scholarly journals What a Pandemic Has Taught Us About the Potential for Innovation in Rural Health: Commencing an Ethnography in Canada, the United States, Sweden, and Australia

2021 ◽  
Vol 9 ◽  
Author(s):  
Samuel Petrie ◽  
Dean Carson ◽  
Paul Peters ◽  
Anna-Karin Hurtig ◽  
Michele LeBlanc ◽  
...  
Keyword(s):  
United States ◽  
Rural Communities ◽  
Absorptive Capacity ◽  
Rural Areas ◽  
Field Research ◽  
The United States ◽  
Local Health ◽  
Programme Implementation ◽  
Care Services ◽  
Community Connections

The COVID-19 pandemic coincided with a multi-national federally funded research project examining the potential for health and care services in small rural areas to identify and implement innovations in service delivery. The project has a strong focus on electronic health (eHealth) but covers other areas of innovation as well. The project has been designed as an ethnography to prelude a realist evaluation, asking the question under what conditions can local health and care services take responsibility for designing and implementing new service models that meet local needs? The project had already engaged with several health care practitioners and research students based in Canada, Sweden, Australia, and the United States. Our attention is particularly on rural communities with fewer than 5,000 residents and which are relatively isolated from larger service centres. Between March and September 2020, the project team undertook ethnographic and auto-ethnographic research in their own communities to investigate what the service model responses to the pandemic were, and the extent to which local service managers were able to customize their responses to suit the needs of their communities. An initial program theory drawn from the extant literature suggested that “successful” response to the pandemic would depend on a level of local autonomy, “absorptive capacity,*” strong service-community connections, an “anti-fragile†” approach to implementing change, and a realistic recognition of the historical barriers to implementing eHealth and other innovations in these types of rural communities. The field research in 2020 has refined the theory by focusing even more attention on absorptive capacity and community connections, and by suggesting that some level of ignorance of the barriers to innovation may be beneficial. The research also emphasized the role and power of external actors to the community which had not been well-explored in the literature. This paper will summarize both what the field research revealed about the capacity to respond well to the COVID-19 challenge and highlight the gaps in innovative strategies at a managerial level required for rapid response to system stress.*Absorptive Capacity is defined as the ability of an organization (community, clinic, hospital) to adapt to change. Organizations with flexible capacity can incorporate change in a productive fashion, while those with rigid capacity take longer to adapt, and may do so inappropriately.†Antifragility is defined as an entities' ability to gain stability through stress. Biological examples include building muscle through consistent use, and bones becoming stronger through subtle stress. Antifragility has been used as a guiding principle in programme implementation in the past.

Extending Educational Opportunities in Rural Areas

2010 ◽  
pp. 276-294
Author(s):  
Wallace Hannum ◽  
Matthew Irvin ◽  
Claire de la Varre
Keyword(s):  
United States ◽  
Distance Education ◽  
Rural Communities ◽  
Rural Schools ◽  
Rural Areas ◽  
The United States ◽  
Further Education ◽  
Educational Opportunities ◽  
Qualified Teachers ◽  
Declining Populations

Rural schools in many countries face problems in providing educational opportunities to children and youth for a variety of reasons. There has been the tendency in many countries to migrate to urban areas, often in search of better economic opportunities. The resulting shift from rural areas to urban/suburban areas has placed increased pressures on schools in rural communities. Schools often form the hub of social and civic activity in rural communities. Although they are an important component to rural communities, many rural schools are struggling under the weight of declining populations, declining budgets, staffing difficulties, and increased pressures to better prepare students for the workforce or further education. Rural schools face particular difficulties in attracting and retaining qualified teachers. Faced with problems of providing a comprehensive curriculum and qualified teachers, many rural schools in the United States have turned to distance education. This case explores the use of distance education in the United States through a national survey of distance education use, analysis of barriers to distance education and an experimental study of enhancing distance education through more appropriate training of local facilitators to support students.

