Wayne Myers, MD
Office of Rural Health Policy, HRSA

Tom Pringle
Governor’s Health Policy Advisor and Policy Administrator, Office of the Governor, Wyoming

• About 70% of Wyoming people live in frontier areas (i.e., less than 6 people per square mile). Wyoming lacks critical mass to develop tertiary care and trauma systems. Major problems include COPD, injuries, and suicide. There is limited access to specialists and public health and other infrastructure.

• There is little recognition of disperse populations in HP 2010. Only 4 objectives address rural populations and none refer to frontier populations. Most of the chairs of the HP Working Groups are from the East.

• Need to recognize that people in rural and frontier states are less likely to support taxes to fund public health or government initiatives.

Mary Selecky
TriCounty Region in Washington State

RF populations tend to be older and less affluent, and less likely to be minority groups. There is a need to talk about disparities among RF populations in addition to ethnic/racial groups.

The TriCounty Health Department has created a health assessment report in collaboration with the 3 local Indian tribes.

Principles for RF health include:

• Build networks and capacity.
• Address needs of special populations.
• Address provider shortages.
• Support communication networks.
• Build collaborations and develop trust.
• Conduct community-wide assessment.

Verne Gibbs
Chairman, National Rural Health Association

• About 20-25% of US population lives in rural and frontier areas. This is similar to proportion of racial/ethnic minorities.
• In 9 of the 20 health indicators cited in HP 2010 (page 19), there are significant disparities among rural and frontier populations.
• Regarding occupational safety, much of the economy is related to mining, forestry, fishing, and agriculture. All are high-risk occupations. Economies of rural and frontier areas differ from area to area.
• There are differences between needs of rural and frontier populations. Many HP 2010 objectives incorrectly assume that primary care is accessible in rural and frontier areas. Rural and frontier areas need to attract residents to become health care providers.
• Regarding Objective B-4 in the Access chapter, the proposed new definitions on shortage designations by the Bureau of Primary Care may mask problems because they change the definition of what is a shortage area.
• Need oversampling of rural and frontier populations in health surveys. Need to examine both crude and adjusted rates for health conditions when looking at RF populations.

Karen Pearson
Alaska Department of Health

• Alaska is the "outlier" of rural and frontier states. It has a very young population and many people have risky lifestyles.
• There are no local health departments. Alaska has 16% of US landmass. Ethnic/racial breakdown: Native Americans 17%, Asian PI 5%, African American 4% (76% is white). Major issues are transportation and getting services to people.
• We need something more achievable for HP 2010 objectives. It is not possible to "eliminate" disparities by 2010.
• Question how the leading health indicators were chosen since some are not relevant for rural and frontier areas. Need to ensure that national objectives are relevant to policy and individual action in rural and frontier areas. It is difficult to apply national goals in rural and frontier areas because many are not relevant. Need for priorities based on specific and local populations not national populations.
• There is a lack of attention to environmental health issues in HP 2010, such as pollution (both domestic and global).

Conclusions/themes:

• Healthy People 2010 does not adequately recognize the unique demographic, economic, and social characteristics of rural/frontier populations.

• Most of the disparities related to racial/ethnic groups cited in HP 2010 also apply to rural/frontier populations

• The model of allocating resources depending on most cost-effective delivery of services (most persons served per dollar) will always shortchange rural/frontier populations. We need another model.

• We must recognize the full range and complexity of health needs (persons with disabilities and special needs) even in rural/frontier areas.

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