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RHQ Rural Health Quarterly

Fall 2017

SPEC DOUB IAL LE IS SUE

2017 Rural Health Report Card

A Publication of the F. Marie Hall Institute for Rural and Community Health


Bringing Care Closer to Home

T

exLa Telehealth Resource Center is a federally funded program of the Texas Tech University Health Sciences Center designed to provide technical assistance and resources to new and existing telehealth programs throughout Texas and Louisiana.

Contact Us

(877) 391-0487 5307 West Loop 289, Suite 301 Lubbock, TX 79414 facebook.com/TexLaTRC www.texlatrc.org

@

texlatrc@ttuhsc.edu

TexLa is a proud member of the National Consortium of Telehealth Resource Centers. The project is supported by the Health Resources and Te x L a i s a p r o u dofmthe e mU.S. b e Department r o f t h e Nofa tHealth i o n a land C oHuman n s o r t Services i u m o f (HHS). Te l e h e a l t h R e s o u r c e C e n t e r s . Services Administration (HRSA) This project is supported by the Health Resources and Services Administration (HRSA) of the U.S. Depar tment of Health and Human Ser vices (HHS).


The Industry Leading Telemedicine Solution

HELPING PROVIDERS INNOVATE, TRANSFORM AND LEAD IN THE AGE OF REMOTE CARE Delivering the Last Mile in Healthcare

snap.md


CONTENTS //

RURAL HEALTH QUARTERLY

Volume 1, No. 4 Fall 2017

Publisher Billy U. Philips, Jr., Ph.D., executive vice president and director of the F. Marie Hall Institute for Rural and Community Health, Lubbock, TX Editor in Chief Scott G. Phillips Section Editors Debra Flores—Health Education Travis Hanson—Health Technology Catherine Hudson—Rural Research Ronald N. Martin—Behavioral Health Cameron Onks—Public Policy Copy Editor Melanie Clevenger Research Associate Debra Curti Web Developer Miguel Carrasco

COVER STORY

RHQ’s 2017 RURAL HEALTH REPORT CARD Grading the state of rural health in America

11-111

Contacts and Permissions Email RHQ at RHQ@ttuhsc.edu. For more contact information, visit www.ruralhealthquarterly.com. Rural Health Quarterly is a free publication of the F. Marie Hall Institute for Rural and Community Health at the Texas Tech University Health Sciences Center.

RURAL REPORTS Rural health reporting from across the nation and around the world 6-10

RHQ CONFERENCE CALENDAR Upcoming rural health conferences across the country 112 RHQ

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RHQ Rural Health Quarterly

Rural Health Quarterly (ISSN 2475-5044) is

published by the F. Marie Hall Institute for Rural and Community Health, 5307 West Loop 289, Lubbock, TX 79414, and the Texas Tech University Health Sciences Center. Copyright 2017—F. Marie Hall Institute for Rural and Community Health. The articles published in Rural Health Quarterly do not necessarily reflect the official policies of the F. Marie Hall Institute or of the Texas Tech University Health Sciences Center. Publication of an advertisement is not to be considered endorsement or approval of the product or service. Rural Health Quarterly is published four times a year and distributed without charge upon request to individuals residing in the U.S. meeting subscription criteria as set forth by the publisher. RHQ ADVISORY BOARD

Jacob Sanchez Diagnosed with autism

Ogechika Alozie, associate professor/chief medical informatics officer, TTUHSC El Paso Paul Fowler, associate dean for the School of Medicine Administration, TTUHSC Permian Basin Coleman Johnson, special assistant to the President, TTUHSC Retta Knox, RN, Hart School-Based Health Clinic, Hart, TX Susan McBride, Ph.D., RN, School of Nursing, TTUHSC Linda McMurray, executive director at TTUHSC Larry Combest Community Health and Wellness Center Will Rodriguez, senior managing director, TTUHSC

Sensory sensitivity is a sign of autism. Learn the others at autismspeaks.org/signs.

Ken Stewart, Ph.D., director of Community Development Initiatives, ASU, San Angelo, TX Dr. Julie St. John, assistant professor, TTUHSC Abilene Shari Wyatt, rural health specialist, State Office of Rural Health, Texas Department of Agriculture


Rural Health Research Gateway The Rural Health Research Gateway is an online library of research and expertise. It’s free to use, searchable, and provides access to the work of all ten federally-funded Rural Health Research Centers and Policy Analysis Initiatives. The Rural Health Research Center (RHRC) is the only Federal program that is dedicated entirely to producing policy-relevant research on health care in rural areas. The Federal Office of Rural Health Policy funds seven RHRCs and three rural health policy analysis initiatives. The Centers study critical issues facing rural communities in their quest to secure adequate, affordable, high-quality health services for their residents.

This online resource of research connects you to: • Research and Policy Centers • Research Projects • Experts • E-mail Alerts • Fact Sheets • Policy Briefs • Reports • Communication Toolkit

How can we help? • info@ruralhealthresearch.org • www.facebook.com/RHRGateway • twitter.com/rhrgateway

ruralhealthresearch.org This project was supported by the Federal Office of Rural Health Policy (FORHP), Health Resources and Services Administration (HRSA), U.S. Department of Health and Human Services (HHS) under grant # U1JRH26218. The information, conclusions, and opinions expressed in this toolkit are those of the authors and no endorsement by FORHP, HRSA, or HHS is intended or should be inferred.


RURAL

REPORTS

ALABAMA //

ARIZONA //

The only hospital in rural Winston County, Lakeland Community Hospital in Haleyville, is closing its doors, adding to a growing list of rural hospital closures in Alabama. Lakeland will bring the number of hospital closures in the state to seven within the past eight years.

The Arizona Telemedicine Program and the University of Arizona Center for Rural Health have partnered to create a program in the state that will train rural primary care providers to treat rheumatic diseases. arizona.edu | 08.08.17

al.com | 11.20.17

RURAL HEALTH REPORTING FROM ACROSS THE NATION AND AROUND THE WORLD

COLORADO //

ARKANSAS //

The rising cost of health insurance in the rural Western Region of Colorado has become a crisis for those who purchase insurance on the individual market.

54 percent of Alaska’s sexual assault victims are Alaska Native, even though Alaska Native people comprise only 20 percent of the state’s population, according to the state’s Department of Public Safety.

The USDA has awarded more than $320,000 to the University of Arkansas Agricultural Extension Service to fund rural chronic pain self management and exercise programs as well as education on alternatives to opioids.

The Colorado Division of Insurance is projecting a potential 37 percent increase in premiums for the Western Region in 2018, compared to just 24 percent in the rest of the state.

alaskapublic.org | 06.28.17

arkansasmatters.com | 11.16.17

summitdaily.com | 11.07.17

ALASKA //

SCOTLAND

INDIA

Doctors working in the Scottish countryside say their funding could be cut by as much as 69 percent by a newly proposed government contract, which is being put to a vote over Christmas.

About five women die every hour in India from complications developed during childbirth. A main reason cited for maternal mortality is unattended births; India has a severe shortage of doctors in rural areas.

The Rural G.P. Association of Scotland said that the impact of working in a rural community, often serving elderly patients, had not been factored into a new formula for allocating money.

globalvoices.org | 11.15.17

www.thetimes.co.uk | 11.30.17

AUSTRALIA

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Nurses and health workers in rural Australian communities will no longer be allowed to work alone after new legislation passed through parliament. The new law means that single nurse postings in rural areas will be abolished and all call outs will require a minimum of two medical personnel. The law was named after nurse Gayle Woodford who was raped and murdered while working in the remote community of Fregon in April 2016. www.adelaidenow.com.au | 11.28.17


What’s news in your neck of the woods? Let us know: Email: Email your rural health news to RHQ at RHQ@ttuhsc.edu

U.S. Mail: Rural Health Quarterly, F. Marie Hall Institute for Rural & Community Health, 5307 West Loop 289, St. 301 Lubbock, Texas 79414

Voicemail: Prefer to call? Leave us a message at (806) 743-9891 FAX: (806) 743-7953

Web: Find more RHQ contacts at ruralhealthquarterly.com or follow us on Facebook at facebook.com/RuralHealthQuarterly.

FLORIDA //

ILLINOIS //

Two bills filed in the Florida House and Senate would create a student loan repayment plan for dentists who practice in rural areas of the state. Eligible dentists must serve Medicaid recipients and low-income patients.

The late Dr. George Bark, a family practitioner at Gibson Area Hospital & Health Services’ Paxton Clinic, received the 2017 Physician of Excellence Award from the Illinois Rural Health Association.

29 rural counties in Florida lack sufficient access to a dentist.

IDAHO //

paxtonrecord.net | 11.21.17

GEORGIA //

A controversial $70 million state contract to drive Idaho Medicaid patients to non-emergency doctor and therapy appointments will end early, amid disputes between the state and the provider, Veyo.

Georgia Southern University School of Nursing has received a $1.6 million grant to prepare students to provide mental health services to rural populations in South Georgia.

Veyo, an Uber-like ridesharing company that specializes in patient transportation, began brokering Medicaid rides in Idaho on July 1, 2016. The state plans to transition to a new provider in 2018.

Amish people living in a part of rural Indiana have a rare genetic mutation that protects them from Type 2 diabetes and appears to extend their life spans. The findings shed light on the processes underlying aging and could lead to new chronic disease therapies.

dailynurse.com | 10.13.17

spokesman.com | 10.31.17

nytimes.com | 11.15.17

CANADA

CHINA

wusfnews.wusf.usf.edu | 11.15.17

INDIANA //

m

MADAGASCAR Madagascar is facing the worst outbreak of plague in 50 years. There have been more than 1,800 cases and 127 deaths since the start of August, according to new figures. The island off the south-east coast of Africa is used to seeing about 400 cases of mostly bubonic plague in the same rural areas every year. This year it has developed into the deadlier pneumonic version and spread to much more populated areas.

Young rural men are at the greatest risk for suicide in Canada, researchers say. Reasons cited as contributing factors include isolation, lack of resources, drug and alcohol use and a pressure to uphold masculine norms.

In a new study conducted in China, researchers found that patients with symptoms of tuberculosis (TB) in rural China – where the disease remains all too prevalent – are not being diagnosed or treated quickly enough.

www.bbc.com | 11.03.17

www.huffingtonpost.ca | 11.08.17

contagionlive.com | 11.13.17 RHQ

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Rural Reports // IOWA //

MISSISSIPPI //

Hy-Vee Pharmacy has acquired two telepharmacy locations in rural Iowa, digitally linking patients with remote pharmacists who can fill prescriptions and answer questions.

The American Medical Association has awarded the Medal of Valor to Robert Smith, M.D. Smith was an instrumental figure during the civil rights movement in Mississippi, delivering rural health care to those with little or no access.

fooddive.com | 11.16.17

MASSACHUSETTS //

medscape.com | 11.13.17

KENTUCKY // The attorney general of Kentucky is suing the maker of the opioid painkiller Opana ER after a sudden spike of overdose deaths due to oxymorphone, the active ingredient in Opana ER. Overdose deaths jumped from 2 percent to 23 percent in a single year, according to the lawsuit.

Pending legislation in the state Senate allows volunteer ambulance services in rural communities to transport a patient receiving care at the nonparamedic level of basic life support to staff the ambulance with one EMT and one first responder. Small, rural towns often have difficulty mobilizing two EMTs in time to help someone in need of medical attention. berkshireeagle.com | 11.10.17

cnn.com | 11.06.17

LOUISIANA // An existing law that provides a tax break to primary care physicians and dentists who work in rural areas of Louisiana has been extended to nurse practitioners who practice in rural areas that have been determined to have a shortage of medical care.

Opioid deaths may top traffic fatalities in Missouri in 2017. In rural Missouri, especially in the southeastern part of the state, the number of prescriptions being filled and the misuse and abuse of oral narcotics remains a source of concern, according to state health officials. ksdk.com | 11.20.17

MICHIGAN // Roughly half of Michigan’s rivers and streams exceed safety standards for E. coli bacteria, and researchers blame pollution from septic tanks, which are common in rural Michigan communities. Michigan is the only state without a uniform septic code. bridgemi.com | 11.13.17

nola.com | 06.26.17

MONTANA //

Katahdin Valley Health Center was given a $2.2 million USDA loan to expand its optometry, behavioral counseling, dental and other health services.

Minnesota lawmakers passed a bill last session allowing agricultural co-ops to offer health insurance plans. Farm groups in the state lobbied for the change.

Medicaid expansion has made a big difference fighting drug addiction in Montana, according to panelists at a “Substance Use Disorder Summit” held in Helena. One treatment court has a recidivism rate of only three percent, and they attribute that success to Medicaid-funded drug treatment programs.

centralmaine.com | 11.24.17

postbulletin.com | 11.15.17

mtpr.org | 11.07.17

MAINE //

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MISSOURI //

RHQ

MINNESOTA //


NEBRASKA // The COPIC Medical Foundation has made a $75,000 gift to the University of Nebraska Foundation to support Simulation in Motion-Nebraska (SIM-NE). The program brings critical training to rural emergency medical service providers by simulating emergency rooms and ambulances. The vehicle is equipped with mannequins that simulate human patients. nebraska.tv | 11.16.17

NEW MEXICO //

OHIO //

Carlsbad is home to one of the top performing rural medical centers in the state. The New Mexico Department of Health and NOSORH recognized the Carlsbad Medical Center as a “top performer” in providing treatment for heart attacks, heart failure, pneumonia and patient safety.

Ohio voters rejected a proposal that sought to curb prescription drug prices paid by the state for poor people, prisoners and injured workers. The pharmaceutical industry spent an estimated $70 million to oppose Issue 2, the Ohio Drug Price Relief Act, saying it would reduce access to medicines and raise prices for veterans and others.

currentargus.com | 11.22.17

usnews.com | 11.08.17

NORTH CAROLINA // UNC Health Care and Carolinas HealthCare System announced plans to expand access to rural parts of the state after forming a joint operating company that would be among the country’s largest health systems. modernhealthcare.com | 11.24.17

OKLAHOMA // Oklahoma researchers are looking to robots to care for aging baby boomers. The OSU project hopes to address the state’s shortage of home health care providers, particularly in Oklahoma’s rural areas. newsok.com | 11.28.17

NEVADA // Nevada Department of Corrections (NDOC) says they are struggling to hire medical professionals in rural areas of state. The state is working to re-certify seven facilities with the National Health Service Corps and plans to attract fourthyear medical and dental students to work for the NDOC with a loan repayment program. reviewjournal.com | 11.07.17

OREGON // The 2017 County Data Book published by Children First for Oregon reports that children in the state are doing better in recent years, but rural counties continue to face the largest barriers for kids.

NORTH DAKOTA //

New Hampshire may allow birth control pills to be prescribed by pharmacists. A state commission voted unanimously to endorse the idea in order to help rural women.

North Dakota has received a $200,000 Lifespan Respite Care Grant to help the state come up with solutions for giving family caregivers a break, particularly in isolated rural parts of the state. Family caregivers provide more than 58 million hours of service a year in North Dakota.

nhpr.org | 11.27.17

publicnewsservice.org | 11.27.17

NEW HAMPSHIRE //

ktvz.com | 11.29.17

PENNSYLVANIA // Pennsylvania received an $11.7 million federal grant to support the Maternal, Infant and Early Childhood Home Visiting Program to help at-risk pregnant women. gantdaily.com | 11.15.17

RHQ

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Rural Reports // SOUTH CAROLINA //

WEST VIRGINIA //

The South Carolina Office of Rural Health has released its first action plan for improving health for more than one million rural South Carolinians.

Health officials in West Virginia stated they are dealing with a major outbreak of HIV infections in the southern part of the state. Officials say that the outbreak comprises individuals from 15 counties, and that the virus was spread through sexual contact, with only some of the individuals becoming infected through intravenous drug use.

The plan contains 15 recommendations and 50-plus corresponding action steps, intended to spur progress over the next three to five years. Some of the recommendations call for increased state funding in local communities. statehousereport.com | 11.22.17

SOUTH DAKOTA // A rural water system serving residents north of New Underwood is on schedule to mitigate excessive radium levels found in its drinking water. The maximum allowable radium contaminate level is 5 picocuries per liter of water. Over the last year, the town’s water has averaged 7.7 picocuries per liter. rapidcityjournal.com | 11.11.17

TEXAS // Texans are falling behind the rest of the country in getting vaccinated against human papillomavirus (HPV), making them more vulnerable to several types of cancer, a new study says. The report, issued by the University of Texas System Office of Health Affairs, also found that those living in urban areas were more likely to be vaccinated than rural residents. Texas currently has the fifth-lowest vaccination rate in the country. texastribune.org | 11.29.17

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RHQ

VERMONT // Starting in January, a new model could reshape the health care payment system for about one out of every five Vermonters. Through the accountable care organization OneCare Vermont, 10 hospitals have agreed to take financial responsibility for health care spending for certain patients in their local areas. That spending will be measured against a set target. burlingtonfreepress.com | 11.03.17

VIRGINIA // Agreements with Virginia spell out schedules for a merged Ballad Health to make good on its financial commitments to improve the region’s health, including $28 million for rural health service.

contagionlive.com | 11.08.17

WISCONSIN // The Wisconsin Farmers Union is encouraging farmers to enroll in the ACA health insurance marketplace, citing the positive impact the marketplace has had on rural Wisconsin by providing affordable coverage to family farmers who are self-employed or having pre-existing conditions. gazettextra.com | 11.16.17

WYOMING //

WASHINGTON //

An innovative partnership between Central Wyoming Counseling Center and Community Health Centers of Central Wyoming is attempting to decrease costs while improving patient care.

A public-private partnership of health organizations, which includes the Washington State Department of Health, Seattle Children’s and Kaiser Permanente, is working on ways to encourage rural residents to vaccinate their children against preventable diseases.

During the first phase, CHCCW will have a primary care provider at Central’s facility two days a week to treat Central’s residential patients for anything from minor injuries to chronic illness. Central also plans to partner with other primary care providers in Natrona County.

seattlemag.com | 11.01.17

oilcitywyo.com | 11.01.17

heraldcourier.com | 11.23.17

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THE STATE OF RURAL HEALTH IN AMERICA

RHQ 97%

RURAL HEALTH REPORT CARD

of the United States is covered by rural areas, and one-fifth of all Americans live in these areas. Major metropolitan centers attract most of the resources, however. That includes the lion’s share of doctors, dentists, psychologists and health care facilities. It’s hardly surprising, then, that urban Americans also have better health outcomes.

To address this disparity, every state in the nation has a government office of rural health. Most also have a state rural health association, a telemedicine resource center and a variety of research institutes and charitable foundations dedicated to helping our most isolated and vulnerable citizens gain access to care. But these efforts, however warranted and welcome, are not equally effective. Some states do an impressive job of providing rural health care while others fail to provide care that is even remotely comparable to the care provided in their urban centers. It’s not clear, however, that individual states deserve all the blame or praise. One of the more surprising revelations of this first annual RHQ Rural Health Report Card is the recurrent theme of regional clustering. Across the nation, it’s clear that rural health strengths and weaknesses don’t occur in isolation. There are strong regional trends at play. We don’t attempt to fully explain these trends, but we hope some of you will take notice and take action. Maybe if we reach out more, across state lines, we can forge new alliances and find solutions that will benefit all rural Americans. RHQ

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FALL 2017 | RHQ   11


STATE RURAL HEALTH RANKINGS & FINAL GRADES STATE RANK GRADE

STATE RANK GRADE

45

F

IN

29

C-

MT

19

B-

SC

44

F

AK

22

C+

IA

9

A-

NE

8

A-

SD

11

B+

AZ

33

D

KS

24

C

NV

30

D+

TN

43

F

AR

38

D-

KY

42

F

NH

1

A+

TX

36

D-

CA

15

B

LA

46

F

NM

31

D+

UT

23

C+

CO

12

B+

ME

13

B+

NY

18

B-

VT

2

A+

CT

3

A+

MD

16

B

NC

34

D

VA

32

D+

FL

37

D-

MA

6

A

ND

10

A-

WA

17

B

GA

40

F

MI

21

C+

OH

28

C-

WV

39

F

HI

4

A

MN

5

A

OK

41

F

WI

7

A

ID

20

B-

MS

47

F

OR

26

C

WY

14

B

IL

27

C-

MO

35

D

PA

25

C

R

RHQ

STATE RANK GRADE

AL

HQ’s U.S. Rural Health Report Card was created to answer a simple question: How does each state’s rural health care stack up when compared to other states? It seemed like a fairly straightforward question, and a useful one, too. How do you know if your state is doing an adequate job without a baseline for comparison? You can’t manage what you don’t measure, right? It quickly became clear, however, that finding a satisfactory answer to this question would be a challenge. First, we had to settle on definitions of “rural” and “rural health.” We weren’t trying to quantify all health care in America, just rural health care, and just rural America. But which rural America? Second, we had to determine which factors to measure and which ones to exclude. That’s harder than it sounds if fairness and utility are your ultimate goals. Suffice it to say, we had some pretty spirited discussions.

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STATE RANK GRADE

Finally, we had to assign weight to everything we measured. All things are not equally important. That means conscientiously ranking the relative importance of many important things. More hand wringing ensued. After many months of discussion, analysis, research and reflection, we finally found consensus, equilibrium and even a sense of satisfaction. We hope you agree that the RHQ Rural Health Report Card is a fair and useful document. If so, please let us know. We plan to make it an annual affair. If you have suggestions or criticisms, please let us know those, too. METHODOLOGY When it came to defining rurality, we settled on counties as our sole unit of measurement. This had the virtue of allowing us to use well-established and reliable data sources. It also helped us ensure a greater measure

*DE, NJ, and RI excluded.

of fairness; i.e., we would always be comparing “apples to apples,” regardless of data source. That did mean excluding three states and Washington D.C. from our study, however. While Delaware, New Jersey and Rhode Island each contains pockets of rurality, these states, like D.C., are largely urbanized, and none contains a single county with a nonmetropolitan population. Following a discussion with the USDA, all the counties in the remainder of the states were sorted as either metropolitan (urban) or non-metropolitan (rural) as defined by the 2013 Rural-Urban Continuum Codes (RUCC). RUCC simply defines a county as rural if it has a population under 50,000 people, whereas the rural-urban commuting area (RUCA) codes classify U.S. census tracts using measures of population density, urbanization and daily commuting. A final composite score was then given to all rural counties individually.


The overall composite scores were calculated using 10 variables divided into three equally weighted categories: Mortality, Quality of Life and Access to Care (see Figure 3). Mortality includes age-adjusted mortality rates for all causes of death in all rural counties in a state. Mortality accounts for 1/3 of each state’s final composite score. Quality of Life includes the percentage of babies born in rural counties with a low birth weight, the percentage of rural residents who reported having poor general health, the number of poor physical health days reported by rural residents in the past 30 days and the number of poor mental health days reported by rural residents in the past 30 days. Each state’s combined Quality of Life score accounts for 1/3 of that state’s final composite score. Access to Care includes the number of non-federal primary patient care physicians practicing in rural counties in 2014 per 100,000 population, the number of non-federal psychiatrists practicing in rural counties in 2014 per 100,000 population, the number of dentists practicing in rural counties in 2015 per 100,000 population, the number of non-federal emergency patient care physicians practicing in rural counties in 2014 per 100,000 population, and the percentage of uninsured rural residents under 65 years of age. Each state’s combined Access to Care score accounts for 1/3 of that state’s final composite score. A variety of measures and data sources related to U.S. health care were reviewed for this study, and it was decided that the three categories and ten variables listed above would best portray an accurate picture of the state of rural health across the nation. While various social determinants of health are discussed in the individual state report cards that follow, the 10 variables listed above were the only variables used to compute each state’s final composite rank and grade. Other

RURAL HEALTH REPORT CARDS:

WHY THEY MATTER In this issue of RHQ, we focused on devising rural health report cards for every state in the nation with at least one rural county. It was a daunting task, and we used a very systematic process to assess and score each state. We did this after some forethought about the consequences of doing such a thing. We anticipated that some people who read this will not agree with the grades. Some will level criticism at the process, at the data and Billy U. Philips, Jr., Ph.D. factors we considered. Some will be concerned over the Publisher of Rural Health age or characteristics of the data. Quarterly and Director of Nevertheless, we are a society that loves report cards, the F. Marie Hall Institute for Rural and Community rankings and anything that has the potential for showing Health us where we stand. As long as we stand out positively from all the rest who are ranked, of course. There is more to this than standings, however. There was a movement some years ago where it was proposed that we use something other than the A, B, C, D, F format in our schools. Instead, some proposed using O, G, S, U, and NI (Outstanding, Good, Satisfactory, Unsatisfactory and Needs Improvement). I like that idea because it places the focus on improvement; however, we stuck with A, B, C, D and F because everyone knows what that means. We think improvement is the basis for any benchmarking project. The idea is to do better, not just in the outcome but by improving the metrics we consider as we apply ranks based upon them. Generally, the more objective these metrics are, the more precise our assessments might be. That increases validity, and if they are objective then it also increases reliability. We think the factors that we considered are not subject to unwarranted variability that is not due to actual reflections of rural health status. I know all of this sounds to your ear (and mine) to be pretty academic, so let me use a personal story to illustrate. When I was a kid going to school, I got a report card every six weeks during the year. It was my teachers’ summation of how I had performed in critical subjects like reading, writing and arithmetic. Later they added things like deportment. Before, that was taken care of with a paddle and a note home; but I digress. The grades were based on things like homework assignments, tests and sometimes on the teacher’s sense of how well we were learning the key subjects. Those report cards were my guideposts, and every six weeks there were consequences when I had not improved. Often those consequences were things like more help from my parents or restrictions on extracurricular activities so I could stay after school to work with willing teachers. They were also badges of honor when I had done better. These grades were personally meaningful, but they were also meaningful to all of my classmates who were in a sense my competitors. So as you read these report cards, I hope they are a good benchmark that motivates improvements. If we all do well, then the competition will have been well worth the toil.

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well-known national health rankings, like the County Health Rankings (CHR) model produced by the Robert Wood Johnson Foundation, rely heavily on a more holistic view of population health, but the RHQ Rural Health Report Card focuses instead on a narrow band of data related specifically to rural health outcomes and access. This choice should not be interpreted as a criticism of other models. Rather, RHQ’s approach takes as a given that social and economic factors exert a powerful influence on health. Our report card instead seeks to highlight a limited set of key variables in an attempt to create a clear snapshot of state and regional differences in rural health care delivery. GRADING SYSTEM Each state was given a letter grade based on calculations using a Z-score. Grades were put into five traditional American grading categories: A, B, C, D and F. Positive and negative delineations (+ and -) were added to each letter grades except F to indicate the top three and bottom three performers in each quintile. We used Z-scores to standardize each measure for each state relative to the average of all states where: Z = (state value – average of all states) / (standard deviation of all states). A positive Z-score indicates a value higher than the average of all states; a negative Z-score indicates a value for that state lower than the average of all states. Z scores for physician supplies (primary care physicians, dental, emergency care and psychiatrists) are reversed; i.e., a positive value is reversed to a negative one and negative one to a positive value. Of the 47 states reported, each grade was based on their overall quintile ranking. KEY FINDINGS The key findings for each state are summarized in each of the individual state report cards that follow this section. In the left-hand column, each state’s final grade and overall rank are given,

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RHQ

followed by a listing of each state’s final rankings in each of the three equally weighted categories. Also on the first page of each report card, a breakdown of each state’s U.S. Census divisional ranking is supplied, followed by a brief overview of rural health in the state, an account of the number of rural health facilities in the state and a calculation of the urban-rural divide in mortality rates. Rural/urban difference is defined as the result of the z-score of rural counties minus the z-score of urban counties of the same state; the county with the smallest value is ranked the highest. On the second page of each state report card, a map of rural and urban counties is provided, along with a “by the numbers” list of facts about each state’s rural residents and highlights from the final scores received by the state in each of the three categories measured to calculate the state’s final grade. Note that not every category of measurement is described at length on every state report card. For a more complete breakdown of each state’s performance in all measures, visit www.RuralHealthQuarterly.com. Finally, we wanted to provide a clearer picture of the phenomenon of regional clustering mentioned in our introduction. In Figure 1 (right), all nine U.S. Census regional divisions are numbered and color coded based on their final average rankings. The top third (green) and middle third (yellow) appear to alternate positions across the northern half of the United States. Note, however, that the yellow states surrounding the Great Lakes are actually comprised of two different U.S. Census divisions, the East North Central (Illinois, Indiana, Michigan, Ohio and Wisconsin) and the Mid-Atlantic (New Jersey, New York and Pennsylvania). Both divisions fall into the middle third of divisional ranks and their adjacency contributes to the green/ yellow zebra-stripe effect. The bottom third (red) regions in our rankings are all adjacent, and all are located in the American South. Remarkably, a similar pattern emerges when divisional averages are removed and all individual states are color coded based on their own unique final rankings

(Figure 2). When we compare Figures 1 and 2, seven states move one position, either up or down among the color-coded thirds, but they tend to do so only when adjacent to a state of the same color. Arizona is the only exception to this rule among the contiguous states. Only two states move two positions: Maryland rises from red to green, and Missouri falls from green to red. It’s hard to know what to make of this persistent grouping of states, but it seems clear that location is a strong predictor of success (or failure) when it comes to rural health care. Further research on regional trends may be a fruitful avenue of inquiry. DATA SOURCES & TOOLS 1. United States Department of Agriculture, Rural-Urban Continuum Codes. 2. United States Census Bureau, Census Regions and Divisions of the United States. 3. Centers for Disease Control and Prevention, National Center for Health Statistics. 4. Robert Wood Johnson Foundation, County Health Rankings. 5. Health Resources and Services Administration of U.S. Department of Health and Human Services. 6. United States Census Bureau. American Community Survey, American Factfinder (S2701) 7. SAS Statistical Package 9.4 ACKNOWLEDGMENTS This research was supported by the Texas Tech University Health Sciences Center and the F. Marie Hall Institute for Rural and Community Health. We thank our colleagues who provided insight and expertise that greatly assisted in the creation of the RHQ Rural Health Report Card, including Billy Philips, Catherine Hudson, Gordon Gong, Debra Curti, Luciano Boas, Miguel Carrasco, Melanie Clevenger and Hope LaFreniere. Please direct all inquiries to RHQ Editor in Chief Scott G. Phillips at RHQ@ttuhsc.edu.


FIGURE 1: U.S. CENSUS REGIONAL DIVISIONS (RANKED AVERAGES)

3

2

4

6

5

TOP THIRD

7

9

8

1

BOTTOM THIRD

MIDDLE THIRD

FIGURE 2: FINAL STATE RANKINGS 17

10

19

26

5

20

14 23

12

15 33

27 24 41

31 36

4

29

35

18 25

28 42

39

43

38 46

2

21

9

8 30

13

7

11

47

45

6 3

1

16

32 34

40

44

37

22

TOP THIRD

MIDDLE THIRD

BOTTOM THIRD

RHQ

15 


FIGURE 3 : RURAL HEALTH RANKING SYSTEM - CATEGORIES AND WEIGHTS

+

MORTALITY: 1/3 AGE-ADJUSTED MORTALITY: 100%

+

QUALITY OF LIFE: 1/3

ACCESS TO CARE: 1/3

FAIR/POOR HEALTH: 20%

PRIMARY CARE: 30%

MENTAL HEALTH DAYS: 20%

MENTAL CARE: 15%

PHYSICAL HEALTH DAYS: 20%

DENTAL CARE: 10%

LOW BIRTH WEIGHT: 40%

EMERGENCY CARE: 5% UNINSURED RATE: 40%

TABLE 2: U.S. RURAL HEALTH RANKINGS BY STATE - ALL CATEGORIES AGE-ADJUSTED MORTALITY

FAIR/POOR HEALTH

MENTAL HEALTH DAYS

PHYSICAL HEALTH DAYS

LOW BIRTH WEIGHT

PRIMARY CARE

MENTAL CARE

DENTAL CARE

EMERGENCY CARE

UNINSURED RATE

1. NEW HAMPSHIRE

7

3

19

8

15

1

1

3

1

14

2. VERMONT

10

2

13

9

11

3

2

8

5

2

3. connecticut

2

1

16

3

18

14

3

5

6

3

4. hawaii

1

13

5

6

28

6

5

7

4

4

5. minnesota

4

6

4

7

2

8

15

20

32

6

6. Massachusetts

5

7

29

16

7

5

6

6

15

1

7. wisconsin

11

12

11

12

6

12

16

18

18

8

8. nebraska

12

10

2

2

8

15

32

9

36

13

9. IOWA

15

4

6

4

9

17

21

24

47

5

10. north dakota

9

8

3

1

10

31

20

19

33

10

11. SOUTH dakota

18

5

1

5

5

19

25

21

41

19

12. COLORADO

3

11

8

10

37

7

17

11

2

39

13. Maine

28

14

22

19

16

2

8

23

11

17

14. wyoming

6

15

9

14

31

11

13

12

9

22

15. california

16

23

28

29

3

13

9

1

8

28

16. maryland

17

21

21

17

34

20

4

16

7

11

17. washington

8

24

25

28

4

25

33

13

19

26

18. new york

19

17

26

23

19

27

7

31

21

7

19. montana

20

9

12

13

20

10

10

10

12

38

20. IDAHO

13

25

14

25

13

18

28

15

13

36

21. MICHIGAN

21

20

23

22

14

22

18

22

20

16

22. ALASKA

22

22

10

24

1

4

11

2

14

47

STATE RANK


AGE-ADJUSTED MORTALITY

FAIR/POOR HEALTH

MENTAL HEALTH DAYS

PHYSICAL HEALTH DAYS

LOW BIRTH WEIGHT

PRIMARY CARE

MENTAL CARE

DENTAL CARE

EMERGENCY CARE

UNINSURED RATE

23. UTAH

14

16

15

18

26

24

39

14

3

32

24. KANSAS

27

28

7

11

17

23

41

25

46

18

25. PENNSYLVANIA

24

18

24

15

21

28

14

28

25

12

26. OREGON

26

30

42

36

12

9

27

4

10

27

27. ILLINOIS

30

19

20

20

23

40

42

30

31

9

28. OHIO

32

29

31

27

22

36

30

34

39

15

29. INDIANA

33

27

30

26

24

44

26

35

40

23

30. NEVADA

25

26

34

30

27

45

47

32

16

37

31. NEW MEXICO

29

39

27

35

36

21

12

26

24

40

32. VIRGINIA

36

31

17

21

40

35

24

37

27

25

33. ARIZONA

23

47

47

44

25

37

46

17

30

42

34. NORTH CAROLINA

31

34

32

33

41

32

19

36

17

35

35. MISSOURI

37

33

40

39

29

30

34

39

35

30

36. TEXAS

35

37

18

31

32

46

40

44

45

46

37. FLORIDA

34

32

36

32

33

47

38

41

29

45

38. ARKANSAS

40

45

39

43

38

29

43

40

38

31

39. WEST VIRGINIA

41

42

46

45

42

16

29

33

23

20

40. GEORGIA

38

35

33

34

43

34

23

45

34

44

41. OKLAHOMA

42

38

35

40

30

38

35

27

43

43

42. KENTUCKY

46

41

38

46

39

26

22

29

26

21

43. TENNESSEE

43

40

45

47

35

41

37

42

37

24

44. SOUTH CAROLINA

39

36

41

38

46

33

36

43

22

34

45. ALABAMA

44

43

44

42

44

43

44

47

42

29

46. LOUISIANA

45

44

43

41

45

42

45

46

44

41

47. MISSISSIPPI

47

46

37

37

47

39

31

38

28

33

STATE rank

TABLE 3: U.S. RURAL HEALTH RANKINGS BY U.S. CENSUS REGIONAL DIVISION - ALL CATEGORIES AGE-ADJUSTED MORTALITY

FAIR/POOR HEALTH

MENTAL HEALTH DAYS

PHYSICAL HEALTH DAYS

LOW BIRTH WEIGHT

PRIMARY CARE

MENTAL CARE

DENTAL CARE

EMERGENCY CARE

UNINSURED RATE

1. NEW ENGLAND

1

1

2

1

3

1

1

2

1

1

2. WEST NORTH CENTRAL

4

3

1

2

2

4

7

4

8

4

3. PACIFIC

2

5

6

6

1

2

3

1

3

6

4. MID-ATLANTIC

5

2

5

3

5

6

2

6

4

2

5. MOUNTAIN

3

6

3

5

6

3

4

3

2

7

6. EAST NORTH CENTRAL

6

4

4

4

4

5

6

5

6

3

7. SOUTH ATLANTIC

7

7

8

7

8

7

5

8

5

8

8. WEST SOUTH CENTRAL

8

8

7

8

7

9

9

9

9

9

9. EAST SOUTH CENTRAL

9

9

9

9

9

8

8

7

7

5

CENSUS DIVISION


IN FREE FALL: REPRODUCTIVE HEALTH AND RIGHTS IN AMERICA

F 45/47 ALABAMA ranks 45th in the nation for rural health out of 47 states with rural counties. Alabama is one of nine states receiving a failing grade. ALABAMA RECEIVED A FAILING GRADE BECAUSE: Alabama ranked in the fifth quintile of states for its rates of mortality in rural counties. Alabama ranked in the fifth quintile of states for measures of daily health and quality of life in rural counties. Alabama ranked in the fifth quintile of states for health care access in rural counties.

18

RHQ

18  RHQ

ALABAMA

WASHINGTON, D.C. – In releasing its fifth annual 50-State Report Card on Reproductive Health and Rights, the Population Institute lowered the U.S. grade from a “D+” to a “D”. The report card, the most comprehensive report card of its kind, tracks multiple indicators of reproductive health and rights, including access to family planning and abortion services.

Along with Mississippi, Tennessee and Kentucky, Alabama is a member of the East The Institute’s president Robert Walker said, “For the past five years, reproductive health and South Central division of the South U.S. Census region. All four states in the division rights in the U.S. have been on a slippery slope.” Five years ago nine states received an “F”. In showed strong similarities in our reporting, and all four states received a failing grade. this year’s report card 20 states—including Alabama—received a failing grade. Walker warned, Alabama (45) performed better butnew the Administration Yellowhammer however, “The worst may be yet tothan come,Mississippi as Congress(47), and the areState expected fell behind Kentucky Tennessee (43)comprehensive in the final rankings. to slash federal funding(42) for and family planning and sex education. The slippery slope is becoming a free fall.”

A

states today more 50% of “plus” or a “minus” for factors Walkerlabama emphasized that “It’s to provide has struggled the Rural Health Information Hub, anthan organiwomen now live in a county not reflected in the core grade. not justadequate abortion rights that are rural health care for years, zation funded by the Federal Office of Rural without an abortion provider. under siege; it’s also access to published by and, according to data Health Policy. ALABAMA RECEIVED A family planning services, and the Alabama Rural Health Association in 2017, Federal support for “MINUS” BECAUSE THEIR when women are denied access the state’s poor performance has had some URBAN-RURAL DIVIDE reproductive health and rights ‘CHOOSE LIFE’ LICENSE to contraception everyone loses: alarming could suffer a major reversal PLATES FUND ANTI-CHOICE there are consequences. more unintended Most U.S. states report a marked difference in 2017. Congress and the new pregnancies, more abortions, and ORGANIZATIONS/CRISIS Life expectancy at birth is in health outcomes between rural and Administration are urban expected to PREGNANCY CENTERS higher health care costs.”for rural Alabamians one-half of a year lower than the life expectancy counties. Alabama reports an 8.6 percent curtail access to contraceptive Only 21 states received a for urban residents years servicesasby blocking to all funding This year’sAlabama report card also and 3 ½“B-“ in rural mortality compared or higher. increase Just five states for Planned Parenthood, drawsthan attention to “a growing lower the national average. Life(California, expectancyNew urban counties. The state ranks 26th for rural/ Jersey, defunding Title X, a 48-year old national divide” on reproductive for residents of rural Wilcox County alone is 9 urban difference in mortality. New Mexico, Oregon and program that provides support health and rights, and Walker years lower than that for the nation.Washington) received an “A”. to family planning clinics warned that Alabama is “on The following states received RURAL RESOURCES serving low-income households, the wrong side of that divide.” All of the state’s rural counties are classified a failing grade in 2016: and eliminating the Affordable Alabama, which received an “F”, Arkansas, as both mental health care shortageAlabama, areas and Rural Florida, health resourceCare organizations in Alabama Act’s no-cost birth control was one of 20 states receiving a Georgia, Idaho,include: Indiana, Kansas, dental care shortage areas. Three counties mandate. Walker noted that failing grade in the latest report Louisiana, Mississippi, Missouri, have no full-time dentists. “In the past five years most of card. Five years ago Alabama Nebraska, North Dakota, • Alabama Department of Public Health: the slippage on reproductive received a “D”. RURAL HEALTH CARE FACILITIESOklahoma, South Carolina, Office of Primary Carehas andoccurred Rural Health health at the state South Dakota, Tennessee, Texas, level, but this year could see MANY FACTORS www.adph.org/ruralhealth Utah, Virginia, and Wisconsin. unprecedented setbacks at the Seven rural counties ACCOUNTED FOR in Alabama (Cleburne, • Alabama Rural Health Association national level, including cuts ALABAMA’S FAILING GRADE Macon, Coosa, Henry, Lamar, Lowndes, and www.arhaonline.org Walker warned that “A woman’s in fundingResource for comprehensive INCLUDING Perry) do not POOR have a SCORES hospital, and 13 rural • should Southeastern Telehealth Center reproductive health not sex education in the schools IN PREVENTION AND counties do not have a dialysis clinic (ARHA). depend on where shewww.setrc.us lives, but and a return to abstinence only AFFORDABILITY it does, as women many for Rural Health Research • inInstitute programs which have been InUsing 1980, 10 ofcriteria, the 12the Black Belt Region counareas are experiencing reduced eleven cchs.ua.edu/research/#irhr proven to be ineffective.” access to reproductive health Rural Development Center Institute’s report card rankedobstetrical ties had hospitals providing service. • Southern care offers services including abortion.” each ofonly the 50 and the Today, onestates hospital in the region srdc.msstate.edu Walker stressed that this Walker noted that 19 states, District of Columbia on four this service. year’s report card should be including Alabama, have refused broad indicators relating to For more information “anabout urgentthe calldata to action” for expand Medicaid under the reproductive healthAccess and rights: There are 4 Critical Hospitals to in Alabama sources used and methodology anyone who isemployed concerned Affordable Care Act, leaving tens effectiveness, prevention, as well as 109 Rural Health Clinics and 14 in RHQ’s 2017 Ruralabout Health Report Card, reproductive health of millions of women without affordability, and access. Based Federally Qualified Health Centers providing and rights. “As disappointing visit www.RuralHealthQuarterly.com. improved access to contraception upon their composite scores (0as 2016 was, 2017 could be services at state 129 sites in the state, according and otherto health care services. 100), each received a “core” a whole lot worse.” Walker also noted that in 27 grade (A, B, C, D or F), but some states received an additional


ALABAMA BY THE NUMBERS Alabama has an estimated population of 4,863,300 people, and 23.7 percent live in one of Alabama’s 38 rural counties. The poverty rate in rural Alabama is 23 percent, compared with 17.1 percent in urban areas of the state. 21.5 percent of the rural population has not completed high school, while 13.9 percent of the urban population lacks a high school diploma.

..

9.4 percent of rural Alabama residents are U.S. military veterans, and 13.9 percent of the rural population under age 65 lives with a disability.

RURAL COUNTIES URBAN COUNTIES

68.9 percent of the state’s rural population is Non-Hispanic White, 24.1 percent is Black/African-American and 4.3 percent is Hispanic/ Latino, 0.7 percent is American Indian/Alaska Native and 0.5 percent is Asian.

MORTALITY

QUALITY OF LIFE

ACCESS TO CARE

Heart Disease: F

Fair/Poor Health: F

Primary Care: F

Heart disease is the leading cause of death in Alabama, and the state is ranked 45th in the U.S. for the number of deaths by heart disease among rural residents. The age-adjusted rate for heart disease in rural counties is 256.3 per 100,000. The national average is 168.5 per 100,000.

The percentage of Alabamians reporting poor general health is among the highest in the nation. The state ranked 43rd for rural counties (22.9 percent) and 46/51 for urban counties (19.1 percent).

Alabama ranks 43rd in the U.S. for the number of primary care physicians practicing in rural counties (42.9 per 100,000). The national average for rural counties is 54.5 per 100,000.

Mental Health: F

Mental Care: F

Rural residents of Alabama reported an average of 4.1 mentally unhealthy days in the past 30 days. The national average is 3.7 days. The state ranked 44th for self-reported mental health in rural counties.

Alabama ranks 44th in the U.S. for the number of psychiatrists practicing in rural counties. Alabama has 1.2 per 100,000 residents. The U.S. rural average is 3.4.

Cancer: D Cancer is the second leading cause of death in Alabama, and the state is ranked 34th in the U.S. for deaths by cancer among rural residents. The ageadjusted rate for cancer in rural counties is 181.4 per 100,000. The national average is 158.5 per 100,000.

CLRD: F Chronic lower respiratory disease (CLRD) is the third leading cause of death in Alabama, and the state is ranked 42nd in the U.S. for deaths by CLRD among rural residents. The ageadjusted rate for CLRD in rural counties is 65.9 per 100,00. The national average is 41.6 per 100,000.

Physical Health: F The number of physically unhealthy days reported in rural Alabama is 4.7 in 30 days, while urban residents report 4.1 days. The national average is 3.9. Rural Alabama ranks 42nd.

Low Birth Weight: F The percentage of live births with low birth weight (< 5 pounds, 8 ounces) in rural Alabama is 10.3 percent, well above the national average of 8 percent. Alabama ranks 44th in the category.

Dental Care: F Alabama ranks last in the nation (47th) for rural access to dental care with 28.1 dentists per 100,000 rural residents. The national rural average is 42.8.

Uninsured Rate: C17 percent of Alabama’s rural population under age 65 is uninsured. The average uninsured rate for urban residents of Alabama is 14 percent. Alabama is one of 19 states that did not adopt Medicaid expansion as offered under the Affordable Care Act.

.

RHQ

19 


IN FREE FALL: REPRODUCTIVE HEALTH AND RIGHTS IN AMERICA

C+ 22/47 ALASKA ranks 22th in the nation for rural health out of 47 states with rural counties. Alaska is one of three states receiving a grade of “C+” ALASKA RECEIVED A GRADE OF “C+” BECAUSE: Alaska ranked in the third quintile of states for its rates of mortality in rural counties. Alaska ranked in the first quintile of states for measures of daily health and quality of life in rural counties. Alaska ranked in the third quintile of states for health care access in rural counties.

20

RHQ

20  RHQ

ALASKA

WASHINGTON, D.C. – In releasing its fifth annual 50-State Report Card on Reproductive Health and Rights, the Population Institute lowered the U.S. grade from a “D+” to a “D”. The report card, the most comprehensive report card of its kind, tracks multiple indicators of reproductive health and rights, including access to family planning and abortion services.

Along with California, Hawaii, Oregon and Washington, Alaska is part of the Pacific The Institute’s president Robert Walker said, “For the past five years, reproductive health and division of the West U.S. Census region. Four of the five states in the division, rights in the U.S. have been on a slippery slope.” Five years ago nine states received an “F”. In including Alaska,card ranked in the top halfAlabama—received of the nation for rural health. this year’s report 20 states—including a failing grade.Alaska Walker(22) warned, performed better than Oregon (26), but the Last Frontier State fell behind however, “The worst may be yet to come, as Congress and the new Administration Hawaii are expected (4), California andfor Washington (17) and in the final rankings. to slash federal (15) funding family planning comprehensive sex education. The slippery slope is becoming a free fall.”

A

today more than 50% of for factors Walker laska emphasized “It’sdoctors.“plus” needs that more The or a “minus” according to the Ruralstates Health Information Hub. women now live in a county not reflected in the core grade. not just abortion rights that are vast majority of Alaska’s counties are A study commissioned by the State of Alaska without an abortion provider. under siege; it’s also access to federally designated Health Professions documented the costs associated with recruiting ALABAMA RECEIVED A family planning services, and Shortage Areas (HPSA), the more BECAUSE primaryTHEIR care providers in rural/frontier Federal support forAlaska when women are deniedmaking access it all“MINUS” remarkable that everyone the state loses: scored in ‘CHOOSE the top LIFE’against recruitment expenditures the “Lower reproductive in health and rights LICENSE to contraception half themore nation. One possible explanation is 48,” finding that rural/frontier Alaska spends apcould suffer a major reversal PLATES FUND ANTI-CHOICE thereofare unintended its willingness to innovate. proximately four times more than otherand states. in 2017. Congress the new pregnancies, more abortions, and ORGANIZATIONS/CRISIS Administration are expected to PREGNANCY CENTERS higher health care costs.” curtail access to contraceptive Take, for example, the Frontier Extended URBAN-RURAL DIVIDE Only 21 states received a services by blocking all funding This year’s report card also Stay Clinic project. One of the most“B-“ pressing or higher. Just five states for Planned Parenthood, draws attention to “a growing Most U.S. states report a marked difference health care issues in rural/frontier Alaska has New Jersey, (California, defunding Title X, a urban 48-year old national divide” on reproductive in health outcomes between rural and been non-reimbursed extended stay primary New Mexico, Oregon and program that provides support health and rights, and Walker counties. Alaska reports a 10.7 percent care, according to the Alaska Center for Rural received an “A”. Washington) to family planning clinics warned that Alabama is “on increase in rural mortality as compared to The following states received Health and Health Workforce. serving low-income households, the wrong side of that divide.” a failing grade in 2016:counties. The state ranks 27th for rural/ urban and eliminating the Affordable Alabama, which received an “F”, Alabama, Arkansas, Florida, urban difference in Care mortality. Because of 20 terrain, Act’s no-cost birth control was one of statesweather receivingand a transportaGeorgia, Idaho, Indiana, Kansas, tion issues, care clinics provide mandate. Walker noted that failing grademany in theprimary latest report Missouri, extended stay care patients whoLouisiana, would Mississippi, “In the past five years most of card. Five years ago to Alabama RURAL Nebraska, North Dakota,RESOURCES otherwise be transferred to another care the slippage on reproductive received a “D”. Oklahoma, South Carolina, provider. In response, Alaska requested funds health has occurredinat the state Rural health resource organizations South Dakota, Tennessee, Texas, level, but this year could see MANY FACTORS to examine the effectiveness of a new type Alaska include: Utah, Virginia, and Wisconsin. unprecedented setbacks at the ACCOUNTED of provider, theFOR Frontier Extended Stay Clinic national level, including cuts ALABAMA’S FAILING GRADE (FESC). The FESC project saved payers $14warned mil- that Walker woman’s • “A Alaska Office of Rural Health in funding for comprehensive INCLUDING POOR SCORES lion, but the project ended in 2013.reproductive A federal health should not dhss.alaska.gov/dph/HealthPlanning/ sex education in the schools IN PREVENTION AND report concluded that frontier communities depend on where shePages/ruralhealth/default.aspx lives, but and a return to abstinence only AFFORDABILITY it does, as women in many would likely not be able to sustain extended • Alaska Center for Rural Health programs which have been areas are experiencing reduced Usingcapacity eleven criteria, the stay under Medicare. www.uaa.alaska.edu/academics/collegeproven to be ineffective.” access to reproductive health Institute’s report card ranked of-health/departments/ACRHHW/ abortion.” each of the 50 states and the RURAL HEALTH CARE FACILITIEScare services including Walker stressed that this • Regional Telehealth Resource Walker noted that 19Northwest states, District of Columbia on four year’s report card should be Center: www.nrtrc.org including Alabama, have refused broad indicators relating to There are 21 hospitals in Alaska, and to theexpand state Medicaid under the “an urgent call to action” for reproductive health and rights: anyone who concerned has 14 hospitals identified as Critical Access For more information about theis data Affordable Care Act, leaving tens effectiveness, prevention, about reproductive health Hospitals. There are zero Rural Health Clinics in sources used and methodology employed of millions of women without affordability, and access. Based and rights. “As disappointing Alaska, andcomposite 29 Federally Qualified Centers improved accessintoRHQ’s contraception upon their scores (0- Health 2017 Rural Health Report Card, as 2016 was, 2017 could be provide services at 177 sites within the state, and other healthvisit carewww.RuralHealthQuarterly.com. services. 100), each state received a “core” a whole lot worse.” Walker also noted that in 27 grade (A, B, C, D or F), but some states received an additional


ALASKA BY THE NUMBERS Alaska has an estimated population of 741,894 people, and 32.2 percent live in one of Alaska’s 26 rural counties. The poverty rate in rural Alaska is 23 percent, compared with 7.7 percent in urban areas of the state. 9.8 percent of the rural population has not completed high school, while 6.9 percent of the urban population lacks a high school diploma.

..

10.8 percent of rural Alaska residents are U.S. military veterans, and 8.6 percent of the rural population under age 65 lives with a disability.

RURAL COUNTIES URBAN COUNTIES

68.9 percent of the state’s rural population is Non-Hispanic White, 0.9 percent is Black/African-American, 4.5 percent is Hispanic/Latino, 5.4 percent Asian and 26.9 percent American Indian/Alaska Native.

MORTALITY

QUALITY OF LIFE

ACCESS TO CARE

Cancer: C-

Fair/Poor Health: C+

Primary Care: A

Cancer is the leading cause of death in Alaska, and the state is ranked 28th in the U.S. for the number of deaths by heart disease among rural residents. The statewide rate for cancer is 159.8 per 100,000. The national average is 158.5 per 100,000.

The percentage of Alaskans reporting poor general health is close to the national average. The state ranked 22nd for rural counties (15.1 percent) and 13/51 for urban counties (12.8 percent).

Alaska ranks 4th in the U.S. for the number of primary care physicians practicing in rural counties (84.3 per 100,000). The national average for rural counties is 54.5 per 100,000.

Heart Disease: C

Mental Health: A-

Mental Care: B+

Rural residents of Alaska reported an average of 3.4 mentally unhealthy days in the past 30 days. The national average is 3.7 days. The state ranked 10th for self-reported mental health in rural counties.

Alaska ranks 11th in the U.S. for the number of psychiatrists practicing in rural counties. Alaska has 5.0 per 100,000 residents. The U.S. rural average is 3.4.

Heart disease is the second leading cause of death in Alaska, and the state is ranked 25th in the U.S. for the number of deaths by heart disease among rural residents. The statewide rate for heart disease is 154.1 per 100,000. The national average is 168.5 per 100,000.

Accidents: F Accidents are the third leading cause of death in Alaska, and Alaska ranked 40th out 47 states for accidental death in rural counties. The statewide rate for accidental death is 57.9 per 100,000. The national average is 40.5 per 100,000.

Physical Health: C The number of physically unhealthy days reported in rural Alaska is 3.9 in 30 days, while urban residents report 3.4 days. The national average is 3.9. Rural Alaska ranks 24th.

Low Birth Weight: A+ The percentage of live births with low birth weight (< 5 pounds, 8 ounces) in rural Alaska is 5.4 percent, well below the national average of 8 percent. Alaska ranks 1st nationally in the category.

Dental Care: A+ Alaska ranks 2nd in the nation for rural access to dental care with 72 dentists per 100,000 rural residents. The national rural average is 42.8.

Uninsured Rate: F 25.7 percent of Alaska’s rural population under age 65 is uninsured, the highest rural uninsured rate in the nation. The average uninsured rate for urban Alaskans is 17 percent. Alaska is one of 31 states that adopted Medicaid expansion as offered under the Affordable Care Act.

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IN FREE FALL: REPRODUCTIVE HEALTH AND RIGHTS IN AMERICA

D 33/47 ARIZONA ranks 33rd in the nation for rural health out of 47 states with rural counties. Arizona is one of three states receiving a grade of “D” ARIZONA RECEIVED A GRADE OF “D” BECAUSE: Arizona ranked in the third quintile of states for its rates of mortality in rural counties. Arizona ranked in the fifth quintile of states for measures of daily health and quality of life in rural counties. Arizona ranked in the fifth quintile of states for health care access in rural counties.

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ARIZONA

WASHINGTON, D.C. – In releasing its fifth annual 50-State Report Card on Reproductive Health and Rights, the Population Institute lowered the U.S. grade from a “D+” to a “D”. The report card, the most comprehensive report card of its kind, tracks multiple indicators of reproductive health and rights, including access to family planning and abortion services.

Along with Colorado, Idaho, Montana, Nevada, New Mexico, Utah and Wyoming, The Institute’s president Robert Walker said, “For the past five years, reproductive health and Arizona is part of the Mountain division of the West U.S. Census region. With the exrights in the U.S. have been on a slippery slope.” Five years ago nine states received an “F”. In ception of high performing Colorado, all states in the division rank near the middle of this year’s report card 20 states—including Alabama—received a failing grade. Walker warned, the nation for rural Canyon Stateand ranked lowest in the division (33) however, “The worsthealth. may beThe yet Grand to come, as Congress the new Administration are expected behind (12), Wyoming (14), Montana (19), Idaho sex (20), Utah (23), to slash Colorado federal funding for family planning and comprehensive education. TheNevada slippery slope (30) and New Mexico is becoming a free fall.” (31).