Exploring Transportation Accessibility to Health Care among Vermont's Rural Seniors

2015 ◽  
Vol 2531 (1) ◽  
pp. 137-145 ◽  
Author(s):  
Geoffrey A. Battista ◽  
Brian H. Y. Lee ◽  
Jane Kolodinsky ◽  
Sarah N. Heiss
Keyword(s):  
Health Care ◽  
Rural Areas ◽  
Health Care Services ◽  
Social Connectedness ◽  
The United States ◽  
Transportation Systems ◽  
Local Health ◽  
Baby Boomer Generation ◽  
Care Services ◽  
Health Care Accessibility

The aging baby boomer generation will have a profound impact on the demand for health care services in the United States. This impact will be felt strongly in rural areas, where the population in general is older and the supplies of health care services and alternative transportation are limited. This study employed a mixed-method approach to assess health care accessibility among seniors in the state of Vermont. A geographic information system was used to project health care accessibility according to the spatial characteristics of the health care and transportation systems. Subsequently, the mechanisms that shaped accessibility were assessed through semistructured interviews with 20 seniors and caregivers. The study found that health care accessibility varied among seniors, given the local health care supply, transportation, and individual resources at their disposal. Health care accessibility also was shaped by less tangible factors, which included social connectedness and personal preferences for care and transportation. The results suggested that mixed methods provided a more nuanced and valid perspective on health care accessibility. This perspective can better inform policy makers as they strive to accommodate rural senior preferences to age in place in a healthy manner.

scholarly journals Food Security and Climate Change: Differences in Impacts and Adaptation Strategies for Rural Communities in the Global South and North

2022 ◽  
Vol 5 ◽  
Author(s):  
Subhashni Raj ◽  
Sam Roodbar ◽  
Catherine Brinkley ◽  
David Walter Wolfe
Keyword(s):  
Climate Change ◽  
United States ◽  
Food Security ◽  
Rural Communities ◽  
Low Income ◽  
Rural Areas ◽  
Food Production ◽  
Climate Adaptation ◽  
The United States ◽  
Global North

This research highlights the mismatch between food security and climate adaptation literature and practice in the Global North and South by focusing on nested case studies in rural India and the United States during the COVID-19 pandemic. The United States is one of the wealthiest countries in the world, but also has one of the largest wealth gaps. Comparatively, India has one of the largest populations of food insecure people. To demonstrate how adaptive food security approaches to climate change will differ, we first review the unique climate, agricultural, demographic, and socio-economic features; and then compare challenges and solutions to food security posed by the COVID-19 pandemic. While both countries rely on rural, low-income farmworkers to produce food, the COVID-19 pandemic has highlighted how agricultural and food security policies differ in their influence on both food insecurity and global hunger alike. Emphasis on agricultural production in developing regions where a majority of individuals living in rural areas are smallholder subsistence farmers will benefit the majority of the population in terms of both poverty alleviation and food production. In the Global North, an emphasis on food access and availability is necessary because rural food insecure populations are often disconnected from food production.

scholarly journals Impact of a Targeted Rural and Underserved Track on Medical Student Match Into Family Medicine and Other Needed Workforce Specialties

2021 ◽  
Vol 53 (2) ◽  
pp. 111-117
Author(s):  
Kimberly Kardonsky ◽  
David V. Evans ◽  
Jay Erickson ◽  
Amanda Kost
Keyword(s):  
United States ◽  
Medical Students ◽  
Rural Communities ◽  
Family Medicine ◽  
Rural Areas ◽  
Primary Care Physicians ◽  
The United States ◽  
Control Group ◽  
Match Rate ◽  
Residency Match

Background and Objectives: There is a shortage of physicians in rural communities in the United States. More than other types of primary care physicians, family physicians are the foundation for care in rural areas.1 There are also critical shortages of other specialties such as general surgery, pediatrics, internal medicine, and psychiatry in rural America.2-7 This study assessed student participation in the University of Washington School of Medicine’s (UWSOM) Targeted Rural Underserved Track (TRUST) program as a predictor for family medicine (FM) and needed workforce specialty residency match. Methods: The study group was 156 medical students from 2009-2014; 102 were accepted to the TRUST program compared to a control group of 54 who were not accepted into the TRUST program but did matriculate to UWSOM. Student characteristics for the two groups were compared using t tests. Logistic regression analysis determined whether acceptance in TRUST predicted the outcomes measures of FM residency match or residency match into a needed rural physician workforce specialty; t tests compared match rates to family medicine for TRUST applicants and graduates, UWSOM graduates, and US allopathic seniors. Results: TRUST program graduates had the same FM residency match rate and match rate in needed workforce specialties as the control group. The FM match rate for TRUST graduates was 29.1% compared to UWSOM at 16.9% and US seniors at 8.7% (P<.001). Conclusions: Although match rates in FM and needed workforce specialties were not different in accepted versus not accepted groups, all TRUST applicants had an FM match rate that approaches 30%, which is higher than the general UWSOM class and the United States. In order to help reach the goal of 25% of medical students matching into FM by 2030, medical schools should consider having a rural program and using rural-focused admissions widely.

