Showing papers on "Rural area published in 2021"

Impacts of the COVID-19 pandemic on rural America.

Abstract: Despite considerable social scientific attention to the impacts of the COVID-19 pandemic on urbanized areas, very little research has examined its impact on rural populations. Yet rural communities-which make up tens of millions of people from diverse backgrounds in the United States-are among the nation's most vulnerable populations and may be less resilient to the effects of such a large-scale exogenous shock. We address this critical knowledge gap with data from a new survey designed to assess the impacts of the pandemic on health-related and economic dimensions of rural well-being in the North American West. Notably, we find that the effects of the COVID-19 pandemic on rural populations have been severe, with significant negative impacts on unemployment, overall life satisfaction, mental health, and economic outlook. Further, we find that these impacts have been generally consistent across age, ethnicity, education, and sex. We discuss how these findings constitute the beginning of a much larger interdisciplinary COVID-19 research effort that integrates rural areas and pushes beyond the predominant focus on cities and nation-states.

Disparities in COVID-19 Vaccination Coverage Between Urban and Rural Counties - United States, December 14, 2020-April 10, 2021.

Abstract: Approximately 60 million persons in the United States live in rural counties, representing almost one fifth (19.3%) of the population.* In September 2020, COVID-19 incidence (cases per 100,000 population) in rural counties surpassed that in urban counties (1). Rural communities often have a higher proportion of residents who lack health insurance, live with comorbidities or disabilities, are aged ≥65 years, and have limited access to health care facilities with intensive care capabilities, which places these residents at increased risk for COVID-19-associated morbidity and mortality (2,3). To better understand COVID-19 vaccination disparities across the urban-rural continuum, CDC analyzed county-level vaccine administration data among adults aged ≥18 years who received their first dose of either the Pfizer-BioNTech or Moderna COVID-19 vaccine, or a single dose of the Janssen COVID-19 vaccine (Johnson & Johnson) during December 14, 2020-April 10, 2021 in 50 U.S. jurisdictions (49 states and the District of Columbia [DC]). Adult COVID-19 vaccination coverage was lower in rural counties (38.9%) than in urban counties (45.7%) overall and among adults aged 18-64 years (29.1% rural, 37.7% urban), those aged ≥65 years (67.6% rural, 76.1% urban), women (41.7% rural, 48.4% urban), and men (35.3% rural, 41.9% urban). Vaccination coverage varied among jurisdictions: 36 jurisdictions had higher coverage in urban counties, five had higher coverage in rural counties, and five had similar coverage (i.e., within 1%) in urban and rural counties; in four jurisdictions with no rural counties, the urban-rural comparison could not be assessed. A larger proportion of persons in the most rural counties (14.6%) traveled for vaccination to nonadjacent counties (i.e., farther from their county of residence) compared with persons in the most urban counties (10.3%). As availability of COVID-19 vaccines expands, public health practitioners should continue collaborating with health care providers, pharmacies, employers, faith leaders, and other community partners to identify and address barriers to COVID-19 vaccination in rural areas (2).

Willingness to vaccinate against COVID-19 among Bangladeshi adults: Understanding the strategies to optimize vaccination coverage.

Abstract: BACKGROUND: Although the approved COVID-19 vaccine has been shown to be safe and effective, mass vaccination in Bangladeshi people remains a challenge. As a vaccination effort, the study provided an empirical evidence on willingness to vaccinate by sociodemographic, clinical and regional differences in Bangladeshi adults. METHODS: This cross-sectional analysis from a household survey of 3646 adults aged 18 years or older was conducted in 8 districts of Bangladesh, from December 12, 2020, to January 7, 2021. Multinomial regression examined the impact of socio-demographic, clinical and healthcare-releated factors on hesitancy and reluctance of vaccination for COVID-19. RESULTS: Of the 3646 respondents (2212 men [60.7%]; mean [sd] age, 37.4 [13.9] years), 74.6% reported their willingness to vaccinate against COVID-19 when a safe and effective vaccine is available without a fee, while 8.5% were reluctant to vaccinate. With a minimum fee, 46.5% of the respondents showed intent to vaccinate. Among the respondents, 16.8% reported adequate adherence to health safety regulations, and 35.5% reported high confidence in the country's healthcare system. The COVID-19 vaccine refusal was significantly high in elderly, rural, semi-urban, and slum communities, farmers, day-laborers, homemakers, low-educated group, and those who had low confidence in the country's healthcare system. Also, the prevalence of vaccine hesitancy was high in the elderly population, low-educated group, day-laborers, people with chronic diseases, and people with low confidence in the country's healthcare system. CONCLUSION: A high prevalence of vaccine refusal and hesitancy was observed in rural people and slum dwellers in Bangladesh. The rural community and slum dwellers had a low literacy level, low adherence to health safety regulations and low confidence in healthcare system. The ongoing app-based registration for vaccination increased hesitancy and reluctancy in low-educated group. For rural, semi-urban, and slum people, outreach centers for vaccination can be established to ensure the vaccine's nearby availability and limit associated travel costs. In rural areas, community health workers, valued community-leaders, and non-governmental organizations can be utilized to motivate and educate people for vaccination against COVID-19. Further, emphasis should be given to the elderly and diseased people with tailored health messages and assurance from healthcare professionals. The media may play a responsible role with the vaccine education program and eliminate the social stigma about the vaccination. Finally, vaccination should be continued without a fee and thus Bangladesh's COVID vaccination program can become a model for other low and middle-income countries.