A

states today more or a “minus” forof factors Walkerrizona emphasized that “It’s low in“plus” ranks relatively this year’s Office Rural Health Policy, there arethan 14 50% of women now live in a county not reflected in the core grade. not justrankings abortiondespite rights that are the state’s relatively Critical Access Hospitals in the state, as well as without an abortion provider. under siege; it’s also access to small rural population (5 percent). 23 Rural Health Clinics and 21 Federally Qualified ALABAMA RECEIVED A family planning services, and Perhaps noteworthy is the fact that, while Health Centers providing services at 149 sites. Federal support for “MINUS” BECAUSE THEIR when women are denied access only four percent of the state’s overall reproductive health and rights ‘CHOOSE LIFE’ LICENSE to contraception everyone loses: population identify as American Indian in U.S. could suffer a major reversal PLATES FUNDURBAN-RURAL ANTI-CHOICE DIVIDE there are more unintended Census data, more approximately (32.8 in 2017. Congress and the new pregnancies, abortions, one-third and ORGANIZATIONS/CRISIS percent) of Arizona’s rural Native Most U.S. states report a marked difference Administration are expected to PREGNANCY CENTERS higher health care costs. ” residents are Americans. curtail access toand contraceptive in health outcomes between rural urban Only 21 states received a services by blocking all funding This year’s report card also counties. Arizona shows a 20.2 percent “B-“ or higher. Just five states for Planned Parenthood, draws attention to “a growing Arizona’s rural counties have significantly increase (California, New Jersey, in rural mortality as compared to X,for a 48-year national divide” on reproductive higher rates of uninsured Native Americans urban counties. The defunding state ranksTitle 42nd rural/ old New Mexico, Oregon and program that provides support health and rights, and Walker and Latinos without ready access toWashington) health urban difference in mortality. received an “A”. to family planning clinics warned that Alabama is “on services, according to The UniversityThe of Arizona following states received serving low-income households, the wrong side of that divide.” failing grade RURAL in 2016: RESOURCES Center for Rural Health’s 2015 Safetya Net and eliminating the Affordable Alabama, which received an “F”, Alabama, Arkansas, Florida, Health Care in Arizona Report. Care Act’s no-cost birth control was one of 20 states receiving a Georgia, Idaho,Rural Indiana, Kansas, health resource organizations Arizona mandate. Walkerinnoted that failing grade in the latest report Missouri, Arizona’s aging population isLouisiana, also likelyMississippi, include: “In the past five years most of card. Fiverapidly years ago Alabama Nebraska, to pose challenges going forward. The numberNorth Dakota, the slippage on reproductive received a “D”. Oklahoma, South Carolina, of Arizonans age 65 and older is expected to health hasHealth occurred at the state • Arizona Center for Rural South Dakota, Tennessee, Texas, increase 174 percent by 2050, and the proporlevel, but this year could see MANY FACTORS crh.arizona.edu Utah, Virginia, and Wisconsin. unprecedented setbacks at the tion of adults age 65 and older in the populaACCOUNTED FOR • Arizona Rural Health Association national level, including cuts ALABAMA’S FAILING GRADE 21Walker tion will increase to an estimated percent www.azrhassociation.org warned that “A woman’s in funding for comprehensive INCLUDING POOR SCORES of the entire population, according reproductive to the • should Southwest health not Telehealth Resource Center sex education in the schools IN PREVENTION AND Arizona Department of Health Services. Theon where shewww.southwesttrc.org depend lives, but and a return to abstinence only AFFORDABILITY University of Arizona Center for Ruralit Health does, as women many Rural Women’s Health Network • in Arizona programs which have been also reports almost of Arizona are experiencing reduced Using eleventhat criteria, theone-quarterareas azrwhn.org proven to be ineffective.” access to reproductive health Institute’s report card ranked physicians (23.2 percent) plan to significantly care by services including abortion. ” each oftheir the 50 statescare and hours the or retire reduce patient For more information about the data Walker stressed that this Walker noted that 19 states, District of Columbia on four 2020. sources used and methodology employed year’s report card should be including Alabama, have refused broad indicators relating to in RHQ’s 2017 Rural“an Health urgentReport call to Card, action” for to expand Medicaid under the reproductive health and rights: RURAL HEALTH CARE FACILITIESAffordable Carevisit anyone who is concerned www.RuralHealthQuarterly.com. Act, leaving tens effectiveness, prevention, about reproductive health of millions of women without affordability, and access. Based and rights. “As disappointing According to the Rural Health Information improved access to contraception upon their composite scores (0as 2016 was, 2017 could be Hub, an organization funded by the Federal 100), each state received a “core” and other health care services. a whole lot worse.” Walker also noted that in 27 grade (A, B, C, D or F), but some states received an additional


ARIZONA BY THE NUMBERS Arizona has an estimated population of 6,931,071 people, and 5 percent live in one of Arizona’s 7 rural counties. The poverty rate in rural Arizona is 26.2 percent, compared with 15.8 percent in urban areas of the state. 20 percent of the rural population has not completed high school, while 13.6 percent of the urban population lacks a high school diploma.

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9.4 percent of rural Arizona residents are U.S. military veterans, and 11 percent of the rural population under age 65 lives with a disability. RURAL COUNTIES URBAN COUNTIES

39.4 percent of the state’s rural population is Non-Hispanic White, 0.7 percent is Black/African-American, 25 percent is Hispanic/Latino, 0.6 percent is Asian and 32.8 percent American Indian/Alaska Native.

MORTALITY

QUALITY OF LIFE

ACCESS TO CARE

Cancer: A

Fair/Poor Health: F

Primary Care: D-

Cancer is the leading cause of death in Arizona, yet the state is ranked 4/47 in the U.S. for deaths by cancer among rural residents. The age-adjusted rate for cancer in rural counties is 148.3 per 100,000. The national average is 158.5 per 100,000.

The percentage of rural Arizonans reporting poor general health is the highest in the nation. The state ranked 47th for rural counties (23.9 percent) and 35/51 for urban counties (16.1 percent).

Arizona ranks 37th in the U.S. for the number of primary care physicians practicing in rural counties (48.7 per 100,000). The national average for rural counties is 54.5 per 100,000.

Mental Health: F

Mental Care: F

Rural residents of Arizona reported an average of 4.9 mentally unhealthy days in the past 30 days. The national average is 3.7 days. The state ranked 47th, last in the nation, for self-reported mental health in rural counties.

Arizona ranks 46th in the U.S. for the number of psychiatrists practicing in rural counties. Arizona has 0.9 per 100,000 residents. The U.S. rural average is 3.4.

Heart Disease: B+ Heart disease is the second leading cause of death in Arizona, and the state is ranked 12th in the U.S. for the number of deaths by heart disease among rural residents. The age-adjusted rate for cancer in rural counties is 157.6 per 100,000. The overall national average is 168.5 per 100,000.

CLRD: A Chronic lower respiratory disease (CLRD) is the third leading cause of death in Arizona, and the state is ranked 4th in the U.S. for deaths by CLRD among rural residents. The ageadjusted rate for CLRD in rural counties is 37.9 per 100,000. The national average is 41.6 per 100,000.

Physical Health: F The number of physically unhealthy days reported in rural Arizona is 5 in 30 days, while urban residents report 4.1 days. The national average is 3.9. Rural Arizona ranks 44th.

Low Birth Weight: C The percentage of live births with low birth weight (< 5 pounds, 8 ounces) in rural Arizona is 7.7 percent. The national average is 8 percent. Arizona ranks 25th in the category.

Dental Care: B Arizona ranks 17th in the nation for rural access to dental care with 52.8 dentists per 100,000 rural residents. The national rural average is 42.8.

Uninsured Rate: F 21.5 percent of Arizona’s rural population under age 65 is uninsured. The average uninsured rate for urban residents of Arizona is 17.4 percent. Arizona is one of 31 states that adopted Medicaid expansion as offered under the Affordable Care Act.

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IN FREE FALL: REPRODUCTIVE HEALTH AND RIGHTS IN AMERICA

D38/47 ARKANSAS ranks 38th in the nation for rural health out of 47 states with rural counties. Arkansas is one of three states receiving a grade of “D-” ARKANSAS RECEIVED A GRADE OF “D-” BECAUSE: Arkansas ranked in the fifth quintile of states for its rates of mortality in rural counties. Arkansas ranked in the fifth quintile of states for measures of daily health and quality of life in rural counties. Arkansas ranked in the fourth quintile of states for health care access in rural counties.

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ARKANSAS

WASHINGTON, D.C. – In releasing its fifth annual 50-State Report Card on Reproductive Health and Rights, the Population Institute lowered the U.S. grade from a “D+” to a “D”. The report card, the most comprehensive report card of its kind, tracks multiple indicators of reproductive health and rights, including access to family planning and abortion services.

Along with Louisiana, Oklahoma and Texas, Arkansas is part of the West South The Institute’s president Robert Walker said, “For the past five years, reproductive health and Central division of the South U.S. Census region. All four states in the division showed rights in the U.S. have been on a slippery slope.” Five years ago nine states received an “F”. In strong similarities in our reporting, and all four states received a low grade. Arkansas this year’s report card 20 states—including Alabama—received a failing grade. Walker warned, (40) performed better and Louisiana (46), but the Natural however, “The worst maythan be yetOklahoma to come, as(41) Congress and the new Administration are expected State fell behind Texasfor (36) in the final and rankings. to slash federal funding family planning comprehensive sex education. The slippery slope is becoming a free fall.”

A

states today more than 50% of “plus”life or a “minus” for factors Walkerrkansas emphasized that “It’s counties with the lowest URBAN-RURAL DIVIDE women now live in a county not reflected in the core grade. not justexpectancy abortion rights that are are predominately located without an abortion provider. under siege; it’s also access to in the rural Arkansas Delta, the 42 Most U.S. states report a marked difference ALABAMA RECEIVED A family planning services, and counties primarily east of the Arkansas River in health outcomes between rural and Federal support forurban “MINUS” BECAUSE THEIR when women are denied access that have been identified as one of the most counties. Arkansas shows a 9.3 percent reproductive health and rights ‘CHOOSE LIFE’ LICENSE to contraception everyone loses: impoverished of the nation,PLATES according in rural mortality as compared could suffer a major to reversal FUNDincrease ANTI-CHOICE there are moreregions unintended to the Delta Regional Authority. urban counties. The in state ranks 28th for rural/ 2017. Congress and the new pregnancies, more abortions, and ORGANIZATIONS/CRISIS difference in mortality. Administration are expected to PREGNANCY urban CENTERS higher health care costs.” The Arkansas Delta is comprised of Only counties curtail access to contraceptive 21 states received a services by blocking all funding This year’s report card also characterized by higher proportions“B-“ of African RURAL RESOURCES or higher. Just five states for Planned Parenthood, draws attention to “a growing Americans with a lower socio-economic statusNew Jersey, (California, defunding Title X, a 48-year old national divide” on reproductive and poorer health outcomes. Most New of the Rural health Mexico, Oregon and resource organizations in Arkansas program that provides support health and rights, and Walker state’s rural residents, however, areWashington) nonreceived include:an “A”. to family planning clinics warned that Alabama is “on Hispanic White (78 percent). Rurality and inac- states received The following serving low-income households, the wrong side of that divide.” a failing grade • in 2016: cessibility to health care resources contribute Arkansas Office ofand Rural Health & Primary Care eliminating the Affordable Alabama, which received an “F”, Alabama, Arkansas, www.healthy.arkansas.gov/programs-serFlorida, to rural health disparities. Care Act’s no-cost birth control was one of 20 states receiving a Georgia, Idaho, Indiana, Kansas, vices/topics/rural-health-and-primary-care mandate. Walker noted that failing grade in the latest report Louisiana, Mississippi, Missouri, The childAlabama poverty rate approaching • Arkansas Department of Rural Services “In the past five years most of card.Delta Five has yearsa ago Nebraska, North Dakota, 40 percent (37.2), while one in three children ruralservices.arkansas.gov the slippage on reproductive received a “D”. Oklahoma, South Carolina, in the Coastal Plains (33.6 percent) live in has occurred at the state • Southern Rural health Development Center South Dakota, Tennessee, Texas, poverty. level, but this year could see MANY FACTORS srdc.msstate.edu Utah, Virginia, and Wisconsin. unprecedented setbacks at the ACCOUNTED FOR • South Central Telehealth Resource Center national level, including cuts ALABAMA’S FAILING GRADE Nearly one in four Arkansans received sup-warned that “A learntelehealth.org Walker woman’s in funding for comprehensive INCLUDING POORassistance SCORES (SNAP), plemental nutrition but the health should not reproductive sex education in the schools IN PREVENTION AND concentration of SNAP recipients independ rural areas on where she lives,information but For more about the data and a return to abstinence only AFFORDABILITY is considerably higher. it does, as women in many sources used and methodology employed programs which have been areas are experiencing reduced Using eleven criteria, the in RHQ’s 2017 Ruralproven Health Card,” to Report be ineffective. health Institute’s report card ranked RURAL HEALTH CARE FACILITIESaccess to reproductive visit www.RuralHealthQuarterly.com. care services including abortion.” each of the 50 states and the Walker stressed that this Walker noted that 19 states, District of Columbia on four According to the Rural Health Information year’s report card should be including Alabama, have refused broad indicators relating to Hub, an organization funded by the Federal “an urgent call to action” for to expand Medicaid under the reproductive health and rights: Office of Rural Health Policy, there areAffordable 29 CriticalCare Act, leaving tens anyone who is concerned effectiveness, prevention, about reproductive health Access Hospitals in the state, as well as 88 of millions of women without affordability, and access. Based and rights. “As disappointing Rural Health Clinics and 12 Federally Qualified improved access to contraception upon their composite scores (0as 2016 was, 2017 could be Health Centers 109other sites.health care services. 100), each stateproviding received aservices “core” atand a whole lot worse.” Walker also noted that in 27 grade (A, B, C, D or F), but some states received an additional


ARKANSAS BY THE NUMBERS Arkansas has an estimated population of 2,988,248 people, and 38 percent live in one of Arkansas’s 55 rural counties. The poverty rate in rural Arkansas is 18.9 percent, compared with 16.2 percent in urban areas of the state. 18 percent of the rural population has not completed high school, while 13.4 percent of the urban population lacks a high school diploma.

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10.1 percent of rural Arkansas residents are U.S. military veterans, and 15.2 percent of the rural population under age 65 lives with a disability. RURAL COUNTIES URBAN COUNTIES

78 percent of the state’s rural population is Non-Hispanic White, 14.4 percent is Black/African-American and 5 percent is Hispanic/Latino, 0.4 percent is American Indian/Alaska Native and 0.5 percent is Asian.

MORTALITY

QUALITY OF LIFE

ACCESS TO CARE

Heart Disease: F

Fair/Poor Health: F

Primary Care: C-

Heart disease is the leading cause of death in Arkansas, and the state is ranked 42nd in the U.S. for the number of deaths by heart disease among rural residents. The age-adjusted rate for heart disease in rural counties is 237.3 per 100,000. The national average is 168.5 per 100,000.

The percentage of Arkansans reporting poor general health is among the highest in the nation. The state ranked 45th for rural counties (22.4 percent) and 46/51 for urban counties (20.1 percent).

Arkansas ranks 29th in the U.S. for the number of primary care physicians practicing in rural counties (51 per 100,000). The national average for rural counties is 54.5 per 100,000.

Mental Health: F

Mental Care: F

Rural residents of Arkansas reported an average of 4.3 mentally unhealthy days in the past 30 days. The national average is 3.7 days. The state ranked 39th for self-reported mental health in rural counties.

Arkansas ranks 43rd in the U.S. for the number of psychiatrists practicing in rural counties. Arkansas has 1.3 per 100,000 residents. The U.S. rural average is 3.4.

Cancer: F Cancer is the second leading cause of death in Arkansas, and the state is ranked 43/47 in the U.S. for deaths by cancer among rural residents. The ageadjusted rate for cancer in rural counties is 192.7 per 100,000. The national average is 158.5 per 100,000.

CLRD: F Chronic lower respiratory disease (CLRD) is the 3rd leading cause of death in Arkansas, and the state has the 6th highest rural rate in the U.S. Arkansas ranked 44th out 47 states for death by CLRD in rural counties.

Physical Health: F The number of physically unhealthy days reported in rural Arkansas is 4.8 in 30 days, while urban residents report 4.3 days. The national average is 3.9. Rural Arkansas ranks 44th.

Low Birth Weight: DThe percentage of live births with low birth weight (< 5 pounds, 8 ounces) in rural Arkansas is 10.3 percent, well above the national average of 8 percent. Arkansas ranks 44th in the category.

Dental Care: F Arkansas ranks 40th in the nation for rural access to dental care with 33.8 dentists per 100,000 rural residents. The national rural average is 42.8.

Uninsured Rate: D+ 17.8 percent of Arkansas’s rural population under age 65 is uninsured. The average uninsured rate for urban residents of Arkansas is 15.9 percent. Arkansas is one of 31 states that adopted Medicaid expansion as offered under the Affordable Care Act.

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IN FREE FALL: REPRODUCTIVE HEALTH AND RIGHTS IN AMERICA

B 15/47 CALIFORNIA ranks 15th in the nation for rural health out of 47 states with rural counties. California is one of four states receiving a grade of “B” CALIFORNIA RECEIVED A GRADE OF “B” BECAUSE: California ranked in the second quintile of states for its rates of mortality in rural counties. California ranked in the second quintile of states for measures of daily health and quality of life in rural counties. California ranked in the second quintile of states for health care access in rural counties.

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CALIFORNIA

WASHINGTON, D.C. – In releasing its fifth annual 50-State Report Card on Reproductive Health and Rights, the Population Institute lowered the U.S. grade from a “D+” to a “D”. The report card, the most comprehensive report card of its kind, tracks multiple indicators of reproductive health and rights, including access to family planning and abortion services.

Along with Alaska, Hawaii, Oregon and Washington, California is part of the Pacific The Institute’s president Robert Walker said, “For the past five years, reproductive health and division of the West U.S. Census region. Four of the five states in the division, rights in the U.S. have been on a slippery slope.” Five years ago nine states received an “F”. In including California, ranked in the top half of the nation for rural health. California this year’s report card 20 states—including Alabama—received a failing grade. Walker warned, (15) performed better Washington Alaska and Administration Oregon (26), but however, “The worst maythan be yet to come, as(17), Congress and(22) the new are the expected Golden behind (4) in theand final divisional rankings. to slash State federalfell funding forHawaii family planning comprehensive sex education. The slippery slope is becoming a free fall.”

C

statesthat today more than 50% of “plus” or a “minus” for factors Walkeralifornia’s emphasized that “It’s is more population urbanQualified Health Centers provide services women now live in a county not reflected in the core grade. not just abortion rights that are ized than that of the U.S. in general, at 1,392 sites. without an abortion provider. under siege; it’s also access to but the state has a significant rural ALABAMA RECEIVED A family planning services, and land mass with a rural population spread URBAN-RURAL DIVIDE Federal support for “MINUS” BECAUSE THEIR when women are denied access across 21 counties. reproductive health and rights ‘CHOOSE LIFE’ LICENSE to contraception everyone loses: U.S. states report a marked difference could suffer a major reversal PLATES FUNDMost ANTI-CHOICE there are more unintended California’s high rural ranking in health outcomes in between rural andand urban 2017. Congress the new ORGANIZATIONS/CRISIS pregnancies,relatively more abortions, andhealth may behealth due incare part to ”Medi-Cal’s expansion are expected to PREGNANCY counties. CENTERSCalifornia Administration higher costs. shows a 21.1 percent of managed care to rural counties, 18 of curtail access to contraceptive Only 21 states increase received ain rural mortality as compared to urservices by40th blocking all funding which are designated as frontier counties or This year’s report card also ban counties. The state ranks for rural/ “B-“ or higher. Just five states for Planned Parenthood, drawsfrontier attention to “a growing have areas. urban difference in mortality. (California, New Jersey, defunding Title X, a 48-year old national divide” on reproductive New Mexico, Oregon and program that provides support health and rights, and Walker Many of these isolated counties have limited received Washington) “A”. RURALan RESOURCES to family planning clinics warned that Alabama is “on health care provider capacity, particularly The following states received serving low-income households, the wrong side of that divide.” for specialty care, behavioral health services, a failing grade Rural in 2016: health resource organizations in Califorand eliminating the Affordable Alabama, which received an “F”, Alabama, Florida, and services for seniors and persons with Arkansas, nia include: Care Act’s no-cost birth control was one of 20 states receiving a Georgia, Idaho, Indiana, Kansas, disabilities. According to the California mandate. Walker noted that failing grade in the latest report Louisiana, Missouri, HealthCare Foundation (CHCF), more than Mississippi, • California State Office of Rural Healthmost of “In the past five years card. Five years ago Alabama Nebraska, 400,000 beneficiaries joined Medi-North Dakota, the slippage on reproductive received Medi-Cal a “D”. www.dhcs.ca.gov/services/rural/Pages/ Oklahoma, Cal managed care health plans under this South Carolina, health has occurred at the state StateOfficeofRuralHealth.aspx South Dakota, Tennessee, Texas, rural expansion during the first year. level, this Association year could see MANY FACTORS • California State Rural but Health Utah, Virginia, and Wisconsin. ACCOUNTED FOR www.csrha.org unprecedented setbacks at the national level, including cuts ALABAMA’S FAILING RURAL HEALTH CARE GRADE FACILITIESWalker warned • that California “A woman’sInstitute for Rural Studies in funding for comprehensive INCLUDING POOR SCORES reproductive health should not www.cirsinc.org sex education in the schools IN PREVENTION AND Community health centers and rural health depend on where lives, but Telehealth Resource Center • sheCalifornia and a return to abstinence only AFFORDABILITY clinics supply much of the ambulatory care it does, as in women in www.caltrc.org many programs which have been are experiencing reducedAssociation of Rural Health Clinics UsingCalifornia eleven criteria, the Accordingareas rural counties. to CHCF, • California proven to be ineffective.” to reproductive health Institute’s report cardofranked almost one-quarter the CHCs in access California www.carhc.org care services including abortion.” each of the 50 statescommunities. and the are located in rural Walker stressed that this Walker noted that 19 states, District of Columbia on four For more information about thecard datashould be year’s report including Alabama, have refused broad indicators to Information According to the relating Rural Health “an urgent callemployed to action” for sources used and methodology to expand Medicaid under the reproductive health and rights: Hub, an organization funded by the Federal anyone who is concerned in RHQ’s 2017 Rural Health Report Card, Affordable Care Act, leaving tens effectiveness, prevention, Office of Rural Health Policy, there are 34 about reproductive health visit www.RuralHealthQuarterly.com. of millions of women without affordability, and access. Based Critical Access Hospitals in the as well access to contraception and rights. “As disappointing upon their composite scores (0-state,improved as 2016 was, 2017 could be as 280 Rural Health Clinics and 176 Federally 100), each state received a “core” and other health care services. a whole lot worse.” Walker also noted that in 27 grade (A, B, C, D or F), but some states received an additional


CALIFORNIA BY THE NUMBERS California has an estimated population of 39,250,017 people, and 2.1 percent live in one of California’s 21 rural counties. The poverty rate in rural California is 17.1 percent, compared with 14.3 percent in urban areas of the state. 12.7 percent of the rural population has not completed high school, while 18.3 percent of the urban population lacks a high school diploma.

..

9.4 percent of rural California residents are U.S. military veterans, and 13.9 percent of the rural population under age 65 lives with a disability. RURAL COUNTIES URBAN COUNTIES

73.9 percent of the state’s rural population is Non-Hispanic White, 1.4 percent is Black/African-American, 16.8 percent is Hispanic/Latino and 1.7 percent is Asian, 2.8 percent is American Indian/Alaska Native.

MORTALITY

QUALITY OF LIFE

ACCESS TO CARE

Heart Disease: C+

Fair/Poor Health: C+

Primary Care: B+

Heart disease is the leading cause of death in California, and the state is ranked 42nd in the U.S. for the number of deaths by heart disease among rural residents. The age-adjusted rate for heart disease in rural counties is 172.6 per 100,000. The national average is 168.5 per 100,000.

The percentage of Californians reporting poor general health is close to the national average. The state ranked 23rd for rural counties (15.4 percent) and 41/51 for urban counties (17.2 percent).

California ranks 13th in the U.S. for the number of primary care physicians practicing in rural counties (66.3 per 100,000). The national average for rural counties is 54.5 per 100,000.

Mental Health: C

Mental Care: A-

Rural residents of California reported an average of 4 mentally unhealthy days in the past 30 days. The national average is 3.7 days. The state ranked 28th for self-reported mental health in rural counties.

California ranks 9th in the U.S. for the number of psychiatrists practicing in rural counties. California has 6 per 100,000 residents. The U.S. rural average is 3.4.

Cancer: B+ Cancer is the second leading cause of death in California, and the state is ranked 12th in the U.S. for deaths by cancer among rural residents. The ageadjusted rate for cancer in rural counties is 155.4 per 100,000. The national average is 158.5 per 100,000.

Stroke: D Cerebrovascular disease is the third leading cause of death in California, and the state is ranked 35th in the U.S. for deaths by stroke among rural residents. The age-adjusted rate for stroke in rural counties is 44.1 per 100,000. The national average is 37.6 per 100,000.

Physical Health: CThe number of physically unhealthy days reported in rural California is 4 in 30 days, while urban residents report 3.7 days. The national average is 3.9. Rural California ranks 29th.

Low Birth Weight: A+ The percentage of live births with low birth weight (< 5 pounds, 8 ounces) in rural California is 6 percent, well below the national average of 8 percent. California ranks 3rd in the category.

Dental Care: A+ California ranks first in the nation for rural access to dental care with 74.1 dentists per 100,000 rural residents. The national rural average is 42.8.

Uninsured Rate: C17.1 percent of California’s rural population under age 65 is uninsured. The average uninsured rate for urban residents of California is 16.5 percent. California is one of 31 states that adopted Medicaid expansion as offered under the Affordable Care Act.

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IN FREE FALL: REPRODUCTIVE HEALTH AND RIGHTS IN AMERICA

B+ 12/47 COLORADO ranks 12th in the nation for rural health out of 47 states with rural counties. Colorado is one of three states receiving a grade of “B+” COLORADO RECEIVED A GRADE OF “B+” BECAUSE: Colorado ranked in the first quintile of states for its rates of mortality in rural counties. Colorado ranked in the third quintile of states for measures of daily health and quality of life in rural counties. Colorado ranked in the second quintile of states for health care access in rural counties.

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COLORADO

WASHINGTON, D.C. – In releasing its fifth annual 50-State Report Card on Reproductive Health and Rights, the Population Institute lowered the U.S. grade from a “D+” to a “D”. The report card, the most comprehensive report card of its kind, tracks multiple indicators of reproductive health and rights, including access to family planning and abortion services.

Along with Arizona, Idaho, Montana, Nevada, New Mexico, Utah and Wyoming, The Institute’s president Robert Walker said, “For the past five years, reproductive health and Colorado is part of the Mountain division of the West U.S. Census region. Colorado rights in the U.S. have been on a slippery slope.” Five years ago nine states received an “F”. In (12) outperforms other states in the division and finishes among the top 10 states this year’s report card 20 states—including Alabama—received a failing grade. Walker warned, nationally for worst rural health. ThetoCentennial State ranks higher than Wyomingare (14), however, “The may be yet come, as Congress and the new Administration expected Montana (19), funding Idaho (20), Utah planning (23), Nevada (30) and Newsex Mexico (31). The slippery slope to slash federal for family and comprehensive education. is becoming a free fall.”

C

states today more 50% of “plus” or a “minus” for factors Walkerolorado emphasized that “It’sother states outperforms in the in health outcomes between rural andthan urban women now live in a county not reflected in the core grade. not just abortion rights that are Mountain West in several categories, counties. Colorado shows an unusual decrease without an abortion provider. under siege; it’s also access to but one clear exception is the state’s high (0.03 percent) in rural mortality as compared ALABAMA RECEIVED A family planning services, and uninsured rate. to urban counties. The state ranks 3rd for Federal support for “MINUS” BECAUSE THEIR when women are denied access rural/urban difference in mortality. reproductive health and rights ‘CHOOSE LIFE’ LICENSE to contraception everyone loses: There maymore be good news on the horizon, could suffer a major reversal PLATES FUND ANTI-CHOICE there are unintended however. According to the Colorado Health RURAL RESOURCES in 2017. Congress and the new pregnancies, more abortions, and ORGANIZATIONS/CRISIS Institute’s newcare Colorado Survey, Administration are expected to PREGNANCY CENTERS higher health costs.” Health Access The state’s overall uninsured rate willOnly fall to 6.5 curtail access toincontraceptive Rural health resource organizations Colorado 21 states received a services by blocking all funding This year’s report card also percent in 2017. include: “B-“ or higher. Just five states for Planned Parenthood, draws attention to “a growing (California, New Jersey, Title X, a 48-year old national divide” on reproductive Rural opioid abuse is another urgent issue • Colorado Rural defunding Health Center New Mexico, Oregon and program that provides support health and rights, and Walker Colorado may need to address. According to received coruralhealth.org Washington) an “A”. to family planning clinics warned that Alabama is “on the Colorado Rural Health Center, rural areas states The following received • Rural Community Assistance Corporation serving low-income households, the wrong side of that divide.” a failing of the state saw a 140 percent increase in grade in 2016: www.rcac.org and eliminating the Affordable Alabama, which received an “F”, Alabama, Florida, Rural Development Center opioid overdose deaths between 2002-2014,Arkansas, • Western Care Act’s no-cost birth control was one of 20 states receiving a Georgia, Idaho, Indiana, Kansas, compared to in a 96 increase in urban wrdc.usu.edu mandate. Walker noted that failing grade thepercent latest report Missouri, areas during the same time frame.Louisiana, Rural Mississippi, • Southwest Telehealth Resource Center “In the past five years most of card. Five years ago Alabama Nebraska, North Dakota, Washington County saw the biggest increase www.southwesttrc.org the slippage on reproductive received a “D”. Oklahoma, South Carolina, in the state, with a 400 percent jump in opioid • Colorado Area Health Education Center health has occurred at the state South Dakota, Tennessee, Texas, overdose deaths between 2002 andUtah, 2014.Virginia, and Wisconsin. level, but this year could see MANY FACTORS www.ucdenver.edu/life/services/ahec/ unprecedented setbacks at the ACCOUNTED FOR Pages/index.aspx national level, including cuts ALABAMA’S FAILING GRADE RURAL HEALTH CARE FACILITIESWalker warned that “A woman’s in funding for comprehensive INCLUDING POOR SCORES For should more information about the data reproductive health not sex education in the schools IN PREVENTION AND The Rural Health Information Hub, an or- on where sources used depend she lives, but and methodology employed and a return to abstinence only AFFORDABILITY it does, many2017 Rural Health Report Card, ganization funded by the Federal Office of as women in in RHQ’s programs which have been areas reduced UsingHealth eleven Policy, criteria,reports the Rural that there areare 30experiencing visit www.RuralHealthQuarterly.com. proven to be ineffective.” access to reproductive health Institute’sidentified report card hospitals asranked Critical Access Hospitals careClinics services including abortion.” the 50 ineach theof state, as states well asand 53 the Rural Health Walker stressed that this Walker District of Columbia on four and 20 Federally Qualified Health Centers noted that 19 states, year’s report card should be including Alabama, have refused broad indicators relating to providing services at 191 sites. “an urgent call to action” for to expand Medicaid under the reproductive health and rights: anyone who is concerned Affordable Care Act, leaving tens effectiveness, prevention, about reproductive health URBAN-RURAL DIVIDE of millions of women without affordability, and access. Based and rights. “As disappointing improved access to contraception upon their composite scores (0as 2016 was, 2017 could be Most report aamarked and other health care services. 100), U.S. eachstates state received “core” difference a whole lot worse.” Walker also noted that in 27 grade (A, B, C, D or F), but some states received an additional


COLORADO BY THE NUMBERS Colorado has an estimated population of 5,540,545 people, and 12.7 percent live in one of Colorado’s 47 rural counties. The poverty rate in rural Colorado is 13.6 percent, compared with 10.7 percent in urban areas of the state. 11.1 percent of the rural population has not completed high school, while 9 percent of the urban population lacks a high school diploma.

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9.6 percent of rural Colorado residents are U.S. military veterans, and 8.4 percent of the rural population under age 65 lives with a disability.

RURAL COUNTIES URBAN COUNTIES

73.6 percent of the state’s rural population is Non-Hispanic White, 1.3 percent is Black/African-American, 21.4 percent is Hispanic/Latino and 1.4 percent is American Indian/Alaska Native and 0.7 percent is Asian.

MORTALITY

QUALITY OF LIFE

ACCESS TO CARE

Cancer: A+

Fair/Poor Health: B+

Primary Care: A

Cancer is the leading cause of death in Colorado, but the state is ranked first (lowest) in the U.S. for deaths by cancer among rural residents. The ageadjusted rate for cancer in rural counties is 128.3 per 100,000. The national average is 158.5 per 100,000.

The percentage of Coloradans reporting poor general health is relatively low. The state ranked 11th for rural counties (13.4 percent) and 14/51 for urban counties (12.8 percent).

Colorado ranks 7th in the U.S. for the number of primary care physicians practicing in rural counties (74.7 per 100,000). The national average for rural counties is 54.5 per 100,000.

Heart Disease: A+

Mental Health: A-

Mental Care: B

Rural residents of Colorado reported an average of 3.4 mentally unhealthy days in the past 30 days. The national average is 3.7 days. The state ranked 8th for self-reported mental health in rural counties.

Colorado ranks 17th in the U.S. for the number of psychiatrists practicing in rural counties. Colorado has 3.6 per 100,000 residents. The U.S. rural average is 3.4.

Heart disease is the second leading cause of death in Colorado, but the state is ranked 3rd in the U.S. for the number of deaths by heart disease among rural residents. The age-adjusted rate for heart disease in rural counties is 139.8 per 100,000. The national average is 168.5 per 100,000.

Accidents: B Accidents are the third leading cause of death in Colorado, and Colorado ranked 15th out of 47 states for accidental death in rural counties. The rural rate for accidental death is 53.6 per 100,000. The national average is 43.2 per 100,000.

Physical Health: AThe number of physically unhealthy days reported in rural Colorado is 3.3 in 30 days, while urban residents also report 3.3 days. The national average is 3.9. Rural Colorado ranks 10th.

Low Birth Weight: DThe percentage of live births with low birth weight (< 5 pounds, 8 ounces) in rural Colorado is 8.9 percent. The national average is 8 percent. Colorado ranks 37th in the category.

Dental Care: B+ Colorado ranks 11th in the nation for rural access to dental care with 57.9 dentists per 100,000 rural residents. The national rural average is 42.8.

Uninsured Rate: F 20 percent of Colorado’s rural population under age 65 is uninsured. The average uninsured rate for urban residents of Colorado is 13.1 percent. Colorado is one of 31 states that adopted Medicaid expansion as offered under the Affordable Care Act.

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A+ 3/47 CONNECTICUT ranks third in the nation for rural health out of 47 states with rural counties. Connecticut is one of three states receiving a grade of “A+” CONNECTICUT RECEIVED A GRADE OF “A+” BECAUSE: Connecticut ranked in the first quintile of states for its rates of mortality in rural counties. Connecticut ranked in the first quintile of states for measures of daily health and quality of life in rural counties. Connecticut ranked in the first quintile of states for health care access in rural counties.

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CONNECTICUT

WASHINGTON, D.C. – In releasing its fifth annual 50-State Report Card on Reproductive Health and Rights, the Population Institute lowered the U.S. grade from a “D+” to a “D”. The report card, the most comprehensive report card of its kind, tracks multiple indicators of reproductive health and rights, including access to family planning and abortion services.

Along with Maine, Massachusetts, New Hampshire, Rhode Island and Vermont, The Institute’s president Robert Walker said, “For the past five years, reproductive health and Connecticut is a member of the New England division of the Northeast U.S. Census rights in the U.S. have been on a slippery slope.” Five years ago nine states received an “F”. In region. Excluding Rhode Island, a state with no rural counties, all states in New Engthis year’s report card 20 states—including Alabama—received a failing grade. Walker warned, land receive high national rankings for rural health. Connecticut (3) performedare better however, “The worst may be yet to come, as Congress and the new Administration expected than Massachusetts (6)for and Maine (13), but the Constitution fell behind New slope to slash federal funding family planning and comprehensive sexState education. The slippery Hampshire andfall.” Vermont (2) in the final rankings. is becoming(1) a free

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states today more than 50% of “plus” or a “minus” for factors Walkeronnecticut emphasized “It’s is athat relatively urbanized state URBAN-RURAL DIVIDE women now live in a county not reflected in the core grade. not just abortion rights that are when compared to the most of the U.S. without an abortion provider. under siege; it’s also access to Rural residents tend to be older and Most U.S. states report a marked difference ALABAMA RECEIVED A family planning services, and tend to have higher incomes when compared in health outcomes between rural and urban Federal support for “MINUS” BECAUSE THEIR when women are denied access to the rest of the state, according to the Concounties. Connecticut shows a small 0.4 percent reproductive health and rights ‘CHOOSE LIFE’ LICENSE to contraception everyone loses: necticut of Rural Health (CORH). in rural mortality as compared to could suffer a major reversal PLATES FUNDincrease ANTI-CHOICE there areOffice more unintended urban counties. Theinstate ranks 4th for rural/ 2017. Congress and the new pregnancies, more abortions, and ORGANIZATIONS/CRISIS For those living in costs. rural”settings utilizing difference in mortality. Administration are expected to PREGNANCY urban CENTERS higher health care federally qualified health centers (FQHCs) the curtail access to contraceptive Only 21 states received a services by blocking all funding rates of hypertension, diabetes and“B-“ asthma This year’s report card also RURAL RESOURCES or higher. Just five states for Planned Parenthood, draws attention to “a growing to the(California, are relatively high, according CORH. New Jersey, defunding Title X, a 48-year old national divide” on reproductive Preventive screening for cervical andNew colorectal Rural health Mexico, Oregon and resource organizations in health and rights, and Walker cancers vary and are generally low.Washington) received an “A”. Conecticut include:program that provides support to family planning clinics warned that Alabama is “on The following states received serving low-income households, the wrong side of that divide.” In 2010, Connecticut was the first state to grade • a failing in 2016: Connecticut State Office of Rural Health and eliminating the Affordable Alabama, which received an “F”, Alabama, Florida, adopt Medicaid expansion by launching the Arkansas,www.ruralhealthct.org Care Act’s no-cost birth control was one of 20 states receiving a Georgia, HUSKY D program, transitioning very low Idaho,• Indiana, New Kansas, England Rural HealthWalker RoundTable mandate. noted that failing grade in the latest report Louisiana, Mississippi, Missouri, income adults from the State Administered www.newenglandruralhealth.org “In the past five years most of card. Five years ago Alabama Dakota, General (SAGA) medical Nebraska, program North • Northeast Telehealth Resource Center the slippage on reproductive receivedAssistance a “D”. Oklahoma, South Carolina, into Medicaid. In July 2012, it was estimated netrc.org health has occurred at the state South Dakota, Tennessee, Texas, that 344,000 Connecticut residents were unin- • Resources for Communities level, butand this year Solutions could see MANY FACTORS People Utah, Virginia, and Wisconsin. sured and highly concentrated in mostly urban unprecedented setbacks at the ACCOUNTED FOR www.rcapsolutions.org national level, including cuts ALABAMA’S FAILING GRADE areas of the state. Virtually all children in the Walker warned that “A woman’s in funding for comprehensive INCLUDING POOR SCORES state are eligible for HUSKY, which keeps the health For more about the data reproductive shouldinformation not sex education in the schools IN PREVENTION AND number of uninsured children low statewide. sources used depend on where she lives, but and methodology employed and a return to abstinence only AFFORDABILITY it does, as women many2017 Rural Health Report Card, in in RHQ’s programs which have been reduced Using eleven criteria, theFACILITIESareas are experiencing RURAL HEALTH CARE visit www.RuralHealthQuarterly.com. proven to be ineffective.” access to reproductive health Institute’s report card ranked services including abortion.” each of statesAccess and theHospitalscare There arethe no50 Critical in ConWalker stressed that this Walker District of Columbia on four necticut, according to the Rural Health Infor-noted that 19 states, year’s report card should be broad indicators relating to fundedincluding mation Hub, an organization by the Alabama, have refused “an urgent call to action” for to expand Medicaid under the reproductive health and rights: Federal Office of Rural Health Policy. Connectianyone who is concerned Affordable Care Act, leaving tens effectiveness, prevention, cut also has zero Rural Health Clinics, but it has about reproductive health of millions of women without affordability, and access. Based and rights. “As disappointing 16 Federally Qualified Health Centers providing improved access to contraception upon their composite scores (0as 2016 was, 2017 could be services at 235 sites within the state. 100), each state received a “core” and other health care services. a whole lot worse.” Walker also noted that in 27 grade (A, B, C, D or F), but some states received an additional


CONNECTICUT BY THE NUMBERS Connecticut has an estimated population of 3,576,452 people, and 5.1 percent live in Connecticut’s one rural county. The poverty rate in rural Connecticut is 6.8 percent, compared with 9.9 percent in urban areas of the state.

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8.6 percent of the rural population has not completed high school, while 10.2 percent of the urban population lacks a high school diploma. 8.7 percent of rural Connecticut residents are U.S. military veterans, and 6.6 percent of the rural population under age 65 live with a disability. RURAL COUNTIES URBAN COUNTIES

90.2 percent of the state’s rural population is Non-Hispanic White, 1.4 percent is Black/African-American, 5.2 percent is Hispanic/Latino, 0.1 percent is American Indian/Alaska Native and 1.8 percent is Asian.

MORTALITY

QUALITY OF LIFE

ACCESS TO CARE

Heart Disease: A

Fair/Poor Health: A+

Primary Care: B

Heart disease is the leading cause of death in Connecticut, but the state is ranked 5th in the U.S. for its low number of deaths by heart disease among rural residents. The age-adjusted rate for heart disease in rural counties is 146.9 per 100,000. The national average is 168.5 per 100,000.

The percentage of rural Connecticuters reporting poor general health is the best in the nation. The state ranked 1st for rural counties (10.6 percent) and 22/51 for urban counties (13.6 percent).

Connecticut ranks 14th in the U.S. for the number of primary care physicians practicing in rural counties (64.3 per 100,000). The national average for rural counties is 54.5 per 100,000.

Mental Health: B

Mental Care: A+

Rural residents of Connecticut reported an average of 3.6 mentally unhealthy days in the past 30 days. The national average is 3.7 days. The state ranked 16th for self-reported mental health in rural counties.

Connecticut ranks 3rd in the U.S. for the number of psychiatrists practicing in rural counties. Connecticut has 11.9 per 100,000 residents. The U.S. rural average is 3.4.

Cancer: A Cancer is the second leading cause of death in Connecticut, and the state is ranked 7th in the U.S. for deaths by cancer among rural residents. The ageadjusted rate for cancer in rural counties is 143.8 per 100,000. The national average is 158.5 per 100,000.

Accidents: CAccidents are the third leading cause of death in Connecticut, and Connecticut ranked 27th out of 47 states for accidental death in rural counties. The statewide rate for accidental death is 58.5 per 100,000. The national average is 43.2 per 100,000.

Physical Health: A+ The number of physically unhealthy days reported in rural Connecticut is 3.1 in 30 days, while urban residents report 3.3 days. The national average is 3.9. Rural Connecticut ranks 3rd.

Low Birth Weight: BThe percentage of live births with low birth weight (< 5 pounds, 8 ounces) in rural Connecticut is 7 percent. The national average is 8 percent. Connecticut ranks 18th in the category.

Dental Care: A Connecticut ranks 5th in the nation for rural access to dental care with 63.2 dentists per 100,000 rural residents. The national rural average is 42.8.

Uninsured Rate: A+ 7.9 percent of Connecticut’s rural population under age 65 is uninsured. The average uninsured rate for urban residents of Connecticut is 9.2 percent. Connecticut is one of 31 states that adopted Medicaid expansion as offered under the Affordable Care Act.

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D37/47 FLORIDA ranks 37th in the nation for rural health out of 47 states with rural counties. Florida is one of three states receiving a grade of “D-” FLORIDA RECEIVED A GRADE OF “D-” BECAUSE: Florida ranked in the fourth quintile of states for its rates of mortality in rural counties. Florida ranked in the fourth quintile of states for measures of daily health and quality of life in rural counties. Florida ranked in the fifth quintile of states for health care access in rural counties.

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FLORIDA

WASHINGTON, D.C. – In releasing its fifth annual 50-State Report Card on Reproductive Health and Rights, the Population Institute lowered the U.S. grade from a “D+” to a “D”. The report card, the most comprehensive report card of its kind, tracks multiple indicators of reproductive health and rights, including access to family planning and abortion services.

Along with Delaware, Georgia, Maryland, North Carolina, South Carolina, Virginia and The Institute’s president Robert Walker said, “For the past five years, reproductive health and West Virginia, Florida is part of the South Atlantic division of the South U.S. Census rights in the U.S. have been on a slippery slope.” Five years ago nine states received an “F”. In region. With thecard exception of MarylandAlabama—received (16) and Delaware (a state withWalker no rural this year’s report 20 states—including a failing grade. warned, counties), most states in the division have poor rural health rankings. Florida however, “The worst may be yet to come, as Congress and the new Administration(37) are expected performed better than West Virginia (39), and Georgia (40) and South Carolina (44), but theslope to slash federal funding for family planning comprehensive sex education. The slippery Sunshine State fellfall.” behind Virginia (32) and North Carolina (34). is becoming a free

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statesbytoday more than 50% of for factors funded Walker emphasized that “It’s state“plus” lorida is a well-populated with or a a “minus” an organization the Federal Office women now live in a county not reflected in the core grade. not just abortion rights that are diverse economy, but it’s hard to locate of Rural Health Policy. There are 155 Rural without an abortion provider. under siege; it’s also access to a bright spot in Florida’s rural health Health Clinics in Florida and 50 Federally ALABAMA RECEIVED A family planning services, and numbers. Rural mortality in the state is high Qualified Health Centers provide services Federal support for at “MINUS” BECAUSE THEIR when women are denied access compared to rates in urban counties, and ruralLIFE’523 sites in the state. All of Florida’s 67 counreproductive health and rights ‘CHOOSE LICENSE to contraception everyone loses: access to more primary care is the lowestPLATES in the FUNDties are designated as primary Health could suffercare a major reversal ANTI-CHOICE there are unintended nation. Professional Shortage (HPSAs). and the new in Areas 2017. Congress pregnancies, more abortions, and ORGANIZATIONS/CRISIS Administration are expected to PREGNANCY CENTERS higher health care costs.” curtail access to contraceptive The Florida Rural Health AssociationOnly is aware URBAN-RURAL DIVIDE 21 states received a services by blocking all funding This report card of theyear’s challenges facedalso by rural providers “B-“ or in higher. Just five states for Planned draws attention to “a growing the state, and they have asked legislators for NewMost U.S. states report a markedParenthood, difference (California, Jersey, defunding Title X, a 48-year old national divide” on reproductive help in addressing these problems. New Among in health Mexico, Oregon andoutcomes between rural and urban program that provides support health and rights,organization’s and Walker concerns the membership are Washington) received an Florida “A”. counties. shows a large 30.7 percent to family planning clinics warned that Alabama is “on The following states received complaints about delayed payments and the increase in rural mortality as compared to serving low-income households, the wrong side of that divide.” a failing in 2016: resulting hardship rural health providers aregrade urban counties. Theand stateeliminating ranks 46ththe forAffordable rural/ Alabama, which received an “F”, Alabama, Arkansas, Florida, experiencing under Medicaid Managed Care, urban difference in mortality. Care Act’s no-cost birth control was one of 20 states receiving a Georgia, Idaho, Indiana, Kansas, as well grade as theinlack access to routine testing mandate. Walker noted that failing theof latest report Missouri, and because Medicaid will Louisiana, not permitMississippi, RURAL RESOURCES “In the past five years most of card.services Five years ago Alabama Nebraska, North Dakota, rural hospitals providing the slippage on reproductive received a “D”. to be reimbursed forOklahoma, South Carolina, these services. health has occurred Rural health resource organizations inat the state South Dakota, Tennessee, Texas, level, but this year could see MANY FACTORS Florida include: Utah, Virginia, and Wisconsin. unprecedented setbacks at the ACCOUNTED FOR Due to these hardships, the FRHA argues, rural level, including cuts ALABAMA’S FAILING GRADE residents are forced to travel long distances • “A Florida Office ofnational Rural Health Walker warned that woman’s in funding for comprehensive INCLUDING POOR SCORES to have tests that were previously provided reproductive health should not www.floridahealth.gov/programs-andsex education in the schools IN PREVENTION AND by rural providers. The group also emphasizes depend on where sheservices/community-health/rural-health/ lives, but and a return to abstinence only AFFORDABILITY it does, as women in many the continued need for more specialty services index.html programs which have been areas reduced Using the health care, in ruraleleven areas,criteria, like mental andare experiencing • Florida Rural Health provenAssociation to be ineffective.” to reproductivefloridaruralhealth.org health Institute’s report cardlack ranked points to the relative of tobaccoaccess cessation care abortion.” each of the states and as thecompared programs in 50 rural Florida toservices urban including • Southeastern Telehealth Resource Walker stressed thatCenter this Walker noted that 19 states, District of Columbia on four areas.    www.setrc.us year’s report card should be including Alabama, have refused broad indicators relating to “an urgent call to action” for to expand Medicaid under the reproductive health and rights: anyone who concerned RURAL HEALTH CARE FACILITIES For more information about theisdata Affordable Care Act, leaving tens effectiveness, prevention, about reproductive health sources used and methodology employed of millions of women without affordability, and access. Based and rights. “As disappointing Florida has composite 12 Critical scores Access(0Hospitals, ac- accessintoRHQ’s 2017 Rural Health Report Card, improved contraception upon their as 2016 was, 2017 could be cording to the Health Information Hub,healthvisit and other carewww.RuralHealthQuarterly.com. services. 100), each stateRural received a “core” a whole lot worse.” Walker also noted that in 27 grade (A, B, C, D or F), but some states received an additional


FLORIDA BY THE NUMBERS Florida has an estimated population of 20,612,439 people, and 3.4 percent live in one of Florida’s 23 rural counties. The poverty rate in rural Florida is 23 percent, compared with 17.1 percent in urban areas of the state.

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21.4 percent of the rural population has not completed high school, while 12.8 percent of the urban population lacks a high school diploma.

RURAL COUNTIES URBAN COUNTIES

11.4 percent of rural Florida residents are U.S. military veterans, and 12.5 percent of the rural population under age 65 lives with a disability. 67.9 percent of the state’s rural population is Non-Hispanic White, 15 percent is Black/African-American and 14.3 percent is Hispanic/Latino, 0.5 percent is American Indian/Alaska Native and 0.6 percent is Asian.

MORTALITY

QUALITY OF LIFE

Heart Disease: C-

Fair/Poor Health: D+ Primary Care: F

Heart disease is the leading cause of death in Florida, and the state is ranked 29th in the U.S. for the number of deaths by heart disease among rural residents. The age-adjusted rate for heart disease in rural counties is 193.8 per 100,000. The national average is 168.5 per0 100,000.

The percentage of Floridians reporting poor general health is among the highest in the nation. The state ranked 32nd for rural counties (18.5 percent) and 36/51 for urban counties (16.3 percent).

Florida ranks last in the U.S. (47/47) for the number of primary care physicians practicing in rural counties (36 per 100,000). The national average for rural counties is 54.5 per 100,000.

Mental Health: D-

Mental Care: D-

Rural residents of Florida reported an average of 4.3 mentally unhealthy days in the past 30 days. The national average is 3.7 days. The state ranked 36th for self-reported mental health in rural counties.

Florida ranks 38th in the U.S. for the number of psychiatrists practicing in rural counties. Florida has 2 per 100,000 residents. The U.S. rural average is 3.4.

Cancer: F Cancer is the second leading cause of death in Florida, and the state is ranked 40th in the U.S. for deaths by cancer among rural residents. The ageadjusted rate for cancer in rural counties is 190.8 per 100,000. The national average is 158.5 per 100,000.

CLRD: D Chronic lower respiratory disease (CLRD) is the third leading cause of death in Florida, and the state is ranked 34th in the U.S. for deaths by CLRD among rural residents. The ageadjusted rate for CLRD in rural counties is 56.7 per 100,000. The national average is 41.6 per 100,000.

Physical Health: D+ The number of physically unhealthy days reported in rural Florida is 4.3 in 30 days, while urban residents report 3.9 days. The national average is 3.9. Rural Florida ranks 32nd.

Low Birth Weight: D The percentage of live births with low birth weight (< 5 pounds, 8 ounces) in rural Florida is 8.5 percent. The national average is 8 percent. Florida ranks 33rd in the category.

ACCESS TO CARE

Dental Care: F Florida ranks 41st in the nation for rural access to dental care with 33.4 dentists per 100,000 rural residents. The national rural average is 42.8.

Uninsured Rate: F 24.7 percent of Florida’s rural population under age 65 is uninsured. The average uninsured rate for urban residents of Florida is 21.6 percent. Florida is one of 19 states that did not adopt Medicaid expansion as offered under the Affordable Care Act.

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F 40/47 GEORGIA ranks 40th in the nation for rural health out of 47 states with rural counties. Georgia is one of nine states receiving a failing grade. GEORGIA RECEIVED A FAILING GRADE BECAUSE: Georgia ranked in the fourth quintile of states for its rates of mortality in rural counties. Georgia ranked in the fourth quintile of states for measures of daily health and quality of life in rural counties. Georgia ranked in the fifth quintile of states for health care access in rural counties.

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GEORGIA

WASHINGTON, D.C. – In releasing its fifth annual 50-State Report Card on Reproductive Health and Rights, the Population Institute lowered the U.S. grade from a “D+” to a “D”. The report card, the most comprehensive report card of its kind, tracks multiple indicators of reproductive health and rights, including access to family planning and abortion services.

Along with Delaware, Florida, Maryland, North Carolina, South Carolina, Virginia and The Institute’s president Robert Walker said, “For the past five years, reproductive health and West Virginia, Georgia is part of the South Atlantic division of the South U.S. Census rights in the U.S. have been on a slippery slope.” Five years ago nine states received an “F”. In region. With the exception of Maryland (16) and Delaware (a state with no rural this year’s report card 20 states—including Alabama—received a failing grade. Walker warned, counties), mostworst states inbe theyet division have poor rural rankings. Georgiaare (40) however, “The may to come, as Congress andhealth the new Administration expected performed better Southfor Carolina (44), butand the comprehensive Peach State fellsex behind Virginia to slash federal funding family planning education. The(32), slippery slope North Carolina (34), Florida (37) and West Virginia (39). is becoming a free fall.”

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states 50% of “plus” for factors Walkereorgia’s emphasized that “It’s low birth weight rates are or a “minus” Hospitals in the state, astoday well more as 90than Rural women now live in a county not reflected in the core grade. not justa abortion rights that are growing concern for providers Health Clinics and 35 Federally Qualified without an abortion provider. under siege; it’s also access to throughout the state, according to the Health Centers providing services at 197 ALABAMA RECEIVED A family planning services, and Georgia Department of Community Health. sites. Federal support for “MINUS” BECAUSE THEIR when women are denied access Atonumber of health and budget watchdog reproductive health and rights ‘CHOOSE LIFE’ LICENSE contraception everyone loses: organizations the state have called for theFUNDURBAN-RURAL could suffer a major reversal PLATES ANTI-CHOICE DIVIDE there are moreinunintended expansion of more Medicaid as provided for under in 2017. Congress and the new pregnancies, abortions, and ORGANIZATIONS/CRISIS the ACAhealth to address this”and other health care Administration are expected to PREGNANCY CENTERS higher care costs. Most U.S. states report a marked difference problems. curtail access toand contraceptive in health outcomes between rural urban Only 21 states received a services by blocking all This year’s report card also counties. Georgia shows a 19.5 percent in-funding “B-“ or higher. Just five states for Planned Parenthood, draws attention to “a growing To help meet the urgent health care(California, needs of Newcrease Jersey,in rural mortality as compared to urban defunding Title X, a 48-year old national divide”the onGeorgia reproductive rural Georgia, Rural Health New Mexico, Oregon andThe state ranks 44th for rural/urban counties. program that provides support health and rights, and Walker Association 2016 Legislative AgendaWashington) called for received an “A”. difference in mortality. to family planning clinics warned that Alabama is “on a raise in the Medicaid reimbursement to states received The rate following serving low-income households, the wrong side of that divide.” a failing grade RURAL in 2016: RESOURCES adequately fund the state portion of Medicaid and eliminating the Affordable Alabama, which received an “F”, and PeachCare for Kids budgets for Alabama, providers.Arkansas, Florida, Care Act’s no-cost birth control was one of 20 states receiving a Georgia, Idaho, Indiana, Kansas, Rural health resource organizations Georgia mandate. Walkerinnoted that failing grade in the latest report Louisiana, Mississippi, Missouri, Georgia has notago increased the Medicaid “In the past five years most of card. Five years Alabama include: Nebraska, North Dakota, reimbursement 10 years, the slippage on reproductive received a “D”. rate to providers inOklahoma, South Carolina, according to the GRHA. Rural providers treat a • Georgia State Office healthofhas occurred Rural Healthat the state South Dakota, Tennessee, Texas, large portion of Medicaid patients, but providlevel, but this year could see MANY FACTORS dch.georgia.gov/state-office-rural-health Utah, Virginia, and Wisconsin. unprecedented setbacks at the ACCOUNTED FOR difficult to participate. ers find it increasingly • Georgia Rural Health Association national level, including cuts ALABAMA’S FAILING GRADE Other efforts at rural hospital stabilization are Walker warned that “A woman’s grhainfo.org in funding for comprehensive INCLUDING POOR SCORES underway, however. The state is focused on health reproductive not • should Southeastern Telehealth Resource sex education in the schools IN PREVENTION stabilizing the ruralAND health care delivery sysdepend on where sheCenter lives, but www.setrc.us and a return to abstinence only AFFORDABILITY tem through pilot efforts that support a “hub it does, as women many Health Research Institute • in Rural programs which have been areas are experiencing reduced Using eleven criteria, the & spoke” model where patients migrate from class.georgiasouthern.edu/rhri proven to be ineffective.” Institute’s card ranked the hub toreport various spokes for healthaccess care.to reproductive health care services including abortion.” each of the 50 states and the For more information about the data Walker stressed that this 19 states, District of Columbia on four RURAL HEALTH CARE FACILITIESWalker noted that year’s report card should be sources used and methodology employed including Alabama, have refused broad indicators relating to “an urgentReport call to Card, action” for in RHQ’s 2017 Rural Health to expand Medicaid under the reproductive health and rights: The Rural Health Information Hub, an anyone who is concerned www.RuralHealthQuarterly.com. Affordable Carevisit Act, leaving tens effectiveness, prevention, about reproductive health organization funded by the Federal Office of millions of women without affordability, and access. Based and rights. “As disappointing of Rural Health Policy, reports that there improved access to contraception upon their composite scores (0as 2016 was, 2017 could be are 30each hospitals identified as Critical Access and other health care services. 100), state received a “core” a whole lot worse.” Walker also noted that in 27 grade (A, B, C, D or F), but some states received an additional


..

RURAL COUNTIES URBAN COUNTIES

GEORGIA BY THE NUMBERS Georgia has an estimated population of 10,310,371 people, and 17.2 percent live in one of Georgia’s 85 rural counties. The poverty rate in rural Georgia is 22.1 percent, compared with 14.7 percent in urban areas of the state. 20.7 percent of the rural population has not completed high school, while 13.3 percent of the urban population lacks a high school diploma. 8.9 percent of rural Georgia residents are U.S. military veterans, and 11.9 percent of the rural population under age 65 lives with a disability. 65.5 percent of the state’s rural population is Non-Hispanic White, 25.8 percent is Black/African-American, 6.4 percent is Hispanic/Latin, 0.2 percent is American Indian/Alaska Native and 0.8 percent is Asian.

MORTALITY

QUALITY OF LIFE

ACCESS TO CARE

Heart Disease: D-

Fair/Poor Health: D

Primary Care: D

Heart disease is the leading cause of death in Georgia, and the state is ranked 37th in the U.S. for the number of deaths by heart disease among rural residents. The age-adjusted rate for heart disease in rural counties is 206.4 per 100,000. The national average is 168.5 per 100,000.

The percentage of Georgians reporting poor general health is among the highest in the nation. The state ranked 35th for rural counties (20.3 percent) and 40/51 for urban counties (16.8 percent).

Georgia ranks 34th in the U.S. for the number of primary care physicians practicing in rural counties (49.6 per 100,000). The national average for rural counties is 54.5 per 100,000.

Mental Health: D

Mental Care: C+

Rural residents of Georgia reported an average of 4.1 mentally unhealthy days in the past 30 days. The national average is 3.7 days. The state ranked 33rd for self-reported mental health in rural counties.

Georgia ranks 23rd in the U.S. for the number of psychiatrists practicing in rural counties. Georgia has 2.9 per 100,000 residents. The U.S. rural average is 3.4.

Cancer: DCancer is the second leading cause of death in Georgia, and the state is ranked 37th in the U.S. for deaths by cancer among rural residents. The ageadjusted rate for cancer in rural counties is 184.7 per 100,000. The national average is 158.5 per 100,000.

