From the Aspen Institute

A place is distinguished by its people, governance and institutions as much as it is by its physical landscape, natural resources, buildings and boundaries.1 The character of a place, its identity, and its people’s sense of belonging are shaped by interaction within the place and with other places, and by its history and its culture. Every person lives in multiple places – both over a lifetime and at any given time – where they reside, work, learn, shop and play. And everyone lives at different scales – home, neighborhood, city, state, nation, other countries.
Quality of life is largely determined by the characteristics of places, for better or worse. Differences between places drive inequalities in economic opportunity, educational attainment and health outcomes.

These differences are often expressed as “geography is destiny” or “geographic inequity.” The idea that where you live determines your life chances strikes at the heart of the American Dream of opportunity for all – that if you work hard, it doesn’t matter where you come from or what you look like, you can achieve a stable and prosperous life. But, the groundbreaking research of Raj Chetty2,3 on economic mobility has shown clearly that geography and race really do shape your destiny.

Rural America is a special place – or more accurately a mosaic of many special places – where connection to the land is the defining characteristic, reinforced by history, culture and lived experiences. Equity in a rural context is complicated – in its relationship with urban and suburban America, in terms of who owns and controls the land and its resources, and in the very present legacies of broken promises to Native peoples and of slavery and discrimination. Yet, it still is a place of both majestic and intimate landscapes, of resilient and resourceful people and communities, and a vital part of the United States, past, present and future.

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Acting Pennsylvania Secretary of Health Alison Beam announced the Department of Health has published the 2020 Pennsylvania State Health Assessment (SHA). The assessment, titled The State of Our Health: A Statewide Health Assessment of Pennsylvania, points to specific health challenges in Pennsylvania and indicates where the largest improvements can be made.

“The State Health Assessment is essential to the department’s mission, which is creating a healthy Pennsylvania for all,” Acting Secretary Beam said. “It identifies health disparities, opportunities for health improvement, and resources available to support and promote improved health status. The State Health Assessment further reinforces our commitment to promoting healthy behaviors, preventing injury and disease, and assuring the safe delivery of quality health care for all Pennsylvanians.”

The 2020 SHA was developed by the department’s Office of Operational Excellence and the Healthy Pennsylvania Partnership (HPP), along with Public Health Management Corporation and Bloom Planning. The HPP is made up of nearly 280 volunteers, including many from the department, who collaborate on the development and maintenance of the SHA, and the development and implementation of the State Health Improvement Plan (SHIP).

In addition to an overarching framework of social determinants of health and equity, there are eight themes in the 2020 SHA:

• Access to care;
• Environmental Health;
• Mental Health;
• Maternal and Infant Health;
• Substance Use;
• Injury and Violence Prevention;
• Chronic Diseases; and
• Infectious Diseases and Immunization.

From the report, we know that Pennsylvania’s population has become increasingly diverse; in 2019, 82 percent of individuals identified as white, 12 percent identified as black, 4 percent identified as Asian, and 2 percent identified as multi-racial or another race.

It is also an aging population, with 19 percent of the population aged 65 and over. In 2018, five percent of the adult population identified as lesbian, gay, or bisexual, and under one percent identified as transgender. Additionally:

• The percent of high school students who, in the past 12 months, felt sad or hopeless almost every day for two weeks or more in a row, so that they stopped doing some usual activities, increased from 28 percent in 2015 to 35 percent in 2019. An even higher percentage of Hispanic and lesbian, gay, and bisexual high school students reported feeling sad or hopeless.
• In 2019, about 17 percent of adults binge drank, 10 percent used illicit drugs, and 7 percent had a substance use disorder. Lesbian, gay or bisexual adults had a higher prevalence of binge drinking.
• Based on 2015-2017 data, approximately one in two Pennsylvania residents will be diagnosed with cancer at some point during their lifetime, and one in five will die of cancer.
• While tobacco use has declined, it remains a leading risk factor for chronic diseases. In 2019, prevalence of smoking was higher among gay, lesbian and bisexual adults, those with lower household incomes, and those with lower educational status.
• Among adults under age 65 in 2018, about 7 percent were uninsured. In 2019, among adults, 16 percent did not have a personal health care provider, and 10 percent needed to see a doctor in the past year but were unable to due to cost.
• In 2018 and 2019, non-Hispanic black adults were less likely to have health care insurance and more unable to see a doctor due to cost than white adults. Hispanics were less likely to have insurance, more unable to see a doctor due to cost, and more likely to not have a personal health care provider than non-Hispanic white adults.
• Early and adequate prenatal care is important for the health of the mother and to reduce newborn risks. In 2018, 2 percent of females who gave birth did not receive prenatal care. Black females were about four times as likely not to receive prenatal care compared to whites.
• There were 1,833 neonatal abstinence syndrome (NAS)-related newborn hospital stays in 2018. NAS was highest among white babies, those from rural counties, and from families with lower household incomes.
• Between 2003 and 2018, syphilis increased by close to 400 percent, chlamydia increased by 59 percent and gonorrhea increased by 34 percent. Black and Hispanic individuals were more likely to be diagnosed with syphilis, gonorrhea, and chlamydia.
• Air pollution is one of the greatest health challenges in Pennsylvania. In 2019, the state ranked 47 of 50 states for the general public’s exposure to acceptable levels of particulate matter.
• Violent crime in Pennsylvania decreased from 400 per 100,000 in 2008 to 306 per 100,000 residents in 2018. Between 2013 and 2018, the homicide rate among white residents held steady at two per 100,000, while for black individuals the rate increased to 29 per 100,000.

“Health departments, other agencies and nonprofit organizations use the State Health Assessment in their planning and program development,” Acting Secretary Beam said. “I encourage all organizations to use this document to educate and mobilize communities, set priorities, generate resources and adopt or revise policies to assure that Pennsylvania is a place where all people can achieve their full physical, mental and social well-being, free of inequities.”

More information on The State of Our Health: A Statewide Health Assessment of Pennsylvania can be found on the Department of Health’s website at health.pa.govOpens In A New Window or follow us on FacebookOpens In A New Window and TwitterOpens In A New Window.

MEDIA CONTACT:  April Hutcheson, ra-dhpressoffice@pa.gov

The Congressional Research Service (CRS) provides objective policy and legal analysis to committees and members of the U.S. House and Senate.  This report provides an overview of federal programs designed to accelerate broadband deployment and adoption in minority communities, rural and tribal areas, and among other eligible households.

The Multidisciplinary Digital Publishing Institute (MDPI) is an international organization providing open access to more than 300 academic journals.  In an article published in the International Journal of Environmental Research and Public Health, researchers examine how racism and related social determinants of health expose rural Black and American Indian/Alaska Native populations to greater risk of developing cancer.

The Pennsylvania Department of Health released a PA Health Alert Network (PAHAN-549-01-29-ADV) on Changes in the CDC Gonorrhea Treatment Recommendations. With the ongoing threat of antibiotic resistance in gonorrhea, the Centers for Disease Control and Prevention (CDC) released a change to the recommended treatment for gonorrhea. It is suggested that providers adopt these new CDC recommendations as cases are at and a historic high. Young adults age 15-30 represent a significant disproportionate number of cases, representing 63% of all reported cases in 2020. Providers are encouraged to maintain a high index of suspicion for the emergence of resistant gonorrhea by immediately reporting any suspected treatment failures to 1-877-PA-HEALTH. Click here to read the PAHAN.