scholarly journals Not in my City: Rural America as Urban Dumping Ground

2014 ◽  
Author(s):  
Forbes Lipschitz
Keyword(s):  
United States ◽  
Rural Communities ◽  
Rural Areas ◽  
Power Plants ◽  
The United States ◽  
Economic Benefits ◽  
Social Consequences ◽  
Meat Production ◽  
Land Uses ◽  
Rural America

The ideological divide between “urban” and “rural” is deeply rooted in the American consciousness, fraught with tensions stemming from false memories of a pastoral past on the one hand and the American yearning for progress as exemplified by the industry of the city on the other. These tensions have figured prominently in design discourse, from Ebenezer Howard’s Garden City to Patrick Geddes Rural-to-Urban Transect and Ian McHarg’s Design with Nature. Over the last twenty years, however, rural issues have been wholly overshadowed by design’s fixation on urbanization. Though urban design and planning are well established subdisciplines of the design professions, rural issues receive limited pedagogical or practical emphasis. Across design disciplines, the contemporary city is touted as the key to technological, economic and cultural innovation while rural decline is accepted as inevitable, if not necessary. This resignation to the eventuality of rural decline has facilitated an exploitative relationship between urban hubs and their rural hinterlands. Rural America —which encompasses roughly seventy-two percent of the nation's landmass—has seen slower population growth for a decade as more young people move to urban and suburban areas for jobs and aging retirees seek out more densely populated places to live. The 2010 census revealed that nonmetropolitan counties officially lost population for the first time. The economic landscape of rural America is also in a state of flux. Rural areas have traditionally relied upon resource-extractive industries, such as agriculture, forestry and energy production. However, technological advances, outsourcing, and the decline of manufacturing have forced rural communities to reevaluate their local economies. Declining populations coupled with limited economic opportunities characterize a number of rural communities across the United States. Looking for stable economic investments, policy makers and officials in rural areas across the country actively court landfills, prisons, and meat production and processing facilities in hopes of creating new jobs and generating revenue for towns in need of economic revitalization. In the United States, Locally Undesirable Land Uses (LULUs) are increasingly being pushed out of cities and into rural areas. Though most city dwellers would agree that LULUs like power plants, factories, and hazardous waste storage facilities are necessary, most would prefer not to live near them. Though LULUs may offer significant benefits to society at large, they do so at the expense of neighboring communities. The siting of such unsavory land uses also typically exploits disadvantaged and unempowered populations and makes the rural-dumping ground paradigm particularly problematic. While the economic benefits of LULUs are largely unproven, the negative environmental and social consequences can be wide ranging. Landfills and livestock operations, for example, pollute land, air, and water resources, negatively impacting biodiversity and public health. As an out-of-sight-out-of-mind strategy, the geographic displacement of these ecologically and socially damaging systems enables relocation over reformation. By analyzing the geography and design of three of the most significant LULUs, meat production and processing facilities, landfills, and prison complexes, this study seeks to illuminate the extent to which unwanted urban land uses are impacting rural areas today.

