2019 County Health Rankings.  Released on Tuesday of this week, the 2019 ranking of health for nearly every county in the nation reminds us that health outcomes are heavily influenced by where we live.  This year’s analysis focuses specifically on homes and the way they shape the health of individuals, families and communities.  Among the key findings is evidence showing that severe housing cost burden has decreased in large urban areas since the end of the real estate crisis that ended in 2010.  In that same period of time, however, nearly half of all rural counties experienced an increase in severe housing costs.

Ongoing Work on Rural Health Issues at the CDC.  In the latest edition of The Rural Monitor, Senior Policy Analyst Diane Hall answers questions about the work on rural health at the Centers for Disease Control and Prevention (CDC). What started as a series in 2017 for their Morbidity and Mortality Weekly Report (MMWR) has continued with ongoing work with representation from each of the CDC’s centers ensuring that rural communities are included in funding opportunities and projects.  The MMWR series oriented the public and policymakers to the rural specifics on topics such as drug overdose deaths, leading causes of death, suicide trends, and cancer incidence and deaths.

Mental Health in Rural Communities Toolkit.  The newest resource from the Rural Health Information Hub compiles evidence-based and promising models to support organizations implementing mental health programs in rural communities across the United States, with a primary focus on adult mental health.

CMS Opioid Prescribing Mapping Tool Improved with Medicaid and Rural Data.

Recently, the Centers for Medicare & Medicaid Services (CMS) released an expanded version of its tool that tracks rates of opioid prescribing over time and across regions to help inform prevention and treatment efforts.   For the first time since the Opioid Prescribing Mapping Tool launched in 2015, the tool allows geographic comparisons of Medicare Part D opioid prescribing rates for urban and rural communities.  See the Learning Events section below for a CMS Rural Health Open Door Forum, taking place today, that will explain what’s new for rural stakeholders.

By Beth Blevins

Human trafficking doesn’t just happen in big cities in the United States—it happens in rural areas as well. Lisa Davis, Director of the Pennsylvania Office of Rural Health (PORH), is working to bring more attention to this issue.

Davis said her interest in human trafficking came unexpectedly, at a presentation given at a Pennsylvania Critical Access Hospital Consortium meeting in November 2017. It was unclear if the topic resonated with the hospital leadership in the audience, she said. “But hospital CEOs came up to me after the meeting and told me they never knew that human trafficking was an issue in rural Pennsylvania or was something they should think about.”

Davis added, “It was clear that their facilities needed to be prepared to identify potential victims and to have systems in place to refer them for the services they would need.”

The administrators then asked if PORH could develop training programs for them. “PORH staff made a deliberate choice to train rural providers on the threat of human trafficking,” Davis said. “We know that we can be a resource for rural hospitals and other providers.”

Since the beginning of 2018, PORH has worked to address the issue in rural Pennsylvania. As a first step, a statewide committee of government, academic, community, and hospital representatives was organized. In November 2018, the group launched the Rural Human Trafficking Initiative with an introductory webinar targeting small rural hospitals, community-based organizations, and others interested in serving potential victims.

Since then, Davis said, “We continue to keep the hospitals informed—we’ve gotten a lot of interest from them.”

Davis also is reaching beyond Pennsylvania to raise awareness of rural human trafficking in other states. She gave a presentation in October 2018 at the Annual Meeting of the National Organization of State Offices of Rural Health (NOSORH) in Cheyenne, Wyoming. “It was the first time anyone had talked about that topic at NOSORH,” Davis said.

“I wanted to have NOSORH begin to think about how State Offices of Rural Health (SORHs) could address human trafficking with the Critical Access Hospitals, Rural Health Clinics, and Federally Qualified Health Clinics with which they work,” she said.

This summer, PORH and its partners will host a summit on rural human trafficking (June 26-27) in State College, Pennsylvania. “We are beginning to put in place some of the training programs that the hospitals can implement to identify point persons in their facilities, and the programs and connections that they need to address human trafficking,” Davis said.

Davis observed, “Human trafficking is often thought of as sexual exploitation but it’s also labor exploitation, which can occur essentially anywhere: in restaurants, domestic service, agricultural production, and more.”

Human trafficking is of special concern in Pennsylvania, Davis said, “because we are a state with two main cities and a number of interstate systems that traverse rural areas. With lots of travel routes into, out of, and through the state, it’s much easier to transport victims from one place to another.” According to the National Human Trafficking Hotline, there were 127 cases of human trafficking in Pennsylvania in 2018, with the majority of those cases sex trafficking.

As PORH staff became more informed about human trafficking, Davis said, they found a large network of individuals and organizations that have been focusing on the issue for a long time.

“We’ve made excellent contacts,” she said. “We’ve connected with Villanova University’s Commercial Sexual Exploitation Institute. We’ve been learning about coordinated efforts between the FBI and other law enforcement agencies to address human trafficking. And we’re working with the Region III offices of HHS and HRSA, which have an intergovernmental task force focused on human trafficking.”

However, she noted, “PORH is still very early in the learning stage and is committed to becoming a trusted resource for rural health care providers.”

Davis concluded, “Every story is heartbreaking and if we can make a difference in even one life, this effort will be well worth it.”

If you see someone who you think might be a human trafficking victim, contact the National Human Trafficking Hotline at 1-888-373-7888 (text to: 233733).

WASHINGTON, Feb. 6, 2019 – Assistant to the Secretary for Rural Development Anne Hazlett today announced the United States Department of Agriculture (USDA) has launched a new toolkit to help support the deployment of high-speed broadband e-Connectivity in rural communities.

“High-speed broadband e-Connectivity is becoming more and more essential to doing business, delivering health care, and, for schoolchildren, doing homework in rural communities,” Hazlett said. “This user-friendly tool will help rural customers find the many resources USDA has available to support the expansion and use of e-Connectivity in rural America.”