CLRD: DChronic lower respiratory disease (CLRD) is the third leading cause of death in Georgia, and the state is ranked 37th in the U.S. for deaths by CLRD among rural residents. The ageadjusted rate for CLRD in rural counties is 59.2 per 100,000. The national average is 41.6 per 100,000.

Physical Health: D The number of physically unhealthy days reported in rural Georgia is 4.4 in 30 days, while urban residents report 3.7 days. The national average is 3.9. Rural Georgia ranks 34th.

Low Birth Weight: F The percentage of live births with low birth weight (< 5 pounds, 8 ounces) in rural Georgia is 10 percent, well above the national average of 8 percent. Georgia ranks 43th in the category.

Dental Care: F Georgia ranks 45th in the nation for rural access to dental care with 30.6 dentists per 100,000 rural residents. The national rural average is 42.8.

Uninsured Rate: F 22.2 percent of Georgia’s rural population under age 65 is uninsured. The average uninsured rate for urban residents of Georgia is 18.7 percent. Georgia is one of 19 states that did not adopt Medicaid expansion as offered under the Affordable Care Act.

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IN FREE FALL: REPRODUCTIVE HEALTH AND RIGHTS IN AMERICA

A 4/47 HAWAII ranks fourth in the nation for rural health out of 47 states with rural counties. Hawaii is one of four states receiving a grade of “A” HAWAII RECEIVED A GRADE OF “A” BECAUSE: Hawaii ranked in the first quintile of states for its rates of mortality in rural counties. Hawaii ranked in the second quintile of states for measures of daily health and quality of life in rural counties. Hawaii ranked in the first quintile of states for health care access in rural counties.

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HAWAII

WASHINGTON, D.C. – In releasing its fifth annual 50-State Report Card on Reproductive Health and Rights, the Population Institute lowered the U.S. grade from a “D+” to a “D”. The report card, the most comprehensive report card of its kind, tracks multiple indicators of reproductive health and rights, including access to family planning and abortion services.

Along with Alaska, California, Oregon and Washington, Hawaii is a member of the The Institute’s president Robert Walker said, “For the past five years, reproductive health and Pacific division of the West U.S. Census region. Four of the five states in the division, rights in the U.S. have been on a slippery slope.” Five years ago nine states received an “F”. In including Hawaii, ranked in the top half of the nation for rural health. Hawaii (4) this year’s report card 20 states—including Alabama—received a failing grade. Walker warned, performed best in the division, and theas Aloha Stateand placed higher than California however, “The worst may be yet to come, Congress the new Administration are expected (15), Washington (17), Alaska (22) and Oregon (26) in the final to slash federal funding for family planning and comprehensive sexdivisional education.rankings. The slippery slope is becoming a free fall.”

H

states provide today more than 50% or a “minus” for factors Walkerawaii emphasized that “It’s rural “plus” has a substantial commuQualified Health Centers services at of women now live in a county not reflected in the core grade. not justnity, abortion rights that are yet it significantly outperforms 71 sites in the state. without an abortion provider. under siege; it’s also access to all other states in the Pacific West and ALABAMA RECEIVED A family planning services, and ranks 4th in the nation overall. URBAN-RURAL DIVIDE Federal support for “MINUS” BECAUSE THEIR when women are denied access reproductive health and rights ‘CHOOSE LIFE’ LICENSE to contraception everyone loses: Technology seems to be at the heartPLATES of Hawaii’s U.S. states report a marked could suffer adifference major reversal FUNDMost ANTI-CHOICE there are more unintended rural health care ECHO for in health outcomes between rural andand urban in 2017. Congress the new ORGANIZATIONS/CRISIS pregnancies, moresuccess. abortions, and Hawaii, example, usescare existing to connect counties. a 11.5 percent Administration are expected to PREGNANCY CENTERSHawaii shows higher health costs.technologies ” an interdisciplinary team of expertsOnly with21 states received curtail access to contraceptive increase ain rural mortality as compared to services by blocking all funding This year’s report card also primary care providers in rural and“B-“ underurban counties. The state ranks 24th for rural/ or higher. Just five states for Planned Parenthood, draws attention to “a growing served communities. Specialists help mentor Newurban difference in mortality. (California, Jersey, defunding Title X, a 48-year old national divide” reproductive participants, withon primary providers continuing New Mexico, Oregon and program that provides support health and rights, and Walker their management and responsibility for Washington) received “A”. RURALanRESOURCES to family planning clinics warned that Alabama is “on patient care. Over time, cliniciansThe develop following states received serving low-income households, the wrong side of that divide.” a failing grade Rural in 2016: comprehensive skills to treat specific, health resource organizations in Hawaii and eliminating the Affordable Alabama, which received an “F”, Arkansas, Florida, complex health conditions withinAlabama, their own include: Care Act’s no-cost birth control was one of 20 states receiving a Georgia, Idaho, Indiana, Kansas, practices. mandate. Walker noted that failing grade in the latest report Louisiana, Mississippi, Missouri, • Hawaii Office of“In Primary Care Rural the past fiveand years most of card. Five years ago Alabama Nebraska, North Dakota, The Hawaii Department of Health has made the slippage on reproductive Health: health.hawaii.gov/opcrh received a “D”. Oklahoma, South Carolina, investment in telehealth a priority for the health has occurred at the state • HawaiiTexas, State Rural Health Association South Dakota, Tennessee, state. The department has announced plans level, but this year could see MANY FACTORS www.hawaiistateruralhealth.org Utah, Virginia, and Wisconsin. unprecedented setbacks at the ACCOUNTED FOR to work with the community to establish • Pacific Basin Telehealth Resource Center national level, including cuts ALABAMA’S FAILING GRADE governance and accountability in assuring www.pbtrc.org Walker warned that “A woman’s in funding for comprehensive INCLUDING SCORES telehealth as POOR a sustainable modality to ad- health reproductive notPacific Islander American Health • should Asian & sex education in the schools IN PREVENTION AND dress specialty provider shortages,depend long waiton where sheForum: lives, butwww.apiahf.org and a return to abstinence only AFFORDABILITY lists for specialists, geographic barriers and it does, as women in many programs which have been areas are experiencing reduced Using eleven criteria, the specialty consultation to primary care practices. For more information about theineffective. data proven to be ” access to reproductive health Institute’s report card ranked sources used and methodology employed care services including abortion.” each of the 50 states andFACILITIES the RURAL HEALTH CARE in RHQ’s 2017 RuralWalker Health Reportthat Card, stressed this Walker noted that 19 states, District of Columbia on four visit www.RuralHealthQuarterly.com. year’s report card should be including Alabama, have refused broad indicators relating to The Rural Health Information Hub, an organi“an urgent call to action” for to expand Medicaid under the reproductive health and rights: zation funded by the Federal OfficeAffordable of Rural Care Act, leaving tens anyone who is concerned effectiveness, prevention, about reproductive health Health Policy, reports that there are nine of millions of women without affordability, and access. Based and rights. “As disappointing Critical Access Hospitals in the state, as well improved access to contraception upon their composite scores (0as 2016 was, 2017 could be as twoeach Ruralstate Health Clinics and 14 Federally and other health care services. 100), received a “core” a whole lot worse.” Walker also noted that in 27 grade (A, B, C, D or F), but some states received an additional


HAWAII BY THE NUMBERS Hawaii has an estimated population of 1,428,557 people, and 18.9 percent live in one of Hawaii’s 2 rural counties. The poverty rate in rural Hawaii is 12.9 percent, compared with 8.5 percent in urban areas of the state. 8.6 percent of the rural population has not completed high school, while 9 percent of the urban population lacks a high school diploma.

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9.8 percent of rural Hawaii residents are U.S. military veterans, and 7.3 percent of the rural population under age 65 lives with a disability. RURAL COUNTIES URBAN COUNTIES

30.6 percent of the state’s rural population is Non-Hispanic White, 0.6 percent is Black/African-American, 11.8 percent is Hispanic/ Latino, 24.7 percent is Asian and 10.5 percent is Native Hawaiian and Other Pacific Islander.

MORTALITY

QUALITY OF LIFE

ACCESS TO CARE

Heart Disease: A

Fair/Poor Health: B+

Primary Care: A

Heart disease is the leading cause of death in Hawaii, and the state is ranked 4th in the U.S. for the low number of deaths by heart disease among rural residents. The age-adjusted rate for heart disease in rural counties is 146.5 per 100,000. The national average is 168.5 per 100,000.

The percentage of Hawaiians reporting poor general health is relatively low. The state ranked 13th for rural counties (13.6 percent) and 10/51 for urban counties (12.4 percent).

Hawaii ranks 6th in the U.S. for the number of primary care physicians practicing in rural counties (76.7 per 100,000). The national average for rural counties is 54.5 per 100,000.

Mental Health: A

Mental Care: A

Cancer: A

Rural residents of Hawaii reported an average of 3 mentally unhealthy days in the past 30 days. The national average is 3.7 days. The state ranked 5th for self-reported mental health in rural counties.

Hawaii ranks 5th in the U.S. for the number of psychiatrists practicing in rural counties. Hawaii has 8.3 per 100,000 residents. The U.S. rural average is 3.4.

Cancer is the second leading cause of death in Hawaii, and the state is ranked 6th in the U.S. for deaths by cancer among rural residents. The age-adjusted rate for cancer in rural counties is 142.5 per 100,000. The national average is 158.5 per 100,000.

Stroke: F Cerebrovascular disease is the third leading cause of death in Hawaii, and the state is ranked 43rd in the U.S. for deaths by stroke among rural residents. The age-adjusted rate for stroke in rural counties is 49.7 per 100,000. The national average is 37.6 per 100,000.

Physical Health: A The number of physically unhealthy days reported in rural Hawaii is 3.2 in 30 days, while urban residents report 2.9 days. The national average is 3.9. Rural Hawaii ranks 6th.

Low Birth Weight: CThe percentage of live births with low birth weight (< 5 pounds, 8 ounces) in rural Hawaii is 7.8 percent. The national average is 8 percent. Hawaii ranks 28th in the category.

Dental Care: A Hawaii ranks 7th in the nation for rural access to dental care with 61.2 dentists per 100,000 rural residents. The national rural average is 42.8.

Uninsured Rate: A 9.4 percent of Hawaii’s rural population under age 65 is uninsured. The average uninsured rate for urban residents of Hawaii is 6.3 percent. Hawaii is one of 31 states that adopted Medicaid expansion as offered under the Affordable Care Act.

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IN FREE FALL: REPRODUCTIVE HEALTH AND RIGHTS IN AMERICA

B20/47 IDAHO ranks 20th in the nation for rural health out of 47 states with rural counties. Idaho is one of three states receiving a grade of “B-” IDAHO RECEIVED A GRADE OF “B-” BECAUSE: Idaho ranked in the second quintile of states for its rates of mortality in rural counties. Idaho ranked in the second quintile of states for measures of daily health and quality of life in rural counties. Idaho ranked in the fourth quintile of states for health care access in rural counties.

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IDAHO

WASHINGTON, D.C. – In releasing its fifth annual 50-State Report Card on Reproductive Health and Rights, the Population Institute lowered the U.S. grade from a “D+” to a “D”. The report card, the most comprehensive report card of its kind, tracks multiple indicators of reproductive health and rights, including access to family planning and abortion services.

Along with Arizona, Colorado, Montana, Nevada, New Mexico, Utah and Wyoming, The Institute’s president Robert Walker said, “For the past five years, reproductive health and Idaho is part of the Mountain division of the West U.S. Census region. With the rights in the U.S. have been on a slippery slope.” Five years ago nine states received an “F”. In exception of high performers Colorado and Wyoming, all states in the division rank this year’s report card 20 states—including Alabama—received a failing grade. Walker warned, near the middle of the nation Idaho (20) higher than Utah (23), however, “The worst may be yetfor to rural come,health. as Congress and theranks new Administration are expected Nevada (30), New Mexico (31) and Arizona but the Gem State fallsThe behind to slash federal funding for family planning and(33), comprehensive sex education. slippery slope Colorado (12), Wyoming (14) and Montana (19). is becoming a free fall.”

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states today more than 50% of or a “minus” for factors Walker “It’s faster “plus” daho’semphasized populationthat is aging than the URBAN-RURAL DIVIDE women now live in a county not reflected in the core grade. not just abortion rights that are nation’s, according to recent estimates by without an abortion provider. under siege; it’s also access to the U.S. Census Bureau. The number of Most U.S. states report a marked difference ALABAMA RECEIVED A family planning services, and Idaho seniors increased by 30 percent from in health outcomes between rural and Federal support for urban “MINUS” BECAUSE THEIR when women are denied access mid-2010 to mid-2016 compared with 22 counties. Idaho shows a 2.9 percent increase reproductive health and rights ‘CHOOSE LIFE’ LICENSE to contraception everyone loses: percent theunintended nation. This groupPLATES accounts rural mortality as could compared counsufferto a urban major reversal FUNDinANTI-CHOICE there arefor more for 15 percent of the state’sand population and ties. The state ranksin 9th for rural/urban differ2017. Congress and the new ORGANIZATIONS/CRISIS pregnancies, more abortions, may pose future for rural health ence in mortality. Administration are expected to PREGNANCY CENTERS higher health carechallenges costs.” care in Idaho. curtail access to contraceptive Only 21 states received a services by blocking all funding This year’s report card also RURAL RESOURCES “B-“ or higher. Just five states for Planned Parenthood, draws attention to “a growing In the short term, Idaho children are likely a New Jersey, (California, defunding Title X, a 48-year old national divide” on reproductive more pressing concern for rural health Rural health Newcare Mexico, Oregon and resource organizations in program that provides support health and rights, and Walker providers in Idaho. Nearly 40 percent of chil- received Washington) an “A”. Idaho include: to family planning clinics warned that Alabama is “on dren in rural Idaho communities rely onfollowing public states received The serving low-income households, the wrong side of that divide.” a failing grade in 2016: assistance for health care. According to an • Bureau of Rural and Health and Primary Care eliminating the Affordable Alabama, which received an “F”, Arkansas, healthandwelfare.idaho.gov/Health/ Florida, independent study by GeorgetownAlabama, University Care Act’s no-cost birth control was one of 20 states receiving a Georgia, Kansas, and thegrade University of North Carolina, IdahoIdaho, Indiana, RuralHealthandPrimaryCare/tabid/104/ mandate. Walker noted that failing in the latest report Mississippi, Missouri, children rural counties areLouisiana, more Default.aspx “In the past five years most of card. Fiveliving yearsin ago Alabama Nebraska, North Dakota, likely to access • Idaho Rural Health Association the slippage on reproductive received a “D”. coverage through Medicaid Oklahoma, South Carolina, and the Children’s Health Insurance Program health has occurred at the state www.idahorha.org South Dakota, Tennessee, Texas, (CHIP) children in urban areas. Unless level, but this year could see MANYthan FACTORS • Wisconsin. Northwest Regional Telehealth Resource Center Utah, Virginia, and ACCOUNTED FOR CHIP is renewed by Congress, the state may www.nrtrc.org unprecedented setbacks at the nationalResearch level, including ALABAMA’S FAILING GRADE run out of funding for the programWalker in thewarned that • “A WWAMI Rural Health Centercuts woman’s in funding for comprehensive INCLUDING POOR SCORES near future. depts.washington.edu/uwrhrc/index.php reproductive health should not sex education in the schools IN PREVENTION AND depend on where she lives, but and a return to abstinence only AFFORDABILITY many information about the data RURAL HEALTH CARE FACILITIESit does, as women Forinmore programs which have been areas are experiencing reduced Using eleven criteria, the sources used and methodology employed proven to be ineffective. ” health Institute’s ranked Hub,access The Rural report Healthcard Information an to reproductive in RHQ’s 2017 Rural Health Report Card, services abortion.” each of the 50funded states and the Federalcare organization by the Office of including visit www.RuralHealthQuarterly.com. Walker stressed that this Walker noted that 19 states, District of Columbia on four Rural Health Policy, reports that there are 27 year’s report card should be including Alabama, have refused broad indicators relating to Critical Access Hospitals in the state, 47 Rural “an urgent call to action” for to expand Medicaid under the reproductive health and rights: Health Clinics, and 14 Federally Qualified anyone who is concerned Affordable Care Act, leaving tens effectiveness, prevention, about reproductive health Health Centers providing services at 86 sites of millions of women without affordability, and access. Based and rights. “As disappointing in the state. improved access to contraception upon their composite scores (0as 2016 was, 2017 could be 100), each state received a “core” and other health care services. a whole lot worse.” Walker also noted that in 27 grade (A, B, C, D or F), but some states received an additional


..

RURAL COUNTIES URBAN COUNTIES

IDAHO BY THE NUMBERS Idaho has an estimated population of 1,683,140 people, and 33.1 percent live in one of Idaho’s 33 rural counties. The poverty rate in rural Idaho is 16.5 percent, compared with 13.3 percent in urban areas of the state. 13.3 percent of the rural population has not completed high school, while 9.1 percent of the urban population lacks a high school diploma. 10.6 percent of rural Idaho residents are U.S. military veterans, and 9.2 percent of the rural population under age 65 lives with a disability. 81.8 percent of the state’s rural population is Non-Hispanic White, 0.4 percent is Black/African-American, 13.8 percent is Hispanic/Latino, 1.3 percent is American Indian/Alaska Native and 0.9 percent is Asian.

MORTALITY

QUALITY OF LIFE

ACCESS TO CARE

Cancer: B

Fair/Poor Health: C

Primary Care: B-

Cancer is the leading cause of death in Idaho, and the state is ranked 10th in the U.S. for deaths by cancer among rural residents. The age-adjusted rate for cancer in rural counties is 153.8 per 100,000. The national average is 158.5 per 100,000.

The percentage of Idahoans reporting poor general health is close to the national average. The state ranked 25th for rural counties (15.8 percent) and 19/51 for urban counties (13.4 percent).

Idaho ranks 18th in the nation for the number of primary care physicians practicing in rural counties (60 per 100,000). The national average for rural counties is 54.5 per 100,000.

Mental Health: B

Mental Care: C-

Rural residents of Idaho reported an average of 3.5 mentally unhealthy days in the past 30 days. The national average is 3.7 days. The state ranked 14th for self-reported mental health in rural counties.

Idaho ranks 28th in the U.S. for the number of psychiatrists practicing in rural counties. Idaho has 2.6 per 100,000 residents. The U.S. rural average is 3.4.

Heart Disease: AHeart disease is second the leading cause of death in Idaho, and the state is ranked 16th in the U.S. for the number of deaths by heart disease among rural residents. The age-adjusted rate for heart disease in rural counties is 159.5 per 100,000. The national average is 168.5 per 100,000.

CLRD: C Chronic lower respiratory disease (CLRD) is the third leading cause of death in Idaho, and the state is ranked 24th in the U.S. for deaths by CLRD among rural residents. The age-adjusted rate for CLRD in rural counties is 51.1 per 100,000. The national average is 41.6 per 100,000.

Physical Health: C The number of physically unhealthy days reported in rural Idaho is 3.9 in 30 days, while urban residents report 3.5 days. The national average is 3.9. Rural Idaho ranks 25th.

Low Birth Weight: B+ The percentage of live births with low birth weight (< 5 pounds, 8 ounces) in rural Idaho is 6.8 percent. The national average is 8 percent. Idaho ranks 13th in the category.

Dental Care: B Idaho ranks 15th in the nation for rural access to dental care with 54.2 dentists per 100,000 rural residents. The national rural average is 42.8.

Uninsured Rate: D 19.4 percent of Idaho’s rural population under age 65 is uninsured. The average uninsured rate for urban residents of Idaho is 15.8 percent. Idaho is one of 19 states that did not adopt Medicaid expansion as offered under the Affordable Care Act.

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IN FREE FALL: REPRODUCTIVE HEALTH AND RIGHTS IN AMERICA

C27/47 ILLINOIS ranks 27th in the nation for rural health out of 47 states with rural counties. Illinois is one of three states receiving a grade of “C-” ILLINOIS RECEIVED A GRADE OF “C-” BECAUSE: Illinois ranked in the fourth quintile of states for its rates of mortality in rural counties. Illinois ranked in the third quintile of states for measures of daily health and quality of life in rural counties. Illinois ranked in the third quintile of states for health care access in rural counties.

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40  RHQ

ILLINOIS

WASHINGTON, D.C. – In releasing its fifth annual 50-State Report Card on Reproductive Health and Rights, the Population Institute lowered the U.S. grade from a “D+” to a “D”. The report card, the most comprehensive report card of its kind, tracks multiple indicators of reproductive health and rights, including access to family planning and abortion services.

Along with Indiana, Michigan, Ohio and Wisconsin, Illinois is a member of the East The Institute’s president Robert Walker said, “For the past five years, reproductive health and North Central division of the Midwest U.S. Census region. With the exception of highrights in the U.S. have been on a slippery slope.” Five years ago nine states received an “F”. In performing Wisconsin, all states in the division rank near the middle of the nation for this year’s report card 20 states—including Alabama—received a failing grade. Walker warned, rural health. (27)be ranked than (28)Administration and Indiana (29), but however, “TheIllinois worst may yet to slightly come, ashigher Congress andOhio the new are expected the Prairie State fell behind Wisconsin and Michigan (21) the final The rankings. to slash federal funding for family planning(7) and comprehensive sexineducation. slippery slope is becoming a free fall.”

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states today more 50% of for factors Walker “It’s llinois’emphasized rural healththat outcomes and“plus” accessor a “minus” in health outcomes between rural andthan urban women now live in a county not reflected in the core grade. not just abortion rights that are rankings are a little uneven, but the state counties. Illinois shows a 16.9 percent without an abortion provider. under siege; it’s also access to manages to fall somewhere near the middle of increase in rural mortality as compared to ALABAMA RECEIVED A family planning services, and the pack in the final rankings. Illinois’ recent urban counties. The Federal state ranks 36th for rural/ support for “MINUS” BECAUSE THEIR when women are denied access budget struggles and internal political strife urban difference in mortality. reproductive health and rights ‘CHOOSE LIFE’ LICENSE to contraception everyone loses: may significant challenges going forward, could suffer a major reversal PLATES FUND ANTI-CHOICE therepose are more unintended however. RURAL RESOURCES in 2017. Congress and the new pregnancies, more abortions, and ORGANIZATIONS/CRISIS Administration are expected to PREGNANCY CENTERS higher health care costs.” Most recently, Illinois went more than two curtail access to contraceptive Rural health resource organizations in Illinois Only 21 states received a services by blocking all funding This year’s report cardspending also years without a state plan,“B-“ andorashigher. Just include: five states for Planned Parenthood, to “aproviders growing waited adraws resultattention health care months New Jersey, (California, defunding Title X, a 48-year old national divide” on reproductive or years to get paid for services to Medicaid • Illinois New Mexico, Oregon and Center for Rural Health program that provides support health and rights, and Walker patients and state employees. www.dph.illinois.gov/topics-services/ Washington) received an “A”. to family planning clinics warned that Alabama is “on The following stateslife-stages-populations/rural-underreceived serving low-income households, the wrong side of that divide.” failing grade in 2016: A political fight between the state’sagovernor served-populations and eliminating the Affordable Alabama, which received an “F”, Florida,Rural Health Association and the general assembly left healthAlabama, care Arkansas, • Illinois Care Act’s no-cost birth control was one of 20 states receiving a Georgia, Idaho, Indiana, Kansas, providers struggling and patients www.ilruralhealth.org mandate. Walker noted that failing grade in the latest report frustrated. Louisiana, Missouri, Many doctors accepting new patientsMississippi, • Upper Midwest Telehealth Center “In the pastResource five years most of card. Five yearsstopped ago Alabama Nebraska, North Dakota, insured patients www.umtrc.orgthe slippage on reproductive receivedthrough a “D”. the state. Sometimes Oklahoma, South Carolina, simply paid the costs out of pocket, but many • National Center for Rural Health Professions health has occurred at the state South Dakota, Tennessee, Texas, others forced to delay getting care. level, but this year could see MANYwere FACTORS www.ncrhp.uic.edu Utah, Virginia, and Wisconsin. unprecedented setbacks at the ACCOUNTED FOR national including cuts ALABAMA’S FAILING GRADE information aboutlevel, the data RURAL HEALTH CARE FACILITIESWalker warned For that more “A woman’s in funding for comprehensive INCLUDING POOR SCORES sources used reproductive health should not and methodology employed sex education in the schools IN PREVENTION AND inshe RHQ’s lives,2017 but Rural Health Report Card, The Rural Health Information Hub,depend an on where and a return to abstinence only AFFORDABILITY does, asofwomen in many visit www.RuralHealthQuarterly.com. organization funded by the Federalit Office programs which have been areas are experiencing reduced Using eleven criteria, the Rural Health Policy, reports that there are 51 proven to be ineffective.” access to reproductive health Institute’s report card ranked Critical Access Hospitals in the state, as well care services including abortion.” each the 50 states Clinics and theand 44 Federally as 223ofRural Health Walker stressed that this Walker noted that 19 states, District of Columbia on four Qualified Health Centers providing services at year’s report card should be including Alabama, have refused broad indicators relating to 407 sites in the state. “an urgent call to action” for to expand Medicaid under the reproductive health and rights: anyone who is concerned Affordable Care Act, leaving tens effectiveness, prevention, about reproductive health URBAN-RURAL DIVIDE of millions of women without affordability, and access. Based and rights. “As disappointing improved access to contraception upon their composite scores (0as 2016 was, 2017 could be and other health care services. 100), U.S. eachstates state received a “core” difference Most report a marked a whole lot worse.” Walker also noted that in 27 grade (A, B, C, D or F), but some states received an additional


ILLINOIS BY THE NUMBERS Illinois has an estimated population of 12,801,539 people, and 11.5 percent live in one of Illinois’s 62 rural counties. The poverty rate in rural Illinois is 14.5 percent, compared with 12.8 percent in urban areas of the state. 12 percent of the rural population has not completed high school, while 12.1 percent of the urban population lacks a high school diploma.

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10.1 percent of rural Illinois residents are U.S. military veterans, and 9.9 percent of the rural population under age 65 lives with a disability.

RURAL COUNTIES URBAN COUNTIES

90.1 percent of the state’s rural population is Non-Hispanic White, 3.8 percent is Black/African-American, 4 percent is Hispanic/Latino, 0.1 percent is American Indian/Alaska Native and 0.6 percent is Asian.

MORTALITY

QUALITY OF LIFE

ACCESS TO CARE

Heart Disease: D+

Fair/Poor Health: B-

Primary Care: F

Heart disease is the leading cause of death in Illinois, and the state is ranked 30th in the U.S. for the number of deaths by heart disease among rural residents. The age-adjusted rate for heart disease in rural counties is 194.3 per 100,000. The national average is 168.5 per 100,000.

The percentage of Illinoisans reporting poor general health is close to the national average. The state ranked 19th for rural counties (14.3 percent) and 30/51 for urban counties (15.6 percent).

Illinois ranks 40th in the U.S. for the number of primary care physicians practicing in rural counties (45.7 per 100,000). The national average for rural counties is 54.5 per 100,000.

Mental Health: B-

Mental Care: F

Rural residents of Illinois reported an average of 4.1 mentally unhealthy days in the past 30 days. The national average is 3.7 days. The state ranked 20th for self-reported mental health in rural counties.

Illinois ranks 42nd in the U.S. for the number of psychiatrists practicing in rural counties. Illinois has 1.7 per 100,000 residents. The U.S. rural average is 3.4.

Cancer: D Cancer is the second leading cause of death in Illinois, and the state is ranked 33rd in the U.S. for deaths by cancer among rural residents. The age-adjusted rate for cancer in rural counties is 181.3 per 100,000. The national average is 158.5 per 100,000.

Stroke: C Cerebrovascular disease is the third leading cause of death in Illinois, and the state is ranked 35th in the U.S. for deaths by stroke among rural residents. The age-adjusted rate for stroke in rural counties is 40 per 100,000. The national average is 37.6 per 100,000.

Physical Health: BThe number of physically unhealthy days reported in rural Illinois is 3.7 in 30 days, while urban residents report 3.5 days. The national average is 3.9. Rural Illinois ranks 20th.

Low Birth Weight: C+ The percentage of live births with low birth weight (< 5 pounds, 8 ounces) in rural Illinois is 7.5 percent. The national average is 8 percent. Illinois ranks 23rd in the category.

Dental Care: D+ Illinois ranks 30th in the nation for rural access to dental care with 40.4 dentists per 100,000 rural residents. The national rural average is 42.8.

Uninsured Rate: A10.8 percent of Illinois’s rural population under age 65 is uninsured. The average uninsured rate for urban residents of Illinois is 12.7 percent. Illinois is one of 31 states that adopted Medicaid expansion as offered under the Affordable Care Act.

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IN FREE FALL: REPRODUCTIVE HEALTH AND RIGHTS IN AMERICA

C29/47 INDIANA ranks 29th in the nation for rural health out of 47 states with rural counties. Illinois is one of three states receiving a grade of “C-” INDIANA RECEIVED A GRADE OF “C-” BECAUSE: Indiana ranked in the fourth quintile of states for its rates of mortality in rural counties. Indiana ranked in the third quintile of states for measures of daily health and quality of life in rural counties. Indiana ranked in the fourth quintile of states for health care access in rural counties.

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RHQ

42  RHQ

INDIANA

WASHINGTON, D.C. – In releasing its fifth annual 50-State Report Card on Reproductive Health and Rights, the Population Institute lowered the U.S. grade from a “D+” to a “D”. The report card, the most comprehensive report card of its kind, tracks multiple indicators of reproductive health and rights, including access to family planning and abortion services.

Along with Illinois, Michigan, Ohio and Wisconsin, the Hoosier State is a member of The Institute’s president Robert Walker said, “For the past five years, reproductive health and the East North Central division of the Midwest U.S. Census region. With the exceprights in the U.S. have been on a slippery slope.” Five years ago nine states received an “F”. In tion of high-performing Wisconsin, all states in the division rank near the middle of this year’s report card 20 states—including Alabama—received a failing grade. Walker warned, the nation forworst ruralmay health. ranked lowest in the division, behind however, “The be yetIndiana to come,(29) as Congress and the new Administration are expected Wisconsin (7), funding Michigan (27) Ohio (28) in final rankings. to slash federal for (21), familyIllinois planning andand comprehensive sexthe education. The slippery slope is becoming a free fall.”

I

states today more than 50% of or a “minus” for factors Walker emphasized that “It’s posed “plus” ndiana faces challenges by demoURBAN-RURAL DIVIDE women now live in a county not reflected in the core grade. not just abortion rights that are graphic shifts and an uneven distribution without an abortion provider. under siege; it’s also access to of health care professionals, and it ranks Most U.S. states report a marked difference ALABAMA RECEIVED A family planning services, and in the lower half of the nation in this year’s in health outcomes Federal between rural and support for “MINUS” BECAUSE THEIR when women are denied access RHQ Rural Health Report Card. urban counties. Indiana shows 3.7 percent reproductivea health and rights ‘CHOOSE LIFE’ LICENSE to contraception everyone loses: in rural mortality as compared to could suffer a major reversal PLATES FUNDincrease ANTI-CHOICE there are more unintended Indiana is one of only a handful states in urban counties. Thein state ranks 10th for 2017. Congress andrural/ the new pregnancies, more abortions, and of ORGANIZATIONS/CRISIS the Midwest Northeast to see its youth urban difference in mortality. Administration are expected to PREGNANCY CENTERS higher health or care costs.” population increase between 2000 and 2010. curtail access to contraceptive Only 21 states received a services by blocking all funding This year’smost reportofcard However, thisalso growth occurred in urRURAL RESOURCES “B-“ or higher. Just five states for Planned Parenthood, draws attention to “a growing ban counties. Large areas of Indiana(California, are aging New Jersey, defunding Title X, a 48-year old national divide” on reproductive rapidly due to out-migration while New families Rural health Mexico, Oregon and resource organizations in Indiana program that provides support health and rights, and Walker are concentrating in less rural regions of the received Washington) include:an “A”. to family planning clinics warned that Alabama is “on state. The following states received serving low-income households, the wrong side of that divide.” a failing grade • in 2016: Indiana State Office of Rural Health and eliminating the Affordable Alabama, which received an “F”, Alabama, Arkansas, www.in.gov/isdh/24432.htm Florida, Indiana’s movement toward an integrated Care Act’s no-cost birth control was one of 20 states receiving a Georgia, Kansas, system of care especially challenging in Idaho,• Indiana, Indiana Rural Health Association mandate. Walker noted that failing grade in is the latest report Louisiana, Mississippi, Missouri, rural according to the State Office of www.indianaruralhealth.org “In the past five years most of card. areas, Five years ago Alabama Nebraska, Dakota, Rural Health. like North • Upper Midwest Telehealth Resource Center the slippage on reproductive received a “D”.Many essential services, Oklahoma, South Carolina, EMS, are simply not available in many small health has occurred at the state www.umtrc.org South Dakota, Tennessee, Texas, communities. State officials have voiced suplevel, but this year could see MANY FACTORS • Wisconsin. Richard G. Lugar Center for Rural Health Utah, Virginia, and unprecedented setbacks at the ACCOUNTED FORtechnologies and models port for emerging www.myunionhospital.org/unionhospital/ national level, including cuts ALABAMA’S GRADE of cooperationFAILING that bring coordinated care to that “A index.php/lugar-center-for-rural-health Walker warned woman’s in funding for comprehensive INCLUDING POOR SCORES Indiana’s rural populations while supporting reproductive health should not sex education in the schools IN PREVENTION AND viable revenue streams for providers. depend on where shemore lives, information but For about the data and a return to abstinence only AFFORDABILITY it does, as women in many sources used and methodology employed programs which have been areas are experiencing reduced Using eleven criteria, the FACILITIES RURAL HEALTH CARE in RHQ’s 2017 Ruralproven Health Card,” to Report be ineffective. access to reproductive health Institute’s report card ranked visit www.RuralHealthQuarterly.com. services including abortion.” eachRural of theHealth 50 states and the Hub,care The Information an orWalker stressed that this Walker District of Columbia on four ganization funded by the Federal Office ofnoted that 19 states, year’s report card should be including Alabama, have refused broad indicators relating to Rural Health Policy, reports that there are 35 “an urgent call to action” for to expand Medicaid under the reproductive health and rights: Critical Access Hospitals in the state, as well anyone who is concerned Affordable Care Act, leaving tens effectiveness, prevention, about reproductive health as 67 Rural Health Clinics and 26 Federally of millions of women without affordability, and access. Based and rights. “As disappointing Qualified Health Centers providing services improved access to contraception upon their composite scores (0as 2016 was, 2017 could be at 172each sites. 100), state received a “core” and other health care services. a whole lot worse.” Walker also noted that in 27 grade (A, B, C, D or F), but some states received an additional


INDIANA BY THE NUMBERS Indiana has an estimated population of 6,633,053 people, and 22.1 percent live in one of Indiana’s 48 rural counties. The poverty rate in rural Indiana is 13.4 percent, compared with 14.3 percent in urban areas of the state. 14.5 percent of the rural population has not completed high school, while 11.5 percent of the urban population lacks a high school diploma.

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9.3 percent of rural Indiana residents are U.S. military veterans, and 10.7 percent of the rural population under age 65 lives with a disability.

RURAL COUNTIES URBAN COUNTIES

92.5 percent of the state’s rural population is Non-Hispanic White, 1.4 percent is Black/African-American, 4.1 percent is Hispanic/Latino, 0.2 percent is American Indian/Alaska Native and 0.5 percent is Asian.

MORTALITY

QUALITY OF LIFE

ACCESS TO CARE

Heart Disease: C

Fair/Poor Health: C-

Primary Care: F

Heart disease is the leading cause of death in Indiana, and the state is ranked 26th in the U.S. for the number of deaths by heart disease among rural residents. The age-adjusted rate for heart disease in rural counties is 186.6 per 100,000. The national average is 168.5 per 100,000.

The percentage of rural Hoosiers reporting poor general health is close to the national average. The state ranked 27th for rural counties (16.2 percent) and 40/51 for urban counties (16.3 percent).

Indiana ranks 44th in the U.S. for the number of primary care physicians practicing in rural counties (42.6 per 100,000). The national average for rural counties is 54.5 per 100,000.

Mental Health: D+

Mental Care: C

Cancer: D+

Rural residents of Indiana reported an average of 4 mentally unhealthy days in the past 30 days. The national average is 3.7 days. The state ranked 30th for self-reported mental health in rural counties.

Indiana ranks 26th in the U.S. for the number of psychiatrists practicing in rural counties. Indiana has 2.8 per 100,000 residents. The U.S. rural average is 3.4.

Cancer is the second leading cause of death in Indiana, and the state is ranked 31st in the U.S. for deaths by cancer among rural residents. The ageadjusted rate for cancer in rural counties is 179.8 per 100,000. The national average is 158.5 per 100,000.

CLRD: F Chronic lower respiratory disease (CLRD) is the third leading cause of death in Indiana, and the state is ranked 40th in the U.S. for deaths by CLRD among rural residents. The ageadjusted rate for CLRD in rural counties is 62.3 per 100,000. The national average is 41.6 per 100,000.

Physical Health: C The number of physically unhealthy days reported in rural Indiana is 3.9 in 30 days, while urban residents report 3.8 days. The national average is 3.9. Rural Indiana ranks 26th.

Low Birth Weight: C The percentage of live births with low birth weight (< 5 pounds, 8 ounces) in rural Indiana is 7.6 percent. The national average is 8 percent. Indiana ranks 24th in the category.

Dental Care: D Indiana ranks 35th in the nation for rural access to dental care with 37.2 dentists per 100,000 rural residents. The national rural average is 42.8.

Uninsured Rate: C+ 16.6 percent of Indiana’s rural population under age 65 is uninsured. The average uninsured rate for urban residents of Indiana is 14.2 percent. Indiana is one of 31 states that adopted Medicaid expansion as offered under the Affordable Care Act.

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IN FREE FALL: REPRODUCTIVE HEALTH AND RIGHTS IN AMERICA

A9/47 IOWA ranks ninth in the nation for rural health out of 47 states with rural counties. Iowa is one of three states receiving a grade of “A-” IOWA RECEIVED A GRADE OF “A-” BECAUSE: Iowa ranked in the second quintile of states for its rates of mortality in rural counties. Iowa ranked in the first quintile of states for measures of daily health and quality of life in rural counties. Iowa ranked in the first quintile of states for health care access in rural counties.

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44  RHQ

IOWA

WASHINGTON, D.C. – In releasing its fifth annual 50-State Report Card on Reproductive Health and Rights, the Population Institute lowered the U.S. grade from a “D+” to a “D”. The report card, the most comprehensive report card of its kind, tracks multiple indicators of reproductive health and rights, including access to family planning and abortion services.

Along with Kansas, Minnesota, Missouri, Nebraska, North Dakota and South Dakota, The Institute’s president Robert Walker said, “For the past five years, reproductive health and The Hawkeye State is a member of the West North Central division of the Midwest U.S. rights in the U.S. have been on a slippery slope.” Five years ago nine states received an “F”. In Census region. With exception of the Alabama—received two southernmostastates the division, most this year’s report cardthe 20 states—including failingingrade. Walker warned, members of the West North Central division rank near the top of the nation for rural however, “The worst may be yet to come, as Congress and the new Administration are expected health. (9)funding outperforms North Dakota South Dakota Kansas (24) and slope to slash Iowa federal for family planning and(10), comprehensive sex (11), education. The slippery Missouri (35), but fall.” falls behind Minnesota (5) and Nebraska (8) in the final rankings. is becoming a free

I

states today moreincrease than 50% of “plus” or a “minus” for factors Walker emphasized that “It’s owa scores particularly well on quality-of counties. Iowa shows a 5.6 percent women now live in a county not reflected in the core grade. not just abortion rights that are -life measures in this year’s RHQ Rural in rural mortality as compared to urban without an abortion provider. under siege; it’s also access to Health Report Card, and the state ranks in counties. The state ranks 16th for rural/urban ALABAMA RECEIVED A family planning services, and the top 10 states for rural health nationwide. difference in mortality. Federal support for “MINUS” BECAUSE THEIR when women are denied access reproductive health and rights ‘CHOOSE LIFE’ LICENSE to contraception everyone loses: There aremore a number of positive signs that FUNDRURAL RESOURCES could suffer a major reversal PLATES ANTI-CHOICE there are unintended Iowa is moving in the right direction. The in 2017. Congress and the new pregnancies, more abortions, and ORGANIZATIONS/CRISIS Centers for Disease Control and Prevention Administration to PREGNANCY Rural CENTERS higher health care costs. ” health resource organizationsare inexpected Iowa curtail access to contraceptive (CDC) released a report indicating Only that after include: 21 states received a services by blocking all funding This year’s card also decades ofreport decline, progress in preventing “B-“ or higher. Just five states forof Planned Parenthood, draws attention to “a growing stroke deaths has slowed across the nation. New• Jersey, Iowa State Office Rural Health (California, defunding Title X, a 48-year old national divide” on reproductive Only 13 states saw stroke death rates continue idph.iowa.gov/ohds/rural-health-primaryNew Mexico, Oregon and program that provides support health and rights, and Walker to decrease steadily from 2000 to 2015, and received Washington) an “A”. care/rural-health to family planning clinics warned that Alabama is “on The following states received Iowa is one of those states. • Iowa Rural Health Association serving low-income households, the wrong side of that divide.” a failing grade in 2016: www.iaruralhealth.org and eliminating the Affordable Alabama, which received an “F”, Florida, The Iowa Rural Health Association Alabama, (IRHA) Arkansas, • Great Plains Telehealth Center Care Act’sResource no-cost birth control was one of 20 states receiving a Georgia, Idaho, Indiana, Kansas, isfailing continuing tothe push for report improvements, www.gptrac.org mandate. Walker noted that grade in latest Louisiana,for Mississippi, Missouri, however. is currently advocating • Iowa Association Rural Clinics “Inofthe pastHealth five years most of card. Five The yearsIRHA ago Alabama Nebraska, North Dakota, the successful iarhc.org the slippage on reproductive received a “D”. implementation of Medicaid Oklahoma, South Carolina, Modernization. health has occurred at the state South Dakota, Tennessee, Texas, level, but this MANY FACTORS For more information about theyear datacould see Utah, Virginia, and Wisconsin. unprecedentedemployed setbacks at the ACCOUNTED FOR RURAL HEALTH CARE FACILITIES sources used and methodology national level, including ALABAMA’S FAILING GRADE in RHQ’s 2017 Rural Health Report Card, cuts Walker warned that “A woman’s in funding for comprehensive INCLUDING POOR SCORES The Rural Health Information Hub,reproductive an visitshould www.RuralHealthQuarterly.com. health not sex education in the schools IN PREVENTION AND depend organization funded by the Federal Officeon where she lives, but and a return to abstinence only AFFORDABILITY does, as women in many of Rural Health Policy, reports thatit there programs which have been are experiencing reduced Using are 82eleven Criticalcriteria, Accessthe Hospitals in areas the state, proven to be ineffective.” to reproductive health Institute’s card Health ranked Clinicsaccess as well as report 170 Rural and 14 services including abortion.” each of the 50 statesHealth and theCenterscare Federally Qualified providing Walker stressed that this Walker noted that 19 states, District of Columbia on four services at 60 sites. year’s report card should be including Alabama, have refused broad indicators relating to “an urgent call to action” for to expand Medicaid under the reproductive health and rights: anyone who is concerned URBAN-RURAL DIVIDE Affordable Care Act, leaving tens effectiveness, prevention, about reproductive health of millions of women without affordability, and access. Based and rights. “As disappointing Most report a marked improved access to contraception upon U.S. theirstates composite scores (0- difference as 2016 was, 2017 could be in health between rural and and other urbanhealth care services. 100), eachoutcomes state received a “core” a whole lot worse.” Walker also noted that in 27 grade (A, B, C, D or F), but some states received an additional


IOWA BY THE NUMBERS Iowa has an estimated population of 3,134,693 people, and 40.7 percent live in one of Iowa’s 78 rural counties. The poverty rate in rural Iowa is 23 percent, compared with 17.1 percent in urban areas of the state. 9.6 percent of the rural population has not completed high school, while 7.7 percent of the urban population lacks a high school diploma.

..

9.7 percent of rural Iowa residents are U.S. military veterans, and 8.6 percent of the rural population under age 65 lives with a disability. RURAL COUNTIES URBAN COUNTIES

91.1 percent of the state’s rural population is Non-Hispanic White, 1.3 percent is Black/African-American, 5.1 percent is Hispanic/Latino, 0.3 percent is American Indian/Alaska Native and 0.9 percent is Asian.

MORTALITY

QUALITY OF LIFE

ACCESS TO CARE

Heart Disease: C

Fair/Poor Health: A

Primary Care: B

Heart disease is the leading cause of death in Iowa, and the state is ranked 24th in the U.S. for the number of deaths by heart disease among rural residents. The age-adjusted rate for heart disease in rural counties is 178.1 per 100,000. The national average is 168.5 per 100,000.

The percentage of Iowans reporting poor general health is among the lowest in the nation. The state ranked 4th for rural counties (12.2 percent) and 7/51 for urban counties (12 percent).

Iowa ranks 17th in the U.S. for the number of primary care physicians practicing in rural counties (60.4 per 100,000). The national average for rural counties is 54.5 per 100,000.

Mental Health: A

Mental Care: C+

Rural residents of Iowa reported an average of 3.2 mentally unhealthy days in the past 30 days. The national average is 3.7 days. The state ranked 6th for self-reported mental health in rural counties.

Iowa ranks 21st in the U.S. for the number of psychiatrists practicing in rural counties. Iowa has 3 per 100,000 residents. The U.S. rural average is 3.4.

Cancer: C Cancer is the second leading cause of death in Iowa, and the state is ranked 24th in the U.S. for deaths by cancer among rural residents. The age-adjusted rate for cancer in rural counties is 169.2 per 100,000. The national average is 158.5 per 100,000.

CLRD: BChronic lower respiratory disease (CLRD) is the third leading cause of death in Iowa, and the state is ranked 18 in the U.S. for deaths by CLRD among rural residents. The age-adjusted rate for CLRD in rural counties is 48.5 per 100,000. The national average is 41.6 per 100,000.

Physical Health: A The number of physically unhealthy days reported in rural Iowa is 3.1 in 30 days, and urban residents also report 3.1 days. The national average is 3.9. Rural Iowa ranks 4th.

Low Birth Weight: AThe percentage of live births with low birth weight (< 5 pounds, 8 ounces) in rural Iowa is 6.4 percent. The national average is 8 percent. Iowa ranks 9th in the category.

Dental Care: C Iowa ranks 24th in the nation for rural access to dental care with 48.9 dentists per 100,000 rural residents. The national rural average is 42.8.

Uninsured Rate: A 9.5 percent of Iowa’s rural population under age 65 is uninsured. The average uninsured rate for urban residents of Iowa is 7.9 percent. Iowa is one of 31 states that adopted Medicaid expansion as offered under the Affordable Care Act.

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IN FREE FALL: REPRODUCTIVE HEALTH AND RIGHTS IN AMERICA

C 24/47 KANSAS ranks 24th in the nation for rural health out of 47 states with rural counties. Kansas is one of three states receiving a grade of “C” KANSAS RECEIVED A GRADE OF “C” BECAUSE: Kansas ranked in the third quintile of states for its rates of mortality in rural counties. Kansas ranked in the second quintile of states for measures of daily health and quality of life in rural counties. Kansas ranked in the third quintile of states for health care access in rural counties.

46

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46  RHQ

KANSAS

WASHINGTON, D.C. – In releasing its fifth annual 50-State Report Card on Reproductive Health and Rights, the Population Institute lowered the U.S. grade from a “D+” to a “D”. The report card, the most comprehensive report card of its kind, tracks multiple indicators of reproductive health and rights, including access to family planning and abortion services.

Along with Iowa, Minnesota, Missouri, Nebraska, North Dakota and South Dakota, The Institute’s president Robert Walker said, “For the past five years, reproductive health and Kansas is a member of the West North Central division of the Midwest U.S. Census region. rights in the U.S. have been on a slippery slope.” Five years ago nine states received an “F”. In Most members of the West North Central division rank near the top of the nation for this year’s report card 20 states—including Alabama—received a failing grade. Walker warned, rural health, Kansas Missouri (24) ranks higherare than however, “Thebut worst may and be yet to come,underperform. as Congress andKansas the new Administration expected Missouri (35), but the Sunflower State falls far behind Nebraska (8), IowaThe (9),slippery North slope to slash federal funding for family planning and comprehensive sex education. Dakota (10) aand is becoming freeSouth fall.” Dakota (11) in the final rankings.

K

statesan today thanin 50% of “plus” or a “minus” for factors Walker emphasized that ansas currently has“It’s an average rural counties. Kansas shows 8.4 more increase women now live in a county not reflected in the core grade. not just abortion rights that are health grade when compared to all rural mortality as compared to urban counties. without an abortion provider. under siege; it’s also access to other states, but it underperforms The state ranks 23rd for rural/urban difference ALABAMA RECEIVED A family planning services, and it’s neighbors to the north and faces some in mortality. Federal support for “MINUS” BECAUSE THEIR when women are denied access daunting challenges in the near future. reproductive health and rights ‘CHOOSE to contraception everyone loses: 46  RHQ LIFE’ LICENSE RESOURCES could suffer a major reversal PLATES FUNDRURAL ANTI-CHOICE there are more unintended Kansas has been in 2017. Congress and the new ORGANIZATIONS/CRISIS pregnancies, moreexperiencing abortions, anda continued shift ofhealth its younger population away from Rural resource organizations in Kansas Administration are expected to PREGNANCY CENTERS higher care costs. ” rural counties. As a result, 40 counties have curtail access to contraceptive include: Only 21 states received a services by blocking all funding This year’s reportof card also over 29 percent residents age 65“B-“ andor higher. Just five states for Planned draws attention to “a growing older, and 26 counties have aged more than New• Jersey, Kansas Office of Primary CareParenthood, & Rural Health (California, defunding Title X, a 48-year old national divide” on reproductive 4 years on average since the 2000 New census. 76 Oregon www.kdheks.gov/olrh/rural.html Mexico, and program that provides support health and rights,have and Walker Kansas counties lost population since Washington) received an “A”. • Kansas Rural Health Association to family planning clinics warned that Alabama is “on 2000, and all but one is rural. The following stateswww.ksrha.org received serving low-income households, the wrong side of that divide.” a failing grade • in 2016: Heartland Telehealth Resource Center and eliminating the Affordable Alabama, which received an “F”, Alabama, Arkansas, heartlandtrc.org Florida, In addition, 69 percent of rural hospitals in Care Act’s no-cost birth control was one of 20 states receiving a Idaho,• Indiana, Kansas, the state are in operating negativeGeorgia, Medicare Kansas Rural Health Education andnoted Services mandate. Walker that failing grade the latestatreport Missouri, margins, rural has seenLouisiana, MedicareMississippi, http://www.kumc.edu/community-en“In the past five years most of card. Fiveand years agoKansas Alabama Nebraska, North Dakota, cuts of $196M to gagement/rural-health.html the slippage on reproductive received a “D”. over 10 years, according Oklahoma, South Carolina, the Kansas Hospital Association. healthWorks has occurred at the state • Kansas Rural Health South Dakota, Tennessee, Texas, level, but this year could see MANY FACTORS krhw.net Utah, Virginia, and Wisconsin. unprecedented setbacks at the ACCOUNTED FOR RURAL HEALTH CARE FACILITIES national cuts ALABAMA’S FAILING GRADE For more information aboutlevel, the including data Walker warned that “A woman’s in funding for comprehensive INCLUDING POOR SCORES The Rural Health Information Hub,reproductive an orsources used health should not and methodology employed sex education in the schools IN PREVENTION AND dependofon where lives,2017 but Rural Health Report Card, ganization funded by the Federal Office inshe RHQ’s and a return to abstinence only AFFORDABILITY it does, in many Rural Health Policy, reports that there areas84women visit www.RuralHealthQuarterly.com. programs which have been areas Using eleven the in the state, Critical Accesscriteria, Hospitals as are wellexperiencing reduced proven to be ineffective.” access Institute’s report cardClinics rankedin Kansas as 170 Rural Health andto19reproductive health services including abortion.” each of the 50 statesHealth and theCenterscare Federally Qualified providing Walker stressed that this Walker noted that 19 states, District of Columbia on four services at 56 sites. year’s report card should be including Alabama, have refused broad indicators relating to “an urgent call to action” for to expand Medicaid under the reproductive health and rights: anyone who is concerned URBAN-RURAL DIVIDE Affordable Care Act, leaving tens effectiveness, prevention, about reproductive health of millions of women without affordability, and access. Based and rights. “As disappointing Most report a marked difference improved access to contraception upon U.S. theirstates composite scores (0as 2016 was, 2017 could be in health between rural and andother urbanhealth care services. 100), eachoutcomes state received a “core” a whole lot worse.” Walker also noted that in 27 grade (A, B, C, D or F), but some states received an additional


KANSAS BY THE NUMBERS Kansas has an estimated population of 2,907,289 people, and 32.1 percent live in one of Kansas’s 86 rural counties. The poverty rate in rural Kansas is 23 percent, compared with 17.1 percent in urban areas of the state. 12.3 percent of the rural population has not completed high school, while 8.5 percent of the urban population lacks a high school diploma.

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9.4 percent of rural Kansas residents are U.S. military veterans, and 9.7 percent of the rural population under age 65 lives with a disability. RURAL COUNTIES URBAN COUNTIES

80.9 percent of the state’s rural population is Non-Hispanic White, 2.4 percent is Black/African-American, 12.4 percent is Hispanic/ Latino, 1.1 percent is Asian and 0.8 percent is American Indian/ Alaska Native.

MORTALITY

QUALITY OF LIFE

ACCESS TO CARE

Heart Disease: C+

Fair/Poor Health: C

Primary Care: C+

Heart disease is the leading cause of death in Kansas, and the state is ranked 23rd in the U.S. for the number of deaths by heart disease among rural residents. The age-adjusted rate for heart disease in rural counties is 173 per 100,000. The national average is 168.5 per 100,000.

The percentage of Kansans reporting poor general health is close to the national average. The state ranked 28th for rural counties (16.2 percent) and 17/51 for urban counties (13.1 percent).

Kansas ranks 23rd in the U.S. for the number of primary care physicians practicing in rural counties (57.4 per 100,000). The national average for rural counties is 54.5 per 100,000.

Mental Health: A

Mental Care: F

Rural residents of Kansas reported an average of 3.2 mentally unhealthy days in the past 30 days. The national average is 3.7 days. The state ranked 7th for self-reported mental health in rural counties.

Kansas ranks 41st in the U.S. for the number of psychiatrists practicing in rural counties. Kansas has 1.8 per 100,000 residents. The U.S. rural average is 3.4.

Cancer: C Cancer is the second leading cause of death in Kansas, and the state is ranked 25th in the U.S. for deaths by cancer among rural residents. The ageadjusted rate for cancer in rural counties is 171.2 per 100,000. The national average is 158.5 per 100,000.

CLRD: D+ Chronic lower respiratory disease (CLRD) is the third leading cause of death in Kansas, and the state is ranked 30 in the U.S. for deaths by CLRD among rural residents. The ageadjusted rate for CLRD in rural counties is 54.2 per 100,000. The national average is 41.6 per 100,000.

Physical Health: B+ The number of physically unhealthy days reported in rural Kansas is 3.4 in 30 days, while urban residents report 2.9 days. The national average is 3.9. Rural Kansas ranks 11th.

Low Birth Weight: B The percentage of live births with low birth weight (< 5 pounds, 8 ounces) in rural Kansas is 7 percent. The national average is 8 percent. Kansas ranks 17th in the category.

Dental Care: C Kansas ranks 25th in the nation for rural access to dental care with 4806 dentists per 100,000 rural residents. The national rural average is 42.8.

Uninsured Rate: B14.1 percent of Kansas’s rural population under age 65 is uninsured. The average uninsured rate for urban residents of Kansas is 12.3 percent. Kansas is one of 19 states that did not adopt Medicaid expansion as offered under the Affordable Care Act.

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Summer 2017 | RHQ   47


IN FREE FALL: REPRODUCTIVE HEALTH AND RIGHTS IN AMERICA

F 42/47 KENTUCKY ranks 42nd in the nation for rural health out of 47 states with rural counties. Kentucky is one of nine states receiving a failing grade. KENTUCKY RECEIVED A FAILING GRADE BECAUSE: Kentucky ranked in the fifth quintile of states for its rates of mortality in rural counties. Kentucky ranked in the fifth quintile of states for measures of daily health and quality of life in rural counties. Kentucky ranked in the third quintile of states for health care access in rural counties.

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KENTUCKY

WASHINGTON, D.C. – In releasing its fifth annual 50-State Report Card on Reproductive Health and Rights, the Population Institute lowered the U.S. grade from a “D+” to a “D”. The report card, the most comprehensive report card of its kind, tracks multiple indicators of reproductive health and rights, including access to family planning and abortion services.

Along with Alabama, Mississippi and Tennessee, Kentucky is a member of the East The Institute’s president Robert Walker said, “For the past five years, reproductive health and South Central division of the South U.S. Census region. All four states in the division rights in the U.S. have been on a slippery slope.” Five years ago nine states received an “F”. In showed strong similarities in our reporting, and all four states received a failing grade. this year’s report card 20 states—including Alabama—received a failing grade. Walker warned, The Bluegrass State (42) ranked highest in the division, followed by Tennessee (43), however, “The worst may be yet to come, as Congress and the new Administration are expected Alabama (45) and Mississippi (47) in theand final rankings. sex education. The slippery slope to slash federal funding for family planning comprehensive is becoming a free fall.”

