The National Advisory Committee
on Rural Health and Human Services
U.S. Department of Health and Human Services
The 2008 Report to the Secretary: Rural Health and Human Service Issues
April 2008
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About the Committee
The National Advisory Committee
on Rural Health and Human Services (NACRHHS) is a citizens’ panel of
nationally recognized rural health and human services experts. The Committee, chaired by former South Carolina
Governor David Beasley, was chartered in 1987 to advise the Secretary
of the U.S. Department of Health and Human Services on ways to address
health problems in rural
The Committee’s private and public-sector
members reflect wide-ranging, firsthand experience with rural issues
– including medicine, nursing, administration, finance, law, research,
business, public health, aging, welfare, and human services. Members include rural health professionals as
well as representatives of State government, provider associations,
and other rural interest groups.
Each year, the Committee highlights
key health and human services issues affecting rural communities.
Background documents are prepared for the Committee by both staff
and contractors to help inform members on the issues.
The Committee then produces a report with recommendations on
those issues for the Secretary by the end of the year.
The Committee also sends letters to the Secretary after each
meeting. The letters serve as a vehicle for the Committee
to raise other issues with the Secretary separate and apart from the
report process.
The Committee meets three times
a year. The first meeting is held
in early winter in
The Committee
is staffed by the Office of Rural Health Policy, located within the
Health Resources and Services Administration of the U.S. Department
of Health and Human Services. Additional
staff support is provided by the Administration on Aging, the Administration
on Children and Families, and the Secretary’s Office of Intergovernmental
Affairs.
Introduction
The National Advisory Committee on Rural Health and Human Services
(NACRHHS) was created in 1987. In
1988, it held its first meeting in
At its February 2007 meeting, the
Committee received a comprehensive briefing on key rural health and
human services developments over the past two decades from a variety
of experts, including speakers from several Rural Health Research Centers,
as well as experts from the U.S. Department of Agriculture’s Economic
Research Service (ERS). The briefings
made it clear that substantial changes in rural demographics and economies
over the past 20 years have resulted in a number of improvements.
For example, the overall level of Federal assistance has increased
in some areas. HHS has administered
a number of rural health grant programs and Medicare and Medicaid payment
changes that have helped to address some of the emerging needs of rural
communities. However, other challenges have arisen that have
not been addressed, which add pressure to the already stressed rural
health and human services sectors.
The first chapter of this report
begins with a retrospective analysis of what the Committee believes
have been the key health and human services issues over the past 20
years, noting the changes that have occurred in the rural health and
human services sectors between 1987, when NACRHHS was established, and
the present. While 1987 is not in itself a particularly significant
year, it serves as the 20 year comparison for this report. The second chapter considers the essential issues
and mechanisms that produced these changes, highlighting some of the
key legislation and regulations that have shaped rural health and human
services delivery. Chapters 1
and 2 were largely compiled by the Federally-funded Rural Health Research
Centers. Again, the scope of this analysis is not meant
to be comprehensive. Rather, the
report focuses on those key indicators and conditions that the Committee
saw as providing a broad picture of the rural health and human services
delivery systems. Comparing two
distinct periods of time poses some data challenges.
When possible, this analysis includes specific data from 1987
and 2007. Where data on those years were not available,
the report notes the lack of data or uses the nearest possible data
points.
The third chapter draws
on the retrospective analysis to broadly examine emerging issues for
rural health and human services. These
issues, ranging from workforce development to emergency preparedness
to data needs, were identified by the Committee as significant challenges
and opportunities facing rural health and human services delivery.
The Committee discusses community development as an important
link for future sustainable health and human services delivery. The report concludes with a series of recommendations
and considerations for use by the Secretary and other policy makers
in order to better equip rural