages in the area are within flying distance of potential breeding sites. There was no positive evidence that expansion of swamp rice farming will increase the incidence of water based/related diseases but a control program for onchocerciasis, which is a major rural health problem, would seem to be a national priority.

Barefoot doctors: symptom not cure

Shortly after the government took office in April 1977 Raj Narain the then Janata Health Minister announced a new policy for health care in India. The government proposed that each village with a population of 1000 would select its own community health worker (CHW). This person would receive three months training in elementary health care. The CHW was expected to become a "peoples health guard" a representative of the community on health matters. The CHW would essentially be an agent for health education inculcating better nutritional practices and mobilizing the community on such issues as environmental sanitation immunisation and family planning. In only 6 months of Mr. Narains tenure his Ministry initiated the worlds biggest effort to train "barefoot doctors" outside of China. The primary objective is to train over 500000 CHWs by the end of the current 5-year plan (1978-1983). The first type of criticism of this program has come primarily from the powerful lobby of physicians who claim that the CHWs will do great harm by handing out medicines in inadequate dosages. They argue also that India has a large number on unemployed physicians and the government should first act to employ this group. Those sympathetic to the plan also identify several flaws including the fact that the training of the CHWs has been left to primary health care doctors who in the past have shown little interest in rural health problems. Th Indian CHW is primarily a pill-pusher and the question arises as to their capability to handle that job. Ministry of Health officials maintain that CHWs have been particularly helpful in providing treatment for minor ailments in distributing eye ointments in disinfecting drinking water wells by chlorination and in some areas in motivating couples to use family planning methods.

International health technology exchange. A multidirectional and multidisciplinary road.

The U.S. and developing countries are participating in an international multidirectional and multidisciplinary exchange of health technology to an unprecedented degree. The information flow is not only from greater to lesser developed countries; it occurs between developing nations and from developing nations to industrialized countries as well. Thus techniques and concepts established in African Asian and Latin American countries have been applied directly to solution of rural and urban health problems in the U.S. Successful international health technology exchange principles include: 1) emphasis on prevention; 2) a multidisciplinary and integrated organizational approach; 3) active community participation; 4) a proper mix of professionals and specially trained paraprofessionals; 5) training programs for health care personnel; 6) self-help health education for community members; 7) infrastructure development and program management; 8) evaluation; 9) legislation giving authority for health systems; and 10) coordination and cooperation among assisting organizations. The Gondar Public Health College and Training Center in Ethiopia and the Danfa Comprehensive Rural Health and Family Planning Project in Ghana are cited as organizations which apply these principles. The Gondar project was based on the ideas of training health officers community nurses and sanitarians in the same institution emphasizing the importance of preventive medicine and stressing a teamwork approach in operating rural health centers. The Danfa project which assisted the government in increasing the effectiveness of primary health care also adhered to these principles with special emphasis on training both locally and overseas.

Rural Health Problems in Developing Countries : The Need for a Comprehensive Community Approach

Rural Health Problems in Developing Countries : The Need for a Comprehensive Community Approach

Health manpower development and rural services

Last year at the 25th National Conference in San Francisco, Dr. Merlin K. DuVal, then Assistant Secretary for Health and Scientific Affairs, concluded his report by saying that "solutions to rural health problems can be found. In turn, government will do its part."¹ Recent federal priority and budget shifts, however, suggest a prior question and answer. Government—who? The government is you. You recall the oft-quoted statement in Kennedy's 1961 Inaugural Address: "Ask not what your country can do for you; ask what you can do for your country." Our country is vast: it was not clear to many just how that noble purpose could be put into practice. The new federalism makes the idea much clearer—"Ask not what your country can do for you; ask rather what you can do for yourself." Laws are not intrinsically good; they represent the breakdown of community and social process and indicate the

Health Manpower Development and Rural Services

Last year at the 25th National Conference in San Francisco, Dr. Merlin K. DuVal, then Assistant Secretary for Health and Scientific Affairs, concluded his report by saying that solutions to rural health problems can be found. In turn, government will do its part. 1 Recent federal priority and budget shifts, however, suggest a prior question and answer. Government—who? The government is you. You recall the oft-quoted statement in Kennedy's 1961 Inaugural Address: Ask not what your country can do for you; ask what you can do for your country. Our country is vast: it was not clear to many just how that noble purpose could be put into practice. The new federalism makes the idea much clearer—Ask not what your country can do for you; ask rather what you can do for yourself. Laws are not intrinsically good; they represent the breakdown of community and social process and indicate the

Latin American experience related to the solution of rural health problems in the United States.