K

states today more than 50% of “plus” or a “minus” for factors Walker emphasized that rural “It’s population entucky has a large relative URBAN-RURAL DIVIDE women now live in a county not reflected in the core grade. not just abortion rights that are to most other states in the U.S., and the without an abortion provider. underextremely siege; it’s also access to rural southeast corner of the Most U.S. states report a marked difference ALABAMA RECEIVED A family planning services, and state faces a number of unique challenges. in health outcomes Federal betweensupport rural and urban for “MINUS” BECAUSE THEIR when women are denied access counties. Kentucky shows a 17.9 increase reproductive health andinrights ‘CHOOSE LIFE’ LICENSE to contraception everyone loses: According to Kentucky Rural Health Information rural mortality as compared to urban councould suffer a major reversal PLATES FUND ANTI-CHOICE there are more unintended Technology, percent of theand rural residents in ties. The state ranksin45th forCongress rural/urban 2017. and the new ORGANIZATIONS/CRISIS pregnancies,55 more abortions, southeast Kentucky live” within 200 PREGNANCY percent of difference Administration are expected to CENTERS in mortality. higher health care costs. the poverty line, and 26.2 percent live below curtail access to contraceptive Only 21 states received a the line, as compared to 14.8 nationservices by blocking all funding Thispoverty year’s report card also RURAL RESOURCES “B-“ or higher. Just five states for Planned Parenthood, draws attention growing ally. CLRD has a to 60“a percent mortality rate in New Jersey, (California, defunding Title X, a 48-year old national divide” on reproductive Knox, Whitley and Laurel counties New alone. Rural health Mexico, Oregon and resource organizations in Kentucky program that provides support health and rights, and Walker Washington) received include:an “A”. to family planning clinics warned that Alabama is “on The opioid epidemic is also cause for Theconcern following states received serving low-income households, the wrong side of that divide.” in the state. In 2015 there were 1,248 druggrade • a failing in 2016: Kentucky State and Office of Rural Health eliminating the Affordable Alabama, which received an “F”, Alabama, Florida, overdose deaths in Kentucky, increased fromArkansas, ruralhealth.med.uky.edu/kentuckyCare Act’s no-cost birth control was one of 20 states receiving a Idaho, Indiana, Kansas, 1,087 in 2014. The Kentucky InjuryGeorgia, Prevention office-rural-health mandate. Walker noted that failing grade in the latest report Louisiana, Mississippi, Missouri, and (KIPRC) has launched • Kentucky Rural “In Health Association the past five years most of card.Research Five yearsCenter ago Alabama Nebraska, the Drug aOverdose Technical Assistance Core North Dakota, www.kyrha.orgthe slippage on reproductive received “D”. Oklahoma, South Carolina, (DOTAC) to support local health departments, health has occurred at the state • Mid-Atlantic South Dakota, Tennessee, Texas, Telehealth Resource Center community coalitions, and state and local level, but this year could see MANY FACTORS www.matrc.org Utah, Virginia, and Wisconsin. unprecedented setbacks at the agencies in their efforts to access timely local ACCOUNTED FOR • Rural and Underserved Health Research Center national level, including cuts ALABAMA’S FAILING GRADE data and analytical results on controlled ruhrc.uky.edu Walkersubwarned that “A woman’s in funding for comprehensive INCLUDING POORdrug SCORES stance prescribing, related morbidity and health • should Centernot of Excellence in Rural Health reproductive sex education in the schools IN PREVENTION AND mortality trends. depend on where sheruralhealth.med.uky.edu lives, but and a return to abstinence only AFFORDABILITY it does, as women many • in Institute for Rural Health Policy programs which have been areas are experiencing reduced Using eleven criteria, theFACILITIES RURAL HEALTH CARE uknowledge.uky.edu/irhp proven to be ineffective.” access to reproductive health Institute’s report card ranked careorganiservices including abortion. ” eachRural of the 50 states and the Hub, an The Health Information For more information about the data Walker stressed that this Walker noted that 19 states, District of Columbia on four zation funded by the Federal Office of Rural sources used and methodology employed year’s report card should be including Alabama, have refused broad indicators relating to Health Policy, reports that there are 27 Critical in RHQ’s 2017 Rural“an Health urgentReport call to Card, action” for to expand Medicaid under the reproductive health and rights: Access Hospitals in the state, as well as 191 anyone who is concerned www.RuralHealthQuarterly.com. Affordable Carevisit Act, leaving tens effectiveness, prevention, about reproductive health Rural Health Clinics and 23 Federally Qualified of millions of women without affordability, and access. Based and rights. “As disappointing Health Centers providing services at 211 sites. improved access to contraception upon their composite scores (0as 2016 was, 2017 could be 100), each state received a “core” and other health care services. a whole lot worse.” Walker also noted that in 27 grade (A, B, C, D or F), but some states received an additional


KENTUCKY BY THE NUMBERS Kentucky has an estimated population of 4,436,974 people, and 41.3 percent live in one of Kentucky’s 85 rural counties. The poverty rate in rural Kentucky is 23.6 percent, compared with 14.9 percent in urban areas of the state.

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21.2 percent of the rural population has not completed high school, while 11.9 percent of the urban population lacks a high school diploma.

RURAL COUNTIES URBAN COUNTIES

8.1 percent of rural Kentucky residents are U.S. military veterans, and 16.2 percent of the rural population under age 65 lives with a disability. 92.7 percent of the state’s rural population is Non-Hispanic White, 3.4 percent is Black/African-American and 1.8 percent is Hispanic/Latino, 0.2 percent is American Indian/Alaska Native and 0.4 percent is Asian.

MORTALITY

QUALITY OF LIFE

ACCESS TO CARE

Cancer: F

Fair/Poor Health: F

Primary Care: C

Cancer is the leading cause of death in Kentucky, and the state is ranked last in the U.S. (47th) for deaths by cancer among rural residents. The age-adjusted rate for cancer in rural counties is 214.8 per 100,000. The national average is 158.5 per 100,000.

The percentage of Kentuckians reporting poor general health is among the highest in the nation. The state ranked 41th for rural counties (22.1 percent) and 43/51 for urban counties (17.8 percent).

Kentucky ranks 26th in the U.S. for the number of primary care physicians practicing in rural counties (53.3 per 100,000). The national average for rural counties is 54.5 per 100,000.

Mental Health: D-

Mental Care: C+

Rural residents of Kentucky reported an average of 4.3 mentally unhealthy days in the past 30 days. The national average is 3.7 days. The state ranked 38th for self-reported mental health in rural counties.

Kentucky ranks 22nd in the U.S. for the number of psychiatrists practicing in rural counties. Kentucky has 2.9 per 100,000 residents. The U.S. rural average is 3.4.

Heart Disease: F Heart disease is the second leading cause of death in Kentucky, and the state is ranked 40th in the U.S. for the number of deaths by heart disease among rural residents. The age-adjusted rate for heart disease in rural counties is 228.7 per 100,000. The national average is 168.5 per 100,000.

CLRD: F Chronic lower respiratory disease (CLRD) is the third leading cause of death in Kentucky, and the state is ranked last in the U.S. (47th) for deaths by CLRD among rural residents. The age-adjusted rate for CLR disease in rural counties is 76.8 per 100,000. The national average is 41.6 per 100,000.

Physical Health: F The number of physically unhealthy days reported in rural Kentucky is 5 in 30 days, while urban residents report 4.2 days. The national average is 3.9. Rural Kentucky ranks 46th.

Low Birth Weight: F The percentage of live births with low birth weight (< 5 pounds, 8 ounces) in rural Kentucky is 9.4 percent, well above the national average of 8 percent. Kentucky ranks 39th in the category.

Dental Care: CKentucky ranks 29th in the nation for rural access to dental care with 41 dentists per 100,000 rural residents. The national rural average is 42.8.

Uninsured Rate: C+ 14.9 percent of Kentucky’s rural population under age 65 is uninsured. The average uninsured rate for urban residents of Kentucky is 12 percent. Kentucky is one of 31 states that adopted Medicaid expansion as offered under the Affordable Care Act.

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IN FREE FALL: REPRODUCTIVE HEALTH AND RIGHTS IN AMERICA

F 46/47 LOUISIANA ranks 46th in the nation for rural health out of 47 states with rural counties. Louisiana is one of nine states receiving a failing grade. LOUISIANA RECEIVED A FAILING GRADE BECAUSE: Louisiana ranked in the fifth quintile of states for its rates of mortality in rural counties. Louisiana ranked in the fifth quintile of states for measures of daily health and quality of life in rural counties. Louisiana ranked in the fifth quintile of states for health care access in rural counties.

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50  RHQ

LOUISIANA

WASHINGTON, D.C. – In releasing its fifth annual 50-State Report Card on Reproductive Health and Rights, the Population Institute lowered the U.S. grade from a “D+” to a “D”. The report card, the most comprehensive report card of its kind, tracks multiple indicators of reproductive health and rights, including access to family planning and abortion services.

Along with Arkansas, Oklahoma and Texas, Louisiana is a member of the West The Institute’s president Robert Walker said, “For the past five years, reproductive health and South Central division of the South U.S. Census region. All four states in the division rights in the U.S. have been on a slippery slope.” Five years ago nine states received an “F”. In showed significant similarities in our reporting, and all four states received a low grade. this year’s report card 20 states—including Alabama—received a failing grade. Walker warned, The Pelican State ranked in theas division (46) Texas (36), Arkansas (38) however, “The worst may belowest yet to come, Congress andbehind the new Administration are expected and Oklahoma (41) in for thefamily final rankings. to slash federal funding planning and comprehensive sex education. The slippery slope is becoming a free fall.”

L

today more than 50% of “plus” or a “minus” for factors Walker emphasized “It’slowest performing ouisiana is onethat of the in health outcomes states between rural and urban women now live in a county not reflected in the core grade. not just abortion rights that are states in this year’s RHQ Rural Health Re- counties. Louisiana shows a 15.7 percent without an abortion provider. under siege; it’s also access to port Card, and there aren’t many bright increase in rural mortality as compared to ALABAMA RECEIVED A family planning services, and spots to speak of. Local providers are“MINUS” expressingBECAUSE urban counties. The Federal state ranks 41st for rural/ support for THEIR when women are denied access hope about the future, however. urban difference in mortality. reproductive health and rights ‘CHOOSE LIFE’ LICENSE to contraception everyone loses: could suffer a major reversal PLATES FUND ANTI-CHOICE there are more unintended In response more to theabortions, serious challenges to RURAL RESOURCES in 2017. Congress and the new pregnancies, and ORGANIZATIONS/CRISIS providing ruralcare health care Louisiana CENTERS Administration are expected to PREGNANCY higher health costs. ” in the state, bucked the trend in southern states and curtail access toincontraceptive Rural health resource organizations Louisiana Only 21 states received a services by blocking all funding This year’sMedicaid report cardexpansion also accepted as offered include: “B-“ or higher. Just five states for Planned Parenthood, draws attention to “a growing under the Affordable Care Act. The LouisianaNew Jersey, (California, defunding Title X, a 48-year old national divide” on reproductive Rural Health Association also madeNew recom• Bureau Mexico, Oregon and of Primary Care and Rural Health program that provides support health and rights, and Walker mendations regarding the rollout ofWashington) Medicaid received new.dhh.louisiana.gov/index.cfm/suban “A”. to family planning clinics warned that Alabama is “on expansion, including streamlining the Thecredenfollowing stateshome/25 received serving low-income households, the wrong side of that divide.” a failing grade in tialing proccess, allowing nurse practitioners • 2016: Louisiana Ruraland Health Association eliminating the Affordable Alabama, which received an “F”, Alabama, Arkansas, www.lrha.org Florida, to open much-needed offices and increasing Care Act’s no-cost birth control was one of 20 states receiving a Georgia, Idaho,• Indiana, Medicaid reimbursement. TexLaKansas, Telehealth Resource Center mandate. Walker noted that failing grade in the latest report Louisiana, Mississippi, Missouri, www.texlatrc.org “In the past five years most of card. Five years ago Alabama Nebraska, North Dakota, RURAL • Louisiana Ruralthe Hospital Coalition slippage on reproductive receivedHEALTH a “D”. CARE FACILITIESOklahoma, South Carolina, www.larhc.org health has occurred at the state South Dakota, Tennessee, Texas, level, but this year could see MANY FACTORS The Rural Health Information Hub, Utah, an organiVirginia, and Wisconsin. unprecedented setbacks at the ACCOUNTED FOR zation funded by the Federal Office of Rural For more information about the data national level, including ALABAMA’S FAILING GRADE Health Policy, reports that there areWalker 27 Critical sources used and methodology employedcuts warned that “A woman’s in funding for comprehensive INCLUDING POOR SCORES Access Hospitals in the state, as well as 129 health in RHQ’s reproductive should2017 not Rural Health Report Card, sex education in the schools IN PREVENTION AND Rural Health Clinics and 34 Federally Qualified visit depend on where she www.RuralHealthQuarterly.com. lives, but and a return to abstinence only AFFORDABILITY does,sites. as women in many Health Centers providing services atit 198 programs which have been areas are experiencing reduced Using eleven criteria, the proven to be ineffective.” to reproductive health Institute’s report Additionally, the card Stateranked of Louisiana access operates a care services each of the 50 states and the “public” hospital system, which provides care including abortion.” Walker stressed that this Walker noted that 19 states, District of Columbia on four to those who are uninsured, under-insured, year’s report card should be including Alabama, have refused broad indicators relating to as well as patients who have health insurance. “an urgent call to action” for to expand Medicaid under the reproductive health and rights: anyone who is concerned Affordable Care Act, leaving tens effectiveness, prevention, about reproductive health URBAN-RURAL DIVIDE of millions of women without affordability, and access. Based and rights. “As disappointing improved access to contraception upon their composite scores (0as 2016 was, 2017 could be Most U.S. states report aamarked and other health care services. 100), each state received “core” difference a whole lot worse.” Walker also noted that in 27 grade (A, B, C, D or F), but some states received an additional


LOUISIANA BY THE NUMBERS Louisiana has an estimated population of 4,681,666 people, and 16.2 percent live in one of Louisiana’s 29 rural counties. The poverty rate in rural Louisiana is 23 percent, compared with 17.1 percent in urban areas of the state. 21.9 percent of the rural population has not completed high school, while 15.6 percent of the urban population lacks a high school diploma.

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8.8 percent of rural Louisiana residents are U.S. military veterans, and 12.9 percent of the rural population under age 65 lives with a disability. RURAL PARISHES URBAN PARISHES

62.5 percent of the state’s rural population is Non-Hispanic White, 31.4 percent is Black/African-American, 2.9 percent is Hispanic/Latino, 0.8 percent is American Indian/Alaska Native and 0.6 percent is Asian.

MORTALITY

QUALITY OF LIFE

ACCESS TO CARE

Heart Disease: F

Fair/Poor Health: F

Primary Care: F

Heart disease is the leading cause of death in Louisiana, and the state is ranked 46th out of 47 states with rural counties for the number of deaths by heart disease among rural residents. The age-adjusted rate for heart disease in rural counties is 258.1 per 100,000. The national average is 168.5 per 100,000.

The percentage of Louisianians reporting poor general health is among the highest in the nation. The state ranked 44th for rural counties (23.3 percent) and 48/51 for urban counties (19.6 percent).

Louisiana ranks 42nd in the U.S. for the number of primary care physicians practicing in rural counties (44.6 per 100,000). The national average for rural counties is 54.5 per 100,000.

Mental Health: F

Mental Care: F

Rural residents of Louisiana reported an average of 4.1 mentally unhealthy days in the past 30 days. The national average is 3.7 days. The state ranked 43rd for self-reported mental health in rural counties.

Louisiana ranks 45th in the U.S. for the number of psychiatrists practicing in rural counties. Louisiana has 1.2 per 100,000 residents. The U.S. rural average is 3.4.

Cancer: F Cancer is the second leading cause of death in Louisiana, and the state is ranked 41st in the U.S. for deaths by cancer among rural residents. The ageadjusted rate for cancer in rural counties is 191.3 per 100,000. The national average is 158.5 per 100,000.

Accidents: DAccidents are the third leading cause of death in Louisiana, and Louisiana ranked 38th out of 47 states for accidental death in rural counties. The statewide rate for accidental death is 62.8 per 100,000. The national average is 43.2 per 100,000.

Physical Health: F The number of physically unhealthy days reported in rural Louisiana is 4.7 in 30 days, while urban residents report 4.2 days. The national average is 3.9. Rural Louisiana ranks 41st.

Low Birth Weight: F The percentage of live births with low birth weight (< 5 pounds, 8 ounces) in rural Louisiana is 10.8 percent, well above the national average of 8 percent. Louisiana ranks 45th in the category.

Dental Care: F Louisiana ranks 46th in the nation for rural access to dental care with 30.4 dentists per 100,000 rural residents. The national rural average is 42.8.

Uninsured Rate: F 20.9 percent of Louisiana’s rural population under age 65 is uninsured. The average uninsured rate for urban residents of Louisiana is 17.1 percent. Louisiana is one of 31 states that adopted Medicaid expansion as offered under the Affordable Care Act.

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IN FREE FALL: REPRODUCTIVE HEALTH AND RIGHTS IN AMERICA

B+ 13/47 MAINE ranks 13th in the nation for rural health out of 47 states with rural counties. Maine is one of three states receiving a grade of “B+” MAINE RECEIVED A GRADE OF “B+” BECAUSE: Maine ranked in the third quintile of states for its rates of mortality in rural counties. Maine ranked in the second quintile of states for measures of daily health and quality of life in rural counties. Maine ranked in the first quintile of states for health care access in rural counties.

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MAINE

WASHINGTON, D.C. – In releasing its fifth annual 50-State Report Card on Reproductive Health and Rights, the Population Institute lowered the U.S. grade from a “D+” to a “D”. The report card, the most comprehensive report card of its kind, tracks multiple indicators of reproductive health and rights, including access to family planning and abortion services.

Along with Connecticut, Massachusetts, New Hampshire, Rhode Island, and Vermont, The Institute’s president Robert Walker said, “For the past five years, reproductive health and the Pine Tree State is a member of the New England division of the Northeast U.S. rights in the U.S. have been on a slippery slope.” Five years ago nine states received an “F”. In Census region. Rhode Island, aAlabama—received state with no rural counties, all Walker states in this year’s reportExcluding card 20 states—including a failing grade. warned, New England receive high national rankings for rural health. Maine (13) ranked however, “The worst may be yet to come, as Congress and the new Administration arelowest expected in falling for behind New Hampshire (1), Vermontsex (2), Connecticut (3), andslope to the slashdivision, federal funding family planning and comprehensive education. The slippery Massachusetts (6)fall.” in the final rankings. is becoming a free

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states today more than 50% of or aof“minus” for factors Walker emphasized that “It’sstate. 50“plus” aine is a very rural percent URBAN-RURAL DIVIDE women now live in a county not reflected in the core grade. not just abortion rights that are Maine’s land area is almost completely without an abortion provider. under siege; it’s also access to uninhabited—about 9,000 people live Most U.S. states report a marked difference ALABAMA RECEIVED A family planning services, and in the 400 townships and coastal islands that in health outcomes Federal between rural and support for urban “MINUS” BECAUSE THEIR when women are denied access comprise the state’s unorganized a 7.6 percent reproductive healthincrease and rights ‘CHOOSE LIFE’counties. LICENSEMaine shows to contraception everyone loses: territory— and percent of the state’s population lives rural mortality ascould compared urbanreversal sufferto a major PLATES FUNDinANTI-CHOICE there40 are more unintended in a rural county. these counties. The state ranks 21st for rural/urban in 2017. Congress and the new ORGANIZATIONS/CRISIS pregnancies, moreDespite abortions, andchallenges, Maine performs year’s difference in mortality. Administration are expected to PREGNANCY CENTERS higher health carerelatively costs.” well in this curtail access to contraceptive RHQ Rural Health Report Card. Only 21 states received a services by blocking all funding This year’s report card also RURAL RESOURCES “B-“ or higher. Just five states for Planned Parenthood, draws attention to “a growing On the other hand, the extreme rurality of (California, New Jersey, defunding Title X, a 48-year old national divide” on reproductive the state may help explain why Maine ranks New Mexico, Oregon and resource organizations in Rural health program that provides support health and rights, and Walker considerably lower than other statesWashington) in New received “A”. Maine an include: to family planning clinics warned that Alabama is “on Theafollowing England. Rural counties in Maine have higher states received serving low-income households, the wrong side of that divide.” a failing and grade in concentration of older adults and veterans, • 2016: Maine Office of and Ruraleliminating Health & Primary Care the Affordable Alabama, which received an “F”, Alabama, Arkansas, www.maine.gov/dhhs/mecdc/dlrs/rhpc/ Florida, Maine’s rural residents are also more likely to Care Act’s no-cost birth control was one of 20 states receiving a Georgia, Idaho, Indiana, Kansas, live in poverty. index.shtml mandate. Walker noted that failing grade in the latest report Louisiana, Mississippi, Missouri, • Maine Rural Health “In theResearch past five Center years most of card. Five years ago Alabama Nebraska, North Dakota, In a number of communities in Maine, home the slippage on reproductive usm.maine.edu/cutler/mrhrc received a “D”. Oklahoma, South Carolina, health, skilled nursing home and other critical health has occurred at the state • New England South Dakota, Tennessee, Texas, Rural Health RoundTable level, but this year could see services are tied to the local rural hospital. MANY FACTORS www.newenglandruralhealth.org Utah, Virginia, and Wisconsin. unprecedented setbacks ACCOUNTED Recruiting and FOR retaining a workforce needed • Northeast Telehealth Resource Centerat the national level, including cuts ALABAMA’S FAILING GRADE to sustain these services is a longstanding netrc.org Walker warned that “A woman’s in funding for comprehensive INCLUDING POOR SCORES challenge in a number of rural communities, reproductive health • should Centernot for Rural Emergency Services and Trauma sex education in the schools IN PREVENTION AND Rural Health according to the Maine Research depend on where shemed.dartmouth-hitchcock.org/crest.html lives, but and a return to abstinence only AFFORDABILITY it does, as women in many Center. programs which have been areas are experiencing reduced Using eleven criteria, the For more information about theineffective. data ” proven to be health Institute’sHEALTH report card ranked RURAL CARE FACILITIESaccess to reproductive sources used and methodology employed care services including abortion.” each of the 50 states and the in RHQ’s 2017 Rural Health Report Card, Walker stressed that this noted that 19 states, District of Columbia on four The Rural Health Information Hub, Walker an organivisit www.RuralHealthQuarterly.com. year’s report card should be including Alabama, have refused broad indicators relating to zation funded by the Federal Office of Rural “an urgent call to action” for to expand Medicaid under the reproductive health and rights: anyone who is concerned Health Policy, reports that there are 16 Critical Affordable Care Act, leaving tens effectiveness, prevention, about reproductive health Access Hospitals in the state, as well as 40 of millions of women without affordability, and access. Based and rights. “As disappointing Rural Clinics and 18 Federally Qualified improved access to contraception upon Health their composite scores (0as 2016 was, 2017 could be Health Centers 123 sites. and other health care services. 100), each state providing received aservices “core” at a whole lot worse.” Walker also noted that in 27 grade (A, B, C, D or F), but some states received an additional


MAINE BY THE NUMBERS Maine has an estimated population of 1,331,479 people, and 40.8 percent live in one of Maine’s 11 rural counties. The poverty rate in rural Maine is 15.1 percent, compared with 11.7 percent in urban areas of the state. 9.3 percent of the rural population has not completed high school, while 7.7 percent of the urban population lacks a high school diploma.

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12 percent of rural Maine residents are U.S. military veterans, and 13.7 percent of the rural population under age 65 lives with a disability.

RURAL COUNTIES URBAN COUNTIES

95.3 percent of the state’s rural population is Non-Hispanic White, 0.5 percent is Black/African-American, 1.2 percent is Hispanic/Latino, 0.8 percent is American Indian/Alaska Native and 0.6 percent is Asian.

MORTALITY

QUALITY OF LIFE

ACCESS TO CARE

Cancer: D

Fair/Poor Health: B

Primary Care: A+

Cancer is the leading cause of death in Maine, and the state is ranked 35th in the U.S. for deaths by cancer among rural residents. The age-adjusted rate for cancer in rural counties is 182.4 per 100,000. The national average is 158.5 per 100,000.

The percentage of Mainers reporting poor general health is among the lowest in the nation. The state ranked 14th for rural counties (13.9 percent) and 6/51 for urban counties (11.8 percent).

Maine ranks 2nd in the U.S. for the number of primary care physicians practicing in rural counties (99.5 per 100,000). The national average for rural counties is 54.5 per 100,000.

Heart Disease: C+

Mental Health: C+

Mental Care: A-

Rural residents of Maine reported an average of 3.7 mentally unhealthy days in the past 30 days. The national average is 3.7 days. The state ranked 22nd for self-reported mental health in rural counties.

Maine ranks 8th in the U.S. for the number of psychiatrists practicing in rural counties. Maine has 6.2 per 100,000 residents. The U.S. rural average is 3.4.

Heart disease is the second leading cause of death in Maine, and the state is ranked 21st in the U.S. for the number of deaths by heart disease among rural residents. The age-adjusted rate for heart disease in rural counties is 172.1 per 100,000. The national average is 168.5 per 100,000.

CLRD: DChronic lower respiratory disease (CLRD) is the third leading cause of death in Maine, and the state is ranked 36th in the U.S. for deaths by CLRD among rural residents. The age-adjusted rate for CLRD in rural counties is 58.7 per 100,000. The national average is 41.6 per 100,000.

Physical Health: BThe number of physically unhealthy days reported in rural Maine is 3.7 in 30 days, while urban residents report 3.4 days. The national average is 3.9. Rural Maine ranks 19th.

Low Birth Weight: B The percentage of live births with low birth weight (< 5 pounds, 8 ounces) in rural Maine is 6.8 percent. The national average is 8 percent. Maine ranks 16th in the category.

Dental Care: C+ Maine ranks 23rd in the nation for rural access to dental care with 49 dentists per 100,000 rural residents. The national rural average is 42.8.

Uninsured Rate: B 14 percent of Maine’s rural population under age 65 is uninsured. The average uninsured rate for urban residents of Maine is 10.8 percent. Maine is one of 19 states that has not yet adopted Medicaid expansion as offered under the Affordable Care Act.

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IN FREE FALL: REPRODUCTIVE HEALTH AND RIGHTS IN AMERICA

B 16/47 MARYLAND ranks 16th in the nation for rural health out of 47 states with rural counties. Maryland is one of four states receiving a grade of “B” MARYLAND RECEIVED A GRADE OF “B” BECAUSE: Maryland ranked in the second quintile of states for its rates of mortality in rural counties. Maryland ranked in the third quintile of states for measures of daily health and quality of life in rural counties. Maryland ranked in the first quintile of states for health care access in rural counties.

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MARYLAND

WASHINGTON, D.C. – In releasing its fifth annual 50-State Report Card on Reproductive Health and Rights, the Population Institute lowered the U.S. grade from a “D+” to a “D”. The report card, the most comprehensive report card of its kind, tracks multiple indicators of reproductive health and rights, including access to family planning and abortion services.

Along with Delaware, Florida, Georgia, North Carolina, South Carolina, Virginia and The Institute’s president Robert Walker said, “For the past five years, reproductive health and West Virginia, Maryland is part of the South Atlantic division of the South U.S. Census rights in the U.S. have been on a slippery slope.” Five years ago nine states received an “F”. In region. With the exception of Delaware (which has no rural counties), all other states this year’s report card 20 states—including Alabama—received a failing grade. Walker warned, in the division have considerably health and rankings than Maryland (16). however, “The worst may be yet to lower come, rural as Congress the new Administration are The expected Old Linefederal State ranks higher than Virginia Carolina sex (34), Florida (37), West slope to slash funding for family planning(32), and North comprehensive education. The slippery Virginia (39),aGeorgia is becoming free fall.”(40) and South Carolina (44).

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states today more than 50% of or a “minus” for factors Walker emphasized that “It’s aryland is more urbanized“plus” than most URBAN-RURAL DIVIDE women now live in a county not reflected in the core grade. not just abortion rights that are states, but, like most states, higher without an abortion provider. under siege; it’s also access to rates of chronic illness and poorer Most U.S. states report a marked difference ALABAMA RECEIVED A family planning services, and overall health are found in its rural “MINUS” communi- BECAUSE in health outcomesFederal between rural and support for urban THEIR when women are denied access ties when compared to urban populations. counties. Maryland shows a 7.3 percent reproductive health and rights ‘CHOOSE LIFE’ LICENSE to contraception everyone loses: in rural mortality as compared to urcould suffer a major reversal PLATES FUNDincrease ANTI-CHOICE there are more unintended The Marylandmore Community ban counties. The state ranks 20th forand rural/ in 2017. Congress the new ORGANIZATIONS/CRISIS pregnancies, abortions,Health and Resources Commission of initiaurban difference in Administration mortality. are expected to PREGNANCY CENTERS higher healthhas carelaunched costs.” a number tives to provide health care services to those curtail access to contraceptive Only 21 states received a services by blocking all funding This year’s reportto card also care in traditional who are unable receive RURAL RESOURCES “B-“ or higher. Just five states for Planned Parenthood, draws attention to “a growing health care settings. (California, New Jersey, defunding Title X, a 48-year old national divide” on reproductive Rural health New Mexico, Oregon and resource organizations in Maryland program that provides support health and rights, and Walker Among these initiatives are the use ofWashington) community received include:an “A”. to family planning clinics warned that Alabama is “on health workers to improve outcomes Theinfollowing states received serving low-income households, the wrong side of that divide.” a failing grade in underserved rural populations experiencing • 2016: Maryland Officeand of eliminating Rural Healththe Affordable Alabama, which received an “F”, Alabama, Arkansas, pophealth.health.maryland.gov/Pages/ Florida, chronic disease conditions, the establishCare Act’s no-cost birth control was one of 20 states receiving a Georgia, Kansas, ment school-based wellness thatIdaho, Indiana, Rural-health.aspx mandate. Walker noted that failingof grade in the latest report centers Missouri, offer families a Louisiana, range of Mississippi, • Maryland Rural“In Health Association the past five years most of card. students Five yearsand ago their Alabama Nebraska, North Dakota, health care services and a “Mobile Integrated www.mdruralhealth.org the slippage on reproductive received a “D”. Oklahoma, South Carolina, Health Care” program that integrates existing • Mid-Atlantic Telehealth health hasResource occurred Center at the state South Dakota, Tennessee, Texas, health services. The Mobile Integrated level, but this year could see MANYcare FACTORS www.matrc.org Utah, Virginia, and Wisconsin. setbacks at the ACCOUNTED FOR is designed to address Health Care model • Rural Marylandunprecedented Council national level, including cuts ALABAMA’S FAILING GRADE the needs of patients who do not qualify for http://rural.maryland.gov/ Walker warned that “A woman’s in funding for comprehensive INCLUDING POOR SCORES home health assistance, yet require oversight health should not reproductive sex education in the schools IN PREVENTION AND after discharge from a health care depend facility.on whereFor shemore lives, information but about the data and a return to abstinence only AFFORDABILITY it does, as women in many sources used and methodology employed programs which have been areas are experiencing reduced Using eleven criteria, the FACILITIES RURAL HEALTH CARE in RHQ’s 2017 Rural Health Card,” proven to Report be ineffective. access to reproductive health Institute’s report card ranked visit www.RuralHealthQuarterly.com. services including abortion.” eachRural of theHealth 50 states and the Hub,care The Information an organiWalker stressed that this Walker noted that 19 states, District of Columbia on four zation funded by the Federal Office of Rural year’s report card should be including Alabama, have refused broad indicators relating to Health Policy, reports that there are zero “an urgent call to action” for to expand Medicaid under the reproductive health and rights: hospitals identified as Critical Access Hospitals anyone who is concerned Affordable Care Act, leaving tens effectiveness, prevention, about reproductive health and zero Rural Health Clinics in the state, but of millions of women without affordability, and access. Based and rights. “As disappointing there are 17 Federally Qualified Health Centers improved access to contraception upon their composite scores (0as 2016 was, 2017 could be providing at 127a sites. 100), each services state received “core” and other health care services. a whole lot worse.” Walker also noted that in 27 grade (A, B, C, D or F), but some states received an additional


MARYLAND BY THE NUMBERS Maryland has an estimated population of 6,016,447 people, and 2.5 percent live in one of Maryland’s 5 rural counties. The poverty rate in rural Maryland is 14.2 percent, compared with 9.5 percent in urban areas of the state.

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13.6 percent of the rural population has not completed high school, while 10.6 percent of the urban population lacks a high school diploma. RURAL COUNTIES URBAN COUNTIES

10.8 percent of rural Maryland residents are U.S. military veterans, and 9.4 percent of the rural population under age 65 lives with a disability. 78.8 percent of the state’s rural population is Non-Hispanic White, 13.8 percent is Black/African-American, 4.4 percent is Hispanic/ Latino, 0.1 percent is American Indian/Alaska Native and 0.9 percent is Asian.

MORTALITY

QUALITY OF LIFE

ACCESS TO CARE

Heart Disease: B-

Fair/Poor Health: C+

Primary Care: B-

Heart disease is the leading cause of death in Maryland, and the state is ranked 20th in the U.S. for the number of deaths by heart disease among rural residents. The age-adjusted rate for heart disease in rural counties is 171 per 100,000. The national average is 168.5 per 100,000.

The percentage of Marylanders reporting poor general health is close to the national average The state ranked 21st for rural counties (14.5 percent) and 16/51 for urban counties (13 percent).

Maryland ranks 20th in the U.S. for the number of primary care physicians practicing in rural counties (59.8 per 100,000). The national average for rural counties is 54.5 per 100,000.

Mental Health: C+

Mental Care: A

Cancer: A-

Rural residents of Maryland reported an average of 3.6 mentally unhealthy days in the past 30 days. The national average is 3.7 days. The state ranked 21st for self-reported mental health in rural counties.

Maryland ranks 4th in the U.S. for the number of psychiatrists practicing in rural counties. Maryland has 11.2 per 100,000 residents. The U.S. rural average is 3.4.

Cancer is the second leading cause of death in Maryland, and the state is ranked 9th in the U.S. for deaths by cancer among rural residents. The ageadjusted rate for cancer in rural counties is 153 per 100,000. The national average is 158.5 per 100,000.

Stroke: F Cerebrovascular disease is the third leading cause of death in Maryland, and the state is ranked 40th in the U.S. for deaths by stroke among rural residents. The age-adjusted rate for stroke in rural counties is 48.1 per 100,000. The national average is 37.6 per 100,000.

Physical Health: B The number of physically unhealthy days reported in rural Maryland is 3.6 in 30 days, while urban residents report 3.2 days. The national average is 3.9. Rural Maryland ranks 17th.

Low Birth Weight: D The percentage of live births with low birth weight (< 5 pounds, 8 ounces) in rural Maryland is 8.8 percent. The national average is 8 percent. Maryland ranks 34th in the category.

Dental Care: B Maryland ranks 16th in the nation for rural access to dental care with 54 dentists per 100,000 rural residents. The national rural average is 42.8.

Uninsured Rate: B+ 12.1 percent of Maryland’s rural population under age 65 is uninsured. The average uninsured rate for urban residents of Maryland is 10.1 percent. Maryland is one of 31 states that adopted Medicaid expansion as offered under the Affordable Care Act.

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IN FREE FALL: REPRODUCTIVE HEALTH AND RIGHTS IN AMERICA

A 6/47 MASSACHUSETTS ranks sixth in the nation for rural health out of 47 states with rural counties. Massachusetts is one of three states receiving a grade of “A” MASSACHUSETTS RECEIVED A GRADE OF “A” BECAUSE: Massachusetts ranked in the highest quintile of states for its rates of mortality in rural counties. Massachusetts ranked in the second quintile of states for measures of daily health and quality of life in rural counties. Massachusetts ranked in the highest quintile of states for health care access in rural counties.

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MASSACHUSETTS

WASHINGTON, D.C. – In releasing its fifth annual 50-State Report Card on Reproductive Health and Rights, the Population Institute lowered the U.S. grade from a “D+” to a “D”. The report card, the most comprehensive report card of its kind, tracks multiple indicators of reproductive health and rights, including access to family planning and abortion services.

Along with Connecticut, Maine, New Hampshire, Rhode Island and Vermont, The Institute’s president Robert Walker said, “For the past five years, reproductive health and Massachusetts is a member of the New England division of the Northeast U.S. rights in the U.S. have been on a slippery slope.” Five years ago nine states received an “F”. In Census region. Excluding Rhode Island, a state with no rural counties, all states in this year’s report card 20 states—including Alabama—received a failing grade. Walker warned, New England high rankings for rural (6)expected perhowever, “The receive worst may be national yet to come, as Congress and health. the new Massachusetts Administration are formed better funding than Maine (13), planning but the Bay State fell behind Hampshire (1), slope to slash federal for family and comprehensive sex New education. The slippery Vermont (2)aand (3) in the final rankings. is becoming free Connecticut fall.”

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states today more than 50% of “plus” or a “minus” for factors Walker emphasized that assachusetts is “It’s largely urbanized, URBAN-RURAL DIVIDE women now live in a county not reflected in the core grade. not just abortion rights that are and only a small percentage of the without an abortion provider. under siege; it’s also access to population of lives in rural counties Most U.S. states report a marked difference ALABAMA RECEIVED A family planning services, and (1.4 percent). In fact, Massachusetts is the in health outcomes Federal betweensupport rural and for urban “MINUS” BECAUSE THEIR when women are denied access third most densely populated state in the nacounties. Massachusetts shows a 2 percent reproductive health and rights ‘CHOOSE LIFE’ LICENSE to contraception everyone loses: tion, it ranks 14th in population count.FUNDincrease in rural mortality as compared to could suffer a major reversal PLATES ANTI-CHOICE thereand are more unintended urban counties. Theinstate ranks 8th forand rural/ 2017. Congress the new pregnancies, more abortions, and ORGANIZATIONS/CRISIS The Commonwealth’s population is PREGNANCY changing in CENTERS urban difference in mortality. Administration are expected to higher health care costs. ” two notable ways, however. Massachusetts is curtail access to contraceptive Only 21 states received a services by blocking all funding This year’smore reportracially card also becoming and ethnically diverse RURAL RESOURCES “B-“ or higher. Just five states for Planned Parenthood, draws attention to “a growing and its median age is rising. The latter is often New Jersey, (California, defunding Title X, ain48-year old national divide” on reproductive attributed to the high cost of housing which has Oregon Rural health resource organizations New Mexico, and program that provides support health and rights, and Walker caused young people to relocate elsewhere. Washington) received an “A”. include: Massachusetts to family planning clinics warned that Alabama is “on The following states received serving low-income households, the wrong side of that divide.” a failingingrade in There has also been a dramatic increase • 2016: Massachusetts and Office of Rural Health eliminating the Affordable Alabama, which received an “F”, Alabama, Arkansas, www.mass.gov/eohhs/gov/departments/ Florida, opioid-related deaths in Massachusetts in reCare Act’s no-cost birth control was one of 20 states receiving a Georgia, Idaho, Indiana, Kansas, cent years, to report a 2017 State Health dph/programs/community-health/primamandate. Walker noted that failing gradeaccording in the latest Louisiana, Mississippi, Missouri, Assessment produced by the Massachusetts rycare-healthaccess/rural-health/ “In the past five years most of card. Five years ago Alabama Nebraska, North Dakota, Department of Public Health. The number • New England Rural Health RoundTable the slippage on reproductive received a “D”. Oklahoma, South Carolina, of opioid-related deaths in 2016 represents health has occurred at the state hwww.newenglandruralhealth.org South Dakota, Tennessee, Texas, aMANY 17 percent increase over 2015, and a 450 level, but this yearCenter could see FACTORS • Wisconsin. Northeast Telehealth Resource Utah, Virginia, and unprecedented setbacks at the ACCOUNTED FOR percent increase since 2000. There is also netrc.org national level, including cuts ALABAMA’S FAILING GRADE synthetic evidence suggesting fentanyl—a Walker warned that “A woman’s in funding for comprehensive INCLUDING POOR SCORES opioid with 50-100 times the potency of mor- health For should more information about the data reproductive not sex education in the schools IN PREVENTION AND phine—is fueling the current epidemic. depend on where she lives, but and methodology employed sources used and a return to abstinence only AFFORDABILITY it does, as women many2017 Rural Health Report Card, in in RHQ’s programs which have been areas are experiencing reduced Using eleven criteria, the RURAL HEALTH CARE FACILITIES visit www.RuralHealthQuarterly.com. proven to be ineffective.” access to reproductive health Institute’s report card ranked services including abortion.” eachRural of theHealth 50 states and the Hub, care The Information an organiWalker stressed that this Walker noted that 19 states, District of Columbia on four zation funded by the Federal Office of Rural year’s report card should be including Alabama, have refused broad indicators relating to Health Policy, reports that there are three “an urgent call to action” for to expand Medicaid under the reproductive health and rights: Critical Access Hospitals in the state as well anyone who is concerned Affordable Care Act, leaving tens effectiveness, prevention, about reproductive health as one Rural Health Clinic and 39 Federally of millions of women without affordability, and access. Based and rights. “As disappointing Qualified Health Centers providing services at improved access to contraception upon their composite scores (0as 2016 was, 2017 could be 277 100),sites. each state received a “core” and other health care services. a whole lot worse.” Walker also noted that in 27 grade (A, B, C, D or F), but some states received an additional


MASSACHUSETTS BY THE NUMBERS Massachusetts has an estimated population of 6,811,779 people, and 1.4 percent live in one of Massachusetts’s 3 rural counties. The poverty rate in rural Massachusetts is 14.8 percent, compared with 14.8 percent in urban areas of the state.

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23.7 percent of the rural population has not completed high school, while 23.5 percent of the urban population lacks a high school diploma. RURAL COUNTIES URBAN COUNTIES

8.5 percent of rural Massachusetts residents are U.S. military veterans, and 8.8 percent of the rural population under age 65 lives with a disability. 90.1 percent of the state’s rural population is Non-Hispanic White, 2.3 percent is Black/African-American, 3.8 percent is Hispanic/Latino, 0.3 percent is American Indian/Alaska Native and 1.4 percent is Asian.

MORTALITY

QUALITY OF LIFE

ACCESS TO CARE

Cancer: A+

Fair/Poor Health: A

Primary Care: A

Cancer is the leading cause of death in Massachusetts, and the state is ranked 3rd in the U.S. for deaths by cancer among rural residents. The age-adjusted rate for cancer in rural counties is 139.9 per 100,000. The national average is 158.5 per 100,000.

The percentage of Massachusettsans reporting poor general health is relatively low. The state ranked 7th for rural counties (13 percent) and 18/51 for urban counties (13.3 percent).

Massachusetts ranks 5th in the U.S. for the number of primary care physicians practicing in rural counties (76.7 per 100,000). The national average for rural counties is 54.5 per 100,000.

Mental Health: C-

Mental Care: A

Rural residents of Massachusetts reported an average of 4 mentally unhealthy days in the past 30 days. The national average is 3.7 days. The state ranked 29th for self-reported mental health in rural counties.

Massachusetts ranks 6th in the U.S. for the number of psychiatrists practicing in rural counties. Massachusetts has 7.1 per 100,000 residents. The U.S. rural average is 3.4.

Heart Disease: A+ Heart disease is the second leading cause of death in Massachusetts, and the state is ranked 2nd in the U.S. for the number of deaths by heart disease among rural residents. The age-adjusted rate for heart disease in rural counties is 139.3 per 100,000. The national average is 168.5 per 100,000.

Accidents: A Accidents are the third leading cause of death in Massachusetts, and Massachusetts ranked 7th out of 47 states for accidental death in rural counties. The statewide rate for accidental death is 46.2 per 100,000. The national average is 43.2 per 100,000.

Physical Health: B The number of physically unhealthy days reported in rural Massachusetts is 3.6 in 30 days, while urban residents report 3.4 days. The national average is 3.9. Rural Massachusetts ranks 16th.

Low Birth Weight: A The percentage of live births with low birth weight (< 5 pounds, 8 ounces) in rural Massachusetts is 6.2 percent, below the national average of 8 percent. Massachusetts ranks 7th in the category.

Dental Care: A Massachusetts ranks 6th in the nation for rural access to dental care with 62.7 dentists per 100,000 rural residents. The national rural average is 42.8.

Uninsured Rate: A+ 5.4 percent of Massachusetts’s rural population under age 65 is uninsured, the best rate in the nation. The average rate for urban Massachusetts is 4 percent. Massachusetts is one of 31 states that adopted Medicaid expansion under the Affordable Care Act.

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IN FREE FALL: REPRODUCTIVE HEALTH AND RIGHTS IN AMERICA

C+ 21/47 MICHIGAN ranks 21nd in the nation for rural health out of 47 states with rural counties. Michigan is one of three states receiving a grade of “C+” MICHIGAN RECEIVED A GRADE OF “C+” BECAUSE: Michigan ranked in the third quintile of states for its rates of mortality in rural counties. Michigan ranked in the second quintile of states for measures of daily health and quality of life in rural counties. Michigan ranked in the second quintile of states for health care access in rural counties.

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58  RHQ

MICHIGAN

WASHINGTON, D.C. – In releasing its fifth annual 50-State Report Card on Reproductive Health and Rights, the Population Institute lowered the U.S. grade from a “D+” to a “D”. The report card, the most comprehensive report card of its kind, tracks multiple indicators of reproductive health and rights, including access to family planning and abortion services.

Along with Illinois, Indiana, Ohio and Wisconsin, Michigan is a member of the East The Institute’s president Robert Walker said, “For the past five years, reproductive health and North Central division of the Midwest U.S. Census region. With the exception of high rights in the U.S. have been on a slippery slope.” Five years ago nine states received an “F”. In performing Wisconsin, all states in the division rank near the middle of the nation for this year’s report card 20 states—including Alabama—received a failing grade. Walker warned, rural health. ranked higher than Illinois Ohio (28) andare Indiana however, “The Michigan worst may (21) be yet to come, as Congress and the(27), new Administration expected (29), butfederal the Great Lakes State planning fell behind (7) sex in the final rankings. to slash funding for family and Wisconsin comprehensive education. The slippery slope is becoming a free fall.”

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states today more than 50% of or a “minus” for factors Walker emphasized thatin“It’s ichigan turned relatively “plus” average URBAN-RURAL DIVIDE women now live in a county not reflected in the core grade. not just abortion rights that are scores in this year’s RHQ Rural without an abortion provider. under siege; it’s also access to Health Report Card, but the rural Most U.S. states report a marked difference ALABAMA RECEIVED A family planning services, and heart disease mortality rate in the state in health outcomes between rural and urban Federal support for “MINUS” BECAUSE THEIR when women are denied access remains cause for concern. counties. Michigan shows a small 0.3 percent reproductive health and rights ‘CHOOSE LIFE’ LICENSE to contraception everyone loses: in rural mortality as compared to could suffer a major reversal PLATES FUNDincrease ANTI-CHOICE there are more unintended Michigan hasmore the 10th highest rate urban counties. Thein state ranks 4th forand rural/ 2017. Congress the new ORGANIZATIONS/CRISIS pregnancies, abortions, anddeath from disease in the PREGNANCY country, urban difference in mortality. Administration are expected to CENTERS highercardiovascular health care costs. ” according to the American Heart Association. curtail access to contraceptive Only 21 states received a The hascard higher rates services by blocking all funding This state year’salso report also than average RURAL RESOURCES “B-“ or higher. Just five states for Planned Parenthood, draws attention toresidents “a growing of obesity and of who are(California, current New Jersey, defunding Title X, a 48-year old national divide” on reproductive smokers. Rural health New Mexico, Oregon and resource organizations in program that provides support health and rights, and Walker Michigan Washington) received an include: “A”. to family planning clinics warned that Alabama is “on Heart disease was the leading cause death states received Theoffollowing serving low-income households, the wrong side of that divide.” in men and women in the state ina 2012, failing grade • in 2016: Michigan Center for Rural Health and eliminating the Affordable Alabama, which received an “F”, Alabama, Florida, according to the Michigan Department of Arkansas, www.mcrh.msu.edu Care Act’s no-cost birth control was one of 20 states receiving a Georgia, Idaho,• Indiana, Kansas, Community Health, and more than 25 percent Michigan Rural mandate. Council Walker noted that failing grade in the latest report Louisiana, Mississippi, Missouri, of deaths in Michigan in 2013 were due to michiganruralcouncil.org “In the past five years most of card. Five years ago Alabama Nebraska, North Dakota, cardiovascular • Upper Midwest Telehealth Resource Center the slippage on reproductive received a “D”. disease and stroke. Oklahoma, South Carolina, www.umtrc.org health has occurred at the state South Dakota, Tennessee, Texas, 34.6 percent of Michigan adults reported level, but this could see MANY FACTORS • Wisconsin. Citizens Research Council of year Michigan Utah, Virginia, and having high blood ACCOUNTED FORpressure in 2013, and 75.7 crcmich.org unprecedented setbacks at the national level, including cuts ALABAMA’S FAILING GRADE percent of Michigan adults with diagnosed Walker warned that “A woman’s in funding for comprehensive INCLUDING POOR SCORES high blood pressure reported taking blood For should more information about the data reproductive health not sex education in the schools IN PREVENTION AND pressure medication. sources used depend on where she lives, but and methodology employed and a return to abstinence only AFFORDABILITY it does, as women many2017 Rural Health Report Card, in in RHQ’s programs which have been areas are experiencing reduced Using eleven criteria, the FACILITIES RURAL HEALTH CARE visit www.RuralHealthQuarterly.com. proven to be ineffective.” access to reproductive health Institute’s report card ranked eachRural of theHealth 50 states and the Hub,care The Information an services including abortion.” Walker stressed that this Walker District of Columbia on four organization funded by the Federal Officenoted of that 19 states, year’s report card should be including Alabama, have refused broadHealth indicators relating to that there Rural Policy, reports are 36 “an urgent call to action” for to expand Medicaid under the reproductive health and rights: Critical Access Hospitals in the state, as well anyone who is concerned Affordable Care Act, leaving tens effectiveness, prevention, as 195 Rural Health Clinics and 38 Federally about reproductive health of millions of women without affordability, and access. Based and rights. “As disappointing Qualified Health Centers providing services improved access to contraception upon their composite scores (0as 2016 was, 2017 could be at 246 sites. 100), each state received a “core” and other health care services. a whole lot worse.” Walker also noted that in 27 grade (A, B, C, D or F), but some states received an additional


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RURAL COUNTIES URBAN COUNTIES

MICHIGAN BY THE NUMBERS Michigan has an estimated population of 4,863,300 people, and 18.1 percent live in one of Michigan’s 57 rural counties. The poverty rate in rural Michigan is 15.4 percent, compared with 14.9 percent in urban areas of the state.

*Several Michigan counties have water boudaries that extend beyond the land mass.

10.6 percent of the rural population has not completed high school, while 10.4 percent of the urban population lacks a high school diploma. 10.5 percent of rural Michigan residents are U.S. military veterans, and 11.9 percent of the rural population under age 65 lives with a disability. 91.2 percent of the state’s rural population is Non-Hispanic White, 1.6 percent is Black/African-American, 3.4 percent is Hispanic/Latino, 1.3 percent is American Indian/Alaska Native and 0.6 percent is Asian.

MORTALITY

QUALITY OF LIFE

Heart Disease: D+

Fair/Poor Health: B- Primary Care: C+

Heart disease is the leading cause of death in Michigan, and the state is ranked 32nd in the U.S. for the number of deaths by heart disease among rural residents. The age-adjusted rate for heart disease in rural counties is 196.4 per 100,000. The national average is 168.5 per 100,000.

The percentage of Michiganians reporting poor general health is among the highest in the nation. The state ranked 20th for rural counties (14.4 percent) and 26/51 for urban counties (14.6 percent).

Michigan ranks 22nd in the U.S. for the number of primary care physicians practicing in rural counties (57.6 per 100,000). The national average for rural counties is 54.5 per 100,000.

Mental Health: C

Mental Care: B-

Cancer: C-

Rural residents of Michigan reported an average of 3.8 mentally unhealthy days in the past 30 days. The national average is 3.7 days. The state ranked 23rd for self-reported mental health in rural counties.

Michigan ranks 18th in the U.S. for the number of psychiatrists practicing in rural counties. Michigan has 3.5 per 100,000 residents. The U.S. rural average is 3.4.

Cancer is the second leading cause of death in Michigan, and the state is ranked 27th in the U.S. for deaths by cancer among rural residents. The ageadjusted rate for cancer in rural counties is 173.8 per 100,000. The national average is 158.5 per 100,000.

CLRD: CChronic lower respiratory disease (CLRD) is the third leading cause of death in Michigan, and the state is ranked 29th in the U.S. for deaths by CLRD among rural residents. The age-adjusted rate for CLR disease in rural counties is 53.8 per 100,000. The national average is 41.6 per 100,000.

Physical Health: C+ The number of physically unhealthy days reported in rural Michigan is 3.8 in 30 days, while urban residents report 3.6 days. The national average is 3.9. Rural Michigan ranks 22nd.

Low Birth Weight: B The percentage of live births with low birth weight (< 5 pounds, 8 ounces) in rural Michigan is 6.8 percent. The national average is 8 percent. Michigan ranks 14th in the category.

ACCESS TO CARE

Dental Care: C+ Michigan ranks 22nd in the nation for rural access to dental care with 50.2 dentists per 100,000 rural residents. The national rural average is 42.8.

Uninsured Rate: B 13.2 percent of Michigan’s rural population under age 65 is uninsured. The average uninsured rate for urban residents of Michigan is 10.8 percent. Michigan is one of 31 states that adopted Medicaid expansion as offered under the Affordable Care Act.

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IN FREE FALL: REPRODUCTIVE HEALTH AND RIGHTS IN AMERICA

A 5/47 MINNESOTA ranks fifth in the nation for rural health out of 47 states with rural counties. Minnesota is one of four states receiving a grade of “A” MINNESOTA RECEIVED A GRADE OF “A” BECAUSE: Minnesota ranked in the first quintile of states for its rates of mortality in rural counties. Minnesota ranked in the first quintile of states for measures of daily health and quality of life in rural counties. Minnesota ranked in the first quintile of states for health care access in rural counties.

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MINNESOTA

WASHINGTON, D.C. – In releasing its fifth annual 50-State Report Card on Reproductive Health and Rights, the Population Institute lowered the U.S. grade from a “D+” to a “D”. The report card, the most comprehensive report card of its kind, tracks multiple indicators of reproductive health and rights, including access to family planning and abortion services.

Along with Iowa, Kansas, Missouri, Nebraska, North Dakota and South Dakota, Minnesota The Institute’s president Robert Walker said, “For the past five years, reproductive health and is a member of the West North Central division of the Midwest U.S. Census region. rights in the U.S. have been on a slippery slope.” Five years ago nine states received an “F”. In Most members the20 West North CentralAlabama—received division rank nearathe topgrade. of theWalker nationwarned, for this year’s reportof card states—including failing rural health, but Kansas (24) and Missouri (35) underperform. Minnesota ranks 5th however, “The worst may be yet to come, as Congress and the new Administration are expected nationally and funding takes the spot in the and division. The North Star State outperforms to slash federal fortop family planning comprehensive sex education. The slippery slope Nebraska (8), Iowafall.” (9), North Dakota (10) and South Dakota (11) in the final rankings. is becoming a free

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states today more than 50% of “plus” or a “minus” for factors Walker emphasized “It’s innesota is that an impressive high perdifference in mortality. women now live in a county not reflected in the core grade. not just abortion rights that are former in several areas of rural health without an abortion provider. under siege; it’s also access to care, but the Minnesota Rural Health RURAL RESOURCES ALABAMA RECEIVED A family planning services, and Association stilldenied sounding the alarm about BECAUSE THEIR Federal support for “MINUS” when womenisare access certain dangers on the horizon. health resourcereproductive organizationshealth in Minnesota and rights ‘CHOOSE LIFE’Rural LICENSE to contraception everyone loses: could suffer a major reversal PLATES FUNDinclude: ANTI-CHOICE there are more unintended Health care workforce shortages areas in 2017. Congress and the new ORGANIZATIONS/CRISIS pregnancies, more abortions, and in rural are a growing cause for”concern, according are expected PREGNANCY CENTERS higher health care costs. • Office of Rural Administration Health and Primary Care to curtail access to contraceptive to the MRHA. Rural areas face an older and www.health.state.mn.us/divs/orhpc/ Only 21 states received a services by blocking all funding This year’shealth reportcare cardworkforce also shrinking with“B-“ tooorfew • five Minnesota higher. Just states Rural Health Association for Planned Parenthood, draws attention to “a growing students in the pipeline to replace them. mnruralhealth.org (California, New Jersey, defunding Title X, a 48-year old national divide” on reproductive • Great New Mexico, Oregon and Plains Telehealth Resource Center program that provides support health and rights, and Walker Poor health outcomes have also remained Washington) received an “A”. www.gptrac.org to family planning clinics warned that Alabama is “on The following states received concentrated in rural Minnesota, and opioid • Rural Health Research Center serving low-income households, the wrong side of that divide.” abuse is an epidemic in rural areas aoffailing the grade in 2016: rhrc.umn.edu and eliminating the Affordable Alabama, which received an “F”, Alabama, Florida, Rural Health Resource Center state. Minnesota sawreceiving a 9.2 percent increase Arkansas, • National Care Act’s no-cost birth control was one of 20 states a Idaho, Indiana, Kansas, in overdose in 2016 over theGeorgia, previous www.ruralcenter.org mandate. Walker noted that failing gradedeaths in the latest report Louisiana, Mississippi, Missouri, year. “In the past five years most of card. Five years ago Alabama Nebraska, North Dakota, For more information the the about slippage ondata reproductive received a “D”. Oklahoma, South Carolina, health has occurred at the state RURAL HEALTH CARE FACILITIESSouth Dakota, Tennessee, sources used and methodology employed Texas, level, but this year Card, could see MANY FACTORS in RHQ’s 2017 Rural Health Report Utah, Virginia, and Wisconsin. unprecedented setbacks at the ACCOUNTED FOR The Rural Health Information Hub, an organivisit www.RuralHealthQuarterly.com. national level, including cuts ALABAMA’S FAILING GRADE zation funded by the Federal OfficeWalker of Rural warned that “A woman’s in funding for comprehensive INCLUDING POOR SCORES Health Policy, reports that there arereproductive 78 Critical health should not sex education in the schools IN PREVENTION AND depend Access Hospitals in the state, as well as 89 on where she lives, but and a return to abstinence only AFFORDABILITY does, as women in many Rural Health Clinic and 16 FederallyitQualified programs which have been areas are experiencing reduced Using eleven criteria, the services at Health Centers providing 81 sites. proven to be ineffective.” access to reproductive health Institute’s report card ranked care services including abortion.” each of the 50 states and the URBAN-RURAL DIVIDE Walker stressed that this Walker noted that 19 states, District of Columbia on four year’s report card should be including Alabama, have refused broad indicators relating to “an urgent call to action” for Most U.S. states report a marked difference to expand Medicaid under the reproductive health and rights: anyone who is concerned in health outcomes between rural and urban Affordable Care Act, leaving tens effectiveness, prevention, about reproductive health counties. Minnesota shows a 5.2% increase in of millions of women without affordability, and access. Based rural as compared to urban coun- access to contraception and rights. “As disappointing improved uponmortality their composite scores (0as 2016 was, 2017 could be and other health care services. 100),The eachstate stateranks received “core” ties. 13tha for rural/urban a whole lot worse.” Walker also noted that in 27 grade (A, B, C, D or F), but some states received an additional


MINNESOTA BY THE NUMBERS Minnesota has an estimated population of 5,519,952 people, and 22.4 percent live in one of Minnesota’s 60 rural counties. The poverty rate in rural Minnesota is 11.2 percent, compared with 9.5 percent in urban areas of the state.

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9.4 percent of the rural population has not completed high school, while 7 percent of the urban population lacks a high school diploma.

RURAL COUNTIES URBAN COUNTIES

10.2 percent of rural Minnesota residents are U.S. military veterans, and 8.2 percent of the rural population under age 65 lives with a disability. 89.6 percent of the state’s rural population is Non-Hispanic White, 1.2 percent is Black/African-American and 4.5 percent is Hispanic/ Latino, 2.2 percent is American Indian/Alaska Native and 1 percent is Asian.

MORTALITY

QUALITY OF LIFE

ACCESS TO CARE

Cancer: B

Fair/Poor Health: A

Primary Care: A-

Cancer is the leading cause of death in Minnesota, and the state is ranked 17th in the U.S. for deaths by cancer among rural residents. The age-adjusted rate for cancer in rural counties is 157.2 per 100,000. The national average is 158.5 per 100,000.

The percentage of Minnesotans reporting poor general health is among the lowest in the nation. The state ranked 6th for rural counties (12.7 percent) and 3/51 for urban counties (10.8 percent).

