[Congressional Record Volume 150, Number 49 (Thursday, April 8, 2004)]
[Senate]
[Pages S4016-S4017]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]




                      NATIONAL PUBLIC HEALTH WEEK

 Mr. JOHNSON. Mr. President, this week is National Public 
Health Week, an annual event sponsored by the American Public Health 
Association or APHA. Every year in April, national, State and local 
public health professionals highlight an important public health issue, 
to raise awareness about leading health problems impacting our nation. 
This year, the theme of National Public Health Week is ``eliminating 
health disparities''.
  There are many groups that experience disparities in health, largely 
a result of limited access to important health care services. Living in 
a rural area is in itself a health risk factor, due to numerous factors 
that can adversely influence health and access and the resulting 
disparities are well documented. Chronic illnesses are more prevalent 
in rural communities and studies have shown that rural residents are 
more likely to describe their overall health status as poorer than 
their urban counterparts. Limitation in activity due to chronic health 
conditions among adults is more common in rural counties than in large 
metro counties.

[[Page S4017]]

  The University of Pittsburg's Center for Rural Health Practices 
released a report this week which highlights specific rural health 
disparity issues. The report indicated that death rates for children 
and young adults are highest in the most rural counties. Nationally and 
within each region, death rates from unintentional injuries increases 
greatly as counties become less urban. And death rates for motor 
vehicle-related injuries in most rural counties are over twice as high 
as the rates in central counties of large metro areas. My home State of 
South Dakota ranks 8th with two other States for having the worst motor 
vehicle death rate in the Nation.
  In addition, adolescents living in the most rural counties are most 
likely to smoke. For example, in 1999 for the United States as a whole, 
19 percent of adolescents in the most rural counties smoked compared 
with 11 percent in metro counties. This disparity also holds true for 
adults who smoke. Adults in rural areas are more likely to consume 
alcohol than those living in other areas, and both men and women in 
rural areas have higher rates of self-reported obesity than men and 
women in other areas.
  Minorities in rural areas also face additional health disparities. 
Diabetes among Native Americans is more than twice that of the general 
population, and heart disease and cancer are the leading causes of 
death among this population. Infant mortality among this population is 
1.7 times higher than among non-Hispanic whites and the sudden infant 
death syndrome or SIDS rate among this minority group is the highest of 
any population group in the nation.
  It is important that we find ways to address rural public health 
disparities. Access to health care providers is a critical component of 
the solution and that is why I have long supported rural provider 
payment equity. Payment equity ensures that the doors stay open at our 
local hospitals and physicians offices. I feel that Congress needs to 
continue to address this important issue and make a commitment to rural 
residents across America that it will support initiatives to remedy 
this problem.
  While payment equity is a critical component in solving this 
disparity issue, it is only part of the overall solution. Access 
problems continue to be a distinct challenge in rural communities, due 
largely to declining rates of health care workers in these areas. In 
1998, there were six times as many general pediatricians per 100,000 in 
central counties of large metro areas as in the most rural counties and 
five times as many general internists.
  One of the ways to address this problem is through enhanced funding 
for important Federal programs that promote the recruitment and 
retention of health care workers. I have recently sent letters to the 
leadership on the Senate Labor, Health and Human Services, Education 
Appropriations Subcommittee, requesting a $63 million dollar increase 
for Title VIII nurse education programs created under the Nurse 
Reinvestment Act. I have also asked the committee to restore the 
President's proposed drastic cuts of almost $200 million for the Title 
VII health professions programs, by providing $308 million for these 
programs.
  In order to further address rural health disparities, we need to 
strengthen efforts towards establishing a 21st century health care 
system that utilizes information technology to allow health care 
professionals across rural America to share their knowledge, expertise 
and resources. I have worked with my colleagues in the Senate to secure 
funding in recent years to allow just that, such as the wonderful 
health information systems project through the Community HealthCare 
Association of South Dakota, and the nurse distance learning project 
through the University of South Dakota and the Good Samaritan Society. 
I encourage my colleagues to continue to build on these types of rural 
specific projects nationwide so that we may see this dream of a modern 
21st century health care system become a reality.
  In order to address the Native American health disparities problems, 
in addition to improving access to direct health care services, it is 
important that we obtain comprehensive data on key health risk factors 
impacting this population. In South Dakota, the Northern Plains Tribal 
Epidemiology Center in Rapid City is providing information to tribes 
and working with tribes to help access health data through good 
assessment tools, which can be used to develop interventions and 
improve the health in Native American communities across the State. 
This is an effective model for approaching a critical minority health 
problem and the Center combines epidemiology, research, and public 
health practice to develop interventions that can be disseminated to 
the tribal communities.
  Often our best solutions come from the local experts. I look forward 
to working with public health experts in both South Dakota, as well as 
the Nation at large, to address these shortfalls in rural health. I 
believe that the information we gain through these discussions will 
provide Congress with a broader scope of knowledge, thus allowing us to 
better meet the needs of those who fall into this health disparity 
category.

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