Tennessee Rural Health Association



NOVEMBER 18, 1998

Thank you Charles for that introduction. And thank you for being such an integral part of introducing family-centered health care to Tennessee. As you know, this is an issue that my husband and I both feel strongly about and highlighted last year at our annual family conference.

As many of you know, I just recently returned from Central America where I met with some of the victims of Hurricane Mitch. I believe that my trip to Central America is relevant to today's discussion because even though Americans are living in a time of great progress and advancement in the field of health care, we know that there are so many people who still don't have access to clean water, medicine, and quality health care.

Whether it's due to distance, lack of health insurance because of unemployment, or limited access to specialists, those in rural areas receive a narrower range of health care services and sometimes limited options. Just yesterday, I met with people from the community of Parrottsville who still don't have running water.

Compounding the situation, the problems in rural health care here at home aren't the same as those in other rural areas. We know that 36% of Tennessee's total population lives in rural areas, 20% live in health provider shortage areas. Tennessee has 63 Community, Migrant and Homeless Health Centers that are critical to serving these populations, providing essential health care services to the uninsured, underinsured and others lacking access to health care providers. Some of the more pressing health care needs of these communities include infant mortality, teen pregnancy, family violence, substance abuse and AIDS prevention and treatment.

Just as Tennessee is different from other states, we know the solutions will be different in Tennessee from solutions that will work in Iowa or Idaho or Alabama. Yet, there are some common themes. One of those themes touches at the heart of this conference. It's an issue of importance to me both personally and as the President's Mental Health Advisor. And that is the important role that rural primary care practitioners must play in diagnosing and treating both physical AND mental health problems for their patients.

All the research that's been done tells us that there just aren't enough specialized mental health professionals working in rural areas. And of those that exist, few understand the issues facing rural families. So what this means is that primary care professionals need to be prepared to address not just the physical health care needs of patients, but also their mental health care needs as well.

You need to know how to recognize the signs and symptoms of serious mental illnesses, many of which begin to appear in adolescence. You need to know how to recognize and treat depression,not only among your patients who are in the prime of their adult years, but also among the partners, grandparents, and children in their families.

You need to know about the links between mental and physical health. Some mental health problems happen in the wake of a physical health problem. Depression isn't uncommon for a woman after breast cancer or a heart attack; isn't uncommon for a man after a stroke or prostate cancer. You've got to recognize it and treat it. It helps people recover from the physical illnesses faster. And there's a lot of research to back that up.

So the challenge to you is to embrace your role as the first line of health care in rural Tennessee, to engage your patients and their families to improve both their mental as well as physical health.

We understand too that it takes more than good people on the front lines, it takes good government on your side. The Clinton/Gore Administration is committed to providing the resources that health care professionals need to provide for people in rural as well as urban and suburban communities.

For example, this year, over $38 million has been allocated to the Rural Health Outreach, Telemedicine and Network Development Grant Program. Last October, $25 million was awarded to health providers in 144 rural communities. This grant emphasizes service delivery through new and creative strategies and partnerships, extending services to at least two million rural citizens across the nation and providing services that include hospice care, health check-ups to children at school, prenatal care to women in remote areas with mobile clinics, and networks of health care providers for remote communities.

Since 1991, approximately $175 million has been allocated to this program, reaching over 300 rural communities.

One of the more innovative uses of this funding in Tennessee is a program called Community Health Outreach, led by Cherokee Health Systems, which is the sole provider of mental health services in Grainger, Union and Claiborne counties. This outreach program teaches children, parents and educators how to stay healthy and how to access the community's network of health services. To date, it has reached out to more than 37,000 children through parent and teacher contacts.

Another outstanding program is the Housing Health Education Rural Outreach Program, led by LaFollette Housing Authority, which provides health education and primary care services to the residents of public housing through a seven-county area in rural east Tennessee. Interventions include community-wide screening for diabetes, vision and dental health; mobile mammography; childhood immunizations; flu vaccines; nutrition assessments; and an eight-week parenting skills course.

The Balanced Budget Act that the President signed in 1997, included a number of initiativesdesigned to protect rural families who cannot afford health care. For example, it included the largest investment in children's health care since the passage of Medicaid in 1965, a program known as the Children's Health Insurance Program, or CHIP. This program is designed to provide health care coverage for millions of children whose parents cannot afford private coverage but do not qualify for Medicaid. The President has also made historic efforts to reach out and enroll the millions of uninsured children who are currently eligible but not enrolled. Strong efforts have been made to reach out to children in rural communities, through public education campaigns and widespread distribution of information to rural communities through health care providers.

The Balanced Budget Act also established a new rural hospital program under Medicare that would allow certain rural hospitals to take advantage of cost cutting measures that overcome obstacles of low-volume, distance and shortage of practitioners. It also stipulates that Medicare for the first time will pay for telemedicine consultations for patients living in rural areas.

In another important development, more than $115 million was allocated to the National Health Service Corps Fellowship Program this year. In Tennessee, this initiative has helped increase primary care accessibility by providing educational opportunities in federally designated underserved areas for students enrolled in Tennessee health professions education programs.

This past summer, the Department of Health and Human Services also created an Office for the Advancement of Telehealth to expand telemedicine and distance learning initiatives, something my husband has worked hard to support, to extend state-of-the-art health care and information to isolated and poor communities.

Although minorities only represent 15% of total rural population, they represent about 30% of the rural poor. To overcome an overall lack of national information minority issues in rural health, the Administration funded a new publication -- Minorities and Rural Health -- to create new strategies to improve the health of minorities in rural communities.

Through the development of good programs and efforts of so many to implement them, the advantages and advancements of our top scientific minds can be brought to bear for people of all communities.

Before I close, I want to take a moment to celebrate the work that many of you do and the difference you have made in the lives of so many members of your community. For the people you serve, you are often the only source of health care information. You are the life line to the community and the life blood of its people. Thank you for your ability to reach out and provide people with the knowledge and tools to live longer and healthier lives.

Thank you.


Tennessee Rural Health Association

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