Minnesota ranks 8th in the U.S. for the number of primary care physicians practicing in rural counties (72.8 per 100,000). The national average for rural counties is 54.5 per 100,000.

Mental Health: A

Mental Care: B

Rural residents of Minnesota reported an average of 3 mentally unhealthy days in the past 30 days. The national average is 3.7 days. The state ranked 4th for self-reported mental health in rural counties.

Minnesota ranks 15th in the U.S. for the number of psychiatrists practicing in rural counties. Minnesota has 3.8 per 100,000 residents. The U.S. rural average is 3.4.

Heart Disease: A+ Heart disease is the second leading cause of death in Minnesota, and the state is ranked 1st (lowest) in the U.S. for the number of deaths by heart disease among rural residents. The ageadjusted rate for heart disease in rural counties is 132.8 per 100,000. The national average is 168.5 per 100,000.

Accidents: A Accidents are the third leading cause of death in Minnesota, and Minnesota ranked 6th out of 47 states for accidental death in rural counties. The statewide rate for accidental death is 45.4 per 100,000. The national average is 43.2 per 100,000.

Physical Health: A The number of physically unhealthy days reported in rural Minnesota is 3.2 in 30 days, while urban residents report 4.1 days. The national average is 2.8. Rural Minnesota ranks 7th.

Low Birth Weight: A+ The percentage of live births with low birth weight (< 5 pounds, 8 ounces) in rural Minnesota is 5.9 percent, well below the national average of 8 percent. Minnesota ranks 2nd in the category.

Dental Care: BMinnesota ranks 20th in the nation for rural access to dental care with 51.6 dentists per 100,000 rural residents. The national rural average is 42.8.

Uninsured Rate: A 9.6 percent of Minnesota’s rural population under age 65 is uninsured. The average uninsured rate for urban residents of Minnesota is 7.7 percent. Minnesota is one of 31 states that adopted Medicaid expansion as offered under the Affordable Care Act.

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IN FREE FALL: REPRODUCTIVE HEALTH AND RIGHTS IN AMERICA

F 47/47 MISSISSIPPI ranks 47th in the nation for rural health out of 47 states with rural counties. Mississippi is one of nine states receiving a failing grade. MISSISSIPPI RECEIVED A FAILING GRADE BECAUSE: Mississippi ranked in the fifth quintile of states for its rates of mortality in rural counties. Mississippi ranked in the fifth quintile of states for measures of daily health and quality of life in rural counties. Mississippi ranked in the fifth quintile of states for health care access in rural counties.

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MISSISSIPPI

WASHINGTON, D.C. – In releasing its fifth annual 50-State Report Card on Reproductive Health and Rights, the Population Institute lowered the U.S. grade from a “D+” to a “D”. The report card, the most comprehensive report card of its kind, tracks multiple indicators of reproductive health and rights, including access to family planning and abortion services.

Along with Alabama, Kentucky and Tennessee, Mississippi is a member of the East The Institute’s president Robert Walker said, “For the past five years, reproductive health and South Central Division of the South U.S. Census Region. All four states in the division rights in the U.S. have been on a slippery slope.” Five years ago nine states received an “F”. In showed strong similarities in our reporting, and all four states received a failing grade for this year’s report card 20 states—including Alabama—received a failing grade. Walker warned, rural health. The Magnolia in theand nation (47)Administration and behind division however, “The worst may be State yet toranks come,lowest as Congress the new are expected members Kentucky (42), (43) and (45) in the final rankings. to slash federal funding forTennessee family planning and Alabama comprehensive sex education. The slippery slope is becoming a free fall.”

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states today moreservices than 50% of “plus” or a “minus” for factors Walker emphasized ississippi isthat the “It’s lowest ranked Qualified Health Centers providing women now live in a county not reflected in the core grade. not just abortion rights that are performer in this year’s RHQ Rural at 188 sites. without an abortion provider. under siege; it’s also access to Health Report Card. The state’s deALABAMA RECEIVED A family planning services, and mographics include high poverty levels, low URBAN-RURAL DIVIDE Federal support for “MINUS” BECAUSE THEIR when women are denied access education levels, limited industry in rural areas, reproductive health and rights ‘CHOOSE LIFE’ LICENSE to contraception everyone loses: poor tax bases and extreme rurality. U.S. states report a marked could suffer a difference major reversal PLATES FUNDMost ANTI-CHOICE there local are more unintended Rural residents andabortions, minorities are population in health outcomes in between rural andand urban 2017. Congress the new ORGANIZATIONS/CRISIS pregnancies, more and groups most affected by expected to counties. MississippiAdministration shows a 12.5 are percent PREGNANCY CENTERS higher health care costs. ” health disparities. curtail access to contraceptive increaseain rural mortality as compared to Only 21 states received services by blocking all funding This year’s to report cardrural alsohealth plan According a 2015 prourban counties. The state ranks 34th for rural/ “B-“ or higher. Just five states for Planned Parenthood, draws attention to “a growing duced by the Mississippi State Department difference in mortality. (California, Newurban Jersey, defunding Title X, a 48-year old national divide” on reproductive of Health, Mississippi is a medicallyNew underMexico, Oregon and program that provides support health and rights, and Walker served state, and statistics presentWashington) a negative received “A”. RURALanRESOURCES to family planning clinics warned that Alabama is “on view of the overall health of citizens. TheComfollowing states received serving low-income households, the wrong side of that divide.” a failing resgrade in 2016: pared to national health data, Mississippi Rural health resourceand organizations in Mississippi eliminating the Affordable Alabama, which received an “F”, Alabama, Florida, idents rank lowest in several overall health Arkansas, include: Care Act’s no-cost birth control was one of 20 states receiving a Georgia, Idaho, Indiana, Kansas, indicators. The state’s rates for cardiovascular mandate. Walker noted that failing grade in the latest report Missouri, disease, teenage Louisiana, pregnancy,Mississippi, • Mississippi Office “In of theRural past Health five years most of card. Fivediabetes, years agoobesity, Alabama Nebraska, North Dakota, premature births, low birth weights and inthe slippage on reproductive received a “D”. msdh.ms.gov/msdhsite/_static/44,0,111. Oklahoma, South Carolina, fant mortality are some of the highest levels html Texas, health has occurred at the state South Dakota, Tennessee, in the nation. level, but this year could see MANY FACTORS • Mississippi Rural Health Association Utah, Virginia, and Wisconsin. unprecedented setbacks at the ACCOUNTED FOR msrha.org national level, including cuts ALABAMA’S FAILING GRADEpriority Some of the state’s published areas • “A South Central Telehealth Resource Center Walker warned that woman’s in funding for comprehensive INCLUDING POOR SCORES include health care for specific population reproductive health should not learntelehealth.org sex education in the schools IN PREVENTION AND groups, including mothers, babies, depend the elderly, on where lives, but Rural Development Center • sheSouthern and a return to abstinence only AFFORDABILITY the indigent, the uninsured, the disabled it does,and as women in srdc.msstate.edu many programs which have been areas are experiencing reduced Using eleven the persons with criteria, developmental conditions. proven to be ineffective.” access to reproductive health Institute’s report card ranked For more information about the data care services including abortion.” each of the 50 states and FACILITIES the RURAL HEALTH CARE sources used and methodology Walker stressedemployed that this Walker noted that 19 states, District of Columbia on four in RHQ’s 2017 Rural Health Report year’s report card Card, should be including Alabama, have refused broad indicators relating to The Rural Health Information Hub, an “an urgent call to action” for visit www.RuralHealthQuarterly.com. to expand Medicaid under the reproductive health and rights: organization funded by the FederalAffordable Office of Care Act, leaving tens anyone who is concerned effectiveness, prevention, about reproductive health Rural Health Policy, reports that there are 31 of millions of women without affordability, and access. Based and rights. “As disappointing Critical Access Hospitals in the state, as well improved access to contraception upon their composite scores (0as 2016 was, 2017 could be as 177each Rural Health Clinics and 21 and Federally other health care services. 100), state received a “core” a whole lot worse.” Walker also noted that in 27 grade (A, B, C, D or F), but some states received an additional


MISSISSIPPI BY THE NUMBERS Mississippi has an estimated population of 2,988,726 people, and 53.9 percent live in one of Mississippi’s 65 rural counties. The poverty rate in rural Mississippi is 24.3 percent, compared with 16.8 percent in urban areas of the state. 20.8 percent of the rural population has not completed high school, while 13.8 percent of the urban population lacks a high school diploma.

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7.3 percent of rural Mississippi residents are U.S. military veterans, and 12.9 percent of the rural population under age 65 live with a disability. RURAL COUNTIES URBAN COUNTIES

56.7 percent of the state’s rural population is Non-Hispanic White, 38.9 percent is Black/African-American, 2.4 percent is Hispanic/Latino, 0.6 percent is American Indian/Alaska Native and 0.5 percent is Asian.

MORTALITY

QUALITY OF LIFE

ACCESS TO CARE

Heart Disease: F

Fair/Poor Health: F

Primary Care: F

Heart disease is the leading cause of death in Mississippi, and the state is ranked 44th in the U.S. for the number of deaths by heart disease among rural residents. The age-adjusted rate for heart disease in rural counties is 254.5 per 100,000. The national average is 168.5 per 100,000.

The percentage of Mississippi reporting poor general health is among the highest in the nation. The state ranked 46th for rural counties (23.7 percent) and 49/51 for urban counties (19.6 percent).

Mississippi ranks 39th in the U.S. for the number of primary care physicians practicing in rural counties (45.9 per 100,000). The national average for rural counties is 54.5 per 100,000.

Mental Health: D-

Mental Care: D+

Cancer: F

Rural residents of Mississippi reported an average of 4.3 mentally unhealthy days in the past 30 days. The national average is 3.7 days. The state ranked 37th for self-reported mental health in rural counties.

Mississippi ranks 31st in the U.S. for the number of psychiatrists practicing in rural counties. Mississippi has 2.4 per 100,000 residents. The U.S. rural average is 3.4.

Cancer is the second leading cause of death in Mississippi, and the state is ranked 42nd in the U.S. for deaths by cancer among rural residents. The ageadjusted rate for cancer in rural counties is 192.1 per 100,000. The national average is 158.5 per 100,000.

CLRD: DChronic lower respiratory disease (CLRD) is the third leading cause of death in Mississippi, and the state is ranked 38th in the U.S. for deaths by CLRD among rural residents. The ageadjusted rate for CLRD in rural counties is 60.4 per 100,000. The national average is 41.6 per 100,000.

Physical Health: DThe number of physically unhealthy days reported in rural Mississippi is 4.5 in 30 days, while urban residents report 4 days. The national average is 3.9. Rural Mississippi ranks 37th.

Low Birth Weight: F The percentage of live births with low birth weight (< 5 pounds, 8 ounces) in rural Mississippi is 12.2 percent, well above the national average of 8 percent. Mississippi ranks last (47th) in the category.

Dental Care: DMississippi ranks 38th in the nation for rural access to dental care with 35.1 dentists per 100,000 rural residents. The national rural average is 42.8.

Uninsured Rate: D 18.7 percent of Mississippi’s rural population under age 65 is uninsured. The average uninsured rate for urban residents of Mississippi is 17.8 percent. Mississippi is one of 19 states that did not adopt Medicaid expansion as offered under the Affordable Care Act.

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IN FREE FALL: REPRODUCTIVE HEALTH AND RIGHTS IN AMERICA

D 35/47 MISSOURI ranks 35th in the nation for rural health out of 47 states with rural counties. Missouri is one of three states receiving a grade of “D” MISSOURI RECEIVED A FAILING GRADE BECAUSE: Missouri ranked in the fourth quintile of states for its rates of mortality in rural counties. Missouri ranked in the fourth quintile of states for measures of daily health and quality of life in rural counties. Missouri ranked in the fourth quintile of states for health care access in rural counties.

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MISSOURI

WASHINGTON, D.C. – In releasing its fifth annual 50-State Report Card on Reproductive Health and Rights, the Population Institute lowered the U.S. grade from a “D+” to a “D”. The report card, the most comprehensive report card of its kind, tracks multiple indicators of reproductive health and rights, including access to family planning and abortion services.

Along with Iowa, Kansas, Minnesota, Nebraska, North Dakota and South Dakota, Missouri The Institute’s president Robert Walker said, “For the past five years, reproductive health and is a member of the West North Central division of the Midwest U.S. Census region. rights in the U.S. have been on a slippery slope.” Five years ago nine states received an “F”. In Most members of the West North Central division rank near the top of the nation for this year’s report card 20 states—including Alabama—received a failing grade. Walker warned, rural health, themay Show-Me State underperforms and last in the division. however, “Thebut worst be yet to come, as Congress and theranks new Administration are expected Missouri (35) falls behind Nebraska (8), Iowa (9), North Dakota (10), South to slash federal funding for family planning and comprehensive sex education. TheDakota slippery slope (11) and Kansas in the final rankings. is becoming a free(24) fall.”

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states today than 50% of or a “minus” for factors Walker emphasized that issouri is the low“It’s performer“plus” among counties. Missouri shows a 13.6more percent women now live in a county not reflected in the core grade. not just abortion rights that are Midwestern states, and the state’s increase in rural mortality as compared to without an abortion provider. under siege; it’s also access to rural health outcome and access urban counties. The state ranks 32nd for rural/ ALABAMA RECEIVED A family planning services, and scores more closely resemble those“MINUS” of its urban difference in mortality. Federal support for BECAUSE THEIR when women are denied access southern neighbors than those of states to reproductive health and rights ‘CHOOSE LIFE’ LICENSE to contraception everyone loses: the north. RESOURCES could suffer a major reversal PLATES FUNDRURAL ANTI-CHOICE there are more unintended in 2017. Congress and the new pregnancies, more abortions, and ORGANIZATIONS/CRISIS The most recent by Rural health resourceAdministration organizations are in Missouri expected to PREGNANCY CENTERS higher health careBiennial costs.” Report published the Missouri Department of Health and Senior curtail access to contraceptive include: Only 21 states received a services by blocking all funding This year’s report alsoCare and Rural Services Office of card Primary “B-“ or higher. Just five states forCare Planned draws attention to “a growing Health reveals that rural Missourians(California, are over- New• Jersey, Office of Primary and Parenthood, Rural Health defunding Title X, a 48-year old national divide” on reproductive all less healthy than their urban counterparts health.mo.gov/living/families/ruralNew Mexico, Oregon and program that provides support health andlikely rights, Walker and more to and die at an earlier age. health Washington) received an “A”. to family planning clinics warned that Alabama is “on The following states received Rural Health Association • Missouri serving low-income households, the wrong side of that divide.” a failing grade in 2016: For all of the 10 leading causes of death, rural www.morha.org and eliminating the Affordable Alabama, which received an “F”, Alabama, Florida, rates are higher than urban rates. The 2004- Arkansas, • Heartland Telehealth Resource Care Act’s no-costCenter birth control was one of 20 states receiving a Georgia, Idaho, Indiana, Kansas, 2012 average life expectancy for rural areas heartlandtrc.org mandate. Walker noted that failing grade in the latest report Louisiana, Mississippi, Missouri, was to 77.8 years for • Missouri Association Rural Health “In theofpast five yearsClinics most of card.76.8 Fiveyears yearscompared ago Alabama Nebraska, North Dakota, urban areas. Emergency room visit rates were www.marhc.orgthe slippage on reproductive received a “D”. Oklahoma, South Carolina, also 7.7 percent higher for rural residents than health has occurred at the state South Dakota, Tennessee, Texas, urban level, but this MANYresidents. FACTORS For more information about theyear datacould see Utah, Virginia, and Wisconsin. unprecedentedemployed setbacks at the ACCOUNTED FOR sources used and methodology national level, including ALABAMA’S FAILING GRADE RURAL HEALTH CARE FACILITIESWalker warned that in RHQ’s 2017 Rural Health Report Card, cuts “A woman’s in funding for comprehensive INCLUDING POOR SCORES visitshould www.RuralHealthQuarterly.com. reproductive health not sex education in the schools IN PREVENTION AND The Rural Health Information Hub, depend an organion where she lives, but and a return to abstinence only AFFORDABILITY as women in many zation funded by the Federal Officeitofdoes, Rural programs which have been areas are experiencing reduced Using eleven criteria, the Health Policy, reports that there are 36 Critical proven to be ineffective.” access to reproductive health Institute’s report card ranked Access Hospitals in the state, as well as 367 care services including abortion.” each of the 50Clinics statesand and29 theFederally Rural Health Qualified Walker stressed that this Walker noted that 19 states, District of Columbia on four Health Centers providing services at 215 sites. year’s report card should be including Alabama, have refused broad indicators relating to “an urgent call to action” for to expand Medicaid under the reproductive health and rights: anyone who is concerned URBAN-RURAL DIVIDE Affordable Care Act, leaving tens effectiveness, prevention, about reproductive health of millions of women without affordability, and access. Based and rights. “As disappointing Most U.S. states report a marked difference improved access to contraception upon their composite scores (0as 2016 was, 2017 could be in health between rural and and urban other health care services. 100), eachoutcomes state received a “core” a whole lot worse.” Walker also noted that in 27 grade (A, B, C, D or F), but some states received an additional


MISSOURI BY THE NUMBERS Missouri has an estimated population of 6,093,000 people, and 25.4 percent live in one of Missouri’s 81 rural counties. The poverty rate in rural Missouri is 23 percent, compared with 17.1 percent in urban areas of the state. 16.4 percent of the rural population has not completed high school, while 9.9 percent of the urban population lacks a high school diploma.

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11.7 percent of rural Missouri residents are U.S. military veterans, and 13.9 percent of the rural population under age 65 lives with a disability. RURAL COUNTIES URBAN COUNTIES

90.7 percent of the state’s rural population is Non-Hispanic White, 3.3 percent is Black/African-American, 2.9 percent is Hispanic/Latino, 0.5 percent is American Indian/Alaska Native and 0.6 percent is Asian.

MORTALITY

QUALITY OF LIFE

ACCESS TO CARE

Heart Disease: F

Fair/Poor Health: D

Primary Care: D+

Heart disease is the leading cause of death in Missouri, and the state is ranked 41st in the U.S. for the number of deaths by heart disease among rural residents. The age-adjusted rate for heart disease in rural counties is 235.3 per 100,000. The national average is 168.5 per 100,000.

The percentage of Missourians reporting poor general health is among the highest in the nation. The state ranked 33rd for rural counties (19.2 percent) and 34/51 for urban counties (16.1 percent).

Missouri ranks 30th in the U.S. for the number of primary care physicians practicing in rural counties (51 per 100,000). The national average for rural counties is 54.5 per 100,000.

Mental Health: F

Mental Care: D

Cancer: D-

Rural residents of Missouri reported an average of 4.4 mentally unhealthy days in the past 30 days. The national average is 3.7 days. The state ranked 40th for self-reported mental health in rural counties.

Missouri ranks 34th in the U.S. for the number of psychiatrists practicing in rural counties. Missouri has 2.4 per 100,000 residents. The U.S. rural average is 3.4.

Cancer is the second leading cause of death in Missouri, and the state is ranked 37th in the U.S. for deaths by cancer among rural residents. The ageadjusted rate for cancer in rural counties is 183.7 per 100,000. The national average is 158.5 per 100,000.

CLRD: F Chronic lower respiratory disease (CLRD) is the third leading cause of death in Missouri, and the state is ranked 41st in the U.S. for deaths by CLRD among rural residents. The ageadjusted rate for CLRD in rural counties is 64.4 per 100,000. The national average is 41.6 per 100,000.

Physical Health: F The number of physically unhealthy days reported in rural Missouri is 4.6 in 30 days, while urban residents report 4 days. The national average is 3.9. Rural Missouri ranks 39th.

Low Birth Weight: CThe percentage of live births with low birth weight (< 5 pounds, 8 ounces) in rural Missouri is 7.9 percent. The national average is 8 percent. Missouri ranks 29th in the category.

Dental Care: F Missouri ranks 39th in the nation for rural access to dental care with 34.8 dentists per 100,000 rural residents. The national rural average is 42.8.

Uninsured Rate: D+ 17.7 percent of Missouri’s rural population under age 65 is uninsured. The average uninsured rate for urban residents of Missouri is 13.2 percent. Missouri is one of 19 states that did not adopt Medicaid expansion as offered under the Affordable Care Act.

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B19/47 MONTANA ranks 19th in the nation for rural health out of 47 states with rural counties. Montana is one of three states receiving a grade of “B-” MONTANA RECEIVED A GRADE OF “B-” BECAUSE: Montana ranked in the second quintile of states for its rates of mortality in rural counties. Montana ranked in the second quintile of states for measures of daily health and quality of life in rural counties. Montana ranked in the second quintile of states for health care access in rural counties.

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MONTANA

WASHINGTON, D.C. – In releasing its fifth annual 50-State Report Card on Reproductive Health and Rights, the Population Institute lowered the U.S. grade from a “D+” to a “D”. The report card, the most comprehensive report card of its kind, tracks multiple indicators of reproductive health and rights, including access to family planning and abortion services.

Along with Arizona, Colorado, Idaho, Nevada, New Mexico, Utah and Wyoming, The Institute’s president Robert Walker said, “For the past five years, reproductive health and Montana is part of the Mountain division of the West U.S. Census region. With the rights in the U.S. have been on a slippery slope.” Five years ago nine states received an “F”. In exception of highcard performers Colorado and Wyoming, all states in the division this year’s report 20 states—including Alabama—received a failing grade. Walkerrank warned, near the middle of the nation for rural health. Montana (19) ranks higher than however, “The worst may be yet to come, as Congress and the new Administration areIdaho expected (20), Utah (23),funding Nevada New Mexico (31) and Arizonasex (33), but theThe Treasure to slash federal for(30), family planning and comprehensive education. slippery slope State falls behind Colorado (12) and Wyoming (14). is becoming a free fall.”

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than 50% of “plus” or a “minus” for factors Walker emphasized that ontana is one of“It’s the most rural states counties. Montana states showstoday a 0.6more percent women now live in a county not reflected in the core grade. not just abortion rights that are in the country, and it performed betincrease in rural mortality as compared to without an abortion provider. under siege; it’s also access to ter than the national average in this urban counties. The state ranks 6th for rural/ ALABAMA RECEIVED A family planning services, and year’s RHQ Rural Health Report Card. The urban difference in Federal mortality. support for “MINUS” BECAUSE THEIR when women are denied access only glaring exception is the high ruralLIFE’ LICENSE reproductive health and rights to contraception everyone loses:state’s‘CHOOSE uninsured rate.unintended RESOURCES could suffer a major reversal PLATES FUNDRURAL ANTI-CHOICE there are more in 2017. Congress and the new pregnancies, more abortions, and ORGANIZATIONS/CRISIS During 2016-2017, the” Montana Office of Administration expected to PREGNANCY CENTERS higher health care costs. Rural health resource organizations are in Montana curtail access to contraceptive Rural Health and the Montana Rural Health include: Only 21 states received a services by blocking all funding This year’s report card also Association embarked on a listening tour to “B-“ or higher. Just five states Parenthood, draws attention to “a growing hear what rural Montanans identified as theirNew• Jersey, Montana Officefor ofPlanned Rural Health (California, defunding Title X, a 48-year old national divide” on reproductive top health concerns. Access to services was Oregon healthinfo.montana.edu/morh/index. New Mexico, and program that provides support health and rights, and Walker an overarching theme. Washington) received an “A”. html to family planning clinics warned that Alabama is “on The following states received Rural Health Association • Montana serving low-income households, the wrong side of that divide.” failing grade in 2016: Rural Montanans expressed a needa for better healthinfo.montana.edu/morh/mrha. and eliminating the Affordable Alabama, which received an “F”, Alabama, Arkansas, html Florida, access to primary care and speciality services, Care Act’s no-cost birth control was one of 20 states receiving a Georgia, Idaho,• Indiana, Kansas,Regional Telehealth Resource mental healthinservices, substance Northwest mandate. Walker noted that failing grade the latestalcohol report andLouisiana, Missouri, abuse services, services and better accessMississippi, Center: www.nrtrc.org “In the past five years most of card. Five years EMS ago Alabama Dakota, to opportunities to be physically Nebraska, active, North • Rural Institute for Communities the Inclusive slippage on reproductive received a “D”. Oklahoma, South Carolina, particularly in inclement weather. health has occurred at the state ruralinstitute.umt.edu South Dakota, Tennessee, Texas, level, but this year could see MANY FACTORS Utah, Virginia, and Wisconsin. unprecedented setbacks at the ACCOUNTED FOR RURAL HEALTH CARE FACILITIES For more information about the data national level, including cuts ALABAMA’S FAILING GRADE sources used and methodology employed Walker warned that “A woman’s in funding for comprehensive INCLUDING POOR SCORES The Rural Health Information Hub, an organi- health in RHQ’s reproductive should2017 not Rural Health Report Card, sex education in the schools IN PREVENTION AND on where she www.RuralHealthQuarterly.com. lives, but zation funded by the Federal Officedepend of Rural visit and a return to abstinence only AFFORDABILITY it does, Health Policy, reports that there are 48 as women in many programs which have been areas Using eleven criteria, the in the state, Critical Access Hospitals as are wellexperiencing reduced proven to be ineffective.” access to reproductive health Institute’s report card ranked as 56 Rural Health Clinics and 17 Federally services including abortion.” each of the 50 states and the Qualified Health Centers providingcare services Walker stressed that this Walker noted that 19 states, District of Columbia on four at 74 sites. year’s report card should be including Alabama, have refused broad indicators relating to “an urgent call to action” for to expand Medicaid under the reproductive health and rights: anyone who is concerned URBAN-RURAL DIVIDE Affordable Care Act, leaving tens effectiveness, prevention, about reproductive health of millions of women without affordability, and access. Based and rights. “As disappointing Most report a marked difference improved access to contraception upon U.S. their states composite scores (0as 2016 was, 2017 could be in health between rural and andother urban health care services. 100), eachoutcomes state received a “core” a whole lot worse.” Walker also noted that in 27 grade (A, B, C, D or F), but some states received an additional


MONTANA BY THE NUMBERS Montana has an estimated population of 1,042,520 people, and 64.7 percent live in one of Montana’s 51 rural counties. The poverty rate in rural Montana is 14.1 percent, compared with 11.9 percent in urban areas of the state.

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7.4 percent of the rural population has not completed high school, while 6.8 percent of the urban population lacks a high school diploma.

RURAL COUNTIES URBAN COUNTIES

11.3 percent of rural Montana residents are U.S. military veterans, and 9 percent of the rural population under age 65 lives with a disability. 68.9 percent of the state’s rural population is Non-Hispanic White, 0.3 percent is Black/African-American, 2.9 percent is Hispanic/Latino, 7.8 percent is American Indian/Alaska Native and 0.6 percent is Asian.

MORTALITY

QUALITY OF LIFE

Cancer: B

Fair/Poor Health: A- Primary Care: A-

Cancer is the leading cause of death in Montana, and the state is ranked 14th in the U.S. for deaths by cancer among rural residents. The age-adjusted rate for cancer in rural counties is 156.2 per 100,000. The national average is 158.5 per 100,000.

The percentage of Montanans reporting poor general health is among the lowest in the nation. The state ranked 9th for rural counties (13.1 percent) and 15/51 for urban counties (12.8 percent).

Montana ranks 10th in the U.S. for the number of primary care physicians practicing in rural counties (71 per 100,000). The national average for rural counties is 54.5 per 100,000.

Mental Health: B+

Mental Care: A-

Rural residents of Montana reported an average of 3.4 mentally unhealthy days in the past 30 days. The national average is 3.7 days. The state ranked 12th for self-reported mental health in rural counties.

Montana ranks 10th in the U.S. for the number of psychiatrists practicing in rural counties. Montana has 5.4 per 100,000 residents. The U.S. rural average is 3.4.

Heart Disease: B+ Heart disease is the second leading cause of death in Montana, and the state is ranked 13th in the U.S. for the number of deaths by heart disease among rural residents. The age-adjusted rate for heart disease in rural counties is 158.1 per 100,000. The national average is 168.5 per 100,000.

CLRD: B Chronic lower respiratory disease (CLRD) is the third leading cause of death in Montana, and the state is ranked 14th in the U.S. for deaths by CLRD among rural residents. The ageadjusted rate for CLRD in rural counties is 45.9 per 100,000. The national average is 41.6 per 100,000.

Physical Health: B+ The number of physically unhealthy days reported in rural Montana is 3.5 in 30 days, while urban residents report 4.1 days. The national average is 3.9. Rural Montana ranks 13th.

Low Birth Weight: BThe percentage of live births with low birth weight (< 5 pounds, 8 ounces) in rural Montana is 7.4 percent. The national average is 8 percent. Montana ranks 20th in the category.

ACCESS TO CARE

Dental Care: AMontana ranks 10th in the nation for rural access to dental care with 58.2 dentists per 100,000 rural residents. The national rural average is 42.8.

Uninsured Rate: D19.5 percent of Montana’s rural population under age 65 is uninsured. The average uninsured rate for urban residents of Montana is 16.3 percent. Montana is one of 31 states that adopted Medicaid expansion as offered under the Affordable Care Act.

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IN FREE FALL: REPRODUCTIVE HEALTH AND RIGHTS IN AMERICA

A8/47 NEBRASKA ranks eighth in the nation for rural health out of 47 states with rural counties. Nebraska is one of three states receiving a grade of “A-” NEBRASKA RECEIVED A GRADE OF “A-” BECAUSE: Nebraska ranked in the second quintile of states for its rates of mortality in rural counties. Nebraska ranked in the first quintile of states for measures of daily health and quality of life in rural counties. Nebraska ranked in the second quintile of states for health care access in rural counties.

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NEBRASKA

WASHINGTON, D.C. – In releasing its fifth annual 50-State Report Card on Reproductive Health and Rights, the Population Institute lowered the U.S. grade from a “D+” to a “D”. The report card, the most comprehensive report card of its kind, tracks multiple indicators of reproductive health and rights, including access to family planning and abortion services.

Along with Iowa, Kansas, Minnesota, Missouri, North Dakota and South Dakota, Nebraska The Institute’s president Robert Walker said, “For the past five years, reproductive health and is a member of the West North Central division of the Midwest U.S. Census region. rights in the U.S. have been on a slippery slope.” Five years ago nine states received an “F”. In Most members the North Central division rank near the top of Walker the nation this year’s report of card 20West states—including Alabama—received a failing grade. warned, for rural health, but Kansas (24) and Missouri (35) underperform. Nebraska (8)expected also however, “The worst may be yet to come, as Congress and the new Administration are outperforms Dakota (10) planning and South (11), butsex the Cornhusker State slope to slash federalNorth funding for family andDakota comprehensive education. The slippery falls behindaMinnesota is becoming free fall.” (5) and Iowa (9) in the final rankings.

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states services today more than 50% of “plus” for factors Walkerebraska emphasized that “It’s the top places among 10 or a “minus” Health Centers providing at 42 sites. women now live in a county not reflected in the core grade. not justperformers abortion rights that are in the nation in this year’s without an abortion provider. under siege; it’s also access to RHQ Rural Health Report Card. One URBAN-RURAL DIVIDE ALABAMA RECEIVED A family planning services, and possible contributing factor to the“MINUS” state’s BECAUSE THEIR Federal support for when women are denied access success is its foresight planning‘CHOOSE for rural LIFE’Most U.S. states report a markedhealth difference reproductive and rights LICENSE to contraception everyoneinloses: health workforce shortages. health outcomes could between rural and urban suffer a major reversal PLATES FUNDinANTI-CHOICE there are more unintended counties. Nebraska shows unusual and de- the new in 2017.anCongress pregnancies, more abortions, and ORGANIZATIONS/CRISIS Nebraska passed Rural and are as expected PREGNANCY CENTERS higher health carethe costs. ” Health Systems crease (0.9 percent)Administration in rural mortality com- to curtailThe access toranks contraceptive Professional Incentive Act in 1991, creating pared to urban counties. state 2nd Only 21 states received a services by blocking all funding ThisRural year’sHealth reportAdvisory card alsoCommission, the for rural/urban “B-“the or higher. Just five states difference in mortality. for Planned Parenthood, draws attention to “a growing Nebraska Rural Health Student Loan Program,New Jersey, (California, defunding Title X, a 48-year old national divide” on reproductive and the Nebraska Loan Repayment Program. New Mexico, Oregon RURALand RESOURCES program that provides support health and rights, and Walker As a result of these rural incentive programs, Washington) received an “A”. to family planning clinics warned that Alabama is “on The following states there were 113 licensed health professionals Rural received health resource organizations in Nebraska serving low-income households, the wrong side of that divide.” a failing grade in 2016: in practice under obligation as of September include: and eliminating the Affordable Alabama, which received an “F”, Alabama, Arkansas, Florida, 2016. Care Act’s no-cost birth control was one of 20 states receiving a Georgia, Idaho, Indiana, Kansas, • Nebraska Officemandate. of Rural Walker Health noted that failing grade in the latest report Louisiana, Mississippi, Missouri, There is still a chronic shortage of behavioral dhhs.ne.gov/publichealth/RuralHealth/ “In the past five years most of card. Five years ago Alabama Nebraska, North Dakota, health professionals in rural Nebraska, however. the slippage on reproductive received a “D”. Pages/RuralHome.aspx Oklahoma, South Carolina, The shortages of personnel include psychiahealth occurred at the state • Nebraska Rural Healthhas Association South Dakota, Tennessee, Texas, level, but this year could see trists, psychologists, health MANY FACTORS licensed mentalUtah, nebraskaruralhealth.org Virginia, and Wisconsin. unprecedented setbacks at the ACCOUNTEDpsychiatric FOR practitioners, mental health nurse • Great Plains Telehealth Resource Center national level, including cuts ALABAMA’S FAILING GRADE practitioner, alcohol and drug abuseWalker counsewww.gptrac.org warned that “A woman’s in funding for comprehensive INCLUDING POOR SCORES lors and others. Currently, the RHACreproductive has fully health • should Healthnot Center Association of Nebraska sex education in the schools IN PREVENTION AND designated 80 counties, and eight additional depend on where shehcanebraska.org lives, but and a return to abstinence only AFFORDABILITY it does, counties have been partially designated as as women in many programs which have been areas are experiencing reduced Using eleven theareas. mental healthcriteria, shortage For more information about theineffective. data ” proven to be access to reproductive health Institute’s report card ranked sources used and methodology employed care services including abortion.” each of the 50 states andFACILITIES the RURAL HEALTH CARE in RHQ’s 2017 Rural Health Report Card, Walker stressed that this Walker noted that 19 states, District of Columbia on four visit www.RuralHealthQuarterly.com. year’s report card should be including Alabama, have refused broad indicators relating to The Rural Health Information Hub, an organi“an urgent call to action” for to expand Medicaid under the reproductive health and rights: anyone who is concerned zation funded by the Federal Office of Rural Affordable Care Act, leaving tens effectiveness, prevention, about reproductive health Health Policy, reports that there are 64 Critical of millions of women without affordability, and access. Based Access Hospitals in the state,(0-as well as 141 access to contraception and rights. “As disappointing improved upon their composite scores as 2016 was, 2017 could be Rural Health Clinics and 7a Federally Qualified other health care services. 100), each state received “core” and a whole lot worse.” Walker also noted that in 27 grade (A, B, C, D or F), but some states received an additional


NEBRASKA BY THE NUMBERS Nebraska has an estimated population of 1,907,116 people, and 35 percent live in one of Nebraska’s 80 rural counties. The poverty rate in rural Nebraska is 23 percent, compared with 17.1 percent in urban areas of the state.

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10.1 percent of the rural population has not completed high school, while 8.9 percent of the urban population lacks a high school diploma.

RURAL COUNTIES URBAN COUNTIES

9.6 percent of rural Nebraska residents are U.S. military veterans, and 7.9 percent of the rural population under age 65 lives with a disability. 86.6 percent of the state’s rural population is Non-Hispanic White, 0.8 percent is Black/African-American, 9.4 percent is Hispanic/Latino, 1.2 percent is American Indian/Alaska Native and 0.6 percent is Asian.

MORTALITY

QUALITY OF LIFE

Heart Disease: B-

Fair/Poor Health: A- Primary Care: B

Heart disease is the leading cause of death in Nebraska, and the state is ranked 19th in the U.S. for the number of deaths by heart disease among rural residents. The age-adjusted rate for heart disease in rural counties is 162.5 per 100,000. The national average is 168.5 per 100,000

The percentage of Nebraskans reporting poor general health is among the lowest in the nation. The state ranked 10th for rural counties (13.1 percent) and 8/51 for urban counties (12.1 percent).

Nebraska ranks 15th in the U.S. for the number of primary care physicians practicing in rural counties (62.8 per 100,000). The national average for rural counties is 54.5 per 100,000.

Mental Health: A+

Mental Care: D+

Rural residents of Nebraska reported an average of 2.9 mentally unhealthy days in the past 30 days. The national average is 3.7 days. The state ranked 2nd for self-reported mental health in rural counties.

Nebraska ranks 32nd in the U.S. for the number of psychiatrists practicing in rural counties. Nebraska has 2.4 per 100,000 residents. The U.S. rural average is 3.4.

The number of physically unhealthy days reported in rural Nebraska is 3 in 30 days, while urban residents report 2.8 days. The national average is 3.9. Rural Nebraska ranks 2nd nationally.

rural access to dental care with 58.6 dentists per 100,000 rural residents. The national rural average is 42.8.

Cancer: ACancer is the second leading cause of death in Nebraska, and the state is ranked 8th in the U.S. for deaths by cancer among rural residents. The ageadjusted rate for cancer in rural counties is 152.9 per 100,000. The national average is 158.5 per 100,000.

CLRD: C Chronic lower respiratory disease (CLRD) is the third leading cause of death in Nebraska, and the state is ranked 25th in the U.S. for deaths by CLRD among rural residents. The ageadjusted rate for CLRD in rural counties is 51.1 per 100,000. The national average is 41.6 per 100,000.

ACCESS TO CARE

Care: APhysical Health: A+ Dental Nebraska ranks 9th in the nation for

Low Birth Weight: AThe percentage of live births with low birth weight (< 5 pounds, 8 ounces) in rural Nebraska is 6.4 percent. The national average is 8 percent. Nebraska ranks 8th in the category.

Uninsured Rate: B+ 12.7 percent of Nebraska’s rural population under age 65 is uninsured. The average uninsured rate for urban residents of Nebraska is 11.4 percent. Nebraska is one of 19 states that did not adopt Medicaid expansion as offered under the Affordable Care Act.

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IN FREE FALL: REPRODUCTIVE HEALTH AND RIGHTS IN AMERICA

D+ 30/47 NEVADA ranks 30th in the nation for rural health out of 47 states with rural counties. Nevada is one of three states receiving a grade of “D+” NEVADA RECEIVED A GRADE OF “D+” BECAUSE: Nevada ranked in the third quintile of states for its rates of mortality in rural counties. Nevada ranked in the fourth quintile of states for measures of daily health and quality of life in rural counties. Nevada ranked in the fifth quintile of states for health care access in rural counties.

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NEVADA

WASHINGTON, D.C. – In releasing its fifth annual 50-State Report Card on Reproductive Health and Rights, the Population Institute lowered the U.S. grade from a “D+” to a “D”. The report card, the most comprehensive report card of its kind, tracks multiple indicators of reproductive health and rights, including access to family planning and abortion services.

Along with Arizona, Colorado, Idaho, Montana, New Mexico, Utah and Wyoming, The Institute’s president Robert Walker said, “For the past five years, reproductive health and Nevada is part of the Mountain division of the West U.S. Census region. With the exrights in the U.S. have been on a slippery slope.” Five years ago nine states received an “F”. In ception of high performers Colorado and Wyoming, all states in the division rank near this year’s report card 20 states—including Alabama—received a failing grade. Walker warned, the middle of the nation rural health. higher than Neware Mexico however, “The worst may for be yet to come, as Nevada Congress(30) and ranks the new Administration expected (31) andfederal Arizona (33), but the Silver Stateand falls behind Colorado (12), Wyoming (14), slope to slash funding for family planning comprehensive sex education. The slippery Montana (19), Idaho is becoming a free fall.”(20) and Utah (23).

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states today than “plus” or a “minus” for factors Walkerevada emphasized that “It’s ranks below the national average Access Hospitals in the state, asmore well as 1250% of women now live in a county not reflected in the core grade. not justinabortion rights that are a number of categories in this year’s Rural Health Clinics and 6 Federally Qualified without an abortion provider. under siege; it’s also access to RHQ Rural Health Report Card, and Health Centers providing services at 31 sites. ALABAMA RECEIVED A family planning services, and rural access to care seems to be a persistent Federal support for “MINUS” BECAUSE THEIR when women are denied access problem for the state. DIVIDE reproductive health and rights ‘CHOOSE LIFE’URBAN-RURAL LICENSE to contraception everyone loses: could suffer a major reversal PLATES FUND ANTI-CHOICE there are more unintended Over the pastmore decade, the total of Most U.S. states report a marked difference in 2017. Congress and the new ORGANIZATIONS/CRISIS pregnancies, abortions, andnumber licensed M.D.scare in Nevada 25.4 in health outcomesAdministration between rural are andexpected to CENTERS higher health costs.” increasedPREGNANCY percent; however, the number of M.D.s per curtailshows accessan to8contraceptive urban counties. Nevada percent Only 21 states received a servicesas bycompared blocking all This year’s report also counties“B-“ capita in rural andcard frontier declined increase in rural mortality to funding or higher. Just five states for Planned Parenthood, draws attention to “a growing dramatically during the same period. counties. The state ranks 22nd for rural/ (California, Newurban Jersey, defunding Title X, a 48-year old national divide” on reproductive urban difference in mortality. New Mexico, Oregon and program that provides support health and rights, and Walker Likewise, there were 190 licensed psychiatrists Washington) received an “A”. to family planning clinics warned that Alabama is “on in Nevada in 2016, according to the The Nevada following states received RURAL RESOURCES serving low-income households, the wrong side of that divide.” failing Rural and Frontier Health Data Book,a but 189grade in 2016: and eliminating the Affordable Alabama, which received an “F”, Arkansas, reside in urban Nevada and only oneAlabama, psychiatrist RuralFlorida, health resource organizations in birth Nevada Care Act’s no-cost control was one of 20 states receiving a Georgia, Idaho, Indiana, Kansas, resides in a rural or frontier county. include: mandate. Walker noted that failing grade in the latest report Louisiana, Mississippi, Missouri, “In the past five years most of card. Five years ago Alabama Dakota, Rural youth violence may be anotherNebraska, cause North the slippage reproductive received a “D”. • Nevada State Office of RuralonHealth Oklahoma, South Carolina, for concern in Nevada. According to the most health has occurred at the state med.unr.edu/rural-health South Dakota, Tennessee, Texas, recent High School Youth Risk Behavior • Wisconsin. level, butPartners this year could see MANYNevada FACTORS Nevada Rural Hospital Utah, Virginia, and unprecedented setbacks at the ACCOUNTED FOR one in five high school Survey (YRBS), nearly nrhp.org national level, including cuts ALABAMA’S FAILING GRADE students are bullied at school (18.5 percent), • “A Southwest Walker warned that woman’s Telehealth Resource Center in funding for comprehensive INCLUDING POOR SCORES and prevalence rates for exposure toreproductive violence health should not www.southwesttrc.org sex education in the schools IN PREVENTION AND are generally higher in rural versus urban areas depend on where she lives, but and a return to abstinence only AFFORDABILITY of the state. it does, as women many information about the data Forinmore programs which have been areas are experiencing reduced Using eleven criteria, the sources used and methodology employed proven to be ineffective. ” reproductive health Institute’s card ranked Nearly onereport in 10 students in the stateaccess reporttobein RHQ’s 2017 Rural Health Report Card, care services including abortion.” each of theto50 states the ing forced have sexand (9 percent). visit www.RuralHealthQuarterly.com. Walker stressed that this Walker noted that 19 states, District of Columbia on four year’s report card should be including Alabama, have refused broad indicators relating to RURAL HEALTH CARE FACILITIES “an urgent call to action” for to expand Medicaid under the reproductive health and rights: anyone who is concerned Affordable Care Act, leaving tens effectiveness, prevention, about reproductive health The Rural Health Information Hub, an organiof millions of women without affordability, and access. Based and rights. “As disappointing zation funded by the Federal Office of Rural improved access to contraception upon their composite scores (0as 2016 was, 2017 could be Health Policy, reports that there areand 13 other Critical health care services. 100), each state received a “core” a whole lot worse.” Walker also noted that in 27 grade (A, B, C, D or F), but some states received an additional


NEVADA BY THE NUMBERS Nevada has an estimated population of 2,940,058 people, and 9.3 percent live in one of Nevada’s 13 rural counties. The poverty rate in rural Nevada is 13.5 percent, compared with 13.8 percent in urban areas of the state. 13.6 percent of the rural population has not completed high school, while 15.1 percent of the urban population lacks a high school diploma.

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14.2 percent of rural Nevada residents are U.S. military veterans, and 12.2 percent of the rural population under age 65 lives with a disability. RURAL COUNTIES URBAN COUNTIES

74.6 percent of the state’s rural population is Non-Hispanic White, 1.4 percent is Black/African-American, 16.8 percent is Hispanic/Latino, 3.4 percent is American Indian/Alaska Native and 1.3 percent is Asian.

MORTALITY

QUALITY OF LIFE

ACCESS TO CARE

Heart Disease: D+

Fair/Poor Health: C

Primary Care: F

Heart disease is the leading cause of death in Nevada and the state is ranked 31st in the U.S. for the number of deaths by heart disease among rural residents. The age-adjusted rate for heart disease in rural counties is 196.1 per 100,000. The national average is 168.5 per 100,000.

The percentage of rural Nevadans reporting poor general health is close to the national average. The state ranked 26th for rural counties (16.1 percent) and 39/51 for urban counties (16.8 percent).

Nevada ranks 45th in the U.S. for the number of primary care physicians practicing in rural counties (41.7 per 100,000). The national average for rural counties is 54.5 per 100,000.

Mental Health: D

Mental Care: F

Rural residents of Nevada reported an average of 4.2 mentally unhealthy days in the past 30 days. The national average is 3.7 days. The state ranked 34th for self-reported mental health in rural counties.

Nevada ranks last in the nation (47/47) for the number of psychiatrists practicing in rural counties. Nevada has 0.7 per 100,000 residents. The U.S. rural average is 3.4.

Cancer: C+ Cancer is the second leading cause of death in Nevada, and the state is ranked 22nd in the U.S. for deaths by cancer among rural residents. The ageadjusted rate for cancer in rural counties is 167.3 per 100,000. The national average is 158.5 per 100,000.

CLRD: F Chronic lower respiratory disease (CLRD) is the third leading cause of death in Nevada, and the state is ranked 43rd in the U.S. for deaths by CLRD among rural residents. The ageadjusted rate for CLRD in rural counties is 68.4 per 100,000. The national average is 41.6 per 100,000.

Physical Health: D+ The number of physically unhealthy days reported in rural Nevada is 4.1 in 30 days, while urban residents report 3.9 days. The national average is 3.9. Rural Nevada ranks 30th.

Low Birth Weight: CThe percentage of live births with low birth weight (< 5 pounds, 8 ounces) in rural Nevada is 7.7 percent. The national average is 8 percent. Nevada ranks 27th in the category.

Dental Care: D+ Nevada ranks 32nd in the nation for rural access to dental care with 38.4 dentists per 100,000 rural residents. The national rural average is 42.8.

Uninsured Rate: D19.4 percent of Nevada’s rural population under age 65 is uninsured. The average uninsured rate for urban residents of Nevada is 21 percent. Nevada is one of 31 states that adopted Medicaid expansion as offered under the Affordable Care Act.

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IN FREE FALL: REPRODUCTIVE HEALTH AND RIGHTS IN AMERICA

A+ 1/47 NEW HAMPSHIRE ranks first in the nation for rural health out of 47 states with rural counties. New Hampshire is one of three states receiving a grade of “A+” NEW HAMPSHIRE RECEIVED A GRADE OF “A+” BECAUSE: New Hampshire ranked in the first quintile of states for its rates of mortality in rural counties. New Hampshire ranked in the first quintile of states for measures of daily health and quality of life in rural counties. New Hampshire ranked in the first quintile of states for health care access in rural counties.

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NEW HAMPSHIRE

WASHINGTON, D.C. – In releasing its fifth annual 50-State Report Card on Reproductive Health and Rights, the Population Institute lowered the U.S. grade from a “D+” to a “D”. The report card, the most comprehensive report card of its kind, tracks multiple indicators of reproductive health and rights, including access to family planning and abortion services.

Along with Connecticut, Maine, Massachusetts, Rhode Island and Vermont, the The Institute’s president Robert Walker said, “For the past five years, reproductive health and Granite State is a member of the New England division of the Northeast U.S. Census region. rights in the U.S. have been on a slippery slope.” Five years ago nine states received an “F”. In Excluding Rhode Island, a state with no rural counties, all states in New England receive this year’s report card 20 states—including Alabama—received a failing grade. Walker warned, high national and New Hampshire takes the top spot the however, “The rankings worst mayfor berural yet tohealth, come, as Congress and the new Administration areinexpected country. New Hamphire performed than Vermont Connecticut (3), slope to slash federal funding for(1) family planningbetter and comprehensive sex (2), education. The slippery Massachusetts (6)fall.” and Maine (13) in the final rankings. is becoming a free

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more Qualified than 50% of “plus” forHealth factorsClinics states Walkerew emphasized that Hampshire is “It’s the nation’s top or a “minus” Rural and 11today Federally women now live in county not reflected in the core grade. not justperformer abortion rights that are when it comes to providing Health Centers providing services at 37a sites. without an abortion provider. under siege; it’s also access to quality rural health care. ALABAMA RECEIVED A family planning services, and URBAN-RURAL DIVIDE Federal support for “MINUS” BECAUSE THEIR when women are denied access Ato2014 study published by the New England reproductive health and rights ‘CHOOSE LIFE’ LICENSE contraception everyone loses: Rural Health the reU.S. states report a marked could suffer difference a major reversal PLATES FUNDMost ANTI-CHOICE there are moreRoundTable unintended found that gion’s rural health is “a functioning yet fragile in health outcomesin between rural and urban 2017. Congress and the new pregnancies, more abortions, and ORGANIZATIONS/CRISIS system struggling overcome a variety of counties. New Hampshire shows aare slight 0.6 to Administration expected PREGNANCY CENTERS higher health care to costs. ” underlying challenges.” The region Only is indeed curtail access to contraceptive increaseain rural mortality as compared to 21 states received services by blocking all funding This year’s report also leads the“B-“ functioning; New card England nation in urban counties. The state ranks 7th for rural/ or higher. Just five states for Planned Parenthood, drawshealth attention to “a growing rural outcomes and access, and New Newurban difference in mortality. (California, Jersey, defunding Title X, a 48-year old national divide” on reproductive Hampshire leads the region. New Mexico, Oregon and program that provides support health and rights, and Walker Washington) received “A”. RURALanRESOURCES to family planning clinics warned that Alabama is “on The fragility mentioned in the RoundTable The following states received serving low-income households, the wrong side of that divide.” a failing 2016: report, however, was not false modesty. Newgrade in Rural health resourceand organizations New eliminatingin the Affordable Alabama, which received an “F”, Alabama, Arkansas, Florida,include: England is gradually undergoing significant Hampshire Care Act’s no-cost birth control was one of 20 states receiving a Georgia,isIdaho, Indiana, Kansas, demographic changes, and New Hampshire mandate. Walker noted that failing grade in the latest report Louisiana, Missouri, no exception to ago thatAlabama trend. Young people are Mississippi, • Rural Health and Section “InPrimary the pastCare five years most of card. Five years Nebraska, North Dakota, moving the slippage on reproductive www.dhhs.nh.gov/dphs/bchs/rhpc/ receivedtoa the “D”.cities. Oklahoma, South Carolina, health has occurred at the state index.htm South Dakota, Tennessee, Texas, Rural residents of New Hampshire are 21 level,Health but thisRoundTable year could see MANY FACTORS • New England Rural Utah, Virginia, and Wisconsin. unprecedented setbacks at the ACCOUNTED FOR than urban residents to be percent more likely www.newenglandruralhealth.org national level, including cuts ALABAMA’S GRADEmore over the age ofFAILING 65. In addition, thanwarned half that • “A Northeast Walker woman’s Telehealth Resource Center in funding for comprehensive INCLUDING POOR SCORES of all primary care physicians are over age 50, health should reproductive not netrc.org sex education in the schools IN PREVENTION AND 15 percent greater than in metro areas. Dendepend on where she lives, but and a return to abstinence only AFFORDABILITY tists are also 36 percent more likelyitto be over does, as women many information about the data Forinmore programs which have been areas are experiencing reduced Using eleven criteria, the age 55 (47.4 percent) and 17 percent more sources used and methodology employed proven to be ineffective. ” access to reproductive health Institute’s card65 ranked likely to bereport over age (11.2 percent). in RHQ’s 2017 Rural Health Report Card, care services including abortion.” each of the 50 states and the visit www.RuralHealthQuarterly.com. Walker stressed that this District of Columbia on four RURAL HEALTH CARE FACILITIESWalker noted that 19 states, year’s report card should be including Alabama, have refused broad indicators relating to “an urgent call to action” for to expand Medicaid under the reproductive health and rights: The Rural Health Information Hub, an organianyone who is concerned Affordable Care Act, leaving tens effectiveness, prevention, about reproductive health zation funded by the Federal Office of Rural of millions of women without affordability, and access. Based and rights. “As disappointing Health Policy, reports that there are 13 Critical improved access to contraception upon their composite scores (0as 2016 was, 2017 could be Access Hospitals in the state, as well as other 14 health care services. and 100), each state received a “core” a whole lot worse.” Walker also noted that in 27 grade (A, B, C, D or F), but some states received an additional


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NEW HAMPSHIRE BY THE NUMBERS RURAL COUNTIES URBAN COUNTIES

New Hampshire has an estimated population of 1,334,795 people, and 37.2 percent live in one of New Hampshire’s 7 rural counties. The poverty rate in rural New Hampshire is 9.2 percent, compared with 6.2 percent in urban areas of the state. 8.2 percent of the rural population has not completed high school, while 7.4 percent of the urban population lacks a high school diploma. 11.2 percent of rural New Hampshire residents are U.S. military veterans, and 9.9 percent of the rural population under age 65 live with a disability. 94.1 percent of the state’s rural population is Non-Hispanic White, 0.8 percent is Black/African-American, 1.7 percent is Hispanic/ Latino, 0.2 percent is American Indian/Alaska Native and 1.5 percent is Asian.

MORTALITY

QUALITY OF LIFE

Cancer: B

Fair/Poor Health: A+ Primary Care: A+

Cancer is the leading cause of death in New Hampshire, and the state is ranked 17th in the U.S. for deaths by cancer among rural residents. The ageadjusted rate for cancer in rural counties is 164.5 per 100,000. The national average is 158.5 per 100,000.

The percentage of New Hampshirites reporting poor general health is among the lowest in the nation. The state ranked 3rd for rural counties (11.5 percent) and 2/51 for urban counties (10.7 percent).

New Hampshire ranks 1st in the U.S. for the number of primary care physicians practicing in rural counties (112.4 per 100,000). The national average for rural counties is 54.5 per 100,000.

Mental Health: B-

Mental Care: A+

Rural residents of New Hampshire reported an average of 3.6 mentally unhealthy days in the past 30 days. The national average is 3.7 days. The state ranked 19th for self-reported mental health in rural counties.

New Hampshire ranks 1st in the U.S. for the number of psychiatrists practicing in rural counties. New Hampshire has 24.2 per 100,000 residents. The U.S. rural average is 3.4.

Heart Disease: A Heart disease is the second leading cause of death in New Hampshire, and the state is ranked 6th in the U.S. for the number of deaths by heart disease among rural residents. The age-adjusted rate for heart disease in rural counties is 149.8 per 100,000. The national average is 168.5 per 100,000.

Accidents: BAccidents are the third leading cause of death in New Hampshire, and New Hampshire ranked 18th out of 47 states for accidental death in rural counties. The statewide rate for accidental death is 54.8 per 100,000. The national average is 43.2 per 100,000.

Physical Health: AThe number of physically unhealthy days reported in rural New Hampshire is 3.3 in 30 days, while urban residents report 3 days. The national average is 3.9. Rural New Hampshire ranks 8th.

Low Birth Weight: B The percentage of live births with low birth weight (< 5 pounds, 8 ounces) in rural New Hampshire is 6.8 percent. The national average of 8 percent. New Hampshire ranks 15th in the category.

ACCESS TO CARE

Dental Care: A+ New Hampshire ranks 3rd in the nation for rural access to dental care with 67.8 dentists per 100,000 rural residents. The national rural average is 42.8.

Uninsured Rate: B 12.7 percent of New Hampshire’s rural population under age 65 is uninsured. The average uninsured rate for urban residents of New Hampshire is 9.8 percent. New Hampshire is one of 31 states that adopted Medicaid expansion as offered under the Affordable Care Act.

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IN FREE FALL: REPRODUCTIVE HEALTH AND RIGHTS IN AMERICA

D+ 31/47 NEW MEXICO ranks 31st ranks in the nation for rural health out of 47 states with rural counties. New Mexico is one of three states receiving a grade of “D+” NEW MEXICO RECEIVED A GRADE OF “D+” BECAUSE: New Mexico ranked in the third quintile of states for its rates of mortality in rural counties. New Mexico ranked in the fourth quintile of states for measures of daily health and quality of life in rural counties. New Mexico ranked in the fourth quintile of states for health care access in rural counties.

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NEW MEXICO

WASHINGTON, D.C. – In releasing its fifth annual 50-State Report Card on Reproductive Health and Rights, the Population Institute lowered the U.S. grade from a “D+” to a “D”. The report card, the most comprehensive report card of its kind, tracks multiple indicators of reproductive health and rights, including access to family planning and abortion services.

Along with Arizona, Colorado, Idaho, Montana, Nevada, Utah and Wyoming, New The Institute’s president Robert Walker said, “For the past five years, reproductive health and Mexico is part of the Mountain division of the West U.S. Census region. With the rights in the U.S. have been on a slippery slope.” Five years ago nine states received an “F”. In exception of high performers Colorado and Wyoming, all states in the division rank this year’s report card 20 states—including Alabama—received a failing grade. Walker warned, near the middle of the nation Newand Mexico (31)Administration ranks higherare than however, “The worst may be yetfor to rural come,health. as Congress the new expected Arizona (33), but the Land of Enchantment behind Colorado (12), Wyoming to slash federal funding for family planning andfalls comprehensive sex education. The slippery slope (14), Montana (19), Idaho (20), Utah (22) and Nevada (30). is becoming a free fall.”