The e-Connectivity Toolkit (PDF, 4.3 MB) features 27 USDA programs that support broadband deployment. The easy-to-use resource is a simple guide that allows customers to identify their type of e-Connectivity project and locate resources the federal government offers for planning, equipment, construction, research and other e-Connectivity projects. Resources such as grants, loans and technical assistance are available from multiple Mission Areas at USDA, including Rural Development, National Institute of Food and Agriculture, Farm Service Agency, Natural Resources Conservation Service, and Forest Service.

The toolkit highlights examples of how e-Connectivity resources are being used to increase access to broadband services in rural communities. It is free and available to the public online, and can be easily printed for offline use.

USDA’s launch of the e-Connectivity Toolkit closely follows Secretary Sonny Perdue’s unveiling of the ReConnect Program, a pilot program authorized by the Consolidated Budget Act of 2018, to facilitate broadband deployment in rural areas that lack sufficient access to broadband.

In April 2017, President Donald J. Trump established the Interagency Task Force on Agriculture and Rural Prosperity to identify legislative, regulatory and policy changes that could promote agriculture and prosperity in rural communities. In January 2018, Secretary Perdue presented the Task Force’s findings to President Trump. These findings included 31 recommendations to align the federal government with state, local and tribal governments to take advantage of opportunities that exist in rural America. Increasing investments in rural infrastructure is a key recommendation of the task force.

To view the report in its entirety, please view the Report to the President of the United States from the Task Force on Agriculture and Rural Prosperity (PDF, 5.4 MB). In addition, to view the categories of the recommendations, please view the Rural Prosperity infographic (PDF, 190 KB).

USDA Rural Development provides loans and grants to help expand economic opportunities and create jobs in rural areas. This assistance supports infrastructure improvements; business development; housing; community facilities such as schools, public safety and health care; and high-speed internet access in rural areas. For more information, visit www.rd.usda.gov.

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USDA is an equal opportunity provider, employer and lender.

F. Douglas Scutchfield, Editor,

The Editorial Staff, and the Editorial and Advisory Boards

Invite you to participate in the launch of the

Journal of Appalachian Health.

The Journal of Appalachian Health is now open for both readers and authors. The journal is an online, open access, peer-reviewed journal with a mission of creating a healthy and thriving Appalachia. The journal, thanks to the support from the Robert Wood Johnson Foundation, will require no subscription fee or author publication fee.

The journal is particularly interested in receiving submissions that focus on Appalachian health inequities and social determinants of health. If you are interested in submitting articles for publication in the journal, the instructions for authors and further description of the journal are located at:

https://uknowledge.uky.edu/jah/

If you are interested in receiving your free copy of the journal, either go to the journal website https://uknowledge.uky.edu/jah/ to sign up for your free journal or send an email to

AppalachHealth@UKy.edu

to be put on our journal mailing list.

We thank you and appreciate your interest and commitment to improving the health of the Appalachian Region.

WASHINGTON, February 6, 2019 – Acting Administrator for USDA’s Rural Utilities Service Bette Brand announced today USDA would extend application deadlines for the Rural eConnectivity Pilot Program (ReConnect Program).

To give potential applicants adequate time to access technical assistance from USDA staff and its partners, the first application deadline will be pushed back to May 31, 2019 or later. Previously, application deadlines began in April. New specific deadlines for ReConnect Program grants, loans, and grant-loan combination applications will be posted in the Federal Register in late February.

“We’ve seen such strong interest in ReConnect from rural telecommunications providers and utility cooperatives, that we want to be sure there’s enough time for them to put solid applications together for these innovative funding opportunities,” said Bette Brand. “The USDA team stands ready to assist with engineering and business plans, to be sure these new Federal funds are as impactful as possible.”

As one part of that technical assistance, USDA is hosting a webinar with general information about the ReConnect program and guidance from experts for potential applicants. This webinar is open to the public and interested parties, and will be offered at 2:00 pm Eastern Time on both Thursday, February 7 and Wednesday, February 13, 2019.

In March 2018, Congress provided $600 million to USDA to expand broadband infrastructure and services in rural America. On December 13, Agriculture Secretary Perdue announced the rules of the program, called “ReConnect”, including how the loans and grants will be awarded to help build broadband infrastructure in rural America.

Telecommunications companies, rural electric cooperatives and utilities, internet service providers and municipalities may apply for funding through USDA’s new ReConnect Program to connect rural areas that currently have insufficient broadband service. Through the ReConnect Program, USDA is making available approximately $200 million for grants, as well as $200 million for loan and grant combinations, and $200 million for low-interest loans. Funds will be awarded to projects that have a financially-sustainable business models that will bring high-speed broadband to rural homes, businesses, farms, ranches, and community facilities such as first responders, healthcare sites, and schools.

More information about the ReConnect program may be found at http://reconnect.usda.gov.

Effective January 1, 2019, CMS announced new strategies to further help Medicare Part D sponsors prevent and combat opioid overuse including additional safety alerts at the time of dispensing as a proactive step to engage both patients and prescribers about overdose risk and prevention.  The new policies include (1) improved safety edits when opioid prescriptions are dispensed at the pharmacy and (2) drug management programs for patients determined to be at-risk for misuse or abuse of opioids or other frequently abused drugs.

CMS has posted tip sheets and other resources to help increase awareness of the new policies among stakeholders. Three sets of outreach materials designed for physician, pharmacist, and beneficiary audiences are available on the CMS website for download. Materials can be found at: https://www.cms.gov/Medicare/Prescription-Drug-coverage/PrescriptionDrugCovContra/RxUtilization.html