Rural and Urban Differences in COVID-19 Prevention Behaviors.

Abstract: PURPOSE: To examine whether the adoption of COVID-19-related preventive health behaviors vary in rural versus urban communities of the United States while accounting for the influence of political ideology, demographic factors, and COVID-19 experiences. METHODS: We rely on a representative survey of 5009 American adults collected from May 28 to June 8, 2020. We analyze the influence of rural status, political ideology, demographic factors, and COVID-19 experiences on self-reported adoption of 8 COVID-19-related preventive health behaviors. FINDINGS: Rural residents are significantly less likely to have worn a mask in public, sanitized their home or workplace with disinfectant, avoided dining at restaurants or bars, or worked from home. These findings, with the exception of dining out, are robust to the inclusion of measures accounting for political ideology, demographic factors, and COVID-19 experiences. CONCLUSIONS: Rural residents are significantly less likely to participate in several COVID-19-related preventive health behaviors. This reality could exacerbate existing disparities in health access and outcomes for rural Americans. Health messaging targeted at improving COVID-19 preventive behavior adoption in rural America is warranted.

Asthma Surveillance - United States, 2006-2018.

Abstract: PROBLEM Asthma is a chronic disease of the airways that requires ongoing medical management. Socioeconomic and demographic factors as well as health care use might influence health patterns in urban and rural areas. Persons living in rural areas tend to have less access to health care and health resources and worse health outcomes. Characterizing asthma indicators (i.e., prevalence of current asthma, asthma attacks, emergency department and urgent care center [ED/UCC] visits, and asthma-associated deaths) and determining how asthma exacerbations and health care use vary across the United States by geographic area, including differences between urban and rural areas, and by sociodemographic factors can help identify subpopulations at risk for asthma-related complications. REPORTING PERIOD 2006-2018. DESCRIPTION OF SYSTEM The National Health Interview Survey (NHIS) is an annual cross-sectional household health survey among the civilian noninstitutionalized population in the United States. NHIS data were used to produce estimates for current asthma and among them, asthma attacks and ED/UCC visits. National Vital Statistics System (NVSS) data were used to estimate asthma deaths. Estimates of current asthma, asthma attacks, ED/UCC visits, and asthma mortality rates are described by demographic characteristics, poverty level (except for deaths), and geographic area for 2016-2018. Trends in asthma indicators by metropolitan statistical area (MSA) category for 2006-2018 were determined. Current asthma and asthma attack prevalence are provided by MSA category and state for 2016-2018. Detailed urban-rural classifications (six levels) were determined by merging 2013 National Center for Health Statistics (NCHS) urban-rural classification data with 2016-2018 NHIS data by county and state variables. All subregional estimates were accessed through the NCHS Research Data Center. RESULTS Current asthma was higher among boys aged <18 years, women aged ≥18 years, non-Hispanic Black (Black) persons, non-Hispanic multiple-race (multiple-race) persons, and Puerto Rican persons. Asthma attacks were more prevalent among children, females, and multiple-race persons. ED/UCC visits were more prevalent among children, women aged ≥18 years, and all racial and ethnic groups (i.e., Black, non-Hispanic Asian, multiple race, and Hispanic, including Puerto Rican, Mexican, and other Hispanic) except American Indian and Alaska Native persons compared with non-Hispanic White (White) persons. Asthma deaths were higher among adults, females, and Black persons. All pertinent asthma outcomes were also more prevalent among persons with low family incomes. Current asthma prevalence was higher in the Northeast than in the South and the West, particularly in small MSA areas. The prevalence was also higher in small and medium metropolitan areas than in large central metropolitan areas. The prevalence of asthma attacks differed by MSA category in four states. The prevalence of ED/UCC visits was higher in the South than the Northeast and the Midwest and was also higher in large central metropolitan areas than in micropolitan and noncore areas. The asthma mortality rate was highest in non-MSAs, specifically noncore areas. The asthma mortality rate was also higher in the Northeast, Midwest, and West than in the South. Within large MSAs, asthma deaths were higher in the Northeast and Midwest than the South and West. INTERPRETATION Despite some improvements in asthma outcomes over time, the findings from this report indicate that disparities in asthma indicators persist by demographic characteristics, poverty level, and geographic location. PUBLIC HEALTH ACTION Disparities in asthma outcomes and health care use in rural and urban populations identified from NHIS and NVSS can aid public health programs in directing resources and interventions to improve asthma outcomes. These data also can be used to develop strategic goals and achieve CDC's Controlling Childhood Asthma and Reducing Emergencies (CCARE) initiative to reduce childhood asthma hospitalizations and ED visits and prevent 500,000 asthma-related hospitalizations and ED visits by 2024.

