County Commission | The Magazine August 2017

FROM THE COVER Rural Health: A Crisis for All of Alabama By Dale E. Quinney, MPH Executive Director, Alabama Rural Health Association A labama’s rural areas are involved in a health care access and health status crisis that involves much more than just health care. Having greater concern for areas with larger populations, to get the biggest bang for your buck, does not apply when considering rural health. So much that is vital to the survival of everyone is produced in our rural areas or produced using materials and resources that come from our rural areas. Healthy rural areas are in the best interest of everyone. Perhaps the most visible evidence of this crisis in our rural areas is the lack of healthy population growth. Twenty-four of the 54 counties that are considered rural by the Alabama Rural Health Association actually lost population during the 100 years between 1910 and 2010. More alarming is the projection that 41 of Alabama’s 67 counties will lose population between 2010 and 2040. Alabama is projected to have the lowest population growth among all southern states, less than half of the growth expected in Mississippi. This trend reflects a lack of economic opportunity in our rural areas. Rural youth continue to have to leave their homes to establish careers. There is a strong relationship between the presence of economic opportunity and having adequate health care and a quality educational system locally available. It is difficult to be adequate in any one of these areas without being adequate in all three. Health care alone is one of the largest employers and most powerful economic engines in rural areas. In DECLINING RURAL OBSTETRICAL SERVICE IN ALABAMA LAUDERDALE MADISON JACKSON LIMESTONE COLBERT LAWRENCE FRANKLIN MARSHALL MORGAN DEKALB CULLMAN MARION CHEROKEE WINSTON ETOWAH BLOUNT WALKER CALHOUN ST. CLAIR FAYETTE LAMAR CLEBURNE JEFFERSON TALLADEGA PICKENS TUSCALOOSA RANDOLPH SHELBY CLAY BIBB GREENE COOSA CHAMBERS CHILTON TALLAPOOSA HALE PERRY LEE ELMORE SUMTER AUTAUGA MACON MONTGOMERY DALLAS MARENGO RUSSELL BULLOCK LOWNDES CHOCTAW BARBOUR WILCOX PIKE BUTLER CLARKE MONROE CRENSHAW HENRY COFFEE DALE WASHINGTON CONECUH ESCAMBIA COVINGTON GENEVA HOUSTON MOBILE BALDWIN Counties with hospitals providing obstetrics in 2016 © Can Stock Photo / tobkatrina THEN 45 of the 54 counties currently considered rural* had hospitals providing obstetrical service in 1980 NOW 16 of the 54 rural* counties have hospitals providing obstetrical service in 2016 Counties that have lost obstetric services since 1980 © Can Stock Photo / Hannamariah No obstetrical services © Can Stock Photo / andreykuzmin Source: Alabama Rural Health Association | *As defined by Alabama Department of Public Health. COUNTY COMMISSION | 21

County Commission | The Magazine August 2017 | Page 21