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states services today more thansites. 50% of for factors Walkerew emphasized “It’s largest“plus” Mexico is that the fifth state or bya “minus” Health Centers providing at 171 women now live in a county not reflected in the core grade. not justland abortion rights that are mass, but has only four cities with without an abortion provider. under siege; it’s also access to population of 50,000 or more. With URBAN-RURAL DIVIDE ALABAMA RECEIVED A family planning services, and 17.2 persons per square mile, the state is one Federal support for “MINUS” BECAUSE THEIR when women are denied access of the most rural states in the nation. U.S. states report a marked difference reproductive health and rights ‘CHOOSE LIFE’Most LICENSE to contraception everyone loses: health outcomescould between andreversal sufferrural a major PLATES FUNDinANTI-CHOICE there are more unintended More than 40more percent of theand state’sORGANIZATIONS/CRISIS populain Mexico 2017. Congress the new pregnancies, abortions, urban counties. New shows aand 17.3% tion is estimated live” in a PrimaryPREGNANCY Care Administration are expected to CENTERS higher health careto costs. increase in rural mortality as compared to Health Professional Shortage Area, according to curtail access37th to contraceptive urban counties. The state ranks for rural/ Only 21 states received a services by blocking all funding ThisUniversity year’s report card Mexico also the of New 2017 NM urban in mortality. “B-“ Health or higher. Just fivedifference states for Planned Parenthood, draws attention to “a growing Data Summary, and 8 counties have(California, no surgicalNew Jersey, defunding Title X, a 48-year old national divide” on reproductive facility for labor and delivery. New Mexico, Oregon RURALand RESOURCES program that provides support health and rights, and Walker Washington) received an “A”. to family planning clinics warned that Alabama is “on New Mexico’s poverty rate is higherThe thanfollowing the states Ruralreceived health resource organizations inhouseholds, New serving low-income the wrong side of that divide.” a failing grade in 2016: include: national average and is now the second highest Mexico and eliminating the Affordable Alabama, which received an “F”, Alabama, Arkansas, Florida, in the nation. Care Act’s no-cost birth control was one of 20 states receiving a Georgia, Idaho, Indiana, Kansas, • Office of Primary Care and Ruralnoted Health mandate. Walker that failing grade in the latest report Louisiana, Mississippi, Missouri, The of ago racialAlabama health disparities is “In the past five years most of card.concept Five years nmhealth.org/about/phd/hsb/oprh Nebraska, North Dakota, especially for New Mexico, where the • New Mexico Health the slippage on reproductive received a relevant “D”. Resources, Inc. Oklahoma, South Carolina, state population is composed of less than 50 health has occurred at the state www.nmhr.org/index.html South Dakota, Tennessee, Texas, percent non-Hispanic whites. The United States • Southwest Telehealth level, but this yearCenter could see MANY FACTORS Resource Utah, Virginia, and Wisconsin. unprecedented setbacks at the FOR but non-Hispanic Whites isACCOUNTED increasingly diverse, www.southwesttrc.org national level, including cuts ALABAMA’S GRADE comprise moreFAILING than sixty percent of the warned that “A woman’s Walker in funding for comprehensive INCLUDING POOR SCORES national population compared to lessreproductive than forty health not For should more information about the data sex education in the schools IN PREVENTION AND percent of New Mexico’s population.depend Additionon where she lives, but and methodology employed sources used and a return to abstinence only AFFORDABILITY ally, almost 12 percent of rural New Mexicans it does, as women many2017 Rural Health Report Card, in in RHQ’s programs which have been areas are experiencing reduced Using eleven criteria, the are Native American. visit www.RuralHealthQuarterly.com. proven to be ineffective.” access to reproductive health Institute’s report card ranked care services including abortion.” each of the 50 states andFACILITIES the RURAL HEALTH CARE Walker stressed that this Walker noted that 19 states, District of Columbia on four year’s report card should be including Alabama, have refused broad indicators relating to The Rural Health Information Hub, an organi“an urgent call to action” for to expand Medicaid under the reproductive health and rights: zation funded by the Federal Office of Rural anyone who is concerned Affordable Care Act, leaving tens effectiveness, prevention, about reproductive health Health Policy, reports that there are 9 Critical of millions of women without affordability, and access. Based and rights. “As disappointing Access Hospitals in the state, as well as 11 improved access to contraception upon their composite scores (0as 2016 was, 2017 could be Rural Health Clinics and 17 Federally Qualified and other health care services. 100), each state received a “core” a whole lot worse.” Walker also noted that in 27 grade (A, B, C, D or F), but some states received an additional


NEW MEXICO BY THE NUMBERS New Mexico has an estimated population of 2,081,015 people, and 33.3 percent live in one of New Mexico’s 26 rural counties. The poverty rate in rural New Mexico is 23.3 percent, compared with 18.1 percent in urban areas of the state. 19.4 percent of the rural population has not completed high school, while 14.1 percent of the urban population lacks a high school diploma.

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10.8 percent of rural New Mexico residents are U.S. military veterans, and 12.3 percent of the rural population under age 65 lives with a disability.

RURAL COUNTIES URBAN COUNTIES

38.9 percent of the state’s rural population is Non-Hispanic White, 1.8 percent is Black/African-American, 45.3 percent is Hispanic/Latino, 11.6 percent is American Indian/Alaska Native and 0.8 percent is Asian.

MORTALITY

QUALITY OF LIFE

ACCESS TO CARE

Cancer: B+

Fair/Poor Health: F

Primary Care: C+

Cancer is the leading cause of death in New Mexico, and the state is ranked 13th in the U.S. for deaths by cancer among rural residents. The age-adjusted rate for cancer in rural counties is 155.9 per 100,000. The national average is 158.5 per 100,000.

The percentage of New Mexicans reporting poor general health is among the highest in the nation. The state ranked 39th for rural counties (21.5 percent) and 44/51 for urban counties (18.6 percent).

New Mexico ranks 21st in the U.S. for the number of primary care physicians practicing in rural counties (58.7 per 100,000). The national average for rural counties is 54.5 per 100,000.

Heart Disease: B

Mental Health: C-

Mental Care: B+

Rural residents of New Mexico reported an average of 3.9 mentally unhealthy days in the past 30 days. The national average is 3.7 days. The state ranked 27th for self-reported mental health in rural counties.

New Mexico ranks 12th in the U.S. for the number of psychiatrists practicing in rural counties. New Mexico has 4.9 per 100,000 residents. The U.S. rural average is 3.4.

Heart disease is the second leading cause of death in New Mexico, and the state is ranked 17th in the U.S. for the number of deaths by heart disease among rural residents. The age-adjusted rate for heart disease in rural counties is 161.2 per 100,000. The national average is 168.5 per 100,000.

Accidents: F Accidents are the third leading cause of death in New Mexico, and New Mexico ranked 44th out of 47 states for accidental death in rural counties. The statewide rate for accidental death is 72.2 per 100,000. The national average is 43.2 per 100,000.

Physical Health: D The number of physically unhealthy days reported in rural New Mexico is 4.5 in 30 days, while urban residents report 4 days. The national average is 3.9. Rural New Mexico ranks 35th.

Low Birth Weight: DThe percentage of live births with low birth weight (< 5 pounds, 8 ounces) in rural New Mexico is 8.8 percent. The national average is 8 percent. New Mexico ranks 36th in the category.

Dental Care: C New Mexico ranks 26th in the nation for rural access to dental care with 48 dentists per 100,000 rural residents. The national rural average is 42.8.

Uninsured Rate: F 20.8 percent of New Mexico’s rural population under age 65 is uninsured. The average uninsured rate for urban residents of New Mexico is 18 percent. New Mexico is one of 31 states that adopted Medicaid expansion as offered under the Affordable Care Act.

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IN FREE FALL: REPRODUCTIVE HEALTH AND RIGHTS IN AMERICA

B18/47 NEW YORK ranks 18th in the nation for rural health out of 47 states with rural counties. New York is one of four states receiving a grade of “B-” NEW YORK RECEIVED A GRADE OF “B-” BECAUSE: New York ranked in the second quintile of states for its rates of mortality in rural counties. New York ranked in the third quintile of states for measures of daily health and quality of life in rural counties. New York ranked in the second quintile of states for health care access in rural counties.

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NEW YORK

WASHINGTON, D.C. – In releasing its fifth annual 50-State Report Card on Reproductive Health and Rights, the Population Institute lowered the U.S. grade from a “D+” to a “D”. The report card, the most comprehensive report card of its kind, tracks multiple indicators of reproductive health and rights, including access to family planning and abortion services.

Along with New Jersey and Pennsylvania, the Empire State is part of the Mid-Atlantic The Institute’s president Robert Walker said, “For the past five years, reproductive health and division of the Northeast U.S. Census region. Excluding New Jersey, a state with no rights in the U.S. have been on a slippery slope.” Five years ago nine states received an “F”. In rural counties, Mid-Atlantic states rank near the middle of the nation for rural this year’s report card 20 states—including Alabama—received a failing grade. Walker warned, health. than neighboring state however,New “TheYork worst(18) mayranks be yethigher to come, as Congress and the newPennsylvania Administration(25). are expected to slash federal funding for family planning and comprehensive sex education. The slippery slope is becoming a free fall.”

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states today than “plus” or a “minus” for factors Walkerew emphasized thaturbanized “It’s York is more than most Access Hospitals in the state, asmore well as 9 50% of women now live in a county not reflected in the core grade. not justU.S. abortion rights that are states, but it still has a fairly Rural Health Clinics and 65 Federally Qualified without an abortion provider. under siege; it’s also access to substantial rural population. Health Health Centers providing services at 590 sites. ALABAMA RECEIVED A family planning services, and disparities in the rural and remote North Federal support for “MINUS” BECAUSE THEIR when women are denied access Country region of upstateloses: New York‘CHOOSE are well LIFE’URBAN-RURAL DIVIDE reproductive health and rights LICENSE to contraception everyone documented, the region struggles with FUND ANTI-CHOICE could suffer a major reversal PLATES there are moreand unintended recruiting providers, resulting in 40ORGANIZATIONS/CRISIS percent Most U.S. states report a marked difference in 2017. Congress and the new pregnancies, more abortions, and fewer carecosts. physicians per capita than in health outcomesAdministration between rural are andexpected urban to PREGNANCY CENTERS higherprimary health care ” the rest of the state. curtail access to contraceptive counties. New York shows a 20.1 percent Only 21 states received a services as by compared blocking alltofunding This year’s report card also increase in rural mortality “B-“ or higher. Just five states for Planned Parenthood, draws attention to “a growing In recent years, significant investments have Newurban (California, Jersey,counties. The state ranks 39th for defunding Title X, a 48-year old national divide” on reproductive been made to improve the way primary care Oregon rural/urban New Mexico, and difference in mortality. program that provides support health and rights, and Walker is delivered in the Adirondack region, and at- received an “A”. Washington) to family planning clinics warned that Alabama is “on tempts are being made to address the The state’s following states received RURAL RESOURCES serving low-income households, the wrong side of that divide.” a failing grade in 2016: rural dentist shortage, as well. To expand and eliminating the Affordable Alabama, which received an “F”, treatment options and address theAlabama, continuedArkansas, RuralFlorida, health resource organizations Newcontrol Care Act’s no-costinbirth was one of 20 states receiving a Georgia, Idaho, Indiana, Kansas, shortage of dentists in underserved areas, York include: mandate. Walker noted that failing grade in the latest report Louisiana, Mississippi, Missouri, New has passed legislation authorizing “In the past five years most of card. York Five years ago Alabama Nebraska, North Dakota, dentists be added to the successful “Docthe slippage on reproductive • New York State Office of Rural Health received to a “D”. Oklahoma, South Carolina, tors Across New York” program. health has occurred at the state www.health.ny.gov South Dakota, Tennessee, Texas, but this for yearRural could see MANY FACTORS • Wisconsin. New York Statelevel, Association Utah, Virginia, and unprecedented setbacks at the ACCOUNTED FORmade recent efforts to The state has also Health www.nysarh.org national level, including cuts ALABAMA’S improve healthFAILING care forGRADE veterans, including • “A Northeast Walker warned that woman’s Telehealth Resource Center in funding for comprehensive INCLUDING POOR SCORES providing combat veterans employed by the health should reproductive not netrc.org sex education in the schools IN PREVENTION AND state with additional days of paid leave toon where she lives, but depend and a return to abstinence only AFFORDABILITY obtain health services and counseling, and it does, as women many information about the data Forinmore programs which have been areas are experiencing reduced Using eleven criteria, the by adding Post Traumatic Stress Disorder as sources used and methodology employed proven to be ineffective. ” access to reproductive health report card ranked aInstitute’s qualifying condition in New York’s medical in RHQ’s 2017 Rural Health Report Card, care services including abortion.” each of theprogram. 50 states and the marijuana visit www.RuralHealthQuarterly.com. Walker stressed that this Walker noted that 19 states, District of Columbia on four year’s report card should be broad indicators relating to RURAL HEALTH CARE FACILITIESincluding Alabama, have refused “an urgent call to action” for to expand Medicaid under the reproductive health and rights: anyone who is concerned Affordable Care Act, leaving tens effectiveness, prevention, about reproductive health The Rural Health Information Hub, an organiof millions of women without affordability, and access. Based and rights. “As disappointing zation funded by the Federal Office of Rural improved access to contraception upon their composite scores (0as 2016 was, 2017 could be Health Policy, reports that there areand 18 other Critical health care services. 100), each state received a “core” a whole lot worse.” Walker also noted that in 27 grade (A, B, C, D or F), but some states received an additional


NEW YORK BY THE NUMBERS New York has an estimated population of 19,745,289 people, and 7 percent live in one of New York’s 24 rural counties. The poverty rate in rural New York is 15.5 percent, compared with 14.7 percent in urban areas of the state.

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21.5 percent of the rural population has not completed high school, while 13.9 percent of the urban population lacks a high school diploma.

RURAL COUNTIES URBAN COUNTIES

9.9 percent of rural New York residents are U.S. military veterans, and 11 percent of the rural population under age 65 lives with a disability. 89.8 percent of the state’s rural population is Non-Hispanic White, 2.9 percent is Black/African-American, 4.1 percent is Hispanic/Latino, 0.7 percent is American Indian/Alaska Native and 0.9 percent is Asian.

MORTALITY

QUALITY OF LIFE

ACCESS TO CARE

Heart Disease: D

Fair/Poor Health: B

Primary Care: C-

Heart disease is the leading cause of death in New York, and the state is ranked 34th in the U.S. for the number of deaths by heart disease among rural residents. The age-adjusted rate for heart disease in rural counties is 198.4 per 100,000. The national average is 168.5 per 100,000.

The percentage of New Yorkers reporting poor general health is close to the national average. The state ranked 17th for rural counties (14 percent) and 29/51 for urban counties (15.3 percent).

New York ranks 27th in the U.S. for the number of primary care physicians practicing in rural counties (52.6 per 100,000). The national average for rural counties is 54.5 per 100,000.

Mental Health: C

Mental Care: A

Rural residents of New York reported an average of 3.9 mentally unhealthy days in the past 30 days. The national average is 3.7 days. The state ranked 26th for self-reported mental health in rural counties.

New York ranks 7th in the U.S. for the number of psychiatrists practicing in rural counties. New York has 6.4 per 100,000 residents. The U.S. rural average is 3.4.

Cancer: B+ Cancer is the second leading cause of death in New York, and the state is ranked 18th in the U.S. for deaths by cancer among rural residents. The ageadjusted rate for cancer in rural counties is 164.8 per 100,000. The national average is 158.5 per 100,000.

CLRD: C+ Chronic lower respiratory disease (CLRD) is the third leading cause of death in New York, and the state is ranked 21st in the U.S. for deaths by CLRD among rural residents. The ageadjusted rate for CLRD in rural counties is 50.1 per 100,000. The national average is 41.6 per 100,000.

Physical Health: C+ The number of physically unhealthy days reported in rural New York is 3.8 in 30 days, while urban residents report 3.6 days. The national average is 3.9. Rural New York ranks 23rd.

Low Birth Weight: BThe percentage of live births with low birth weight (< 5 pounds, 8 ounces) in rural New York is 7.3 percent. The national average is 8 percent. New York ranks 19th in the category.

Dental Care: D+ New York ranks 31st in the nation for rural access to dental care with 40.2 dentists per 100,000 rural residents. The national rural average is 42.8.

Uninsured Rate: A 10.3 percent of New York’s rural population under age 65 is uninsured. The average uninsured rate for urban residents of New York is 11.1 percent. New York is one of 31 states that adopted Medicaid expansion as offered under the Affordable Care Act.

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IN FREE FALL: REPRODUCTIVE HEALTH AND RIGHTS IN AMERICA

D 34/47 NORTH CAROLINA ranks 34th in the nation for rural health out of 47 states with rural counties. North Carolina is one of three states receiving a grade of “D” NORTH CAROLINA RECEIVED A GRADE OF “D” BECAUSE: North Carolina ranked in the fourth quintile of states for its rates of mortality in rural counties. North Carolina ranked in the fourth quintile of states for measures of daily health and quality of life in rural counties. North Carolina ranked in the fourth quintile of states for health care access in rural counties.

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NORTH CAROLINA

WASHINGTON, D.C. – In releasing its fifth annual 50-State Report Card on Reproductive Health and Rights, the Population Institute lowered the U.S. grade from a “D+” to a “D”. The report card, the most comprehensive report card of its kind, tracks multiple indicators of reproductive health and rights, including access to family planning and abortion services.

Along with Delaware, Florida, Georgia, Maryland, South Carolina, Virginia and West The Institute’s president Robert Walker said, “For the past five years, reproductive health and Virginia, North Carolina is part of the South Atlantic division of the South U.S. Census rights in the U.S. have been on a slippery slope.” Five years ago nine states received an “F”. In region. With the exception of Maryland and Delaware (a state with no rural counties), this year’s report card 20 states—including Alabama—received a failing grade. Walker warned, most states in worst the division poor rural health rankings. North Carolina (34)are perhowever, “The may behave yet to come, as Congress and the new Administration expected formed Florida (37), West Virginia (39), Georgia (40), South Carolina (44), slope to slash better federalthan funding for family planning and comprehensive sex education. The slippery but the Tar Heel State is becoming a free fall.”fell behind Marlyland (16) and Virginia (32).

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states today more than 50% of “plus” a “minus” for factors Walkerorth emphasized Carolinathat has“It’s a broad mix of or rural URBAN-RURAL DIVIDE women now live in a county not reflected in the core grade. not justand abortion rights that are urban areas, but approximately without an abortion provider. under siege; it’s also access to one-in-five North Carolinians, almost Most U.S. states report a marked difference ALABAMA RECEIVED A family planning services, and 2.2 million people, live in a rural county. in health outcomes Federal betweensupport rural and for urban “MINUS” BECAUSE THEIR when women are denied access counties. North Carolina shows a 10.5 reproductive healthpercent and rights ‘CHOOSE LIFE’ LICENSE to contraception everyone loses: In addition to poor health outcomes, residents in rural mortality as compared to could suffer a major reversal PLATES FUNDincrease ANTI-CHOICE there are more unintended of rural Northmore Carolina have and limitedORGANIZATIONS/CRISIS access urban counties. Theinstate ranks 29th for 2017. Congress andrural/ the new pregnancies, abortions, to care.health In some counties, more than urban difference in mortality. Administration are expected to PREGNANCY CENTERS higher carerural costs. ” one out of every four nonelderly persons is curtail access to contraceptive Only 21 states received a services by blocking all funding This year’s report card are also66 counties uninsured, and there that are RURAL RESOURCES “B-“ or higher. Just five states for Planned Parenthood, draws attention to “a growing considered primary care shortage (California, areas, 22 New Jersey, defunding Title X, a 48-year old national divide” on reproductive counties that are behavioral health Rural health NewshortMexico, Oregon and resource organizations in North program that provides support health and rights, and Walker age areas and 69 counties that are Washington) dental received aninclude: “A”. Carolina to family planning clinics warned that Alabama is “on shortage areas. Most of these counties are The following states received serving low-income households, the wrong side of that divide.” a failing grade in rural. • 2016: North Carolina and Office of Rural Health eliminating the Affordable Alabama, which received an “F”, Alabama, Arkansas, www.ncdhhs.gov/divisions/orh Florida, Care Act’s no-cost birth control was one of 20 states receiving a Georgia, The number babies born with a low birthIdaho,• Indiana, NorthKansas, Carolina Rural Health Leadership mandate. Walker noted that failing grade of in the latest report Louisiana, Mississippi, Missouri, weight in rural Carolina is also cause for Alliance: foundationhli.org/programs/ “In the past five years most of card. Five years North ago Alabama Nebraska, North Dakota, concern. 2014, 8.9 percent of live births in nc-rural-health-leadership-alliance the slippage on reproductive received aIn“D”. Oklahoma, South Carolina, the state were low birth weight. In rural coun- • Mid-Atlantic Telehealth health hasResource occurred Center at the state South Dakota, Tennessee, Texas, ties, theFACTORS total was almost 10 percent. Black level, but this year could see MANY www.matrc.org Utah, Virginia, and Wisconsin. unprecedented setbacks at the ACCOUNTED FOR were about 2 times as infants (13.5 percent) • North Carolina Rural Health Research national level, including cuts ALABAMA’S FAILING GRADE likely as Hispanic infants (6.7 percent) to be Program: Walker warned that “A woman’swww.shepscenter.unc.edu/ in funding for comprehensive INCLUDING POOR SCORES born with a low birth weight duringreproductive 2012programs-projects/rural-health health should not sex education in the schools IN PREVENTION AND 2014. depend on where she lives, but and a return to abstinence only AFFORDABILITY it does, as women many information about the data Forinmore programs which have been areas are experiencing reduced Using eleven criteria, the RURAL HEALTH CARE FACILITIES sources used and methodology employed proven to be ineffective. ” access to reproductive health Institute’s report card ranked in RHQ’s 2017 Rural Health Report Card, care abortion.” eachRural of theHealth 50 states and the Hub, The Information an services including visit www.RuralHealthQuarterly.com. Walker stressed that this Walker noted that 19 states, District of Columbia on four organization funded by the Federal Office year’s report card should be including Alabama, have refused broad indicators relating to of Rural Health Policy, reports that there “an urgent call to action” for to expand Medicaid under the reproductive health and rights: are 21 Critical Access Hospitals in the state, anyone who is concerned Affordable Care Act, leaving tens effectiveness, prevention, about reproductive health as well as 73 Rural Health Clinics and 38 of millions of women without affordability, and access. Based and rights. “As disappointing Federally Qualified Health Centers providing improved access to contraception upon their composite scores (0as 2016 was, 2017 could be services atstate 222 received sites. a “core” and other health care services. 100), each a whole lot worse.” Walker also noted that in 27 grade (A, B, C, D or F), but some states received an additional


NORTH CAROLINA BY THE NUMBERS North Carolina has an estimated population of 10,146,788 people, and 21.7 percent live in one of North Carolina’s 54 rural counties. The poverty rate in rural North Carolina is 19.2 percent, compared with 14.3 percent in urban areas of the state.

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18.8 percent of the rural population has not completed high school, while 12.8 percent of the urban population lacks a high school diploma. RURAL COUNTIES URBAN COUNTIES

9.6 percent of rural North Carolina residents are U.S. military veterans, and 12.9 percent of the rural population under age 65 lives with a disability. 64.9 percent of the state’s rural population is Non-Hispanic White, 21.8 percent is Black/African-American, 7.2 percent is Hispanic/Latino, 3.5 percent is American Indian/Alaska Native and 0.7 percent is Asian.

MORTALITY

QUALITY OF LIFE

ACCESS TO CARE

Cancer: C

Fair/Poor Health: D

Primary Care: D+

Cancer is the leading cause of death in North Carolina, and the state is ranked 26th in the U.S. for deaths by cancer among rural residents. The age-adjusted rate for cancer in rural counties is 172.3 per 100,000. The national average is 158.5 per 100,000.

The percentage of North Carolinians reporting poor general health is among the highest in the nation. The state ranked 34th for rural counties (20.3 percent) and 38/51 for urban counties (16.8 percent).

North Carolina ranks 32nd in the U.S. for the number of primary care physicians practicing in rural counties (50.6 per 100,000). The national average for rural counties is 54.5 per 100,000.

Heart Disease: C-

Mental Health: D+

Mental Care: B-

Rural residents of North Carolina reported an average of 4 mentally unhealthy days in the past 30 days. The national average is 3.7 days. The state ranked 32nd for self-reported mental health in rural counties.

North Carolina ranks 19th in the U.S. for the number of psychiatrists practicing in rural counties. North Carolina has 3.4 per 100,000 residents. The U.S. rural average is 3.4.

Heart disease is the second leading cause of death in North Carolina, and the state is ranked 27th in the U.S. for the number of deaths by heart disease among rural residents. The age-adjusted rate for heart disease in rural counties is 189.7 per 100,000. The national average is 168.5 per 100,000.

CLRD: B Chronic lower respiratory disease (CLRD) is the third leading cause of death in North Carolina, and the state is ranked 17th in the U.S. for deaths by CLRD among rural residents. The ageadjusted rate for CLRD in rural counties is 48.4 per 100,000. The national average is 41.6 per 100,000.

Physical Health: D The number of physically unhealthy days reported in rural North Carolina is 4.3 in 30 days, while urban residents report 3.8 days. The national average is 3.9. Rural North Carolina ranks 33rd.

Low Birth Weight: F The percentage of live births with low birth weight (< 5 pounds, 8 ounces) in rural North Carolina is 9.6 percent, well above the national average of 8 percent. North Carolina ranks 41st in the category.

Dental Care: DNorth Carolina ranks 36th in the nation for rural access to dental care with 36.7 dentists per 100,000 rural residents. The national rural average is 42.8.

Uninsured Rate: D 19.3 percent of North Carolina’s rural population under age 65 is uninsured. The average uninsured rate for urban residents of North Carolina is 16 percent. North Carolina is one of 19 states that did not adopt Medicaid expansion as offered under the Affordable Care Act.

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IN FREE FALL: REPRODUCTIVE HEALTH AND RIGHTS IN AMERICA

A10/47 NORTH DAKOTA ranks 10th in the nation for rural health out of 47 states with rural counties. North Dakota is one of three states receiving a grade of “A-” NORTH DAKOTA RECEIVED A GRADE OF “A-” BECAUSE: North Dakota ranked in the first quintile of states for its rates of mortality in rural counties. North Dakota ranked in the first quintile of states for measures of daily health and quality of life in rural counties. North Dakota ranked in the second quintile of states for health care access in rural counties.

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NORTH DAKOTA

WASHINGTON, D.C. – In releasing its fifth annual 50-State Report Card on Reproductive Health and Rights, the Population Institute lowered the U.S. grade from a “D+” to a “D”. The report card, the most comprehensive report card of its kind, tracks multiple indicators of reproductive health and rights, including access to family planning and abortion services.

Along with Iowa, Kansas, Minnesota, Missouri, Nebraska and South Dakota, North Dakota The Institute’s president Robert Walker said, “For the past five years, reproductive health and is a member of the West North Central division of the Midwest U.S. Census region. rights in the U.S. have been on a slippery slope.” Five years ago nine states received an “F”. In Most members of the West North Central division rank near the top of the nation for this year’s report card 20 states—including Alabama—received a failing grade. Walker warned, rural health, Kansas and (35) underperform. North Dakota are (10)expected also however, “Thebut worst may (24) be yet to Missouri come, as Congress and the new Administration outperforms Dakota (11),planning but the Peace Garden Statesex falls behind The Minnesota to slash federalSouth funding for family and comprehensive education. slippery slope (5), Nebraska (8) and is becoming a free fall.”Iowa (9) in the final rankings.

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states today more 50% of “plus” or a “minus” for factors Walkerorth emphasized that “It’s Dakota is one of the more rural Health Centers providing services at than 16 sites. women now live in a county not reflected in the core grade. not juststates abortion rights that are in the country and more than without an abortion provider. under siege; it’s also access to half of the population lives in a rural URBAN-RURAL DIVIDE ALABAMA RECEIVED A family planning services, and county, making it all the more remarkable Federal support for “MINUS” BECAUSE THEIR when women are denied access that the state performs well in this year’s LIFE’Most U.S. states report a markedhealth difference reproductive and rights ‘CHOOSE LICENSE to contraception everyoneso loses: RHQ Health Report Card. PLATES FUNDinANTI-CHOICE health outcomes could between rural and urban suffer a major reversal thereRural are more unintended in 2017. Congress the new pregnancies, more abortions, and ORGANIZATIONS/CRISIS counties. North Dakota shows a 10.1 and percent Rural supply remains a serious cause Administration are expected to PREGNANCY CENTERS higherprovider health care costs. ” increase in rural mortality as compared to for concern, however. According toOnly a report curtail access25th to contraceptive urban counties. The state ranks for rural/ 21 states received a services by blocking all funding This year’sby report card also of North“B-“ prepared the University Dakota urban in mortality. or higher. Just fivedifference states for Planned Parenthood, draws attention to “a growing School of Medicine and Health Sciences (California, New Jersey, defunding Title X, a 48-year old national divide” on reproductive Advisory Council, there has been a New chronic Mexico, Oregon RURALand RESOURCES program that provides support health and rights, and Walker shortage of primary care providers Washington) in the state received an “A”. to family planning clinics warned that Alabama is “on dating back decades, and the problem proThe is following states Ruralreceived health resource organizations inhouseholds, North serving low-income the wrong side of that divide.” a failing grade in 2016: include: jected to get worse in the years to come. Part Dakota and eliminating the Affordable Alabama, which received an “F”, Alabama, of the problem is an inadequate number of Arkansas, Florida, Care Act’s no-cost birth control was one of 20 states receiving a Georgia, Idaho, Indiana, Kansas, providers, butinathe larger portion problem • North Dakota State OfficeWalker of Rural Health mandate. noted that failing grade latest reportof the Louisiana, Mississippi, Missouri, iscard. a maldistribution of providers dispropor“In the past five years most of Five years ago Alabama ruralhealth.und.edu/projects/stateNebraska, North Dakota, tionately of the the slippage on reproductive received alocated “D”. in urbanized areasOklahoma, office-of-rural-health South Carolina, state. healthHealth has occurred at the state • North Dakota Rural Association South Dakota, Tennessee, Texas, level, but this year could see MANY FACTORS www.ndrha.org Utah, Virginia, and Wisconsin. unprecedented setbacks at the ACCOUNTED North Dakota isFOR addressing its health care • Great Plains Telehealth Resource Center national level, including cuts ALABAMA’S FAILING GRADE delivery challenges with a plan for health carewarned that “A Walker woman’s www.gptrac.org in funding for comprehensive INCLUDING POOR SCORES workforce development, the Healthcare Work- health reproductive not Rural Health Education Project • should Targeted sex education in the schools IN PREVENTION AND force Initiative (HWI). The HWI has depend alreadyon where shewww.ndrha.org/trhe lives, but and a return to abstinence only AFFORDABILITY increased medical and health sciences class it does, as women many Health Reform Policy Research • in Rural programs which have been areas are experiencing reducedruralhealth.und.edu/projects/ Usingalong eleven criteria, the residency sizes with increasing slots. Center: proven to be ineffective.” access to reproductive health Institute’s report card ranked health-reform-policy-research-center care services including abortion.” each of the 50 states and FACILITIES the RURAL HEALTH CARE Walker stressed that this Walker noted that 19 states, District of Columbia on four year’s report For more information about thecard datashould be including Alabama, have refused broad indicators relating to The Rural Health Information Hub, an organi- sources used and methodology “an urgent callemployed to action” for to expand Medicaid under the reproductive health and rights: zation funded by the Federal Office of Rural anyone who is concerned in RHQ’s 2017 Rural Health Report Card, Affordable Care Act, leaving tens effectiveness, prevention, about reproductive health Health Policy, reports that there are 36 Critivisit www.RuralHealthQuarterly.com. of millions of women without affordability, and access. Based and rights. “As disappointing cal Access the state, well as 52 access to contraception upon their Hospitals compositein scores (0- asimproved as 2016 was, 2017 could be Rural Health Clinics and a4“core” Federallyand Qualified other health care services. 100), each state received a whole lot worse.” Walker also noted that in 27 grade (A, B, C, D or F), but some states received an additional


NORTH DAKOTA BY THE NUMBERS North Dakota has an estimated population of 757,952 people, and 50.1 percent live in one of North Dakota’s 47 rural counties. The poverty rate in rural North Dakota is 9.9 percent, compared with 11.6 percent in urban areas of the state. 10.1 percent of the rural population has not completed high school, while 6.3 percent of the urban population lacks a high school diploma.

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10.2 percent of rural North Dakota residents are U.S. military veterans, and 7 percent of the rural population under age 65 lives with a disability. RURAL COUNTIES URBAN COUNTIES

85.9 percent of the state’s rural population is Non-Hispanic White, 1.1 percent is Black/African-American, 3.2 percent is Hispanic/Latino, 7.1 percent is American Indian/Alaska Native and 0.6 percent is Asian.

MORTALITY

QUALITY OF LIFE

Heart Disease: B

Fair/Poor Health: A- Primary Care: D+

Heart disease is the leading cause of death in North Dakota, and the state is ranked 14th in the U.S. for the number of deaths by heart disease among rural residents. The age-adjusted rate for heart disease in rural counties is 158.5 per 100,000. The national average is 168.5 per 100,000.

The percentage of North Dakotans reporting poor general health is among the lowest in the nation. The state ranked 8th for rural counties (13 percent) and 5/51 for urban counties (11.8 percent).

North Dakota ranks 31st in the U.S. for the number of primary care physicians practicing in rural counties (50.8 per 100,000). The national average for rural counties is 54.5 per 100,000.

Mental Health: A+

Mental Care: B-

Rural residents of North Dakota reported an average of 3 mentally unhealthy days in the past 30 days. The national average is 3.7 days. The state ranked 3rd for self-reported mental health in rural counties.

North Dakota ranks 20th in the U.S. for the number of psychiatrists practicing in rural counties. North Dakota has 3.2 per 100,000 residents. The U.S. rural average is 3.4.

The number of physically unhealthy days reported in rural North Dakota is 2.9 in 30 days. Urban residents report 2.7 days. The national average is 3.9. Rural North Dakota ranks 1st in the U.S.

for rural access to dental care with 51.7 dentists per 100,000 rural residents. The national rural average is 42.8.

Cancer: B Cancer is the second leading cause of death in North Dakota, and the state is ranked 15th in the U.S. for deaths by cancer among rural residents. The ageadjusted rate for cancer in rural counties is 156.3 per 100,000. The national average is 158.5 per 100,000.

Accidents: B Accidents are the fourth leading cause of death in North Dakota, and North Dakota ranked 14th out of 47 states for accidental death in rural counties. The statewide rate for accidental death is 52 per 100,000. The national average is 43.2 per 100,000.

ACCESS TO CARE

Care: BPhysical Health: A+ Dental North Dakota ranks 19th in the nation

Low Birth Weight: AThe percentage of live births with low birth weight (< 5 pounds, 8 ounces) in rural North Dakota is 6.5 percent. The national average is 8 percent. North Dakota ranks 10th in the category.

Uninsured Rate: A12 percent of North Dakota’s rural population under age 65 is uninsured. The average uninsured rate for urban residents of North Dakota is 9 percent. North Dakota is one of 31 states that adopted Medicaid expansion as offered under the Affordable Care Act.

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IN FREE FALL: REPRODUCTIVE HEALTH AND RIGHTS IN AMERICA

C28/47 OHIO ranks 28th in the nation for rural health out of 47 states with rural counties. Ohio is one of three states receiving a grade of “C-” NORTH CAROLINA RECEIVED A GRADE OF “C-” BECAUSE: Ohio ranked in the fourth quintile of states for its rates of mortality in rural counties. Ohio ranked in the third quintile of states for measures of daily health and quality of life in rural counties. Ohio ranked in the third quintile of states for health care access in rural counties.

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OHIO

WASHINGTON, D.C. – In releasing its fifth annual 50-State Report Card on Reproductive Health and Rights, the Population Institute lowered the U.S. grade from a “D+” to a “D”. The report card, the most comprehensive report card of its kind, tracks multiple indicators of reproductive health and rights, including access to family planning and abortion services.

Along with Illinois, Indiana, Michigan and Wisconsin, Ohio is a member of the East The Institute’s president Robert Walker said, “For the past five years, reproductive health and North Central division of the Midwest U.S. Census region. With the exception of highrights in the U.S. have been on a slippery slope.” Five years ago nine states received an “F”. In performing Wisconsin, states in the division rank near the middle of the nation for this year’s report card 20 all states—including Alabama—received a failing grade. Walker warned, rural health. Ohio (28) ranked higher than Indiana (29), but the Buckeye State however, “The worst may be yet to come, as Congress and the new Administration are expected fell behind Wisconsin (7),family Michigan (21) and Illinois (27) sex in the final rankings. to slash federal funding for planning and comprehensive education. The slippery slope is becoming a free fall.”

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states today more than 50% of “plus” or a “minus” for factors Walker hio emphasized that “It’s the national ranks a bit below URBAN-RURAL DIVIDE women now live in a county not reflected in the core grade. not justaverage abortioninrights that are this year’s RHQ Rural Health without an abortion provider. under siege; it’s also access to Report Card. Like many of its regional Most U.S. states report a marked difference ALABAMA RECEIVED A family planning services, and neighbors, one contributing factor “MINUS” to its in health outcomes Federal between rural and support for urban BECAUSE THEIR when women are denied access underwhelming rural health performance may LIFE’counties. a 4 percenthealth increase reproductive and in rights ‘CHOOSE LICENSEOhio shows to contraception everyone loses: be theare state’s well-documented problem with FUNDrural mortality as compared to urban counties. could suffer a major reversal PLATES ANTI-CHOICE there more unintended opioid abuse.more abortions, and ORGANIZATIONS/CRISIS The state ranks 12thinfor rural/urban 2017. Congressdifference and the new pregnancies, in mortality. Administration are expected to PREGNANCY CENTERS higher health care costs.” curtail access to contraceptive Ohio has the fifth highest rate of drug overdose Only 21 states received a services by blocking all funding This year’s report card also deaths (24.6 deaths per 100,000) in“B-“ the United RURAL RESOURCES or higher. Just five states for Planned Parenthood, draws attention to “a growing States. Unintentional drug overdose (California, has becomeNew Jersey, defunding Title X, a 48-year old national divide” on reproductive the leading cause of injury-related death in New Mexico, Oregon and resource organizations in Ohio Rural health program that provides support health and rights, and Walker Ohio, and in 2015 there were 3,050 Washington) overdose received an “A”. include: to family planning clinics warned that Alabama is “on The following states received deaths in the state. serving low-income households, the wrong side of that divide.” a failing grade in • 2016: Ohio State Office of eliminating Rural Healththe Affordable and Alabama, which received an “F”, Alabama, Arkansas, www.odh.ohio.gov/SORH Florida, In rural areas of the state, people have exCare Act’s no-cost birth control was one of 20 states receiving a Georgia, Idaho, Indiana, Kansas, tremely limited access to report medication-assisted • Appalachian Rural Health Walker Institutenoted that mandate. failing grade in the latest Louisiana, Missouri, treatment, a critical issue in the rural areas ofMississippi, www.ohio.edu/chsp/arhi “In the past five years most of card. Five years ago Alabama Nebraska, North Dakota, southwest Ohio where opioid abuse rates are slippageResource on reproductive • Carolina, Upper Midwest the Telehealth Center received a “D”. Oklahoma, South particularly high. health has occurred at the state www.umtrc.org South Dakota, Tennessee, Texas, level, but this year could see MANY FACTORS • Wisconsin. Integrating Professionals for Appalachian Children Utah, Virginia, and unprecedented setbacks at the ACCOUNTED Looking ahead,FOR Ohio also faces challenges www.ipacohio.org national level, including cuts ALABAMA’S FAILING GRADE with provider supply in rural counties. There Walker warned that “A woman’s in funding for comprehensive INCLUDING POOR SCORES are 137 Health Professional Shortage Areas health reproductive not For should more information about the data sex education in the schools IN PREVENTION AND designated for primary care in Ohio. depend on where she lives, but and methodology employed sources used and a return to abstinence only AFFORDABILITY it does, as women many2017 Rural Health Report Card, in in RHQ’s programs which have been reduced Using eleven criteria, the FACILITIESareas are experiencing RURAL HEALTH CARE visit www.RuralHealthQuarterly.com. proven to be ineffective.” access to reproductive health Institute’s report card ranked services including abortion.” eachRural of theHealth 50 states and the Hub, care The Information an organiWalker stressed that this Walker noted that 19 states, District of Columbia on four zation funded by the Federal Office of Rural year’s report card should be including Alabama, have refused broad indicators relating to Health Policy, reports that there are 33 Critical “an urgent call to action” for to expand Medicaid under the reproductive health and rights: anyone who is concerned Access Hospitals in the state, as well as 48 Affordable Care Act, leaving tens effectiveness, prevention, about reproductive health Rural Health Clinics and 45 Federally Qualified of millions of women without affordability, and access. Based and rights. “As disappointing Health Centers providing services 252 sites. access to contraception upon their composite scores (0- atimproved as 2016 was, 2017 could be 100), each state received a “core” and other health care services. a whole lot worse.” Walker also noted that in 27 grade (A, B, C, D or F), but some states received an additional


OHIO BY THE NUMBERS Ohio has an estimated population of 11,614,373 people, and 20.3 percent live in one of Ohio’s 50 rural counties. The poverty rate in rural Ohio is 14.3 percent, compared with 14.6 percent in urban areas of the state. 13.1 percent of the rural population has not completed high school, while 10.3 percent of the urban population lacks a high school diploma.

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9.7 percent of rural Ohio residents are U.S. military veterans, and 11.1 percent of the rural population under age 65 lives with a disability.

RURAL COUNTIES URBAN COUNTIES

93.1 percent of the state’s rural population is Non-Hispanic White, 2 percent is Black/African-American, 2.5 percent is Hispanic/Latino, 0.1 percent is American Indian/Alaska Native and 0.5 percent is Asian.

MORTALITY

QUALITY OF LIFE

Heart Disease: D

Fair/Poor Health: C- Primary Care: D-

Heart disease is the leading cause of death in Ohio, and the state is ranked 35th in the U.S. for the number of deaths by heart disease among rural residents. The age-adjusted rate for heart disease in rural counties is 203.5 per 100,000. The national average is 168.5 per 100,000.

The percentage of Ohioans reporting poor general health is close to the national average. The state ranked 29th for rural counties (16.6 percent) and 31/51 for urban counties (19.1 percent).

Ohio ranks 36th in the U.S. for the number of primary care physicians practicing in rural counties (48.7 per 100,000). The national average for rural counties is 54.5 per 100,000.

Mental Health: D+

Mental Care: D+

Cancer: D+

Rural residents of Ohio reported an average of 4 mentally unhealthy days in the past 30 days. The national average is 3.7 days. The state ranked 31st for self-reported mental health in rural counties.

Ohio ranks 30th in the U.S. for the number of psychiatrists practicing in rural counties. Ohio has 2.4 per 100,000 residents. The U.S. rural average is 3.4.

Cancer is the second leading cause of death in Ohio, and the state is ranked 30th in the U.S. for deaths by cancer among rural residents. The age-adjusted rate for cancer in rural counties is 177.1 per 100,000. The national average is 158.5 per 100,000.

CLRD: D Chronic lower respiratory disease (CLRD) is the third leading cause of death in Ohio, and the state is ranked 35th in the U.S. for deaths by CLRD among rural residents. The age-adjusted rate for CLRD in rural counties is 58.1 per 100,000. The national average is 41.6 per 100,000.

Physical Health: C The number of physically unhealthy days reported in rural Ohio is 3.9 in 30 days, while urban residents report 3.7 days. The national average is 3.9. Rural Ohio ranks 27th.

Low Birth Weight: C+ The percentage of live births with low birth weight (< 5 pounds, 8 ounces) in rural Ohio is 7.5 percent. The national average is 8 percent. Ohio ranks 22nd in the category.

ACCESS TO CARE

Dental Care: D Ohio ranks 34th in the nation for rural access to dental care with 37.5 dentists per 100,000 rural residents. The national rural average is 42.8.

Uninsured Rate: B 13 percent of Ohio’s rural population under age 65 is uninsured. The average uninsured rate for urban residents of Ohio is 10.9 percent. Ohio is one of 31 states that adopted Medicaid expansion as offered under the Affordable Care Act.

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IN FREE FALL: REPRODUCTIVE HEALTH AND RIGHTS IN AMERICA

F 41/47 OKLAHOMA ranks 41st in the nation for rural health out of 47 states with rural counties. Oklahoma is one of nine states receiving a failing grade.

OKLAHOMA RECEIVED A GRADE OF “F” BECAUSE: Oklahoma ranked in the fifth quintile of states for its rates of mortality in rural counties. Oklahoma ranked in the fourth quintile of states for measures of daily health and quality of life in rural counties. Oklahoma ranked in the fifth quintile of states for health care access in rural counties.

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OKLAHOMA

WASHINGTON, D.C. – In releasing its fifth annual 50-State Report Card on Reproductive Health and Rights, the Population Institute lowered the U.S. grade from a “D+” to a “D”. The report card, the most comprehensive report card of its kind, tracks multiple indicators of reproductive health and rights, including access to family planning and abortion services.

Along with Arkansas, Louisiana and Texas, Oklahoma is a member of the West The Institute’s president Robert Walker said, “For the past five years, reproductive health and South Central division of the South U.S. Census region. All four states in the division rights in the U.S. have been on a slippery slope.” Five years ago nine states received an “F”. In showed significant similarities in our reporting, and all four states received low grade. this year’s report card 20 states—including Alabama—received a failing grade. a Walker warned, The Sooner State (41) ranked behind Texas (36) and Arkansas (38) in the division, however, “The worst may be yet to come, as Congress and the new Administration are expected but it outperformed in the final rankings. sex education. The slippery slope to slash federal fundingLouisiana for family(46) planning and comprehensive is becoming a free fall.”

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today more than 50% of “plus” or a “minus” for factors Walker klahoma emphasized “It’srural population hasthat a large in health outcomes states between rural and urban women now live in a county not reflected in the core grade. not just abortion rights that are as a percentage of the total population counties. Oklahoma shows a 12.3 percent without an abortion provider. under siege; it’s also access to of the state. Oklahoma also has the increase in rural mortality as compared to ALABAMA RECEIVED A family planning services, and 4th highest deathaccess from all causes in BECAUSE urban counties. state ranks 31stfor for rural/ support “MINUS” THEIR TheFederal when womenrate areof denied the nation, according to aloses: 2014 State of the LIFE’urban difference in reproductive mortality. health and rights ‘CHOOSE LICENSE to contraception everyone State’s Health could suffer a major reversal PLATES FUND ANTI-CHOICE there are more Report. unintended RURAL RESOURCES in 2017. Congress and the new pregnancies, more abortions, and ORGANIZATIONS/CRISIS Tobacco use continues to preventAdministration are expected to CENTERS higher health care costs. ” be a leadingPREGNANCY curtail access toincontraceptive able cause of death in Oklahoma, according to Rural health resource organizations Oklahoma Only 21 states received a services by blocking all funding This year’s report card also a 2015 Oklahoma Health Improvement include: “B-“Plan. or higher. Just five states for Planned Parenthood, draws attention “a growing Smoking causes to about 6,000 deaths(California, per year New Jersey, defunding X, a 48-year old national divide” on reproductive in the state, more than alcohol, autoNew accidents, • Oklahoma Office of Rural Title Health Mexico, Oregon and program that provides support health and rights, and Walker HIV/AIDS, suicides, murders and illegal drugs Washington) received an “A”. www.healthsciences.okstate.edu/ruralto family planning clinics warned that Alabama is “on The following states received combined. Oklahoma’s adult smoking rate, 23.7 health/orh.cfmserving low-income households, the wrong side of that divide.” failing grade in 2016: percent, is still far above the nationalaaverage • Rural Health Association of Oklahoma and eliminating the Affordable Alabama, which received an “F”, Alabama, Arkansas, www.rhao.org Florida, of 17.8 percent. Approximately one in four Care Act’s no-cost birth control was one of 20 states receiving a Georgia, Idaho,• Indiana, Kansas,Telehealth Resource Center Oklahoma adults smoke one in five Heartland mandate. Walker noted that failing grade in the latestcompared report toLouisiana, Mississippi, Missouri, nationally. heartlandtrc.org “In the past five years most of card. Five years ago Alabama Nebraska, North Dakota, • OSU Center for Rural Health the slippage on reproductive received a “D”. Oklahoma, South Carolina, Oklahoma has made progress in recent years health has occurred at the state osururalhealth.blogspot.com South Dakota, Tennessee, Texas, but this year could see MANY FACTORS in reducing the state’s high uninsured rate, but and • Wisconsin. Rural Oklahomalevel, Network Utah, Virginia, unprecedented setbacks at the ACCOUNTED FOR that progress appears to have stalled. business.okstate.edu/chsi/research-netnational level, including cuts ALABAMA’S FAILING GRADE work.html Walker warned that “A woman’s in funding for comprehensive INCLUDING POOR SCORES RURAL HEALTH CARE FACILITIESreproductive health should not sex education in the schools IN PREVENTION AND depend on whereFor shemore lives, information but about the data and a return to abstinence only AFFORDABILITY as women in many The Rural Health Information Hub, itandoes, organisources used and methodology employed programs which have been are experiencing reduced Using eleven zation fundedcriteria, by thethe Federal Officeareas of Rural in RHQ’s 2017 Rural Health Report Card,” proven to be ineffective. to reproductive health Institute’s report card ranked Health Policy, reports that there areaccess 37 Critical visit www.RuralHealthQuarterly.com. services each ofHospitals the 50 states and the as wellcare Access in the state, as 58 Rural including abortion.” Walker stressed that this Walker noted that 19 states, District of Columbia on four Health Clinics and 20 Federally Qualified Health year’s report card should be including Alabama, have refused broad indicators relating to Centers providing services at 88 sites. “an urgent call to action” for to expand Medicaid under the reproductive health and rights: anyone who is concerned Affordable Care Act, leaving tens effectiveness, prevention, about reproductive health URBAN-RURAL DIVIDE of millions of women without affordability, and access. Based and rights. “As disappointing improved access to contraception upon their composite scores (0as 2016 was, 2017 could be and other health care services. 100), each state received “core” difference Most U.S. states report aamarked a whole lot worse.” Walker also noted that in 27 grade (A, B, C, D or F), but some states received an additional


OKLAHOMA BY THE NUMBERS Oklahoma has an estimated population of 3,923,561 people, and 34.3 percent live in one of Oklahomaâ&#x20AC;&#x2122;s 59 rural counties. The poverty rate in rural Oklahoma is 19 percent, compared with 15 percent in urban areas of the state.

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15 percent of the rural population has not completed high school, while 12 percent of the urban population lacks a high school diploma.

RURAL COUNTIES URBAN COUNTIES

10.1 percent of rural Oklahoma residents are U.S. military veterans, and 12.7 percent of the rural population under age 65 lives with a disability. 69.8 percent of the stateâ&#x20AC;&#x2122;s rural population is Non-Hispanic White, 3.3 percent is Black/African-American, 7.7 percent is Hispanic/Latino, 10.5 percent is American Indian/Alaska Native and 0.8 percent is Asian.

MORTALITY

QUALITY OF LIFE

Heart Disease: F

Fair/Poor Health: D- Primary Care: D-

Heart disease is the leading cause of death in Oklahoma, and the state is ranked last (47/47) in the U.S. for the number of deaths by heart disease among rural residents. The age-adjusted rate for heart disease in rural counties is 258.3 per 100,000. The national average is 168.5 per 100,000.

The percentage of Oklahomans reporting poor general health is among the highest in the nation. The state ranked 38th for rural counties (20.9 percent) and 42/51 for urban counties (17.6 percent).

Oklahoma ranks 38th in the U.S. for the number of primary care physicians practicing in rural counties (46.4 per 100,000). The national average for rural counties is 54.5 per 100,000.

Mental Health: D

Mental Care: D

Rural residents of Oklahoma reported an average of 4.3 mentally unhealthy days in the past 30 days. The national average is 3.7 days. The state ranked 35th for self-reported mental health in rural counties.

Oklahoma ranks 35th in the U.S. for the number of psychiatrists practicing in rural counties. Oklahoma has 2.1 per 100,000 residents. The U.S. rural average is 3.4.

Cancer: F Cancer is the second leading cause of death in Oklahoma, and the state is ranked 46th in the U.S. for deaths by cancer among rural residents. The ageadjusted rate for cancer in rural counties is 197.4 per 100,000. The national average is 158.5 per 100,000.

CLRD: F Chronic lower respiratory disease (CLRD) is the third leading cause of death in Oklahoma, and the state is ranked 46th in the U.S. for deaths by CLRD among rural residents. The ageadjusted rate for CLRD in rural counties is 73.5 per 100,000. The national average is 41.6 per 100,000.

Physical Health: F The number of physically unhealthy days reported in rural Oklahoma is 4.6 in 30 days, while urban residents report 4 days. The national average is 3.9. Rural Oklahoma ranks 40th.

Low Birth Weight: D+ The percentage of live births with low birth weight (< 5 pounds, 8 ounces) in rural Oklahoma is 7.9 percent. The national average of 8 percent. Oklahoma ranks 30th in the category.

ACCESS TO CARE

Dental Care: COklahoma ranks 27th in the nation for rural access to dental care with 42.9 dentists per 100,000 rural residents. The national rural average is 42.8.

Uninsured Rate: F 21.5 percent of Oklahoma rural population under age 65 is uninsured. The average uninsured rate for urban residents of Oklahoma is 18.1 percent. Oklahoma is one of 19 states that did not adopt Medicaid expansion as offered under the Affordable Care Act.

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IN FREE FALL: REPRODUCTIVE HEALTH AND RIGHTS IN AMERICA

C 26/47 OREGON ranks 26th in the nation for rural health out of 47 states with rural counties. Oregon is one of three states receiving a grade of “C” OREGON RECEIVED A GRADE OF “C” BECAUSE: Oregon ranked in the third quintile of states for its rates of mortality in rural counties. Oregon ranked in the third quintile of states for measures of daily health and quality of life in rural counties. Oregon ranked in the second quintile of states for health care access in rural counties.

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OREGON

WASHINGTON, D.C. – In releasing its fifth annual 50-State Report Card on Reproductive Health and Rights, the Population Institute lowered the U.S. grade from a “D+” to a “D”. The report card, the most comprehensive report card of its kind, tracks multiple indicators of reproductive health and rights, including access to family planning and abortion services.

Along with Alaska, California, Hawaii and Washington, Oregon is a member of the The Institute’s president Robert Walker said, “For the past five years, reproductive health and Pacific division of the West U.S. Census region. The other four states in the division rights in the U.S. have been on a slippery slope.” Five years ago nine states received an “F”. In rank in the top half of the nation for rural health, but Oregon (26) slips into the bottom this year’s report card 20 states—including Alabama—received a failing grade. Walker warned, half. The State ranks behind Hawaii (4), California Washington (17) however, Beaver “The worst may be yet to come, as Congress and the(15), new Administration are and expected Alaska in the final for divisional rankings. to slash(22) federal funding family planning and comprehensive sex education. The slippery slope is becoming a free fall.”

O

states than 50% of “plus” a “minus” for factors Walker emphasized that regon’s Office of “It’s Rural Health wentoron Health Policy, reports thattoday theremore are 25 Critical women now live in a county not reflected in the core grade. not just aabortion rights that are listening tour in 2016. In the process Access Hospitals in the state, as well as 83 without an abortion provider. under siege; it’s also access to they discovered that provider shortRural Health Clinics and 31 Federally Qualified ALABAMA RECEIVED A family planning services, and ages are a primary source of concern“MINUS” across BECAUSE Health THEIR Centers providing services at 214 sites. Federal support for when women are denied access rural areas of the state. Discussion focused on reproductive health and rights ‘CHOOSE LIFE’ LICENSE to contraception everyone loses: recruiting primary care providers, PLATES dentists,FUNDURBAN-RURAL could suffer a major reversal ANTI-CHOICE DIVIDE there are more unintended behavioral specialistsand and ancillary in 2017. Congress and the new ORGANIZATIONS/CRISIS pregnancies,health more abortions, staff. Most U.S. states report a marked difference Administration are expected to PREGNANCY CENTERS higher health care costs.” curtail access toand contraceptive in health outcomes between rural urban Only 21 states received a services by blocking all funding This year’srural report also areas are Oregon’s andcard frontier also counties. Oregon shows a 15.4 percent “B-“ or higher. Just five states for Planned Parenthood, draws attention to “a growing experiencing nursing shortages and(California, are facing Newincrease Jersey, in rural mortality as compared to a 48-year nationalprojected divide” on reproductive severe challenges with recruiting urban counties. Thedefunding state ranksTitle 33rdX,for rural/ old New Mexico, Oregon and program that provides support health and rights, and Walker and retaining nurses. urban difference in mortality. Washington) received an “A”. to family planning clinics warned that Alabama is “on The following states received serving low-income households, the wrong side of that divide.” grade in 2016: RESOURCES The state’s rapidly aging population aisfailing another RURAL and eliminating the Affordable Alabama, which received an “F”, Alabama, cause for concern. As of 2016, Oregon was Arkansas, Florida, Care Act’s no-cost birth control was one of 20 states receiving a Georgia, Idaho, Indiana, Kansas, home overinhalf million residents aged 65 Rural health resource organizations Oregon mandate. Walkerinnoted that failing to grade thealatest report Louisiana, Missouri, years and years older,ago of which 43.5 percent reside Mississippi, include: “In the past five years most of card. Five Alabama Nebraska, North Dakota, in rural areas, is the slippage on reproductive received a “D”. and the 65+ population Oklahoma, South Carolina, expected to double by 2050. health occurred at the state • Oregon Office of Ruralhas Health South Dakota, Tennessee, Texas, level, but this year could see MANY FACTORS www.ohsu.edu/xd/outreach/oregonUtah, Virginia, and Wisconsin. unprecedented setbacks at the ACCOUNTEDcounties FOR Twenty-three have a life expectancy rural-health/index.cfm national level, including cuts ALABAMA’S FAILING GRADE below the state average, and 18 ofWalker thesewarned are that • “A Oregon Rural Health Association woman’s in funding for comprehensive INCLUDING POOR SCORES rural counties. reproductive health should not www.orha.org sex education in the schools IN PREVENTION AND depend on where lives, but Regional Telehealth Resource • sheNorthwest and a return to abstinence only AFFORDABILITY many nrtrc.org RURAL HEALTH CARE FACILITIESit does, as women in Center: programs which have been areas are experiencing reduced Using eleven criteria, the • Oregon Rural Practice-based Research Network proven to be ineffective. ” access to reproductivewww.ohsu.edu/xd/outreach/oregonhealth report card ranked AInstitute’s consistently discussed challenge for facilities services including abortion.” each the 50 states on theoflistening tour and was the the lack ofcare acute rural-practice-based-research-network/ Walker stressed that this Walker noted that 19 states, District of Columbia on four care availability in their areas. This shortage index.cfm year’s report card should be including Alabama, have refused broad indicators relating to includes acute mental health care beds, sub“an urgent call to action” for to expand Medicaid under the reproductive health and rights: stance abuse treatment and long-term care. anyone who concerned For more information about theis data Affordable Care Act, leaving tens effectiveness, prevention, about reproductive health sources used and methodology employed of millions of women without affordability, and access. Based and rights.Report “As disappointing The Rural Health Information Hub, an organiin RHQ’s 2017 Rural Health Card, improved access to contraception upon their composite scores (0as 2016 was, 2017 could be zation funded the Federal Officeand of Rural other healthvisit carewww.RuralHealthQuarterly.com. services. 100), each statebyreceived a “core” a whole lot worse.” Walker also noted that in 27 grade (A, B, C, D or F), but some states received an additional


OREGON BY THE NUMBERS Oregon has an estimated population of 4,093,465 people, and 16.2 percent live in one of Oregon’s 23 rural counties. The poverty rate in rural Oregon is 15.4 percent, compared with 13 percent in urban areas of the state. 12.7 percent of the rural population has not completed high school, while 9.7 percent of the urban population lacks a high school diploma.

