ural America is economically, socially, culturally, geographically, and demographically diverse. This multidimensional diversity presents complex challenges and unique opportunities related to delivering health care and improving health outcomes and health equity in rural communities.

To explore issues related to population health in rural America, the Roundtable on Population Health Improvement of the Board on Population Health and Public Health Practice of the National Academies of Sciences, Engineering, and Medicine convened a public virtual workshop, “Population Health in Rural America in 2020” on June 24–25, 2020. The workshop planning committee was composed of rural health experts representing public health, health care, and tribal health. Presentations and discussions focused on rural America in context, rural health vital signs, rural health care in action, assessment and implementation strategies for improving the health and health equity in rural populations, and rural health policy.

This Proceedings of a Workshop summarizes the presentations and discussions from the workshop.

Download the publication here.

The White House Interagency Working Group on Coal and Power Plant Communities and Economic Revitalization delivered a report  to President Biden with their initial recommendations  to catalyze economic development and create good-paying jobs in hard-hit energy communities across the country. ARC ‘s participation in this working group enabled the organization to provide a voice for Appalachia and strengthen partnerships with other federal agencies to maximize the resources available to coal-impacted communities.

The report identified an array of existing federal funding opportunities that could be accessed by energy communities to support community revitalization efforts. ARC’s POWER (Partnerships for Opportunity and Workforce and Economic Revitalization) Initiative, which targets federal resources to help communities affected by job losses in coal mining, coal power plant operations, and coal-related supply chain industries, is highlighted in the report. POWER has invested $238 million in 293 projects touching 353 coal-impacted communities since 2015.

The report also identifies 25 specific communities that are most directly impacted by changes in the energy economy—eight of those are in Appalachia, covering 84 counties. The Appalachian communities on this list are:

• Southern West Virginia non-metropolitan area
• East Kentucky non-metropolitan area
• Wheeling, West Virginia -Ohio
• Southwest Virginia non-metropolitan area
• Northern West Virginia non-metropolitan area
• Beckley, West Virginia
• Charleston, West Virginia
• Western Pennsylvania non-metropolitan area

This ranking helps identify areas that are most vulnerable to additional near-term coal mine and power plant closures.

Access the report and fact sheet to learn more. For more background on the economic impact of energy transitions, access ARC’s report An Overview of Coal and the Economy in Appalachia.

Health Affairs

New research from the HRSA-funded University of Minnesota Rural Health Research Center shows that among rural hospitals, those hospitals that have stopped providing obstetric care are smaller and more likely to be located in remote rural areas or in majority Black rural counties. This research is critically important for informing programs aimed at addressing disparities in access to maternal health care, like the recently announced RMOMS Program.

The Primary Care Collaborative has released a new report: “Innovations in Oral Health and Primary Care Integration.” The report provides a comprehensive look at the critical need to integrate oral health and primary care and showcases the multitude of ways that healthcare clinicians, community, and public health leaders are working together across the country to make it happen.

Click here to read the report.

The Journal of Appalachian Health has many research articles pertaining to the Coronavirus pandemic. Check them out HERE:

COVID-19 and Opioid Use in Appalachian Kentucky: Challenges and Silver Linings

Authors: Rachel Vickers-Smith, Hannah L.F. Cooper, April M. Young

Rural Appalachia Battling the Intersection of Two Crises: COVID-19 and Substance Use Disorders

Authors: Margaret Miller, Rebekah Rollston, Kate E. Beatty, Michael Meit

Impact of the COVID-19 Shutdown on Mental Health in Appalachia by Working Status

Authors: Erin N. Haynes, Timothy J. Hilbert, Susan C. Westneat, Kate Leger, Katie Keynton, et al.

A Description of COVID-19 Lifestyle Restrictions Among a Sample of Rural Appalachian Women

Authors: Michele Staton, Martha Tillson, J. Matthew Webster

The Health Wagon Partners with the Virginia Department of Health to Provide COVID-19 Testing in Rural Southwest Virginia

Authors: Tauna Gulley, Teresa Tyson, Ethan Collins, Rachel Helton, Paula Hill-Collins, et al.

Advancing Cancer Prevention Practice Facilitation Work in Rural Primary Care During COVID-19

Authors: Dannell Boatman, Susan Eason, Mary E. Conn, Summer Miller, Stephenie Kennedy-Rea

Poll Finds Rural Residents More Hesitant to Get Vaccinated

Author: Tim Marema

For victims of sexual assault, high-quality health care provided by sexual assault nurse examiners (SANEs) is associated with improved health and prosecutorial outcomes. However, very little is known about access to SANEs.

Sheridan Miyamoto, assistant professor and SAFE-T Center principal investigator, and Elizabeth Thiede, nursing doctoral student and 2021 ENRS Student Conference Scholarship Award winner, wanted to learn more about whether rural areas in particular may have disparate access to SANEs.

“If rural areas have limited SANE availability, then rural victims of sexual assault may be at risk of receiving lower-quality care, which has implications not only for their health but also for prosecutorial outcomes,” stated Thiede.

The research recently was published in The Journal of Rural Health.

To examine rural access to SANEs, Thiede and Miyamoto analyzed data from the International Association of Forensic Nurses (IAFN) as well as data collected from 43 rural Pennsylvania hospitals.

The IAFN data showed that certified SANEs — those who have met rigorous qualifications and passed a certification exam — were only present in 16.7% of rural counties. The data collected from individual hospitals confirmed that very few have certified SANEs on staff and, instead, most rely on registered nurses with varying levels of additional training in sexual assault care.

Thiede and Miyamoto also found that most of these hospitals are not able to provide continuous sexual assault care coverage. This may lead them to encourage victims to seek care elsewhere or to rely on health care providers without additional training and experience in sexual assault care when victims present to emergency rooms.

Miyamoto and Thiede suspect that the absence of certified SANEs in the majority of rural Pennsylvania counties could be indicative of barriers to meeting certification requirements for rural SANEs. The two suggested one likely barrier to certification is the difficulty obtaining the supervised practice hours required for certification eligibility.

“Rural communities face challenges in recruiting, training, and retaining SANE nurses. Creative solutions are needed to increase access to quality sexual assault care.” Miyamoto stated. “The intent of the Penn State Sexual Assault Forensic Examination Telehealth (SAFE-T) program is to pair less experienced nurses working in rural areas with expert SANEs to receive examination support, precepting, and peer review via telehealth technology. Programs like this show great promise in growing and sustaining a rural SANE workforce.”

To continue ensuring that rural sexual assault victims receive expert quality sexual assault care, further research is needed to better understand how hospitals make decisions related to how they will provide sexual assault care and how ecological factors, such as hospital resources, the population size of the surrounding community, organizational culture, and state-level oversight may influence this decision-making.

More information about the SAFE-T Center and their work can be found on the website.