Policy Statement 4 - March 2006
Rural Public Health
A 2000 report by the National Advisory Committee on Rural Health, “Stabilizing the Rural Public Health Infrastructure,” clearly outlined the workforce challenges in rural areas. The movement away from delivering personal healthcare services reduces Medicaid resources needed to support essential public health services. In addition, the loss of personal healthcare services erodes the already crumbling safety net. The report further notes, “The loss of community disease surveillance capacity, lack of oversight over local sanitation, and inadequate assurance of safe food and water supplies are behind many recent, nationally publicized outbreaks of preventable disease, such as hepatitis A and E-coli induced food poisoning and new outbreaks of tuberculosis. The growing prevalence of hepatitis C has put further burden on public health agencies as the number of people affected continues to multiply and practitioners struggle with diagnosing and treating the disease.” This report preceded the events of September 11, 2001. Now there are even greater demands for a strong and prepared public health workforce. Implications for rural public health workforce training and development are significant. While rural public health workers prefer local, in-person instruction to further their degrees, many are taking advantage of distance education and Internet-based learning opportunities that allow them to gain additional training in their rural home communities. Despite this progress, there remains a great need for increased investment in public health educational programs directed toward the current rural public health workforce.
Policy Recommendations:
• The NeRHA believes that all citizens and all communities should have comparable access to agencies and individuals that assure the provision of the essential public health services. Whether provided locally or on a regional basis, by governmental agencies or the private sector, every citizen has the right to expect access to the full complement of essential public health services in their community.
• The NeRHA supports greater flexibility in the use of public health resources to respond to local public health priorities. The current public health system is limited by categorical funding which often forces it to address state and federal priorities rather than local needs. Public health works best when it is responsive to locally identified priorities. Funding streams need to support rather than inhibit this responsiveness.
• The NeRHA recognizes that public health is a common good and that there is a governmental responsibility to assure access to essential public health services in every community. Regardless of who actually provides the service, there is a governmental responsibility to provide oversight and the governmental public health infrastructure must be strengthened to support this role.
• The NeRHA supports efforts to utilize bioterrorism and emergency preparedness resources to build public health capacity in rural areas. It is recognized that rural areas have the potential to be affected by both direct targeting (e.g., agro terrorism) and indirectly as citizens evacuate targeted urban areas. A strong public health infrastructure will be needed to effectively respond to both of these scenarios. Furthermore, a strong public health infrastructure will also serve rural communities in the event of other emergencies such as natural disasters and infectious disease outbreaks, while enhancing the ability to improve community health status through everyday provision of essential public health services.
• The NeRHA supports enhanced training and continuing education of the rural public health workforce accessible to them in their rural communities, and appropriate for their current level of training and experience. A key ingredient to assuring adequate public health services is a competent public health workforce. Whether employed in the public or private sector, public health workers must be well versed in their field.
• The NeRHA supports strengthening communication systems and technological capacities within the rural public health system. In order to effectively manage public health emergencies, conduct disease surveillance, or simply receive up-to-date public health information, rural public health must have access to advanced communications systems and technologies.