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13.5 percent of rural Oregon residents are U.S. military veterans, and 13.7 percent of the rural population under age 65 lives with a disability. RURAL COUNTIES URBAN COUNTIES

80.6 percent of the state’s rural population is Non-Hispanic White, 0.5 percent is Black/African-American, 12.5 percent is Hispanic/Latino, 2.2 percent is American Indian/Alaska Native and 0.9 percent is Asian.

MORTALITY

QUALITY OF LIFE

ACCESS TO CARE

Cancer: D+

Fair/Poor Health: D+

Primary Care: A-

Cancer is the leading cause of death in Oregon, and the state is ranked 32nd in the U.S. for deaths by cancer among rural residents. The age-adjusted rate for cancer in rural counties is 180.4 per 100,000. The national average is 158.5 per 100,000.

The percentage of Oregonians reporting poor general health is close to the national average. The state ranked 30th for rural counties (16.9 percent) and 25/51 for urban counties (14.4 percent).

Oregon ranks 9th in the U.S. for the number of primary care physicians practicing in rural counties (71.8 per 100,000). The national average for rural counties is 54.5 per 100,000.

Heart Disease: A

Mental Health: F

Mental Care: C

Rural residents of Oregon reported an average of 4.5 mentally unhealthy days in the past 30 days. The national average is 3.7 days. The state ranked 42nd for self-reported mental health in rural counties.

Oregon ranks 27th in the U.S. for the number of psychiatrists practicing in rural counties. Oregon has 2.6 per 100,000 residents. The U.S. rural average is 3.4.

Heart disease is the second leading cause of death in Oregon, yet the state is ranked 7th in the U.S. for the low number of deaths by heart disease among rural residents. The age-adjusted rate for heart disease in rural counties is 151 per 100,000. The national average is 168.5 per 100,000.

CLRD: D Chronic lower respiratory disease (CLRD) is the third leading cause of death in Oregon, and the state is ranked 33rd in the U.S. for deaths by CLRD among rural residents. The ageadjusted rate for CLRD in rural counties is 55.8 per 100,000. The national average is 41.6 per 100,000.

Physical Health: DThe number of physically unhealthy days reported in rural Oregon is 4.5 in 30 days, while urban residents report 3.9 days. The national average is 3.9. Rural Oregon ranks 36th.

Low Birth Weight: B+ The percentage of live births with low birth weight (< 5 pounds, 8 ounces) in rural Oregon is 6.6 percent. The national average of 8 percent. Oregon ranks 12th in the category.

Dental Care: A Oregon ranks 4th in the nation for rural access to dental care with 66.1 dentists per 100,000 rural residents. The national rural average is 42.8.

Uninsured Rate: C17 percent of Oregon’s rural population under age 65 is uninsured. The average uninsured rate for urban residents of Oregon is 14 percent. Oregon is one of 31 states that adopted Medicaid expansion as offered under the Affordable Care Act.

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IN FREE FALL: REPRODUCTIVE HEALTH AND RIGHTS IN AMERICA

C 25/47 PENNSYLVANIA ranks 25th in the nation for rural health out of 47 states with rural counties. Pennsylvania is one of three states receiving a grade of “C” PENNSYLVANIA RECEIVED A GRADE OF “C” BECAUSE: Pennsylvania ranked in the third quintile of states for its rates of mortality in rural counties. Pennsylvania ranked in the second quintile of states for measures of daily health and quality of life in rural counties. Pennsylvania ranked in the second quintile of states for health care access in rural counties.

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PENNSYLVANIA

WASHINGTON, D.C. – In releasing its fifth annual 50-State Report Card on Reproductive Health and Rights, the Population Institute lowered the U.S. grade from a “D+” to a “D”. The report card, the most comprehensive report card of its kind, tracks multiple indicators of reproductive health and rights, including access to family planning and abortion services.

Along with New Jersey and New York, the Keystone State is part of the Mid-Atlantic The Institute’s president Robert Walker said, “For the past five years, reproductive health and division of the Northeast U.S. Census region. Excluding New Jersey, a state with rights in the U.S. have been on a slippery slope.” Five years ago nine states received an “F”. In no rural counties, Mid-Atlantic states rank near the middle of the nation for rural this year’s report card 20 states—including Alabama—received a failing grade. Walker warned, health. (25) ranks lowerasthan neighboring state New York (18). however,Pennsylvania “The worst may be yet to come, Congress and the new Administration are expected to slash federal funding for family planning and comprehensive sex education. The slippery slope is becoming a free fall.”

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states services today more thansites. 50% of “plus”rural or a “minus” for factors Walker emphasized that “It’s ennsylvania has the third largest Health Centers providing at 252 women now live in a county not reflected in the core grade. not just abortion rights that are population of any state, if you’re without an abortion provider. under siege; it’s also access to counting heads. One out of every five URBAN-RURAL DIVIDE ALABAMA RECEIVED A family planning services, and Pennsylvanians lives in a rural area,“MINUS” but many BECAUSE THEIR Federal support for when women are denied access face limited access to care and uneven resultsLIFE’Most U.S. states report a markedhealth difference reproductive and rights ‘CHOOSE LICENSE to contraception everyone loses: in terms health outcomes. health outcomes could between rural and urban suffer a major reversal PLATES FUNDinANTI-CHOICE there areof more unintended in 2017. Congress and the new pregnancies, more abortions, and ORGANIZATIONS/CRISIS counties. Pennsylvania shows a 6.2 percent Preventable in ruralPREGNANCY areas Administration are expected to CENTERS higher health hospital care costs.stays ” increase in rural mortality as compared to topped 67 per 1,000 Medicare enrollees, curtail access19th to contraceptive urban counties. The state ranks for rural/ Only 21 states received a services by blocking all funding This year’s to report card1,000 also Medicare compared 57 per enrollees urban in mortality. “B-“ or higher. Just fivedifference states for Planned Parenthood, draws attention to “a growing statewide. (California, New Jersey, defunding Title X, a 48-year old national divide” on reproductive New Mexico, Oregon RURALand RESOURCES program that provides support health and rights, and Walker The state has launched a number Washington) of recent received an “A”. to family planning clinics warned that Alabama is “on initiatives to improve the health of Pennsylvania’s The following states Ruralreceived health resource organizations inhouseholds, Pennserving low-income the wrong side of that divide.” a failing 2016: include: rural residents, including a prescription druggrade in sylvania and eliminating the Affordable Alabama, which received an “F”, Alabama, Arkansas, Florida, monitoring program, the expansion of telehealth Care Act’s no-cost birth control was one of 20 states receiving a Georgia, Idaho, Indiana, Kansas, services and an increased use of community • Pennsylvania Office of Rural Health mandate. Walker noted that failing grade in the latest report Louisiana, Mississippi, Missouri, health workers. “In the past five years most of card. Five years ago Alabama www.porh.psu.edu Nebraska, North Dakota, the slippage on reproductive received a “D”. • Carolina, Pennsylvania Rural Health Association Oklahoma, South The Pennsylvania Rural Health Model is a new health has occurred at the state www.paruralhealth.org South Dakota, Tennessee, Texas, Centers Medicare & Medicaid Services level, but Resource this year could see MANY for FACTORS • Wisconsin. Mid-Atlantic Telehealth Center Utah, Virginia, and ACCOUNTED FOR (CMS) alternative payment model designed www.matrc.orgunprecedented setbacks at the national level, including cuts ALABAMA’S FAILING GRADE to improve health and health care inWalker rural warned that woman’s • “A Center for Rural Health Practice in funding for comprehensive INCLUDING POOR SCORES Pennsylvania. There will be seven performance reproductive health should not www.upb.pitt.edu/crhp sex education in the schools IN PREVENTION AND years for the program, which begandepend on Januon where she lives, but and a return to abstinence only AFFORDABILITY ary 12, 2017 and will conclude on December it does, as women many information about the data Forinmore programs which have been areas are experiencing reduced Using eleven criteria, the 31, 2023. sources used and methodology employed proven to be ineffective. ” access to reproductive health Institute’s report card ranked in RHQ’s 2017 Rural Health Report Card, care services including abortion.” each of the 50 states andFACILITIES the RURAL HEALTH CARE visit www.RuralHealthQuarterly.com. Walker stressed that this Walker noted that 19 states, District of Columbia on four year’s report card should be including Alabama, have refused broad indicators relating to The Rural Health Information Hub, an organi“an urgent call to action” for to expand Medicaid under the reproductive health and rights: zation funded by the Federal Office of Rural anyone who is concerned Affordable Care Act, leaving tens effectiveness, prevention, about reproductive health Health Policy, reports that there are 15 Critical of millions of women without affordability, and access. Based and rights. “As disappointing Access Hospitals in the state, as well as 72 improved access to contraception upon their composite scores (0as 2016 was, 2017 could be Rural Health Clinics and 44 Federally Qualified and other health care services. 100), each state received a “core” a whole lot worse.” Walker also noted that in 27 grade (A, B, C, D or F), but some states received an additional


PENNSYLVANIA BY THE NUMBERS Pennsylvania has an estimated population of 12,784,227 people, and 11.5 percent live in one of Pennsylvania’s 30 rural counties. The poverty rate in rural Pennsylvania is 13.8 percent, compared with 12.8 percent in urban areas of the state.

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12.6 percent of the rural population has not completed high school, while 10.5 percent of the urban population lacks a high school diploma. 10.5 percent of rural Pennsylvania residents are U.S. military veterans, and 11.3 percent of the rural population under age 65 lives with a disability. RURAL COUNTIES URBAN COUNTIES

94 percent of the state’s rural population is Non-Hispanic White, 2.2 percent is Black/African-American, 2 percent is Hispanic/Latino, 0.1 percent is American Indian/Alaska Native and 0.5 percent is Asian.

MORTALITY

QUALITY OF LIFE

Heart Disease: C-

Fair/Poor Health: B- Primary Care: C-

Heart disease is the leading cause of death in Pennsylvania, and the state is ranked 28th in the U.S. for the number of deaths by heart disease among rural residents. The age-adjusted rate for heart disease in rural counties is 193.3 per 100,000. The national average is 168.5 per 100,000.

The percentage of Pennsylvanians reporting poor general health is close to the national average. The state ranked 18th for rural counties (14.1 percent) and 24/51 for urban counties (14.1 percent).

Pennsylvania ranks 28th in the U.S. for the number of primary care physicians practicing in rural counties (52 per 100,000). The national average for rural counties is 54.5 per 100,000.

Mental Health: C

Mental Care: B

Rural residents of Pennsylvania reported an average of 3.8 mentally unhealthy days in the past 30 days. The national average is 3.7 days. The state ranked 24th for self-reported mental health in rural counties.

Pennsylvania ranks 14th in the U.S. for the number of psychiatrists practicing in rural counties. Pennsylvania has 4 per 100,000 residents. The U.S. rural average is 3.4.

Cancer: CCancer is the second leading cause of death in Pennsylvania, and the state is ranked 29th in the U.S. for deaths by cancer among rural residents. The ageadjusted rate for cancer in rural counties is 175.4 per 100,000. The national average is 158.5 per 100,000.

Accidents: CAccidents are the third leading cause of death in Pennsylvania, and Pennsylvania ranked 29th out of 47 states for accidental death in rural counties. The statewide rate for accidental death is 59.1 per 100,000. The national average is 43.2 per 100,000.

Physical Health: B The number of physically unhealthy days reported in rural Pennsylvania is 3.6 in 30 days, while urban residents report 3.4 days. The national average is 3.9. Rural Pennsylvania ranks 15th.

Low Birth Weight: C+ The percentage of live births with low birth weight (< 5 pounds, 8 ounces) in rural Pennsylvania is 7.4 percent. The national average is 8 percent. Pennsylvania ranks 21st in the category.

ACCESS TO CARE

Dental Care: CPennsylvania ranks 28th in the nation for rural access to dental care with 41.4 dentists per 100,000 rural residents. The national rural average is 42.8.

Uninsured Rate: B+ 12.2 percent of Pennsylvania’s rural population under age 65 is uninsured. The average uninsured rate for urban residents of Pennsylvania is 10.1 percent. Pennsylvania is one of 31 states that adopted Medicaid expansion as offered under the Affordable Care Act.

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F 44/47 SOUTH CAROLINA ranks 44th in the nation for rural health out of 47 states with rural counties. South Carolina is one of nine states receiving a failing grade. SOUTH CAROLINA RECEIVED A GRADE OF “F” BECAUSE: South Carolina ranked in the fifth quintile of states for its rates of mortality in rural counties. South Carolina ranked in the fifth quintile of states for measures of daily health and quality of life in rural counties. South Carolina ranked in the fourth quintile of states for health care access in rural counties.

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SOUTH CAROLINA

WASHINGTON, D.C. – In releasing its fifth annual 50-State Report Card on Reproductive Health and Rights, the Population Institute lowered the U.S. grade from a “D+” to a “D”. The report card, the most comprehensive report card of its kind, tracks multiple indicators of reproductive health and rights, including access to family planning and abortion services.

Along with Delaware, Florida, Georgia, Maryland, North Carolina, Virginia and West The Institute’s president Robert Walker said, “For the past five years, reproductive health and Virginia, South Carolina is part of the South Atlantic division of the South U.S. Census rights in the U.S. have been on a slippery slope.” Five years ago nine states received an “F”. In region. With the exception of northernmost division members Maryland and Delaware this year’s report card 20 states—including Alabama—received a failing grade. Walker warned, (a state rural counties), in the and division have low rural health rankhowever,with “Theno worst may be yet tomost come,states as Congress the new Administration are expected ings. Thefederal Palmetto Stateforranked in theand division (44), behind Virginiaslope to slash funding familylast planning comprehensive sexMaryland education.(16), The slippery (32), North Carolina (34), Florida (37), West Virginia (39) and Georgia (40). is becoming a free fall.”

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today more than 50% of “plus” or a “minus” for factors Walker emphasized thatmore “It’s than one outh Carolina has million in health outcomes states between rural and urban women now live in a county not reflected in the core grade. not just abortion rights that are rural residents, and rural areas of the counties. South Carolina shows a 14.9 percent without an abortion provider. under siege; it’s also access to state have a larger proportion of African- increase in rural mortality as compared to ALABAMA RECEIVED A family planning services, and American residents. urban counties. TheFederal state ranks 38th for rural/ support for “MINUS” BECAUSE THEIR when women are denied access urban difference in mortality. reproductive health and rights ‘CHOOSE LIFE’ LICENSE to contraception everyone loses: In 2016, South Carolina Office PLATES of Rural FUND ANTI-CHOICE could suffer a major reversal there arethe more unintended Health launched South Carolina Rural RURAL RESOURCES in 2017. Congress and the new pregnancies, morethe abortions, and ORGANIZATIONS/CRISIS Health Action care Plancosts. Task”Force to improve the Administration are expected to PREGNANCY CENTERS higher health state’s attempts to provide quality rural health curtail access to contraceptive Rural health resource organizations in South Only 21 states received a services by blocking all funding This year’s report card also care. Task force recommendations, designed to Carolina include: “B-“ or higher. Just five states for Planned Parenthood, draws attention to “a growing be achieved by the end of 2022, include ensur- New Jersey, (California, defunding Title X, a 48-year old national divide” on reproductive ing every one has adequate and appropriate • South New Mexico, Oregon and Carolina Office of Rural Health program that provides support health and rights, and Walker access, locally or via telehealth, to health care; received scorh.net Washington) an “A”. to family planning clinics warned that Alabama is “on supporting efforts to recruit and retain rural The following states received • Southeastern Telehealth Resource Center serving low-income households, the wrong side of that divide.” a failing health care professionals; and advocating forgrade in 2016: www.setrc.us and eliminating the Affordable Alabama, which received an “F”, Alabama, Florida,Carolina Rural Health Research every rural resident “to have a mechanism to Arkansas, • South Care Act’s no-cost birth control was one of 20 states receiving a Georgia, Idaho, Indiana, Kansas, receive timelyinhealth carereport services so that they Center: rhr.sph.sc.edu mandate. Walker noted that failing grade the latest do notFive delay care due to an inabilityLouisiana, to pay.” Mississippi, Missouri, “In the past five years most of card. years ago Alabama Nebraska, North Dakota, For more information the the about slippage ondata reproductive received a “D”. Oklahoma, South Carolina, The task force also made recommendations sources used and methodology employed health has occurred at the state South Dakota, Tennessee, Texas, concerning community assets and leadership, level, but this year Card, could see MANY FACTORS in RHQ’s 2017 Rural Health Report Utah, Virginia, and Wisconsin. unprecedented setbacks at the ACCOUNTED FOR economic development, education and housing. visit www.RuralHealthQuarterly.com. national level, including cuts ALABAMA’S FAILING GRADE Walker warned that “A woman’s in funding for comprehensive INCLUDING POOR SCORES RURAL HEALTH CARE FACILITIESreproductive health should not sex education in the schools IN PREVENTION AND depend on where she lives, but and a return to abstinence only AFFORDABILITY as women in many The Rural Health Information Hub, itandoes, organiprograms which have been areas are experiencing reduced Using eleven criteria, the zation funded by the Federal Office of Rural proven to be ineffective.” to reproductive health Institute’s report card ranked Health Policy, reports that there areaccess five Critieach of theHospitals 50 states in and the cal Access the state, ascare wellservices as 87 including abortion.” Walker stressed that this Walker noted that 19 states, District of Columbia on four Rural Health Clinics and 22 Federally Qualified year’s report card should be including Alabama, have refused broad indicators relating to Health Centers providing services at 173 sites. “an urgent call to action” for to expand Medicaid under the reproductive health and rights: anyone who is concerned Affordable Care Act, leaving tens effectiveness, prevention, about reproductive health URBAN-RURAL DIVIDE of millions of women without affordability, and access. Based and rights. “As disappointing improved access to contraception upon their composite scores (0as 2016 was, 2017 could be Most U.S. states report aamarked and other health care services. 100), each state received “core” difference a whole lot worse.” Walker also noted that in 27 grade (A, B, C, D or F), but some states received an additional


SOUTH CAROLINA BY THE NUMBERS South Carolina has an estimated population of 4,863,300 people, and 23.7 percent live in one of South Carolina‘s 20 rural counties. The poverty rate in rural South Carolina is 20.4 percent, compared with 14.4 percent in urban areas of the state. 21.5 percent of the rural population has not completed high school, while 13.9 percent of the urban population lacks a high school diploma.

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9.2 percent of rural South Carolina residents are U.S. military veterans, and 13.6 percent of the rural population under age 65 lives with a disability. RURAL COUNTIES URBAN COUNTIES

54.2 percent of the state’s rural population is Non-Hispanic White, 39.9 percent is Black/African-American, 3.5 percent is Hispanic/Latino, 0.5 percent is American Indian/Alaska Native and 0.5 percent is Asian.

MORTALITY

QUALITY OF LIFE

ACCESS TO CARE

Heart Disease: F

Fair/Poor Health: D-

Primary Care: D

Heart disease is the leading cause of death in South Carolina, and the state is ranked 39th in the U.S. for the number of deaths by heart disease among rural residents. The age-adjusted rate for heart disease in rural counties is 212.8 per 100,000. The national average is 168.5 per 100,000.

The percentage of South Carolinians reporting poor general health is among the highest in the nation. The state ranked 36th for rural counties (20.7 percent) and 32/51 for urban counties (15.7 percent).

South Carolina ranks 33rd in the U.S. for the number of primary care physicians practicing in rural counties (50.2 per 100,000). The national average for rural counties is 54.5 per 100,000.

Mental Health: F

Mental Care: D-

Rural residents of South Carolina reported an average of 4.1 mentally unhealthy days in the past 30 days. The national average is 3.7 days. The state ranked 41st for self-reported mental health in rural counties.

South Carolina ranks 36th in the U.S. for the number of psychiatrists practicing in rural counties. South Carolina has 2.1 per 100,000 residents. The U.S. rural average is 3.4.

Cancer: DCancer is the second leading cause of death in South Carolina, and the state is ranked 38th in the U.S. for deaths by cancer among rural residents. The ageadjusted rate for cancer in rural counties is 188.8 per 100,000. The national average is 158.5 per 100,000.

CLRD: C+ Chronic lower respiratory disease (CLRD) is the third leading cause of death in South Carolina, and the state is ranked 22nd in the U.S. for deaths by CLRD among rural residents. The ageadjusted rate for CLRD in rural counties is 50.3 per 100,000. The national average is 41.6 per 100,000.

Physical Health: DThe number of physically unhealthy days reported in rural South Carolina is 4.6 in 30 days, while urban residents report 3.8 days. The national average is 3.9. Rural South Carolina ranks 38th.

Low Birth Weight: F The percentage of live births with low birth weight (< 5 pounds, 8 ounces) in rural South Carolina is 11.3 percent, well above the national average of 8 percent. South Carolina ranks 46th in the category.

Dental Care: F South Carolina ranks 43rd in the nation for rural access to dental care with 32 dentists per 100,000 rural residents. The national rural average is 42.8.

Uninsured Rate: D 19.2 percent of South Carolina’s rural population under age 65 is uninsured. The average uninsured rate for urban residents of South Carolina is 16.6 percent. South Carolina is one of 19 states that did not adopt Medicaid expansion as offered under the Affordable Care Act.

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B+ 11/47 SOUTH DAKOTA ranks 11th in the nation for rural health out of 47 states with rural counties. South Dakota is one of three states receiving a grade of “B+” SOUTH DAKOTA RECEIVED A GRADE OF “B+” BECAUSE: South Dakota ranked in the second quintile of states for its rates of mortality in rural counties. South Dakota ranked in the first quintile of states for measures of daily health and quality of life in rural counties. South Dakota ranked in the third quintile of states for health care access in rural counties.

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SOUTH DAKOTA

WASHINGTON, D.C. – In releasing its fifth annual 50-State Report Card on Reproductive Health and Rights, the Population Institute lowered the U.S. grade from a “D+” to a “D”. The report card, the most comprehensive report card of its kind, tracks multiple indicators of reproductive health and rights, including access to family planning and abortion services.

Along with Iowa, Kansas, Minnesota, Missouri, Nebraska and North Dakota, South Dakota The Institute’s president Robert Walker said, “For the past five years, reproductive health and is a member of the West North Central division of the Midwest U.S. Census region. rights in the U.S. have been on a slippery slope.” Five years ago nine states received an “F”. In Most members of the West North Central division rank near the top of the nation for this year’s report card 20 states—including Alabama—received a failing grade. Walker warned, rural health, Kansas and (35) underperform. South Dakota are (11)expected however, “Thebut worst may (24) be yet to Missouri come, as Congress and the new Administration outperforms Missouri, but the Rushmore State fallsThe behind to slash federalKansas fundingand for family planning and Mount comprehensive sex education. slippery slope Minnesota Nebraska (8), Iowa (9) and North Dakota (10) in the final rankings. is becoming (5), a free fall.”

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more Qualified than 50% of “plus” or a “minus” forHealth factorsClinics states Walker emphasized that “It’s rural population outh Dakota has a large Rural and sixtoday Federally women now live in county not reflected in the core grade. not just abortion rights that are percentage (51.9 percent) spread across Health Centers providing services at 49a sites. without an abortion provider. under siege; it’s also access to an equally large land mass. Nevertheless, ALABAMA RECEIVED A family planning services, and the state performs well in this year’s RHQ URBAN-RURAL DIVIDE Federal support for “MINUS” BECAUSE THEIR when women are denied access Rural Health Report Card. reproductive health and rights ‘CHOOSE LIFE’ LICENSE to contraception everyone loses: U.S. states report a marked could suffer a difference major reversal PLATES FUNDMost ANTI-CHOICE there are more unintended As is the casemore with abortions, many surrounding states, in health outcomes in between rural andand urban 2017. Congress the new pregnancies, and ORGANIZATIONS/CRISIS however, South Dakota ‘rural counties. South Dakota shows a 12.5 Administration arepercent expected to PREGNANCY CENTERS higher health care costs.”is experiencing flight,’ where, despite falling populations in rucurtail access to contraceptive increaseain rural mortality as compared to Only 21 states received services by blocking all funding This year’s report card also ral counties, the overall population of the state urban counties. The state ranks 30th for rural/ “B-“ or higher. Just five states for Planned Parenthood, draws attention to “a growing is increasing. This trend is active among health Newurban difference in mortality. (California, Jersey, defunding Title X, a 48-year old national divide”as onwell. reproductive care providers, New Mexico, Oregon and program that provides support health and rights, and Walker Washington) received “A”. RURALanRESOURCES to family planning clinics warned that Alabama is “on According to the South Dakota Department The following states received serving low-income households, the wrong side of that divide.” a failing 2016: of Health Office of Rural Health, there are 86grade in Rural health resource inAffordable South andorganizations eliminating the Alabama, which received an “F”, Alabama, Florida, primary care shortage area designations of Arkansas, Dakota include: Care Act’s no-cost birth control was one of 20 states receiving a Georgia, Idaho, Indiana, Kansas, various typesin (geographic areas, population mandate. Walker noted that failing grade the latest report Louisiana, Missouri, groups andyears facilities) across South Dakota, andMississippi, • South Dakota Office Rural “In theofpast fiveHealth years most of card. Five ago Alabama Nebraska, North Dakota, the threeaareas the slippage on reproductive doh.sd.gov/providers/RuralHealth received “D”. with the greatest shortages Oklahoma, South Carolina, are located on tribal land or are Indian Health health has occurred at the state • Office Texas, of Rural Health, EMS Program South Dakota, Tennessee, Service level, but this year could see MANY Facilities. FACTORS dps.sd.gov Utah, Virginia, and Wisconsin. unprecedented setbacks at the ACCOUNTED FOR • Great Plains Telehealth Resource Center national level, including cuts ALABAMA’S FAILING GRADE In addition, more than half of all counties in www.gptrac.org Walker warned that “A woman’s in funding for comprehensive INCLUDING POOR designated SCORES dental the state represent health health reproductive • should Rural not Office of Community Services sex education in the schools IN PREVENTION AND shortage areas based on rural geography dependoron where shedss.sd.gov/economicassistance/commulives, but and a return to abstinence only AFFORDABILITY low-income, and all but two of the itlargest does, as women in nityassistance/rural.aspx many programs which have been areas are experiencing reduced Using eleven criteria, the metropolitan areas of the state are designated proven to be ineffective.” health Institute’s ranked as mental report healthcard shortage areas. access to reproductive For more information about the data care services including abortion.” each of the 50 states and the sources used and methodology employed Walker stressed that this 19 states, District of Columbia on four RURAL HEALTH CARE FACILITIESWalker noted that in RHQ’s 2017 Rural Health Report year’s report card Card, should be including Alabama, have refused broad indicators relating to “an urgent call to action” for visit www.RuralHealthQuarterly.com. to expand Medicaid under the reproductive health and rights: The Rural Health Information Hub, Affordable an organi- Care Act, leaving tens anyone who is concerned effectiveness, prevention, about reproductive health zation funded by the Federal Office of Rural of millions of women without affordability, and access. Based and rights. “As disappointing Health Policy, reports that there are 38 Critical improved access to contraception upon their composite scores (0as 2016 was, 2017 could be Access Hospitals in the state, as well as other 60 health care services. and 100), each state received a “core” a whole lot worse.” Walker also noted that in 27 grade (A, B, C, D or F), but some states received an additional


SOUTH DAKOTA BY THE NUMBERS South Dakota has an estimated population of 865,454 people, and 51.9 percent live in one of South Dakota’s 58 rural counties. The poverty rate in rural South Dakota is 15.3 percent, compared with 11 percent in urban areas of the state.

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10.2 percent of the rural population has not completed high school, while 7.8 percent of the urban population lacks a high school diploma.

RURAL COUNTIES URBAN COUNTIES

9.5 percent of rural South Dakota residents are U.S. military veterans, and 8.6 percent of the rural population under age 65 lives with a disability. 80.9 percent of the state’s rural population is Non-Hispanic White, 0.7 percent is Black/African-American, 2.6 percent is Hispanic/Latino, 12.6 percent is American Indian/Alaska Native and 1.1 percent is Asian.

MORTALITY

QUALITY OF LIFE

ACCESS TO CARE

Heart Disease: A-

Fair/Poor Health: A

Primary Care: B-

Heart disease is the leading cause of death in South Dakota, and the state is ranked 10th in the U.S. for the number of deaths by heart disease among rural residents. The age-adjusted rate for heart disease in rural counties is 156.8 per 100,000. The national average is 168.5 per 100,000.

The percentage of South Dakotans reporting poor general health is among the lowest in the nation. The state ranked 5th for rural counties (12.6 percent) and 4/51 for urban counties (11.1 percent).

South Dakota ranks 19th in the U.S. for the number of primary care physicians practicing in rural counties (59.8 per 100,000). The national average for rural counties is 54.5 per 100,000.

Mental Health: A+

Mental Care: C

Rural residents of South Dakota reported an average of 2.8 mentally unhealthy days in the past 30 days. The national average is 3.7 days. The state ranked 1st nationally for self-reported mental health in rural counties.

South Dakota ranks 25th in the U.S. for the number of psychiatrists practicing in rural counties. South Dakota has 2.9 per 100,000 residents. The U.S. rural average is 3.4.

Cancer: B+ Cancer is the second leading cause of death in South Dakota, and the state is ranked 11th in the U.S. for deaths by cancer among rural residents. The ageadjusted rate for cancer in rural counties is 154.5 per 100,000. The national average is 158.5 per 100,000.

CLRD: B Chronic lower respiratory disease (CLRD) is the third leading cause of death in South Dakota, and the state is ranked 15th in the U.S. for deaths by CLRD among rural residents. The ageadjusted rate for CLRD in rural counties is 46.7 per 100,000. The national average is 41.6 per 100,000.

Physical Health: A The number of physically unhealthy days reported in rural South Dakota is 3.2 in 30 days, while urban residents report 3 days. The national average is 3.9. Rural South Dakota ranks 5th.

Low Birth Weight: A The percentage of live births with low birth weight (< 5 pounds, 8 ounces) in rural South Dakota is 6.1 percent. The national average is 8 percent. South Dakota ranks 5th in the category.

Dental Care: C+ South Dakota ranks 21st in the nation for rural access to dental care with 51.6 dentists per 100,000 rural residents. The national rural average is 42.8.

Uninsured Rate: B14.4 percent of South Dakota’s rural population under age 65 is uninsured. The average uninsured rate for urban residents of South Dakota is 11.1 percent. South Dakota is one of 19 states that did not adopt Medicaid expansion as offered under the Affordable Care Act.

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IN FREE FALL: REPRODUCTIVE HEALTH AND RIGHTS IN AMERICA

F 43/47 TENNESSEE ranks 43rd in the nation for rural health out of 47 states with rural counties. Tennessee is one of nine states receiving a failing grade. TENNESSEE RECEIVED A FAILING GRADE BECAUSE: Tennessee ranked in the fifth quintile of states for its rates of mortality in rural counties. Tennessee ranked in the fifth quintile of states for measures of daily health and quality of life in rural counties. Tennessee ranked in the fourth quintile of states for health care access in rural counties.

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TENNESSEE

WASHINGTON, D.C. – In releasing its fifth annual 50-State Report Card on Reproductive Health and Rights, the Population Institute lowered the U.S. grade from a “D+” to a “D”. The report card, the most comprehensive report card of its kind, tracks multiple indicators of reproductive health and rights, including access to family planning and abortion services.

Along with Alabama, Mississippi and Kentucky, Tennessee is a member of the East The Institute’s president Robert Walker said, “For the past five years, reproductive health and South Central Division of the South U.S. Census Region. All four states in the division rights in the U.S. have been on a slippery slope.” Five years ago nine states received an “F”. In showed strong similarities in our reporting, and all four states received a failing grade. this year’s report card 20 states—including Alabama—received a failing grade. Walker warned, Tennessee performed better than Alabama (45) andand Mississippi (47), but the Volunteer however, “The worst may be yet to come, as Congress the new Administration are expected State fellfederal behind Kentucky (42) inplanning the finaland rankings. to slash funding for family comprehensive sex education. The slippery slope is becoming a free fall.”

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today more than 50% of “plus” or a “minus” for factors Walkerennessee emphasized has that well“It’s over a million rural in health outcomes states between rural and urban women now live in a county not reflected in the core grade. not just abortion rights that are citizens, but the state ranks last in the counties. Tennessee shows a 13.8 percent without an abortion provider. under siege; it’s also access to nation for the number of physically unincrease in rural mortality as compared to ALABAMA RECEIVED A family planning services, and healthy days reported by rural residents, and urban counties. TheFederal state ranks 35th for rural/ support for “MINUS” BECAUSE THEIR when women are denied access the state performs poorly across many other urban difference in mortality. reproductive health and rights ‘CHOOSE LIFE’ LICENSE to contraception everyone loses: rural measures. Tennessee has seen FUND ANTI-CHOICE could suffer a major reversal PLATES therehealth are more unintended eight rural hospitals close since RURAL RESOURCES in 2017. Congress and the new ORGANIZATIONS/CRISIS pregnancies, more abortions, and2010. Administration are expected to PREGNANCY CENTERS higher health care costs.” Tennessee also ranks among the worst in curtail access toincontraceptive Rural health resource organizations Tennessee Only 21 states received a services by blocking all funding This year’s report card alsoof hypertension, terms of statewide rates include: “B-“ or higher. Just five states for Planned Parenthood, draws attention to “a growing diabetes and obesity. In addition, more than New Jersey, (California, defunding X, a 48-year old national divide” on reproductive 360,000 uninsured adults age 18 to New 64, living • Tennessee Office of Rural Title Health Mexico, Oregon and program that provides support health and rights, and Walker below 138% of the poverty threshold in Tentn.gov/health/topic/rural-health Washington) received an “A”. to family planning clinics warned that Alabama is “on nessee, fall into the health coverageThe gap:following they states received Rural Health Association • Tennessee serving low-income households, the wrong side of that divide.” a failing do not qualify for Medicaid (TennCare) basedgrade in 2016: www.rhat.org and eliminating the Affordable Alabama, which received an “F”, Alabama, Florida, on their income levels. Tennessee did not Arkansas, • South Central Telehealth Center Care Act’sResource no-cost birth control was one of 20 states receiving a Georgia, Idaho, Indiana, Kansas, adopt Medicaid expansion as offered under learntelehealth.org mandate. Walker noted that failing grade in the latest report Louisiana, Mississippi, Missouri, Rural Partnership the • Tennessee “In the past five years most of card.ACA. Five years ago Alabama Nebraska, North Dakota, tnrp.org the slippage on reproductive received a “D”. Oklahoma, South Carolina, In June of 2017, the governor of Tennessee health has occurred at the state South Dakota, Tennessee, Texas, signed joint resolution declaring pornography For more information level, but this MANYaFACTORS about theyear datacould see Utah, Virginia, and Wisconsin. unprecedentedemployed setbacks at the aACCOUNTED “public healthFOR crisis” in the state. sources used and methodology national level, including ALABAMA’S FAILING GRADE in RHQ’s 2017 Rural Health Report Card, cuts Walker warned that “A woman’s in funding for comprehensive INCLUDING POOR SCORES RURAL HEALTH CARE FACILITIESreproductive health visitshould www.RuralHealthQuarterly.com. not sex education in the schools IN PREVENTION AND depend on where she lives, but and a return to abstinence only AFFORDABILITY as women in many The Rural Health Information Hub, itandoes, organiprograms which have been areas are experiencing reduced Using eleven criteria, the zation funded by the Federal Office of Rural proven to be ineffective.” to reproductive health Institute’s report card ranked Health Policy, reports that there areaccess 14 Critical care each ofHospitals the 50 states andstate, the as well Access in the as services 112 including abortion.” Walker stressed that this Walker noted that 19 states, District of Columbia on four Rural Health Clinics and 29 Federally Qualified year’s report card should be including Alabama, have refused broad indicators relating to Health Centers providing services at 179 sites. “an urgent call to action” for to expand Medicaid under the reproductive health and rights: anyone who is concerned Affordable Care Act, leaving tens effectiveness, prevention, about reproductive health URBAN-RURAL DIVIDE of millions of women without affordability, and access. Based and rights. “As disappointing improved access to contraception upon their composite scores (0as 2016 was, 2017 could be Most U.S. states report aamarked and other health care services. 100), each state received “core” difference a whole lot worse.” Walker also noted that in 27 grade (A, B, C, D or F), but some states received an additional


TENNESSEE BY THE NUMBERS Tennessee has an estimated population of 6,651,194 people, and 22.6 percent live in one of Tennessee’s 53 rural counties. The poverty rate in rural Tennessee is 18.7 percent, compared with 14.9 percent in urban areas of the state.

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19.5 percent of the rural population has not completed high school, while 13 percent of the urban population lacks a high school diploma. RURAL COUNTIES URBAN COUNTIES

9.6 percent of rural Tennessee residents are U.S. military veterans, and 14.6 percent of the rural population under age 65 lives with a disability. 87.9 percent of the state’s rural population is Non-Hispanic White, 6.1 percent is Black/African-American, 3.3 percent is Hispanic/Latino, 0.2 percent is American Indian/Alaska Native and 0.5 percent is Asian.

MORTALITY

QUALITY OF LIFE

ACCESS TO CARE

Heart Disease: F

Fair/Poor Health: F

Primary Care: F

Heart disease is the leading cause of death in Tennessee, and the state is ranked 43rd in the U.S. for the number of deaths by heart disease among rural residents. The age-adjusted rate for heart disease in rural counties is 242.9 per 100,000. The national average is 168.5 per 100,000.

The percentage of Tennesseeans reporting poor general health is among the highest in the nation. The state ranked 40th for rural counties (21.7 percent) and 47/51 for urban counties (19.1 percent).

Tennessee ranks 41st in the U.S. for the number of primary care physicians practicing in rural counties (45.3 per 100,000). The national average for rural counties is 54.5 per 100,000.

Mental Health: F

Mental Care: D-

Rural residents of Tennessee reported an average of 4.8 mentally unhealthy days in the past 30 days. The national average is 3.7 days. The state ranked 45th for self-reported mental health in rural counties.

Tennessee ranks 37th in the U.S. for the number of psychiatrists practicing in rural counties. Tennessee has 2.1 per 100,000 residents. The U.S. rural average is 3.4.

Cancer: F Cancer is the second leading cause of death in Tennessee, and the state is ranked 45th in the U.S. for deaths by cancer among rural residents. The ageadjusted rate for cancer in rural counties is 195.7 per 100,000. The national average is 158.5 per 100,000.

CLRD: F Chronic lower respiratory disease (CLRD) is the third leading cause of death in Tennessee, and the state is ranked 39th in the U.S. for deaths by CLRD among rural residents. The ageadjusted rate for CLRD in rural counties is 60.7 per 100,000. The national average is 41.6 per 100,000.

Physical Health: F The number of physically unhealthy days reported in rural Tennessee is 5.1 in 30 days, while urban residents report 4.5 days. The national average is 3.9. Rural Tennessee ranks last in the nation (47/47).

Low Birth Weight: D The percentage of live births with low birth weight (< 5 pounds, 8 ounces) in rural Tennessee is 8.8 percent. The national average is 8 percent. Tennessee ranks 35th in the category.

Dental Care: F Tennessee ranks 42nd in the nation for rural access to dental care with 32.3 dentists per 100,000 rural residents. The national rural average is 42.8.

Uninsured Rate: C 16.7 percent of Tennessee’s rural population under age 65 is uninsured. The average uninsured rate for urban residents of Tennessee is 14.3 percent. Tennessee is one of 19 states that did not adopt Medicaid expansion as offered under the Affordable Care Act.

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IN FREE FALL: REPRODUCTIVE HEALTH AND RIGHTS IN AMERICA

D36/47 TEXAS ranks 36th in the nation for rural health out of 47 states with rural counties. Texas is one of three states receiving a grade of “D-” TEXAS RECEIVED A GRADE OF “D-” BECAUSE: Texas ranked in the fourth quintile of states for its rates of mortality in rural counties. Texas ranked in the fourth quintile of states for measures of daily health and quality of life in rural counties. Texas ranked in the fifth quintile of states for health care access in rural counties.

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TEXAS

WASHINGTON, D.C. – In releasing its fifth annual 50-State Report Card on Reproductive Health and Rights, the Population Institute lowered the U.S. grade from a “D+” to a “D”. The report card, the most comprehensive report card of its kind, tracks multiple indicators of reproductive health and rights, including access to family planning and abortion services.

Along with Arkansas, Louisiana and Oklahoma, Texas is a member of the West The Institute’s president Robert Walker said, “For the past five years, reproductive health and South Central division of the South U.S. Census region. All four states in the division rights in the U.S. have been on a slippery slope.” Five years ago nine states received an “F”. In showed significant similarities in our reporting, and all four states received low grade. this year’s report card 20 states—including Alabama—received a failing grade. a Walker warned, The Lone Star State (36) performed best in the division, followed by Arkansas (38), however, “The worst may be yet to come, as Congress and the new Administration are expected Oklahoma (41)funding and Louisiana (46) in theand final rankings. sex education. The slippery slope to slash federal for family planning comprehensive is becoming a free fall.”

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today more than 50% of “plus” or a “minus” for factors Walkerexas emphasized that “It’spercentage has the highest and in health outcomes states between rural and urban women now live in a county not reflected in the core grade. not just abortion rights that are number of uninsured residents in the counties. Texas shows a 18.8 percent increase without an abortion provider. under siege; it’s also access to nation, and 16 rural hospitals, nearly 10 in rural mortality as compared to urban ALABAMA RECEIVED A family planning services, and percent of all are rural hospitals in the “MINUS” state, haveBECAUSE counties. The state ranks 43rd for rural/urban Federal support for THEIR when women denied access closed since 2013. reproductive health and rights ‘CHOOSE LIFE’difference LICENSE in mortality. to contraception everyone loses: could suffer a major reversal PLATES FUND ANTI-CHOICE there are more unintended The state’s rural careand system faces RURAL RESOURCES in 2017. Congress and the new ORGANIZATIONS/CRISIS pregnancies, morehealth abortions, declining reimbursement with rising CENTERS Administration are expected to higher health care costs.” rates alongPREGNANCY curtail access to contraceptive costs, according to a 2017 study produced by Rural health resource organizations in Texas Only 21 states received a services by blocking all funding This year’s report card also the Texas Organization of Rural and “B-“ Community include: or higher. Just five states for Planned Parenthood, draws attention to “a growing Hospitals (TORCH). Demographic shifts are New Jersey, (California, defunding Title X, a 48-year old national divide” on reproductive also dramatically changing the makeup of the Oregon • Texas New Mexico, and State Office of Rural Health program that provides support health and rights, and Walker state’s rural populations. Washington) received an “A”. www.texasagriculture.gov/GrantsServicto family planning clinics warned that Alabama is “on The following stateses/RuralEconomicDevelopment/StateOfreceived serving low-income households, the wrong side of that divide.” a failing Recent studies published by the Texas Tech grade in 2016: ficeofRuralHealth.aspx and eliminating the Affordable Alabama, which received an “F”, Alabama, Florida, University Sciences Center’s F. Marie Arkansas, • Texas Rural Health CareAssociation Act’s no-cost birth control was one ofHealth 20 states receiving a Georgia, Idaho, Indiana, Kansas, Hall Institute forthe Rural and Community Health trha.org mandate. Walker noted that failing grade in latest report Louisiana, Missouri, show clearyears disparities in mortality from com- Mississippi, • TexLa Telehealth Center “InResource the past five years most of card. Five ago Alabama Nebraska, North Dakota, mon causes of death in rural areas of the state www.texlatrc.org the slippage on reproductive received a “D”. Oklahoma, South Carolina, and primary care provider supply shortages health has occurred at the state • Texas Organization of Rural & Community South Dakota, Tennessee, Texas, level, but this year could see MANY that areFACTORS significantly larger in rural Utah, areas,Virginia, and Wisconsin. Hospitals: www.torchnet.org unprecedented setbacks at the ACCOUNTED FOR and South Texas. particularly in West • Texas Association of Rural Health Clinics national level, including cuts ALABAMA’S FAILING GRADE www.tarhc.org Walker warned that “A woman’s in funding for comprehensive INCLUDING POOR SCORES RURAL HEALTH CARE FACILITIESreproductive health • should F. Marie not Hall Institute for Rural and sex education in the schools IN PREVENTION AND depend on where sheCommunity lives, but Health: www.ttuhsc.edu/ and a return to abstinence only AFFORDABILITY as women in many The Rural Health Information Hub, itandoes, organirural-health programs which have been are experiencing reduced Using eleven zation fundedcriteria, by thethe Federal Officeareas of Rural proven to be ineffective.” access to reproductive health Institute’s report card ranked Health Policy, reports that there are 82 Critical For more information about the data services abortion. each ofHospitals the 50 states theas well care Access in theand state, as 305 Rural including sources used ”and methodology Walker stressedemployed that this Walker noted that 19 states, District of Columbia on four Health Clinics in Texas and 73 Federally Qualified in RHQ’s 2017 Rural Health Report Card, be year’s report card should including Alabama, have refused broad indicators relating to Health Centers providing services at 447 sites. visit www.RuralHealthQuarterly.com. “an urgent call to action” for to expand Medicaid under the reproductive health and rights: anyone who is concerned Affordable Care Act, leaving tens effectiveness, prevention, about reproductive health URBAN-RURAL DIVIDE of millions of women without affordability, and access. Based and rights. “As disappointing improved access to contraception upon their composite scores (0as 2016 was, 2017 could be and other health care services. 100), each state received “core” difference Most U.S. states report aamarked a whole lot worse.” Walker also noted that in 27 grade (A, B, C, D or F), but some states received an additional


TEXAS BY THE NUMBERS Texas has an estimated population of 27,862,596 people, and 11 percent live in one of Texas’s 172 rural counties. The poverty rate in rural Texas is 18.1 percent, compared with 15.3 percent in urban areas of the state.

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21.9 percent of the rural population has not completed high school, while 17.5 percent of the urban population lacks a high school diploma.

RURAL COUNTIES URBAN COUNTIES

9.1 percent of rural Texas residents are U.S. military veterans, and 11.3 percent of the rural population under age 65 lives with a disability. 57 percent of the state’s rural population is Non-Hispanic White, 7.9 percent is Black/African-American, 32.9 percent is Hispanic/Latino, 0.3 percent is American Indian/Alaska Native and 0.5 percent is Asian.

MORTALITY

QUALITY OF LIFE

Heart Disease: D-

Fair/Poor Health: D- Primary Care: F

Heart disease is the leading cause of death in Texas, and the state is ranked 38th in the U.S. for the number of deaths by heart disease among rural residents. The age-adjusted rate for heart disease in rural counties is 209.7 per 100,000. The national average is 168.5 per 100,000.

The percentage of Texans reporting poor general health is among the highest in the nation. The state ranked 37th for rural counties (20.7 percent) and 45/51 for urban counties (18.7 percent).

Texas ranks 46th in the U.S. for the number of primary care physicians practicing in rural counties (39.1 per 100,000). The national average for rural counties is 54.5 per 100,000.

Mental Health: B-

Mental Care: F

Rural residents of Texas reported an average of 3.6 mentally unhealthy days in the past 30 days. The national average is 3.7 days. The state ranked 18th for self-reported mental health in rural counties.

Texas ranks 40th in the U.S. for the number of psychiatrists practicing in rural counties. Texas has 1.8 per 100,000 residents. The U.S. rural average is 3.4.

Cancer: BCancer is the second leading cause of death in Texas, and the state is ranked 19th in the U.S. for deaths by cancer among rural residents. The age-adjusted rate for cancer in rural counties is 165.5 per 100,000. The national average is 158.5 per 100,000.

Stroke: F Cerebrovascular disease is the third leading cause of death in Texas, and the state is ranked 39th in the U.S. for deaths by stroke among rural residents. The age-adjusted rate for stroke in rural counties is 46.7 per 100,000. The national average is 37.6 per 100,000.

Physical Health: D+ The number of physically unhealthy days reported in rural Texas is 4.1 in 30 days, while urban residents report 3.7 days. The national average is 3.9. Rural Texas ranks 31st.

Low Birth Weight: D+ The percentage of live births with low birth weight (< 5 pounds, 8 ounces) in rural Texas is 8.3 percent. The national average is 8 percent. Texas ranks 32nd in the category.

ACCESS TO CARE

Dental Care: F Texas ranks 44th in the nation for rural access to dental care with 31 dentists per 100,000 rural residents. The national rural average is 42.8.

Uninsured Rate: F 25.3 percent of Texas’s rural population under age 65 is uninsured. The average uninsured rate for urban residents of Texas is 22.6 percent, ranking last in the country. Texas is one of 19 states that did not adopt Medicaid expansion as offered under the Affordable Care Act.

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IN FREE FALL: REPRODUCTIVE HEALTH AND RIGHTS IN AMERICA

C+ 23/47 UTAH ranks 23rd in the nation for rural health out of 47 states with rural counties. Utah is one of three states receiving a grade of “C+” UTAH RECEIVED A GRADE OF “C+” BECAUSE: Utah ranked in the second quintile of states for its rates of mortality in rural counties. Utah ranked in the third quintile of states for measures of daily health and quality of life in rural counties. Utah ranked in the third quintile of states for health care access in rural counties.

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UTAH

WASHINGTON, D.C. – In releasing its fifth annual 50-State Report Card on Reproductive Health and Rights, the Population Institute lowered the U.S. grade from a “D+” to a “D”. The report card, the most comprehensive report card of its kind, tracks multiple indicators of reproductive health and rights, including access to family planning and abortion services.

Along with Arizona, Colorado, Idaho, Montana, Nevada, New Mexico and Wyoming, The Institute’s president Robert Walker said, “For the past five years, reproductive health and Utah is part of the Mountain division of the West U.S. Census region. With the exception rights in the U.S. have been on a slippery slope.” Five years ago nine states received an “F”. In of high performers Colorado and Wyoming, all states in the division rank near the this year’s report card 20 states—including Alabama—received a failing grade. Walker warned, middle the worst nationmay for be rural (23) ranks Nevada (30), New however,of“The yet health. to come,Utah as Congress and higher the newthan Administration are expected Mexico (31) and Arizona the Beehive State falls behind Colorado to slash federal funding for (33), familybut planning and comprehensive sex education. The(12), slippery slope Wyoming (14), Montana (19) and Idaho (20). is becoming a free fall.”

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states today than “plus” for factors Walkertah emphasized that “It’spopulation has the youngest in or a “minus” Access Hospitals in the state, asmore well as 1450% of women now live in a county not reflected in the core grade. not justAmerica, abortionaccording rights thattoare the Utah DepartRural Health Clinics and 13 Federally Qualified without an abortion provider. under siege; it’s also access to ment of Health. 82 rural hospitals in Health Centers providing services at 51 sites. ALABAMA RECEIVED A family planning services, and the United States have closed since“MINUS” 2010, butBECAUSE THEIR Federal support for when women are denied access none have closedeveryone in Utah.loses: The state‘CHOOSE helps ruralLIFE’URBAN-RURAL DIVIDE reproductive health and rights LICENSE to contraception facilities administering federal money through could suffer a major reversal PLATES FUND ANTI-CHOICE there arebymore unintended various grants,more and doctors in rural can also Most U.S. states report a marked difference in 2017. Congress and the new ORGANIZATIONS/CRISIS pregnancies, abortions, and areas apply up tocare $15,000 the Depart- CENTERS in health outcomes Administration between rural and urban to are expected higherfor health costs.per ” year fromPREGNANCY ment of Health to apply toward their student curtail access to contraceptive counties. Utah shows a 4.9 percent increase Only 21 states received a by blocking This year’s report card also loans. in rural asservices compared to urban all funding “B-“ or higher. Just five mortality states for Planned Parenthood, draws attention to “a growing (California, Newcounties. Jersey, The state ranks 15th for rural/urban defunding Title X, a 48-year old national divide” on reproductive The state still faces challenges in other areas difference New Mexico, Oregon and in mortality. program that provides support health and rights, and Walker of rural health care delivery, however. Much Washington) received an “A”. to family planning clinics warned that Alabama is “on of the state is sparsely populated, and Thethirteen following states received RURAL RESOURCES serving low-income households, the wrong side of that divide.” a failing grade in 2016: counties qualify as “frontier” because the popand eliminating the Affordable Alabama, which received an “F”, Arkansas, ulation density is under 6.1 persons Alabama, per square RuralFlorida, health resource Utah Careorganizations Act’s no-cost in birth control was one of 20 states receiving a Georgia, Idaho, Indiana, Kansas, mile. For the most isolated portions of the include: mandate. Walker noted that failing grade in the latest report state, ambulances travel moreLouisiana, than an Mississippi, Missouri, “In the past five years most of card. Five years agomust Alabama Nebraska, Dakota, hour to the scene, and behavioral health care North the slippage • Utah Office of Primary Careon andreproductive Rural received a “D”. Oklahoma, South Carolina, can require travel over even longer distances. health has occurred at the state Health: health.utah.gov/primarycare/ South Dakota, Tennessee, Texas, level, but this year could see MANY FACTORS index.php Utah, Virginia, and Wisconsin. unprecedented setbacks at the ACCOUNTED FOR Native American health care is another cause • Rural Health Association of Utah national level, including cuts ALABAMA’S FAILING GRADE for concern in some rural areas of the state.warned that “A www.suu.edu/ahec/rhau.html Walker woman’s in funding for comprehensive INCLUDING POOR SCORES Not all tribes have equal access to health care health reproductive not Telehealth Resource Center • should Southwest sex education in the schools IN PREVENTION AND resources, which are often allocateddepend based on where shewww.southwesttrc.org lives, but and a return to abstinence only AFFORDABILITY on population size. As a result, at least one as of women in many it does, programs which have been areas are experiencing reduced Using eleven criteria, the Utah’s smaller tribes has no medical services For more information about theineffective. data ” proven to be to reproductive health Institute’s report card ranked to theaccess on the reservation, according 2013 Utah sources used and methodology employed care services including abortion.” each of the 50 states and the Rural Health Plan. in RHQ’s 2017 Rural Health Reportthat Card, Walker stressed this Walker noted that 19 states, District of Columbia on four visit www.RuralHealthQuarterly.com. year’s report card should be broad indicators relating to RURAL HEALTH CARE FACILITIESincluding Alabama, have refused “an urgent call to action” for to expand Medicaid under the reproductive health and rights: anyone who is concerned Affordable Care Act, leaving tens effectiveness, prevention, about reproductive health The Rural Health Information Hub, an organiof millions of women without affordability, and access. Based and rights. “As disappointing zation funded by the Federal Office of Rural improved access to contraception upon their composite scores (0as 2016 was, 2017 could be Health Policy, reports that there areand 12 other Critical health care services. 100), each state received a “core” a whole lot worse.” Walker also noted that in 27 grade (A, B, C, D or F), but some states received an additional


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RURAL COUNTIES URBAN COUNTIES

UTAH BY THE NUMBERS Utah has an estimated population of 3,051,217 people, and 10.6 percent live in one of Utah’s 19 rural counties. The poverty rate in rural Utah is 13.9 percent, compared with 9.8 percent in urban areas of the state. 10 percent of the rural population has not completed high school, while 8.6 percent of the urban population lacks a high school diploma. 7.4 percent of rural Utah residents are U.S. military veterans, and 7.6 percent of the rural population under age 65 lives with a disability. 84.2 percent of the state’s rural population is Non-Hispanic White, 0.4 percent is Black/African-American, 9 percent is Hispanic/Latino, 4.1 percent is American Indian/Alaska Native and 0.8 percent is Asian.

MORTALITY

QUALITY OF LIFE

ACCESS TO CARE

Heart Disease: B+

Fair/Poor Health: B

Primary Care: C

Heart disease is the leading cause of death in Utah, and the state is ranked 11th in the U.S. for the number of deaths by heart disease among rural residents. The age-adjusted rate for heart disease in rural counties is 157.2 per 100,000. The national average is 168.5 per 100,000.

The percentage of Utahns reporting poor general health is relatively low. The state ranked 16th for rural counties (14 percent) and 9/51 for urban counties (12.3 percent).

Utah ranks 24th in the U.S. for the number of primary care physicians practicing in rural counties (55.5 per 100,000). The national average for rural counties is 54.5 per 100,000.

Mental Health: B

Mental Care: F

Rural residents of Utah reported an average of 3.6 mentally unhealthy days in the past 30 days. The national average is 3.7 days. The state ranked 15th for self-reported mental health in rural counties.

Utah ranks 39th in the U.S. for the number of psychiatrists practicing in rural counties. Utah has 1.9 per 100,000 residents. The U.S. rural average is 3.4.

Cancer: A+ Cancer is the second leading cause of death in Utah, and the state is ranked 2nd in the U.S. for deaths by cancer among rural residents. The age-adjusted rate for cancer in rural counties is 132.6 per 100,000. The national average is 158.5 per 100,000.

Accidents: D Accidents are the third leading cause of death in Utah, and Utah ranked 33rd out of 47 states for accidental death in rural counties. The statewide rate for accidental death is 60.5 per 100,000. The national average is 43.2 per 100,000.

Physical Health: BThe number of physically unhealthy days reported in rural Utah is 3.7 in 30 days, while urban residents report 3.4 days. The national average is 3.9. Rural Utah ranks 18th.

Low Birth Weight: C The percentage of live births with low birth weight (< 5 pounds, 8 ounces) in rural Utah is 7.7 percent. The national average is 8 percent. Utah ranks 26th in the category.

Dental Care: B Utah ranks 14th in the nation for rural access to dental care with 54.3 dentists per 100,000 rural residents. The national rural average is 42.8.

Uninsured Rate: D+ 18.6 percent of Utah’s rural population under age 65 is uninsured. The average uninsured rate for urban residents of Utah is 14.1 percent. Utah is one of 19 states that did not adopt Medicaid expansion as offered under the Affordable Care Act.

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IN FREE FALL: REPRODUCTIVE HEALTH AND RIGHTS IN AMERICA

A+ 2/47 VERMONT ranks second in the nation for rural health out of 47 states with rural counties. Vermont is one of three states receiving a grade of “A+” VERMONT RECEIVED A GRADE OF “A+” BECAUSE: Vermont ranked in the first quintile of states for its rates of mortality in rural counties. Vermont ranked in the first quintile of states for measures of daily health and quality of life in rural counties. Vermont ranked in the first quintile of states for health care access in rural counties.

100

RHQ

100  RHQ

VERMONT

WASHINGTON, D.C. – In releasing its fifth annual 50-State Report Card on Reproductive Health and Rights, the Population Institute lowered the U.S. grade from a “D+” to a “D”. The report card, the most comprehensive report card of its kind, tracks multiple indicators of reproductive health and rights, including access to family planning and abortion services.