Latin American experience related to the solution of rural health problems in the United States.

Mobile units: a solution to the rural health problem?

The fundamental problem of rural health is the extremely low density of health professionals per unit of surface area, resulting in large distances between patient and services. To deliver services in rural areas either stationary facilities or mobile units can be used. The underdeveloped world has had considerable experience with different varieties of mobile units. From this experience, certain principles can be derived which are useful in choosing between stationary and mobile facilities for specific situations. The first consideration is the geographic-demographic layout. Second is the type of health service desired, with mobile units most applicable to periodic health services employing simple facilities, but not desirable for comprehensive care. The third factor in deciding between stationary and mobile systems is the determination of which provides more benefits per cost. Whereas mobile units are an attractive method for rural health service delivery, stationary facilities are often preferable.

HEALTH PROBLEMS IN RURAL AMERICA

A recent survey by the AMA Council on Rural Health of health educators and home economics leaders in 44 State cooperative extension services indicates that water pollution and sanitation are the primary rural health problems. Assurance of an ample supply of uncontaminated water for family and farm use is an increasing problem, not only in rural fringe areas near suburban developments but also in the more remote farm areas. Smaller towns have had less experience in dealing with such problems and are less likely to have well-developed planning and zoning programs. In addition, in many instances they fail to enforce existing zoning regulations without fully considering the consequences of such laxity. The need for health education was the second most urgent problem highlighted in the AMA survey. Health education can keep the people alert to medical developments and encourage the wisest use of these advances. Education can also develop willingness

Special Health Problems of Negroes in Rural Areas

The purpose or function of public health activities is to strengthen and save human life in order that this life may be used for the advancement of the community and nation. This paper is confined to a consideration of the rural health problems as they affect the Negro, and to giving some explanation and recommendations for improving these problems. The factual data for this paper are obtained from a study of the 1920 and 1930 United States Census reports, various bulletins of the United States Public Health Service, the records of the United States Department of Education, and different sociological studies in which factors of maladjustment are considered. To these data have been added the annual reports of nine different Southern states; records from the John A. Andrew Memorial Hospital, in Tuskegee, Alabama; the annual reports of certain agencies such as the Rockefeller Foundation, and several survey pamphlets; including our own, and those from the States of Tennessee and Alabama. A large variety of material has been received from various county and state health officers in response to our questions concerning their local rural health problems. The major health problems of the rural Negro are chiefly those of the Cotton Belt farmer who raises cotton, corn, and molasses cane. The Negro's relationship to the farm is primarily that of share-cropper or day wage hand. These are the two lowest rungs of the rural socio-economic ladder. There are certain areas of exception, such as the Eastern Shore area of Maryland, the farms of Southwestern Kansas, the tobacco plantations of North Carolina, and the rural peach industry of Georgia. Since there are many Negroes who live in small towns of approximately 2,500 but who work on the farm, chiefly as day laborers, and whose living environment is primarily that of the farmer, an estimate of 17 per cent can be added to the regular rural percentage. This gives 73.3 per cent of the Negro population which is affected directly by rural health problems. In the 1935 state census and estimates, it was reported that of the 5,503,000 Negroes 10 years old and over in the United States who were gainfully employed, one-third of that number was employed in agriculture. The percentage of Negroes so employed varied necessarily with the states. In the State of Mississippi, for example, 60 per cent of the total population are Negroes; and 72 per cent of all the Negroes in that state 10 years old and over who are gainfully employed are engaged in agriculturerural employment. In some counties

An Approach to a Rural Mental Health Problem

An Approach to a Rural Mental Health Problem

Rural Health Problems, the Problems Themselves, and Their Control

Rural Health Problems, the Problems Themselves, and Their Control

The Family Survey as a Method of Studying Rural Health Problems: Brunswick-Greensville Health Administration Studies No. 3

The Family Survey as a Method of Studying Rural Health Problems: Brunswick-Greensville Health Administration Studies No. 3