Office of Primary Care and Rural Health:
The Missouri Office of Rural Health (Office) was established by the 1990 General Assembly to “assume a leadership role in working or contracting with state and federal agencies, universities, private interest groups, communities, foundations and local health centers to develop rural health initiatives and maximize the use of existing resources...” Located within the Missouri Department of Health and Senior Services’ Office of Primary Care and Rural Health, the Office reports on current activities and makes recommendations to the Missouri Governor and General Assembly every two years. This report also provides an analysis of the current health of rural Missourians to support those activities and recommendations.
Introduction
The Missouri Office of Rural Health (hereinafter referred to as the “Office”) was established by the 1990 General Assembly to “assume a leadership role in working or contracting with state and federal agencies, universities, private interest groups, communities, foundations and local health centers to develop rural health initiatives and maximize the use of existing resources...” Located within the Department of Health and Senior Services, Office of Primary Care and Rural Health (OPCRH), the Office reports on current activities and makes recommendations to the Missouri Governor and General Assembly every two years.
Defining Rural Missouri
Health in Rural MissouriThe U.S. Census Bureau and various federal agencies use different definitions of rural. Each definition emphasizes different criteria, such as commuting patterns, population size and population density. As a result, different definitions generate different numbers of rural residents. This report defines urban counties as those with a 2013 population density of greater than 150 persons per square mile, plus any county that contains at least part of the central city of a Census-defined Metropolitan Statistical Area (MSA). Using this definition,14 Missouri counties are urban.2 The remaining 101 counties in Missouri are rural.
Demographic and Socioeconomic Indicators
The U.S. Census Bureau estimates the 2013 Missouri resident population to be 6,044,171. Most of Missouri’s population resides in counties designated by this report as urban. The resident population for these counties is estimated to be 3.82 million. Only 2.23 million people, or 36.9 percent of the state’s total population, live in counties designated as rural. The 2013 Missouri population estimate represents a 5.9 percent increase over the 2003 estimate. In comparison, the U.S. population growth between 2003 and 2013 was larger at 9.0 percent.
Health Status
The 2004-2012 life expectancy at birth for Missouri residents is estimated to be 77.2 years. Residents of urban counties enjoy a significantly longer life expectancy (77.8 years) than rural residents (76.8 years). The three individual counties with the highest life expectancy rates are all urban. In fact, 5 of the top 10 counties in terms of longest life expectancy are urban, and 8 of the 14 urban counties have life expectancy rates that are higher than the state average. Conversely, of the 15 counties with life expectancy rates below 75 years, 14 are rural.
Maternal, Infant and Child Health
Maternal, infant and child health indicators can also be used to measure the health status of a community. The health of mothers, infants and children is important because “their well-being determines the health of the next generation and can help predict future public health challenges for families, communities, and the health care system.
Health Behaviors and Risk Factors
Several common health behaviors and risk factors affect many of the health conditions discussed in the Health Status section of this report. The Missouri Department of Health and Senior Services, with assistance and support from the CDC, conducts the BRFSS survey to produce estimates of the prevalence of many health behaviors and risk factors related to chronic diseases.119 Annual estimates are prepared for Missouri and for seven regions within Missouri. The Office of Epidemiology within the Missouri Department of Health and Senior Services completed a special analysis in order to provide rates using the rural and urban categories designated in this report.
Health Care Resources
Health care resources are key elements in the maintenance of health and the prevention and treatment of disease. Basic access to primary care physicians and dentists, hospital services and specialty care services improve overall health and contribute significantly to an area’s economic vitality.
Recommendations
As demonstrated throughout this report, rural Missourians face many challenges related to their health. Overcoming the long standing inequality in health between rural and urban Missourians will require a holistic approach; there is no “silver bullet.” In light of this, the Office makes the following recommendations.
State Office of Rural Health Activities
The program and activity areas of the Office are designed to support the health of rural communities. Although health care providers and health systems are often the primary recipients of the technical assistance or services provided by the Office, all members of the rural community are necessary partners and participants in the overall efforts.