THE INSTITUTIONAL EFFECTS OF LEADERSHIP: THE UNITED STATES GENERAL ACCOUNTING OFFICE AND ITS AUDIT REPORT REVIEW PROCESS

1994 ◽  
Vol 21 (1) ◽  
pp. 255-273 ◽  
Author(s):  
Onker N. Basu
Keyword(s):  
United States ◽  
Review Process ◽  
Field Research ◽  
The United States ◽  
Organizational Leaders ◽  
Audit Report ◽  
The Public ◽  
General Accounting Office ◽  
Audit Team ◽  
The Impact

In accounting research, the role of organizational leaders has been underrepresented. The limited research dealing with leadership issues has focused on the impact of leadership on micro activities such as performance evaluation, budget satisfaction, and audit team performance. The impact of leadership on the structure of accounting and audit systems and organizations has been ignored. This paper focuses on the impact that past Comptrollers General have had on the working and structure of one federal audit agency, the United States General Accounting Office (GAO). In addition, it also focuses on the influence of the two most recent Comptrollers General on one important audit related activity, i.e., the audit report review process. Using qualitative field research methods, this paper documents how the organizational leadership impacts its long-term audit practices and thereby influences auditing, especially in the public sector.

scholarly journals Factors Influencing Land Values in the Presence of Suburban Sprawl

1974 ◽  
Vol 3 (1) ◽  
pp. 112-124 ◽  
Author(s):  
Bruce E. Lindsay ◽  
Cleve E. Willis
Keyword(s):  
United States ◽  
Rural Areas ◽  
The United States ◽  
Land Values ◽  
Suburban Sprawl ◽  
Factors Influencing ◽  
Definition Of

The spread of suburbs into previously rural areas has become commonplace in the United States. A rather striking aspect of this phenomenon has been the discontinuity which results. This aspect is often manifest in a haphazard mixture of unused and densely settled areas which has been described as “sprawl”. A more useful definition of suburban sprawl, its causes, and its consequences, is provided below in order to introduce the econometric objectives of this paper.

scholarly journals Italianness in the United States between migrants’ informal gardening practices and agricultural diplomacy (1880–1912)

Modern Italy ◽  
2021 ◽  
pp. 1-17
Author(s):  
Gilberto Mazzoli
Keyword(s):  
United States ◽  
Environmental History ◽  
Rural Areas ◽  
Food Production ◽  
East Coast ◽  
The United States ◽  
Southern United States ◽  
Mass Migration ◽  
Us Cities ◽  
Political Radicalism

During the Age of Mass Migration more than four million Italians reached the United States. The experience of Italians in US cities has been widely explored: however, the study of how migrants adjusted in relation to nature and food production is a relatively recent concern. Due to a mixture of racism and fear of political radicalism, Italians were deemed to be undesirable immigrants in East Coast cities and American authorities had long perceived Italian immigrants as unclean, unhealthy and carriers of diseases. As a flipside to this narrative, Italians were also believed to possess a ‘natural’ talent for agriculture, which encouraged Italian diplomats and politicians to propose the establishment of agricultural colonies in the southern United States. In rural areas Italians could profit from their agricultural skills and finally turn into ‘desirable immigrants’. The aim of this paper is to explore this ‘emigrant colonialism’ through the lens of environmental history, comparing the Italian and US diplomatic and public discourses on the potential and limits of Italians’ agricultural skills.

scholarly journals PM2.5 polluters disproportionately and systemically affect people of color in the United States

2021 ◽  
Vol 7 (18) ◽  
pp. eabf4491
Author(s):  
Christopher W. Tessum ◽  
David A. Paolella ◽  
Sarah E. Chambliss ◽  
Joshua S. Apte ◽  
Jason D. Hill ◽  
...  
Keyword(s):  
United States ◽  
Rural Areas ◽  
The United States ◽  
People Of Color ◽  
Emission Sources ◽  
Particulate Air Pollution ◽  
Fine Particulate ◽  
Exposure Levels ◽  
Urban And Rural Areas ◽  
Racial Ethnic

Racial-ethnic minorities in the United States are exposed to disproportionately high levels of ambient fine particulate air pollution (PM2.5), the largest environmental cause of human mortality. However, it is unknown which emission sources drive this disparity and whether differences exist by emission sector, geography, or demographics. Quantifying the PM2.5 exposure caused by each emitter type, we show that nearly all major emission categories—consistently across states, urban and rural areas, income levels, and exposure levels—contribute to the systemic PM2.5 exposure disparity experienced by people of color. We identify the most inequitable emission source types by state and city, thereby highlighting potential opportunities for addressing this persistent environmental inequity.

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