National Public Health Week

NATIONAL PUBLIC HEALTH WEEK

Mr. JOHNSON. Mr. President, this week is National Public Health Week, an annual event sponsored by the American Public Health Association or APHA. Every year in April, national, State and local public health professionals highlight an important public health issue, to raise awareness about leading health problems impacting our nation. This year, the theme of National Public Health Week is "eliminating health disparities".

There are many groups that experience disparities in health, largely a result of limited access to important health care services. Living in a rural area is in itself a health risk factor, due to numerous factors that can adversely influence health and access and the resulting disparities are well documented. Chronic illnesses are more prevalent in rural communities and studies have shown that rural residents are more likely to describe their overall health status as poorer than their urban counterparts. Limitation in activity due to chronic health conditions among adults is more common in rural counties than in large metro counties.

The University of Pittsburg's Center for Rural Health Practices released a report this week which highlights specific rural health disparity issues. The report indicated that death rates for children and young adults are highest in the most rural counties. Nationally and within each region, death rates from unintentional injuries increases greatly as counties become less urban. And death rates for motor vehicle-related injuries in most rural counties are over twice as high as the rates in central counties of large metro areas. My home State of South Dakota ranks 8th with two other States for having the worst motor vehicle death rate in the Nation.

In addition, adolescents living in the most rural counties are most likely to smoke. For example, in 1999 for the United States as a whole, 19 percent of adolescents in the most rural counties smoked compared with 11 percent in metro counties. This disparity also holds true for adults who smoke. Adults in rural areas are more likely to consume alcohol than those living in other areas, and both men and women in rural areas have higher rates of self-reported obesity than men and women in other areas.

Minorities in rural areas also face additional health disparities. Diabetes among Native Americans is more than twice that of the general population, and heart disease and cancer are the leading causes of death among this population. Infant mortality among this population is 1.7 times higher than among non-Hispanic whites and the sudden infant death syndrome or SIDS rate among this minority group is the highest of any population group in the nation.

It is important that we find ways to address rural public health disparities. Access to health care providers is a critical component of the solution and that is why I have long supported rural provider payment equity. Payment equity ensures that the doors stay open at our local hospitals and physicians offices. I feel that Congress needs to continue to address this important issue and make a commitment to rural residents across America that it will support initiatives to remedy this problem.

While payment equity is a critical component in solving this disparity issue, it is only part of the overall solution. Access problems continue to be a distinct challenge in rural communities, due largely to declining rates of health care workers in these areas. In 1998, there were six times as many general pediatricians per 100,000 in central counties of large metro areas as in the most rural counties and five times as many general internists.

One of the ways to address this problem is through enhanced funding for important Federal programs that promote the recruitment and retention of health care workers. I have recently sent letters to the leadership on the Senate Labor, Health and Human Services, Education Appropriations Subcommittee, requesting a $63 million dollar increase for Title VIII nurse education programs created under the Nurse Reinvestment Act. I have also asked the committee to restore the President's proposed drastic cuts of almost $200 million for the Title VII health professions programs, by providing $308 million for these programs.

In order to further address rural health disparities, we need to strengthen efforts towards establishing a 21st century health care system that utilizes information technology to allow health care professionals across rural America to share their knowledge, expertise and resources. I have worked with my colleagues in the Senate to secure funding in recent years to allow just that, such as the wonderful health information systems project through the Community HealthCare Association of South Dakota, and the nurse distance learning project through the University of South Dakota and the Good Samaritan Society. I encourage my colleagues to continue to build on these types of rural specific projects nationwide so that we may see this dream of a modern 21st century health care system become a reality.

In order to address the Native American health disparities problems, in addition to improving access to direct health care services, it is important that we obtain comprehensive data on key health risk factors impacting this population. In South Dakota, the Northern Plains Tribal Epidemiology Center in Rapid City is providing information to tribes and working with tribes to help access health data through good assessment tools, which can be used to develop interventions and improve the health in Native American communities across the State. This is an effective model for approaching a critical minority health problem and the Center combines epidemiology, research, and public health practice to develop interventions that can be disseminated to the tribal communities.

Often our best solutions come from the local experts. I look forward to working with public health experts in both South Dakota, as well as the Nation at large, to address these shortfalls in rural health. I believe that the information we gain through these discussions will provide Congress with a broader scope of knowledge, thus allowing us to better meet the needs of those who fall into this health disparity category.