Along with Connecticut, Maine, Massachusetts, New Hampshire and Rhode Island, The Institute’s president Robert Walker said, “For the past five years, reproductive health and the Green Mountain State is a member of the New England division of the Northeast rights in the U.S. have been on a slippery slope.” Five years ago nine states received an “F”. In U.S. Census region. Excluding Rhode Island, a state with no rural counties, states in this year’s report card 20 states—including Alabama—received a failing grade. all Walker warned, New England receive high rankings for rural health, and Vermont comes in behind only however, “The worst may be yet to come, as Congress and the new Administration are expected neighboring New Hamphire (1) planning in the national rankings. Vermont (2) performed to slash federal funding for family and comprehensive sex education. The slippery slope better than aConnecticut (3), Massachusetts (6) and Maine (13) in the final rankings. is becoming free fall.”

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states today more than 50% of “plus” for factors Walkerermont emphasized that “It’s continues to be one of the or a “minus” URBAN-RURAL DIVIDE women now live in a county not reflected in the core grade. not justhealthiest abortion rights that are states in the country, despite without an abortion provider. under siege; it’s also access to being one the nation’s most rural states. Most U.S. states report a marked difference ALABAMA RECEIVED A family planning services, and in health outcomes Federal between rural and support for urban “MINUS” BECAUSE THEIR when women are denied access One look at the state’s Healthy a 6.8 percent reproductive health and rights ‘CHOOSE LIFE’counties. LICENSEVermont shows to contraception everyone loses: Vermonters 2020 Scorecard reveals a stateFUNDincrease in rural mortality as compared to could suffer a major reversal PLATES ANTI-CHOICE there Performance are more unintended that not onlymore sets ambitious takes urban counties. Theinstate ranks 18th for 2017. Congress andrural/ the new ORGANIZATIONS/CRISIS pregnancies, abortions, goals and but steps achieve ranked urban difference in mortality. Administration are expected to PREGNANCY CENTERS highertohealth carethem. costs.”Vermont was curtail access to contraceptive 20th in American Health Rankings in 1990 and Only 21 states received a services by blocking all funding This year’s report card 1991, but the state hasalso ranked consistently at RURAL RESOURCES “B-“ or higher. Just five states for Planned Parenthood, draws attention to “a growing or near the top for the past several(California, years. New Jersey, defunding Title X, a 48-year old national divide” on reproductive New Mexico, Oregon and resource organizations in Vermont Rural health program that provides support health and rights, and Walker Vermont’s strengths include some ofWashington) the social received include:an “A”. to family planning clinics warned that Alabama is “on The following states received determinants that are at the foundation of serving low-income households, the wrong side of that divide.” a failing good health: a high rate of education, highergrade in • 2016: Vermont Office of Rural Health and and eliminating thePrimary Affordable Alabama, which received an “F”, Alabama, Arkansas, Care: Florida, median household income, lower unemploywww.healthvermont.gov/healthCare Act’s no-cost birth control was one of 20 states receiving a Kansas, ment, violent high ratesGeorgia, of healthIdaho, Indiana, professionals-systems/hospitals-healthmandate. Walker noted that failing few grade in thecrimes, latest report Louisiana, Mississippi, Missouri, insurance coverage ready availability of systems/rural-health “In the past five years most of card. Five years ago and Alabama Nebraska, North Dakota, primary providers. the slippage on reproductive • New England Rural Health RoundTable receivedcare a “D”. Oklahoma, South Carolina, health has occurred at the state www.newenglandruralhealth.org South Dakota, Tennessee, Texas, level, but this yearCenter could see Vermont’s aging population could poseUtah, challenges MANY FACTORS • Wisconsin. Northeast Telehealth Resource Virginia, and unprecedented setbacks at the ACCOUNTED going forward, FOR however. Vermont is aging faster netrc.org level, Services includingand cuts ALABAMA’S FAILING GRADE than other states, and the age gap isWalker widening, • “A Center for Ruralnational Emergency warned that woman’s in funding for comprehensive INCLUDING POOR SCORES from about two years in 2000 to four years in health should reproductive not med.dartmouth-hitchcock.org/ Trauma: sex education in the schools IN PREVENTION AND of Vermonters 2010. More than one-third dependare on where shecrest.html lives, but and a return to abstinence only AFFORDABILITY it does, as women in many between the ages of 40 and 64. programs which have been areas are experiencing reduced Using eleven criteria, the For more information about theineffective. data ” proven to be health Institute’sHEALTH report card ranked RURAL CARE FACILITIESaccess to reproductive sources used and methodology employed care services including abortion.” each of the 50 states and the in RHQ’s 2017 Rural Health Report Card, Walker stressed that this noted that 19 states, District of Columbia on four The Rural Health Information Hub, Walker an organivisit www.RuralHealthQuarterly.com. year’s report card should be including Alabama, have refused broad indicators relating to zation funded by the Federal Office of Rural “an urgent call to action” for to expand Medicaid under the reproductive health and rights: anyone who is concerned Health Policy, reports that there are 8 Critical Affordable Care Act, leaving tens effectiveness, prevention, about reproductive health Access Hospitals in the state, as well as 11 of millions of women without affordability, and access. Based and rights. “As disappointing Rural Clinics and 11 Federally Qualified improved access to contraception upon Health their composite scores (0as 2016 was, 2017 could be Health Centers 61other sites.health care services. 100), each state providing received aservices “core” atand a whole lot worse.” Walker also noted that in 27 grade (A, B, C, D or F), but some states received an additional


VERMONT BY THE NUMBERS Vermont has an estimated population of 624,594 people, and 65.1 percent live in one of Vermont’s 11 rural counties. The poverty rate in rural Vermont is 12.7 percent, compared with 10.3 percent in urban areas of the state. 8.7 percent of the rural population has not completed high school, while 7.2 percent of the urban population lacks a high school diploma.

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9.6 percent of rural Vermont residents are U.S. military veterans, and 11 percent of the rural population under age 65 lives with a disability. RURAL COUNTIES URBAN COUNTIES

94.9 percent of the state’s rural population is Non-Hispanic White, 0.7 percent is Black/African-American,1.6 percent is Hispanic/Latino, 0.3 percent is American Indian/Alaska Native and 0.8 percent is Asian.

MORTALITY

QUALITY OF LIFE

Heart Disease: B

Fair/Poor Health: A+ Primary Care: A+

Heart disease is the leading cause of death in Vermont, and the state is ranked 15th in the U.S. for the number of deaths by heart disease among rural residents. The age-adjusted rate for heart disease in rural counties is 158.8 per 100,000. The national average is 168.5 per 100,000.

The percentage of Vermonters reporting poor general health is among the lowest in the nation. The state ranked 2nd for rural counties (11.2 percent) and 1st for urban counties (9.1 percent).

Vermont ranks 3rd in the U.S. for the number of primary care physicians practicing in rural counties (95.3 per 100,000). The national average for rural counties is 54.5 per 100,000.

Mental Health: B+

Mental Care: A+

Cancer: B-

Rural residents of Vermont reported an average of 3.5 mentally unhealthy days in the past 30 days. The national average is 3.7 days. The state ranked 13th for self-reported mental health in rural counties.

Vermont ranks 2nd in the U.S. for the number of psychiatrists practicing in rural counties. Vermont has 17.3 per 100,000 residents. The U.S. rural average is 3.4.

Cancer is the second leading cause of death in Vermont, and the state is ranked 20th in the U.S. for deaths by cancer among rural residents. The ageadjusted rate for cancer in rural counties is 167.1 per 100,000. The national average is 158.5 per 100,000.

Accidents: AAccidents are the third leading cause of death in Vermont, and Vermont ranked 9th out of 47 states for accidental death in rural counties. The statewide rate for accidental death is 48.8 per 100,000. The national average is 43.2 per 100,000.

Physical Health: AThe number of physically unhealthy days reported in rural Vermont is 3.3 in 30 days, while urban residents report 2.9 days. The national average is 3.9. Rural Vermont ranks 9th.

Low Birth Weight: B+ The percentage of live births with low birth weight (< 5 pounds, 8 ounces) in rural Vermont is 6.5 percent. The national average is 8 percent. Vermont ranks 11th in the category.

ACCESS TO CARE

Dental Care: AVermont ranks 8th in the nation for rural access to dental care with 61.1 dentists per 100,000 rural residents. The national rural average is 42.8.

Uninsured Rate: A+ 7.7 percent of Vermont’s rural population under age 65 is uninsured. The average uninsured rate for urban residents of Vermont is 5.5 percent. Vermont is one of 31 states that adopted Medicaid expansion as offered under the Affordable Care Act.

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IN FREE FALL: REPRODUCTIVE HEALTH AND RIGHTS IN AMERICA

D+ 32/47 VIRGINIA ranks 32nd in the nation for rural health out of 47 states with rural counties. Vermont is one of three states receiving a grade of “D+” VIRGINIA RECEIVED A GRADE OF “D+” BECAUSE: Virginia ranked in the fourth quintile of states for its rates of mortality in rural counties. Virginia ranked in the fourth quintile of states for measures of daily health and quality of life in rural counties. Virginia ranked in the fourth quintile of states for health care access in rural counties.

102

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102  RHQ

VIRGINIA

WASHINGTON, D.C. – In releasing its fifth annual 50-State Report Card on Reproductive Health and Rights, the Population Institute lowered the U.S. grade from a “D+” to a “D”. The report card, the most comprehensive report card of its kind, tracks multiple indicators of reproductive health and rights, including access to family planning and abortion services.

Along with Delaware, Florida, Georgia, Maryland, North Carolina, South Carolina and The Institute’s president Robert Walker said, “For the past five years, reproductive health and West Virginia, Virginia is part of the South Atlantic division of the South U.S. Census rerights in the U.S. have been on a slippery slope.” Five years ago nine states received an “F”. In gion. With the exception of northernmost division members Maryland and Delaware (no this year’s report card 20 states—including Alabama—received a failing grade. Walker warned, rural counties), mostmay states the poor and ruralthe health rankings. Virginia however, “The worst bein yet to division come, ashave Congress new Administration are(32) expected performed better than for North Carolina (34), Florida (37), Westsex Virginia (39), The Georgia (40)slope to slash federal funding family planning and comprehensive education. slippery and South Carolina (44). Old Dominion fell behind Maryland (16) in divisional rankings. is becoming a free fall.”

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statesproviding today more than 50% “plus”oforthe a “minus” for factors Walkerirginia’s emphasized “It’s have some rural that counties Qualified Health Centers services at of women now live in a county not reflected in the core grade. not justmost abortion rights that are significant disparities in health 142 sites. without an abortion provider. under siege; it’s also access to outcomes, and the rural southwest, ALABAMA RECEIVED A family planning services, and south side, northern neck and eastern shore URBAN-RURAL DIVIDE Federal support for “MINUS” BECAUSE THEIR when women are denied access regions are some of the least healthy areas of reproductive health and rights ‘CHOOSE LIFE’ LICENSE to contraception everyone loses: the state terms of morbidity and mortality. U.S. states report a marked could suffer a difference major reversal PLATES FUNDMost ANTI-CHOICE there are in more unintended in health outcomes in between rural andand urban 2017. Congress the new pregnancies, more abortions, and ORGANIZATIONS/CRISIS According to Virginia’s Rural Health Plan, Administration expected to counties. Virginia shows a large 29.1are increase PREGNANCY CENTERS higher health care costs.latest ” significant barriers often limit rural residents’ curtail access to contraceptive in rural mortality as compared to urban counOnly 21 states received a services bynation blocking all funding This year’s reportcare. card Appropriate also access to health services ties. The state ranks last in the (47/47) “B-“ or higher. Just five states for Planned Parenthood, draws attention to “a growing may not be available nearby, and many rural Newfor rural/urban difference in mortality. (California, Jersey, defunding Title X, a 48-year old national divide” reproductive residents report on driving several hours to access New Mexico, Oregon and program that provides support health and rights, and Walker specialty care or even primary care. Washington) Even safety received “A”. RURALanRESOURCES to family planning clinics warned that Alabama is “on net providers in some rural communities have The following states received serving low-income households, the wrong side of that divide.” a failing in 2016: unintentional barriers, such as income limitsgrade in Rural health resourceand organizations Virginia eliminatingin the Affordable Alabama, which received an “F”, Alabama, Arkansas, Florida, free and sliding scale clinics that exclude people include: Care Act’s no-cost birth control was one of 20 states receiving a Georgia, Idaho, Indiana, Kansas, who need such mandate. Walker noted that failing grade in services. the latest report Louisiana, Mississippi, Missouri, • Virginia State Office Rural “In theofpast fiveHealth years most of card. Five years ago Alabama Nebraska, North Dakota, Rates of low birth weight also continue to be a the slippage on reproductive received a “D”. www.vdh.virginia.gov/OMHHE/primaryOklahoma, South Carolina, cause for concern in Virginia, and racial disparihealth has occurred at the state care/ruralhealth South Dakota, Tennessee, Texas, ties mayFACTORS play a role. According to theUtah, National level, but this year could see MANY • Virginia Rural Health Association Virginia, and Wisconsin. ACCOUNTED FOR Center for Health Statistics, statewide preterm www.vrha.org unprecedented setbacks at the national level, including cuts ALABAMA’S GRADE birth rates fromFAILING 2011-2013 were highest • “A Mid-Atlantic Walkerfor warned that woman’s Telehealth Resource Center in funding for comprehensive INCLUDING POOR SCORES black infants (15 percent), followedreproductive by Native health should not www.matrc.org sex education in the schools IN PREVENTION AND Americans (13.5 percent), Hispanicsdepend (12 peron where lives, but • sheRural Health Initiative Program and a return to abstinence only AFFORDABILITY cent), Asians (10.1 percent) and then whites it does, as women in www.richmond.va.gov/The_Rural_ many programs which have been areas are experiencing reduced Using eleven criteria, the (9.7 percent). Health_Inititative.asp proven to be ineffective.” access to reproductive health Rural Health Resource Center Institute’s report card ranked • Virginia care services including abortion.” each of the 50 states andFACILITIES the RURAL HEALTH CARE www.vrhrc.org Walker stressed that this Walker noted that 19 states, District of Columbia on four year’s report card should be including Alabama, have refused broad indicators relating to The Rural Health Information Hub, an organi“an about urgentthe calldata to action” for For more information to expand Medicaid under the reproductive health and rights: zation funded by the Federal Office of Rural anyone who isemployed concerned sources used and methodology Affordable Care Act, leaving tens effectiveness, prevention, about reproductive health Health Policy,and reports that there areofeight in RHQ’s 2017 Rural Health Report Card, millions of women without affordability, access. Based and rights. “As disappointing Critical Access Hospitals in the state, as well visit www.RuralHealthQuarterly.com. improved access to contraception upon their composite scores (0as 2016 was, 2017 could be as 30 each Ruralstate Health Clinicsaand 26 Federally and other health care services. 100), received “core” a whole lot worse.” Walker also noted that in 27 grade (A, B, C, D or F), but some states received an additional


VIRGINIA BY THE NUMBERS Virginia has an estimated population of 8,411,808 people, and 12.4 percent live in one of Virginia’s 53 rural counties. The poverty rate in rural Virginia is 16.7 percent, compared with 10.2 percent in urban areas of the state.

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19.8 percent of the rural population has not completed high school, while 10.4 percent of the urban population lacks a high school diploma.

RURAL COUNTIES URBAN COUNTIES

9.9 percent of rural Virginia residents are U.S. military veterans, and 12.8 percent of the rural population under age 65 lives with a disability. 75.9 percent of the state’s rural population is Non-Hispanic White, 19 percent is Black/African-American, 2.8 percent is Hispanic/Latino, 0.1 percent is American Indian/Alaska Native and 0.6 percent is Asian.

MORTALITY

QUALITY OF LIFE

Heart Disease: D

Fair/Poor Health: D+ Primary Care: D

Heart disease is the leading cause of death in Virginia, and the state is ranked 33rd in the U.S. for the number of deaths by heart disease among rural residents. The age-adjusted rate for heart disease in rural counties is 198.3 per 100,000. The national average is 168.5 per 100,000.

The percentage of Virginians reporting poor general health is relatively high. The state ranked 31st for rural counties (17.1 percent) and 20/51 for urban counties (13.5 percent).

Virginia ranks 35th in the U.S. for the number of primary care physicians practicing in rural counties (48.7 per 100,000). The national average for rural counties is 54.5 per 100,000.

Mental Health: B

Mental Care: C

Rural residents of Virginia reported an average of 3.6 mentally unhealthy days in the past 30 days. The national average is 3.7 days. The state ranked 17th for self-reported mental health in rural counties.

Virginia ranks 24th in the U.S. for the number of psychiatrists practicing in rural counties. Virginia has 2.9 per 100,000 residents. The U.S. rural average is 3.4.

Cancer: F Cancer is the second leading cause of death in Virginia, and the state is ranked 39th in the U.S. for deaths by cancer among rural residents. The ageadjusted rate for cancer in rural counties is 188.8 per 100,000. The national average is 158.5 per 100,000.

Accidents: DAccidents are the third leading cause of death in Virginia, and Virginia ranked 36th out of 47 states for accidental death in rural counties. The statewide rate for accidental death is 61.5 per 100,000. The national average is 43.2 per 100,000.

Physical Health: C+ The number of physically unhealthy days reported in rural Virginia is 3.8 in 30 days, while urban residents report 3.1 days. The national average is 3.9. Rural Virginia ranks 21st.

Low Birth Weight: F The percentage of live births with low birth weight (< 5 pounds, 8 ounces) in rural Virginia is 9.4 percent, well above the national average of 8 percent. Virginia ranks 40th in the category.

ACCESS TO CARE

Dental Care: DVirginia ranks 37th in the nation for rural access to dental care with 35.6 dentists per 100,000 rural residents. The national rural average is 42.8.

Uninsured Rate: C 16.8 percent of Virginia’s rural population under age 65 is uninsured. The average uninsured rate for urban residents of Virginia is 12.5 percent. Virginia is one of 19 states that did not adopt Medicaid expansion as offered under the Affordable Care Act.

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IN FREE FALL: REPRODUCTIVE HEALTH AND RIGHTS IN AMERICA

B17/47 WASHINGTON ranks 17th in the nation for rural health out of 47 states with rural counties. Washington is one of three states receiving a grade of “B-” WASHINTON RECEIVED A GRADE OF “B-” BECAUSE: Washington ranked in the first quintile of states for its rates of mortality in rural counties. Washington ranked in the second quintile of states for measures of daily health and quality of life in rural counties. Washington ranked in the third quintile of states for health care access in rural counties.

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104  RHQ

WASHINGTON

WASHINGTON, D.C. – In releasing its fifth annual 50-State Report Card on Reproductive Health and Rights, the Population Institute lowered the U.S. grade from a “D+” to a “D”. The report card, the most comprehensive report card of its kind, tracks multiple indicators of reproductive health and rights, including access to family planning and abortion services.

Along with Alaska, California, Hawaii and Oregon, Washington is a member of the The Institute’s president Robert Walker said, “For the past five years, reproductive health and Pacific division of the West U.S. Census region. Four of the five states in the division, rights in the U.S. have been on a slippery slope.” Five years ago nine states received an “F”. In including ranked in the top half of the nation fora rural this year’sWashington, report card 20 states—including Alabama—received failinghealth. grade. Washington Walker warned, (17) ranked higher than Alaska (22) and Oregon (26), but the Evergreen Stateare fellexpected however, “The worst may be yet to come, as Congress and the new Administration behind (4) and for California (15) in the divisional rankings. to slash Hawaii federal funding family planning andfinal comprehensive sex education. The slippery slope is becoming a free fall.”

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states today more thanto50% of for factors Walker emphasized ashingtonthat has“It’s millions of“plus” ruralor a “minus” increase in rural mortality as compared women now live in a county not reflected in the core grade. not just abortion rights that are residents, but acccording to a 2017 urban counties. The state ranks 17th for rural/ without an abortion provider. under siege; it’s also access to Healthier Washington report, rural urban difference in mortality. ALABAMA RECEIVED A family planning services, and residents in the state are, as a group, older Federal support for “MINUS” BECAUSE THEIR when women are denied access and sicker, and they have higher of obesityLIFE’RURAL RESOURCES reproductive health and rights LICENSE to contraception everyone loses: rates‘CHOOSE and could suffer a major reversal PLATES FUND ANTI-CHOICE theresubstance are moreabuse. unintended in 2017. Congress and pregnancies, more abortions, and ORGANIZATIONS/CRISIS Rural health resource organizations in the new Washington’s Ruralcosts. Health Accelera- CENTERS Administration are expected to PREGNANCY higher health care ” Innovation Washington include: curtail access to contraceptive tor Committee (RHIAC) is attemptingOnly to address 21 states received a services all funding This year’s report also has already these issues. The card committee • five Washington State Officebyofblocking Community “B-“ ormade higher. Just states for Planned Parenthood, draws attention to “a growing a number of recommendations, including and Rural Health: www.doh.wa.gov/ (California, New Jersey, defunding Title X, a 48-year old national divide” on reproductive redefining primary care to include virtual care, Oregon New Mexico, and ForPublicHealthandHealthcareProviders/ program that provides support health and rights, and Walker care teams and alternative settingsWashington) convenient received an “A”. RuralHealth to family planning clinics warned that Alabama is “on The following states received for patients. • Washington Rural Health Association serving low-income households, the wrong side of that divide.” a failing grade in 2016: www.wrha.com and eliminating the Affordable Alabama, which received an “F”, Alabama, Florida, The group is also calling for the creation of Arkansas, • Northwest Regional Telehealth Care Act’s no-costResource birth control was one of 20 states receiving a Georgia, Idaho, Indiana, Kansas, public-private to find novel soCenter: www.nrtrc.org mandate. Walker noted that failing grade inpartnerships the latest report Missouri, lutions foryears ruralago health issues and aLouisiana, broader Mississippi, • Washington Rural Health “In the pastCollaborative five years most of card. Five Alabama Nebraska, North Dakota, systemwide policy investment that creates an the slippage on reproductive received a “D”. wwrhcc.org Oklahoma, South Carolina, environment of collaboration. healthAssociation has occurredofat the state • Rural Texas, Health Clinic South Dakota, Tennessee, level, but this year could see MANY FACTORS Washington: rhcaw.net Utah, Virginia, and Wisconsin. unprecedented setbacks at the ACCOUNTED FOR RURAL HEALTH CARE FACILITIES national cuts ALABAMA’S FAILING GRADE For more information aboutlevel, the including data Walker warned that “A woman’s in funding for comprehensive INCLUDING POOR SCORES The Rural Health Information Hub, reproductive an organi- health shouldused not and methodology employed sources sex education in the schools IN PREVENTION AND on where lives,2017 but Rural Health Report Card, zation funded by the Federal Officedepend of Rural inshe RHQ’s and a return to abstinence only AFFORDABILITY does, as women in many Health Policy, reports that there areit 39 Critical visit www.RuralHealthQuarterly.com. programs which have been areas are experiencing reduced Using eleven criteria, thestate, as well Access Hospitals in the as 118 proven to be ineffective.” access to reproductive health Institute’s report cardand ranked Rural Health Clinics 28 Federally Qualified each ofCenters the 50 states and the Health providing services atcare 291services sites. including abortion.” Walker stressed that this Walker noted that 19 states, District of Columbia on four year’s report card should be including Alabama, have refused broad indicators relating to “an urgent call to action” for URBAN-RURAL DIVIDE to expand Medicaid under the reproductive health and rights: anyone who is concerned Affordable Care Act, leaving tens effectiveness, prevention, about reproductive health Most U.S. states report a marked difference of millions of women without affordability, and access. Based in health rural and urbanaccess to contraception and rights. “As disappointing improved upon theiroutcomes compositebetween scores (0as 2016 was, 2017 could be counties. shows a 6.2 and percent other health care services. 100), eachWashington state received a “core” a whole lot worse.” Walker also noted that in 27 grade (A, B, C, D or F), but some states received an additional


WASHINGTON BY THE NUMBERS Washington has an estimated population of 7,288,00 people, and 10 percent live in one of Washington’s 18 rural counties. The poverty rate in rural Washington is 16.4 percent, compared with 10.7 percent in urban areas of the state. 12 percent of the rural population has not completed high school, while 9.3 percent of the urban population lacks a high school diploma.

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13.4 percent of rural Washington residents are U.S. military veterans, and 12 percent of the rural population under age 65 lives with a disability. RURAL COUNTIES URBAN COUNTIES

77.3 percent of the state’s rural population is Non-Hispanic White, 1.1 percent is Black/African-American, 13.7 percent is Hispanic/Latino, 2.4 percent is American Indian/Alaska Native and 2.1 percent is Asian.

MORTALITY

QUALITY OF LIFE

ACCESS TO CARE

Cancer: C

Fair/Poor Health: C

Primary Care: C

Cancer is the leading cause of death in Washington, and the state is ranked 23rd in the U.S. for deaths by cancer among rural residents. The age-adjusted rate for cancer in rural counties is 167.4 per 100,000. The national average is 158.5 per 100,000.

The percentage of rural Washingtonians reporting poor general health is close to the national average. The state ranked 24th for rural counties (15.7 percent) and 12/51 for urban counties (19.1 percent).

Washington ranks 25th in the U.S. for the number of primary care physicians practicing in rural counties (54.8 per 100,000). The national average for rural counties is 54.5 per 100,000.

Heart Disease: A-

Mental Health: C

Mental Care: D

Rural residents of Washington reported an average of 3.8 mentally unhealthy days in the past 30 days. The national average is 3.7 days. The state ranked 25th for self-reported mental health in rural counties.

Washington ranks 33rd in the U.S. for the number of psychiatrists practicing in rural counties. Washington has 2.4 per 100,000 residents. The U.S. rural average is 3.4.

Heart disease is the second leading cause of death in Washington, and the state is ranked 9th in the U.S. for the number of deaths by heart disease among rural residents. The age-adjusted rate for heart disease in rural counties is 155.6 per 100,000. The national average is 168.5 per 100,000.

Accidents: BAccidents are the fourth leading cause of death in Washington, and Washington ranked 11th out of 47 states for accidental death in rural counties. The statewide rate for accidental death is 49.1 per 100,000. The national average is 43.2 per 100,000.

Physical Health: CThe number of physically unhealthy days reported in rural Washington is 4 in 30 days, while urban residents report 3.4 days. The national average is 3.9. Rural Washington ranks 28th.

Low Birth Weight: A The percentage of live births with low birth weight (< 5 pounds, 8 ounces) in rural Washington is 6 percent. The national average is 8 percent. Washington ranks 4th in the category.

Dental Care: B+ Washington ranks 13th in the nation for rural access to dental care with 57.1 dentists per 100,000 rural residents. The national rural average is 42.8.

Uninsured Rate: C 16.9 percent of Washington’s rural population under age 65 is uninsured. The average uninsured rate for urban residents of Washington is 12.7 percent. Washington is one of 31 states that adopted Medicaid expansion as offered under the Affordable Care Act.

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IN FREE FALL: REPRODUCTIVE HEALTH AND RIGHTS IN AMERICA

F 39/47 WEST VIRGINIA ranks 39th in the nation for rural health out of 47 states with rural counties. West Virginia is one of nine states receiving a failing grade. WEST VIRGINIA RECEIVED A FAILING GRADE BECAUSE: West Virginia ranked in the fifth quintile of states for its rates of mortality in rural counties. West Virginia ranked in the fifth quintile of states for measures of daily health and quality of life in rural counties. West Virginia ranked in the third quintile of states for health care access in rural counties.

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WEST VIRGINIA

WASHINGTON, D.C. – In releasing its fifth annual 50-State Report Card on Reproductive Health and Rights, the Population Institute lowered the U.S. grade from a “D+” to a “D”. The report card, the most comprehensive report card of its kind, tracks multiple indicators of reproductive health and rights, including access to family planning and abortion services.

Along with Delaware, Florida, Georgia, Maryland, North Carolina, South Carolina and The Institute’s president Robert Walker said, “For the past five years, reproductive health and Virginia, West Virginia is part of the South Atlantic division of the South U.S. Census rights in the U.S. have been on a slippery slope.” Five years ago nine states received an “F”. In region. With the exception of division members Maryland and Delaware (a state with no this year’s report card 20 states—including Alabama—received a failing grade. Walker warned, rural counties), mostmay states in the division have low rural ranks. West are Virginia however, “The worst be yet to come, as Congress and the health new Administration expected (39) performed better than Georgia (40) and Carolina sex (44),education. but the Mountain to slash federal funding for family planning and South comprehensive The slippery slope State fell behind (16), Virginia (32), North Carolina (34) and Florida (37). is becoming a freeMaryland fall.”

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states todayamore than 50% of “plus” or a “minus” for factors Walker emphasized that “It’s est Virgina is struggling. The opioid counties. West Virginia shows 3.6 percent women now live in a county not reflected in the core grade. not just abortion rights that are overdose death rate in the state increase in rural mortality as compared to without an abortion provider. under siege; it’s also access to ranked highest in the nation in urban counties. The state ranks 14th for rural/ ALABAMA RECEIVED A family planning services, and 2015, and a large percentage of the populaurban difference in mortality. Federal support for “MINUS” BECAUSE THEIR when women are denied access tion affected lives in rural areas. Long distances reproductive health and rights ‘CHOOSE LIFE’ LICENSE to contraception everyone loses: between people and resources contributes RESOURCES could suffer a major reversal PLATES FUNDRURAL ANTI-CHOICE there are more unintended to a lack of access to healthand care, particularly in 2017. Congress and the new ORGANIZATIONS/CRISIS pregnancies, more abortions, behavioral health care”and dental PREGNANCY care. Rural health resource organizations West to Administration areinexpected CENTERS higher health care costs. curtail access to contraceptive Virginia include: Only 21 states received a services by blocking all funding This state’s year’s report card also The population is also among theor higher. Just five states “B-“ for Planned Parenthood, draws attention to “a growing oldest in the country. West Virginia(California, is one of New• Jersey, West Virginia Division of Rural Health & defunding Title X, a 48-year old national divide” on reproductive only seven states with a median ageNew above 40. Oregon Recruitment: www.dhhr.wv.gov/hpcd/ Mexico, and program that provides support health and rights, and Walker Pages/default.aspx/OCHSHPDivisions/ Washington) received an “A”. to family planning clinics warned that Alabama is “on In addition, West Virginia’s population The has following statesRuralHealthandRecruitment/tabid/1919/ received serving low-income households, the wrong side of that divide.” a failing one of the highest rates of adult obesity in grade in 2016: Default.aspx and eliminating the Affordable Alabama, which received an “F”, Alabama, Arkansas, Florida, the U.S. Among the 54 states and territories • West Virginia Rural Association Care Health Act’s no-cost birth control was one of 20 states receiving a Georgia, Idaho, Indiana, Kansas, that participated in the Behavioral Risk Factor wvrha.org mandate. Walker noted that failing grade in the latest report Louisiana, Missouri, Telehealth Resource Center Surveillance System in 2010, West Virginia re-Mississippi, • Mid-Atlantic “In the past five years most of card. Five years ago Alabama Nebraska, North Dakota, ported third highest percentage of obesity. www.matrc.orgthe slippage on reproductive receivedthe a “D”. Oklahoma, South Carolina, Obesity prevalence does not vary by gender, • West Virginia Center Health health for hasRural occurred at the state South Dakota, Tennessee, Texas, education or income. level, but this year could see MANY FACTORS Development: wvruralhealth.org Utah, Virginia, and Wisconsin. unprecedented setbacks at the ACCOUNTED FOR national cuts ALABAMA’S FAILING GRADE RURAL HEALTH CARE FACILITIESWalker warned that For more information aboutlevel, the including data “A woman’s in funding for comprehensive INCLUDING POOR SCORES sources used reproductive health should not and methodology employed sex education in the schools IN PREVENTION AND The Rural Health Information Hub, depend an organiinshe RHQ’s on where lives,2017 but Rural Health Report Card, and a return to abstinence only AFFORDABILITY as women in many zation funded by the Federal Officeitofdoes, Rural visit www.RuralHealthQuarterly.com. programs which have been areas are experiencing reduced Using eleven criteria, the Health Policy, reports that there are 20 Critical proven to be ineffective.” access Institute’s report card ranked Access Hospitals in the state, as well as 53to reproductive health care services including abortion.” each of the 50Clinics statesand and28 theFederally Rural Health Qualified Walker stressed that this Walker noted that 19 states, District of Columbia on four Health Centers providing services at 270 sites. year’s report card should be including Alabama, have refused broad indicators relating to “an urgent call to action” for to expand Medicaid under the reproductive health and rights: anyone who is concerned URBAN-RURAL DIVIDE Affordable Care Act, leaving tens effectiveness, prevention, about reproductive health of millions of women without affordability, and access. Based and rights. “As disappointing Most U.S. states report a marked difference improved access to contraception upon their composite scores (0as 2016 was, 2017 could be in health between rural and and urban other health care services. 100), eachoutcomes state received a “core” a whole lot worse.” Walker also noted that in 27 grade (A, B, C, D or F), but some states received an additional


WEST VIRGINIA BY THE NUMBERS West Virginia has an estimated population of 1,831,102 people, and 38.2 percent live in one of West Virginia’s 34 rural counties. The poverty rate in rural West Virginia is 18.7 percent, compared with 17.4 percent in urban areas of the state.

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17.6 percent of the rural population has not completed high school, while 13.4 percent of the urban population lacks a high school diploma.

RURAL COUNTIES URBAN COUNTIES

10.2 percent of rural West Virginia residents are U.S. military veterans, and 15.9 percent of the rural population under age 65 lives with a disability. 95 percent of the state’s rural population is Non-Hispanic White, 2.2 percent is Black/African-American, 1 percent is Hispanic/Latino, 0.1 percent is American Indian/Alaska Native and 0.3 percent is Asian.

MORTALITY

QUALITY OF LIFE

ACCESS TO CARE

Cancer: F

Fair/Poor Health: F

Primary Care: B

Cancer is the leading cause of death in West Virginia, and the state is ranked 44th in the U.S. for deaths by cancer among rural residents. The age-adjusted rate for cancer in rural counties is 193.7 per 100,000. The national average is 158.5 per 100,000.

The percentage of West Virginians reporting poor general health is among the highest in the nation. The state ranked 42nd for rural counties (22.7 percent) and last (51/51) for urban counties (19.1 percent).

West Virginia ranks 16th in the U.S. for the number of primary care physicians practicing in rural counties (60.7 per 100,000). The national average for rural counties is 54.5 per 100,000.

Heart Disease: D-

Mental Health: F

Mental Care: C-

Rural residents of West Virginia reported an average of 4.8 mentally unhealthy days in the past 30 days. The national average is 3.7 days. The state ranked 46th for self-reported mental health in rural counties.

West Virginia ranks 29th in the U.S. for the number of psychiatrists practicing in rural counties. West Virginia has 2.5 per 100,000 residents. The U.S. rural average is 3.4.

Heart disease is the second leading cause of death in West Virginia, and the state is ranked 36th in the U.S. for the number of deaths by heart disease among rural residents. The age-adjusted rate for heart disease in rural counties is 204 per 100,000. The national average is 168.5 per 100,000.

CLRD: F Chronic lower respiratory disease (CLRD) is the third leading cause of death in West Virginia, and the state is ranked 44th in the U.S. for deaths by CLRD among rural residents. The ageadjusted rate for CLRD in rural counties is 68.4 per 100,000. The national average is 41.6 per 100,000.

Physical Health: F The number of physically unhealthy days reported in rural West Virginia is 5 in 30 days, while urban residents report 4.8 days. The national average is 3.9. Rural West Virginia ranks 45th.

Low Birth Weight: F The percentage of live births with low birth weight (< 5 pounds, 8 ounces) in rural West Virginia is 9.7 percent, well above the national average of 8 percent. West Virginia ranks 42nd in the category.

Dental Care: D West Virginia ranks 33rd in the nation for rural access to dental care with 37.9 dentists per 100,000 rural residents. The national rural average is 42.8.

Uninsured Rate: B14.8 percent of West Virginia’s rural population under age 65 is uninsured. The average uninsured rate for urban residents of West Virginia is 13.1 percent. West Virginia is one of 31 states that adopted Medicaid expansion as offered under the Affordable Care Act.

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A 7/47 WISCONSIN ranks seventh in the nation for rural health out of 47 states with rural counties. Wisconsin is one of four states receiving a grade of “A” WISCONSIN RECEIVED A GRADE OF “A” BECAUSE: Wisconsin ranked in the second quintile of states for its rates of mortality in rural counties. Wisconsin ranked in the first quintile of states for measures of daily health and quality of life in rural counties. Wisconsin ranked in the first quintile of states for health care access in rural counties.

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WISCONSIN

WASHINGTON, D.C. – In releasing its fifth annual 50-State Report Card on Reproductive Health and Rights, the Population Institute lowered the U.S. grade from a “D+” to a “D”. The report card, the most comprehensive report card of its kind, tracks multiple indicators of reproductive health and rights, including access to family planning and abortion services.

Along with Illinois, Indiana, Michigan and Ohio, the Badger State is a member of The Institute’s president Robert Walker said, “For the past five years, reproductive health and the East North Central division of the Midwest U.S. Census region. Wisconsin perrights in the U.S. have been on a slippery slope.” Five years ago nine states received an “F”. In formed considerably better than all other states in the division, which otherwise this year’s report card 20 states—including Alabama—received a failing grade. Walker warned, rank near the middle of the nation for rural health. Wisconsin (7) outperforms however, “The worst may be yet to come, as Congress and the new Administration are expected Michigan (21),funding Illinoisfor (27), Ohio (28) and (29) insex theeducation. final rankings. to slash federal family planning andIndiana comprehensive The slippery slope is becoming a free fall.”

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states today more than 50% of “plus” for factors Walker emphasized isconsin isthat one“It’s the nation’s top or a “minus” URBAN-RURAL DIVIDE women now live in a county not reflected in the core grade. not just abortion rights that are performers in this years RHQ Rural without an abortion provider. under siege; it’s also access to Health Report Card, and the state’s Most U.S. states report a marked difference ALABAMA RECEIVED A family planning services, and Critical Access Hospitals also ranked first in in health outcomes Federal betweensupport rural and for urban “MINUS” BECAUSE THEIR when women are denied access the nation on 28 federal quality measures. counties. Wisconsin shows a 4.4 percent reproductive health and rights ‘CHOOSE LIFE’ LICENSE to contraception everyone loses: Not in rural mortality as compared to could suffer a major reversal PLATES FUNDincrease ANTI-CHOICE therebad. are more unintended urban counties. Theinstate ranks 11th for 2017. Congress andrural/ the new pregnancies, more abortions, and ORGANIZATIONS/CRISIS The report from the Medicare Beneficiary urban difference in mortality. Administration are expected to PREGNANCY CENTERS higher health care costs. ” Quality Improvement Project ranks the health curtail access to contraceptive Only 21 states received a services by blocking all funding This at year’s report card also care Wisconsin’s rural hospitals as“B-“ among the RURAL RESOURCES or higher. Just five states for Planned Parenthood, draws attention to “a growing best in terms of patient outcomes. The state New Jersey, (California, defunding Title X, a 48-year old national divide” on reproductive ranked high due in part to fewer deaths Rural health Newtied Mexico, Oregon and resource organizations in Wisconsin program that provides support health and rights, and Walker to HIV, less antipsychotic drug use inWashington) nursing received include:an “A”. to family planning clinics warned that Alabama is “on homes and fewer cases of sepsis after Theoperafollowing states received serving low-income households, the wrong side of that divide.” a failing grade in 2016: tions. The report also notes that rural hospitals • Wisconsin Office ofeliminating Rural Health and the Affordable Alabama, which received an “F”, Alabama, Florida, in Wisconsin are more financially stable than Arkansas, worh.org Care Act’s no-cost birth control was one of 20 states receiving a Georgia, Idaho,• Indiana, Kansas,Academy for Rural Medicine most. Wisconsin mandate. Walker noted that failing grade in the latest report Louisiana, Mississippi, Missouri, www.med.wisc.edu/education/md-pro“In the past five years most of card. Five years ago Alabama Nebraska, Wisconsin are alsoNorth Dakota, gram/warm the slippage on reproductive received a health “D”. insurance premiums Oklahoma, South Carolina, growing considerably slower than other states. health has occurredCenter at the state • Great Texas, Plains Telehealth Resource South Dakota, Tennessee, While the level, but this year could see MANYWisconsin FACTORSdecided not to adopt www.gptrac.org Utah, Virginia, and Wisconsin. unprecedented setbacks at the Medicaid expansion, ACCOUNTED FOR thousands of previously • Rural Health Initiative national level, including cuts ALABAMA’S FAILING GRADE uninsured Wisconsinites enrolled inWalker healthwarned that “A wiruralhealth.org woman’s inHealth funding for comprehensive INCLUDING POOR SCORES coverage through the state’s BadgerCare • should Rural Wisconsin Cooperative reproductive health not sex education in the schools IN PREVENTION AND Medicaid waiver, which increases coverage towhere shewww.rwhc.com depend on lives, but and a return to abstinence only AFFORDABILITY low-income populations. it does, as women in many programs which have been areas are experiencing reduced Using eleven criteria, the For more information about the data proven to be ineffective.” health Institute’s report card ranked RURAL HEALTH CARE FACILITIESaccess to reproductive sources used and methodology employed care services including abortion. each of the 50 states and the in RHQ’s 2017” RuralWalker Health Reportthat Card, stressed this Walker noted that 19 states, District of Columbia on four The Rural Health Information Hub, an organivisit www.RuralHealthQuarterly.com. year’s report card should be broad indicators relating to zation funded by the Federal Officeincluding of Rural Alabama, have refused “an urgent call to action” for to expand Medicaid under the reproductive health and rights: Health Policy, reports that there are 58 Critical anyone who is concerned Affordable Care Act, leaving tens effectiveness, prevention, about reproductive health Access Hospitals in the state, as well as 76 of millions of women without affordability, and access. Based and rights. “As disappointing Rural Health Clinics and 17 Federally Qualified improved access to contraception upon their composite scores (0as 2016 was, 2017 could be Health Centers providing services at 101 sites. and other health care services. 100), each state received a “core” a whole lot worse.” Walker also noted that in 27 grade (A, B, C, D or F), but some states received an additional


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RURAL COUNTIES URBAN COUNTIES

WISCONSIN BY THE NUMBERS Wisconsin has an estimated population of 5,778,708 people, and 25.9 percent live in one of Wisconsin’s 46 rural counties. The poverty rate in rural Wisconsin is 11.3 percent, compared with 11.9 percent in urban areas of the state. 9.9 percent of the rural population has not completed high school, while 8.6 percent of the urban population lacks a high school diploma. 10.3 percent of rural Wisconsin residents are U.S. military veterans, and 8.8 percent of the rural population under age 65 lives with a disability. 91.8 percent of the state’s rural population is Non-Hispanic White, 0.8 percent is Black/African-American, 3.6 percent is Hispanic/Latino, 1.6 percent is American Indian/Alaska Native and 0.9 percent is Asian.

MORTALITY

QUALITY OF LIFE

ACCESS TO CARE

Cancer: C+

Fair/Poor Health: B+

Primary Care: B+

Cancer is the leading cause of death in Wisconsin, and the state is ranked 21st in the U.S. for deaths by cancer among rural residents. The age-adjusted rate for cancer in rural counties is 167.1 per 100,000. The national average is 158.5 per 100,000.

The percentage of Wisconsinites reporting poor general health is relatively low. The state ranked 12th for rural counties (13.5 percent) and 21/51 for urban counties (13.5 percent).

Wisconsin ranks 12th in the U.S. for the number of primary care physicians practicing in rural counties (67.6 per 100,000). The national average for rural counties is 54.5 per 100,000.

Heart Disease: B-

Mental Health: B+

Mental Care: B

Rural residents of Wisconsin reported an average of 3.4 mentally unhealthy days in the past 30 days. The national average is 3.7 days. The state ranked 11th for self-reported mental health in rural counties.

Wisconsin ranks 16th in the U.S. for the number of psychiatrists practicing in rural counties. Wisconsin has 3.7 per 100,000 residents. The U.S. rural average is 3.4.

Heart disease is the second leading cause of death in Wisconsin, and the state is ranked 18th in the U.S. for the number of deaths by heart disease among rural residents. The age-adjusted rate for heart disease in rural counties is 161.2 per 100,000. The national average is 168.5 per 100,000.

Accidents: AAccidents are the third leading cause of death in Wisconsin, and the state ranked 10th out of 47 states for accidental death in rural counties. The statewide rate for accidental death is 48.9 per 100,000. The national average is 43.2 per 100,000.

Physical Health: B+ The number of physically unhealthy days reported in rural Wisconsin is 4.5 in 30 days, while urban residents report 4.1 days. The national average is 3.9. Rural Wisconsin ranks 12th.

Low Birth Weight: A The percentage of live births with low birth weight (< 5 pounds, 8 ounces) in rural Wisconsin is 6.1 percent. The national average is 8 percent. Wisconsin ranks 6th in the category.

Dental Care: BWisconsin ranks 18th in the nation for rural access to dental care with 52 dentists per 100,000 rural residents. The national rural average is 42.8.

Uninsured Rate: A10.5 percent of Wisconsin’s rural population under age 65 is uninsured. The average uninsured rate for urban residents of Wisconsin is 8.7 percent. Wisconsin is one of 19 states that did not adopt Medicaid expansion as offered under the Affordable Care Act.

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IN FREE FALL: REPRODUCTIVE HEALTH AND RIGHTS IN AMERICA

B 14/47 WYOMING ranks 14th in the nation for rural health out of 47 states with rural counties. Wyoming is one of four states receiving a grade of “B” WYOMING RECEIVED A GRADE OF “B” BECAUSE: Wyoming ranked in the first quintile of states for its rates of mortality in rural counties. Wyoming ranked in the third quintile of states for measures of daily health and quality of life in rural counties. Wyoming ranked in the second quintile of states for health care access in rural counties.

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WYOMING

WASHINGTON, D.C. – In releasing its fifth annual 50-State Report Card on Reproductive Health and Rights, the Population Institute lowered the U.S. grade from a “D+” to a “D”. The report card, the most comprehensive report card of its kind, tracks multiple indicators of reproductive health and rights, including access to family planning and abortion services.

Along with Arizona, Colorado, Idaho, Montana, Nevada, New Mexico and Utah, Wyoming The Institute’s president Robert Walker said, “For the past five years, reproductive health and is part of the Mountain division of the West U.S. Census region. With the exception of rights in the U.S. have been on a slippery slope.” Five years ago nine states received an “F”. In high performers Colorado and Wyoming, all states in the division rank near the middle this year’s report card 20 states—including Alabama—received a failing grade. Walker warned, of the nation rural health. ranksand higher thanAdministration Montana (19), however, “Thefor worst may be yetWyoming to come, as(14) Congress the new areIdaho expected (20), Utah (23),funding Nevada New Mexico (31) and Arizonasex (33). The Equality State slope to slash federal for(30), family planning and comprehensive education. The slippery falls behindaonly (12) in the final divisional rankings. is becoming free Colorado fall.”

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todayasmore 50% of “plus” for factors Walker emphasized yoming is that wide“It’s open. With theor a “minus” Access Hospitals in states the state, wellthan as 16 women now live in a county not reflected in the core grade. not just abortion rights that are exception of people living in and Rural Health Clinics and 6 Federally Qualified without an abortion provider. under siege; it’s also access to around Cheyenne and Casper, the Health Centers providing services at 13 sites. ALABAMA RECEIVED A family planning services, and remaining population lives in rural“MINUS” areas. BECAUSE THEIR Federal support for when women are denied access Nevertheless, the state gets high marks for LIFE’URBAN-RURAL DIVIDE reproductive health and rights ‘CHOOSE LICENSE to contraception everyone loses: many measures of rural health care. could suffer a major reversal PLATES FUND ANTI-CHOICE there are more unintended Most U.S. states report a marked difference in 2017. Congress and the new pregnancies, more abortions, and ORGANIZATIONS/CRISIS The relatively highcosts. percentage of babies born CENTERS are expected in health outcomes Administration between rural and urban to PREGNANCY higher health care ” in Wyoming with a low birth weight remain a curtail access to contraceptive counties. Wyoming shows an unusual, and Only 21 states received a services(-10.7 by blocking all in funding This year’s report card also cause for concern, however. The problem has unusually large, decrease percent) “B-“ or higher. Just five states for Planned Parenthood, draws attention to “a growing worsened in Wyoming since 2008,(California, and the Newrural mortality as compared to urban counties. Jersey, defunding Title X, a 48-year old national divide” onDepartment reproductive hasNew Wyoming Health said Mexico, the As a result, Oregon and the state ranks first nationally for program that provides support health and rights, and Walker problem is due in part to women smoking rural/urban difference in mortality. Washington) received an “A”. to family planning clinics warned that Alabama is “on or drinking too much during pregnancy. 13 The following states received serving low-income households, the wrong side of that divide.” a failing grade in 2016: RESOURCES percent of Wyoming mothers reported smokRURAL and eliminating the Affordable Alabama, which received an “F”, Alabama,acArkansas, Florida, ing in the last three months of pregnancy, Care Act’s no-cost birth control was one of 20 states receiving a Georgia, Idaho, Indiana, Kansas, cording to Wyoming BRFSS and PRAMS Data. Rural health resourcemandate. organizations in Wyoming Walker noted that failing grade in the latest report Louisiana, Mississippi, Missouri, include: “In the past five years most of card. Five years ago Alabama Nebraska, North Dakota, American times as the slippage on reproductive received a Indian “D”. babies are also 1.9 Oklahoma, South Carolina, likely to die compared with White babies in health has Health occurred at the state • Wyoming Office of Rural South Dakota, Tennessee, Texas, the state, according to Wyoming Vital Statistics level, but this year could see MANY FACTORS health.wyo.gov/publichealth/rural/ Utah, Virginia, and Wisconsin. unprecedented setbacks at the ACCOUNTED FOR Services. officeofruralhealth national level, including cuts ALABAMA’S FAILING GRADE • “A Wyoming Walker warned that woman’sRural and Frontier Health Division in funding for comprehensive INCLUDING POOR SCORES Wyoming also continues to have one of the health should reproductive not health.wyo.gov/publichealth/rural/ sex education in the schools IN PREVENTION AND highest rates of suicide in the nation. Theon where• sheNorthwest depend lives, but Regional Telehealth Resource and a return to abstinence only AFFORDABILITY state had the fourth-highest rate of deaths it does, as women in Center: many www.nrtrc.org programs which have been areas are experiencing reduced Using eleven the in 2014, according by suicide in criteria, the country proven to be ineffective.” access to reproductive health Institute’s report cardwas ranked to the CDC. Suicide the seventh-highest For more information about the data care services including abortion.” each ofofthe 50 states thethat year. cause death in theand state sources used and methodology Walker stressedemployed that this Walker noted that 19 states, District of Columbia on four in RHQ’s 2017 Rural Health Report year’s report card Card, should be including Alabama, have refused broad indicators relating to RURAL HEALTH CARE FACILITIES “an urgent call to action” for visit www.RuralHealthQuarterly.com. to expand Medicaid under the reproductive health and rights: anyone who is concerned Affordable Care Act, leaving tens effectiveness, prevention, about reproductive health The Rural Health Information Hub, an organiof millions of women without affordability, and access. Based and rights. “As disappointing zation funded by the Federal Office of Rural improved access to contraception upon their composite scores (0as 2016 was, 2017 could be Health Policy, that there are 16other Critical and health care services. 100), each statereports received a “core” a whole lot worse.” Walker also noted that in 27 grade (A, B, C, D or F), but some states received an additional


WYOMING BY THE NUMBERS Wyoming has an estimated population of 585,501 people, and 69.4 percent live in one of Wyoming’s 21 rural counties. The poverty rate in rural Wyoming is 12.1 percent, compared with 9.5 percent in urban areas of the state. 7.7 percent of the rural population has not completed high school, while 7.8 percent of the urban population lacks a high school diploma.

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10 percent of rural Wyoming residents are U.S. military veterans, and 8.3 percent of the rural population under age 65 lives with a disability.

RURAL COUNTIES URBAN COUNTIES

85.2 percent of the state’s rural population is Non-Hispanic White, 0.6 percent is Black/African-American, 8.9 percent is Hispanic/Latino, 2.4 percent is American Indian/Alaska Native and 0.8 percent is Asian.

MORTALITY

QUALITY OF LIFE

ACCESS TO CARE

Heart Disease: A-

Fair/Poor Health: B

Primary Care: B+

Heart disease is the leading cause of death in Wyoming, and the state is ranked 8th in the U.S. for the number of deaths by heart disease among rural residents. The age-adjusted rate for heart disease in rural counties is 153.1 per 100,000. The national average is 168.5 per 100,000.

The percentage of Wyomingites reporting poor general health is relatively low. The state ranked 15th for rural counties (13.9 percent) and 23/51 for urban counties (14 percent).

Wyoming ranks 11th in the U.S. for the number of primary care physicians practicing in rural counties (67.7 per 100,000). The national average for rural counties is 54.5 per 100,000.

Mental Health: A-

Mental Care: B+

Cancer: A+

Rural residents of Wyoming reported an average of 3.4 mentally unhealthy days in the past 30 days. The national average is 3.7 days. The state ranked 9th for self-reported mental health in rural counties.

Wyoming ranks 13th in the U.S. for the number of psychiatrists practicing in rural counties. Wyoming has 4.7 per 100,000 residents. The U.S. rural average is 3.4.

Cancer is the second leading cause of death in Wyoming, and the state is ranked 3rd in the U.S. for deaths by cancer among rural residents. The ageadjusted rate for cancer in rural counties is 137 per 100,000. The national average is 158.5 per 100,000.

Accidents: F Accidents are the third leading cause of death in Wyoming, and Wyoming ranked 43rd out of 47 states for accidental death in rural counties. The statewide rate for accidental death is 70.4 per 100,000. The national average is 43.2 per 100,000.

Physical Health: B The number of physically unhealthy days reported in rural Wyoming is 3.6 in 30 days, while urban residents report 3.7 days. The national average is 3.9. Rural Wyoming ranks 14th.

Low Birth Weight: D+ The percentage of live births with low birth weight (< 5 pounds, 8 ounces) in rural Wyoming is 8.3 percent. The national average is 8 percent. Wyoming ranks 31st in the category.

Dental Care: B+ Wyoming ranks 12th in the nation for rural access to dental care with 57.2 dentists per 100,000 rural residents. The national rural average is 42.8.

Uninsured Rate: C+ 15.6 percent of Wyoming’s rural population under age 65 is uninsured. The average uninsured rate for urban residents of Wyoming is 14.8 percent. Wyoming is one of 19 states that did not adopt Medicaid expansion as offered under the Affordable Care Act.

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RHQ CONFERENCE CALENDAR

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heck out our list of rural health conferences, and let us know if youâ&#x20AC;&#x2122;re hosting one so we can help spread the word. Email us the details at RHQ@ttuhsc.edu. 31st Annual AHA Rural Health Care Leadership Conference February 4 - 7, 2018 Arizona Grand Resort and Spa, 8000 S. Arizona Grand Parkway Phoenix, AZ www.healthforum-edu.com/rural/ overview.dhtml NRHA Rural Health Policy Institute February 6 - 8, 2018 Omni Shoreham Hotel, 2500 Calvert Street NW Washington, D.C. www.ruralhealthweb.org Michigan Rural Health Conference March 3 - 4, 2018 Soaring Eagle Casino and Resort, 6800 Soaring Eagle Blvd. Mount Pleasant, MI www.mcrh.msu.edu/events/events2. html National Association of Rural Health Clinics 2018 Institute March 19 - 21, 2018 Hyatt Regency Riverwalk, 123 Losoya St. San Antonio, TX 78205 narhc.org NWRHC Annual Conference March 26 - 28, 2018 Davenport Grand Hotel, Spokane, 10 S Post Street Spokane, WA 99201 www.wrha.com 19th Annual Rural Health Conference: Substance Abuse in Alabama April 25 - 26, 2018 Bryant Conference Center, 240 Paul W Bryant Drive Tuscaloosa, AL rhc.ua.edu NRHA Annual Rural Health Conference May 8 - 11, 2018 New Orleans Marriot Hotel, 555 Canal St New Orleans, LA www.ruralhealthweb.org Rural Hospital Innovation Summit May 8 - 11, 2018 New Orleans Marriot Hotel, 555

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Canal St New Orleans, LA www.ruralhealthweb.org NRHA Health Equity Conference May 8, 2018 New Orleans Marriot Hotel, 555 Canal St New Orleans, LA www.ruralhealthweb.org Rural Medical Education Conference May 8, 2018 New Orleans Marriot Hotel, 555 Canal St New Orleans, LA www.ruralhealthweb.org Oklahoma Rural Health Conference May 22 - 23, 2018 Embassy Suites Norman Hotel and Conference Center, 2501 Conference Dr. Norman, OK 73069 www.rhao.org Wisconsin Rural Health Conference June 27 - 29, 2018 Osthoff Resort, 101 Osthoff Avenue Elkhart Lake, WI www.wha.org NRHA SRHA Leadership Conference July 17 - 18, 2018 Omni Shoreham Hotel, 2500 Calvert Street NW Washington, D.C. www.ruralhealthweb.org

NRHA Rural Quality and Clinical Conference July 18 - 20, 2018 Omni Shoreham Hotel, 2500 Calvert Street NW Washington, D.C. www.ruralhealthweb.org Rural Health Clinic Conference September 25 - 26, 2018 Sheraton Kansas City Hotel at Crown Center, 2345 McGee Street Kansas City, MO www.ruralhealthweb.org Critical Access Hospital Conference September 27 - 29, 2018 Sheraton Kansas City Hotel at Crown Center, 2345 McGee Street Kansas City, MO www.ruralhealthweb.org 35th Annual Oregon Rural Health Conference October 3 - 5, 2018 The Riverhouse, 3075 N. Business 97 Bend, OR www.ohsu.edu/xd/outreach/oregonrural-health/contact.cfm National Association of Rural Health Clinics Fall 2018 Institute October 23 - 25, 2018 Hyatt Regency Lake Tahoe, 111 Country Club Drive Incline Village, NV narhc.org

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Making a Healthy Difference for Rural Texans

SERVING THE TEXAS RURAL HEALTH COMMUNITY The obstacles faced by health care providers and patients in rural areas are vastly different than those in urban areas. The Texas Rural Health Association (TRHA) is a nonprofit organization whose primary goal is to improve the health of rural Texans. Since 1984, individuals and organizations of TRHA have been dedicated to providing leadership on rural health care issues through advocacy, communication, and education.

THE TRHA MISSION  Promote rural health as a distinct concern in Texas.  Serve as a strong and unifying voice for concerned citizens,

community leaders, public officials, and health care providers and organizations working to improve rural health in Texas.  Advocate for rural health and promote an enhanced status

and improved health system for rural Texans.  Provide a forum for exchange and distribution of

information and ideas related to improvement of rural health.  Encourage the development of appropriate health resources

to all rural areas of Texas.

WWW.TRHA.ORG | 512-368-9860 | PO BOX 201363 AUSTIN, TX 78720


HQ Plaza, 5307 West Loop 289, Suite 301 Lubbock, TX 79414

www.myamerigroup.com/tx

1-800-600-4441 (TTY 711) TXMKTAL-0558-15 12.15

Profile for Rural Health Quarterly (RHQ)

Rural Health Quarterly 1.4 - Fall 2017  

SPECIAL DOUBLE ISSUE: 2017 U.S. Rural Health Report Card

Rural Health Quarterly 1.4 - Fall 2017  

SPECIAL DOUBLE ISSUE: 2017 U.S. Rural Health Report Card

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