Urban-rural differences in COVID-19 exposures and outcomes in the South: A preliminary analysis of South Carolina.

Abstract: As the COVID-19 pandemic moved beyond the initial heavily impacted and urbanized Northeast region of the United States, hotspots of cases in other urban areas ensued across the country in early 2020. In South Carolina, the spatial and temporal patterns were different, initially concentrating in small towns within metro counties, then diffusing to centralized urban areas and rural areas. When mitigation restrictions were relaxed, hotspots reappeared in the major cities. This paper examines the county-scale spatial and temporal patterns of confirmed cases of COVID-19 for South Carolina from March 1st-September 5th, 2020. We first describe the initial diffusion of the new confirmed cases per week across the state, which remained under 2,000 cases until Memorial Day weekend (epi week 23) then dramatically increased, peaking in mid-July (epi week 29), and slowly declining thereafter. Second, we found significant differences in cases and deaths between urban and rural counties, partially related to the timing of the number of confirmed cases and deaths and the implementation of state and local mitigations. Third, we found that the case rates and mortality rates positively correlated with pre-existing social vulnerability. There was also a negative correlation between mortality rates and county resilience patterns, as expected, suggesting that counties with higher levels of inherent resilience had fewer deaths per 100,000 population.

Integrating multicriteria decision-making analysis for a GIS-based settlement area in the district of Atakum, Samsun, Turkey

Abstract: The last century witnessed a boom in the world population, reaching an unprecedented level. In particular, in recent decades, the population has concentrated in cities. Migration from rural areas to urban areas brings many problems to urban areas, necessitating the opening of new settlement areas. These new settlement areas that are needed are mostly determined in line with the initiatives of local authorities based on the situation of infrastructure facilities, not scientific evaluations. If the wrong places are selected, various natural events each year may cause the loss of property and lives, in addition to significant amounts of energy consumption. This study uses various parameters and creates a method for place selection based on multiple criteria. The district of Atakum in the city of Samsun, which has been subject to continuous migration and where new settlement areas have been established, is selected as the study area. Within the scope of this study, in addition to landslide and flood risks, which constitute the most important natural disasters in the region, situations of high voltage electricity transmission lines in places where the establishment of a residential area would be objectionable are evaluated. The situation of biocomfort, which is significantly important, especially with respect to energy efficiency as well as human health, peace, and comfort, is also evaluated. This study is conducted based on these criteria, and as a result, it calculates that only 15.11% of the district of Atakum is appropriate for use as a settlement area. In addition to serving as a reference for the short- and long-term area planning studies that will be conducted in the region, this study also holds significance due to the new perspective it offers regarding urban planning studies.

Urban poverty and nutrition challenges associated with accessibility to a healthy diet: a global systematic literature review

Abstract: There is an increasing global trend towards urbanization. In general, there are less food access issues in urban than rural areas, but this “urban advantage” does not benefit the poorest who face disproportionate barriers to accessing healthy food and have an increased risk of malnutrition. This systematic literature review aimed to assess urban poverty as a determinant of access to a healthy diet, and to examine the contribution of urban poverty to the nutritional status of individuals. Following the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) methodology, our review included quantitative and qualitative studies published in English or in Spanish between 2000 and 2019. The articles were eligible if they focused on nutrition access (i.e. access to a healthy diet) or nutrition outcomes (i.e., anemia, overweight and obesity, micronutrient deficiency, micronutrient malnutrition) among urban poor populations. Articles were excluded if they did not meet pre-established criteria. The quality of the quantitative studies was assessed by applying Khan et al.’s methodology. Similarly, we assessed the quality of qualitative articles through an adapted version of the National Institute for Health and Care Excellence (NICE) methodology checklist. Finally, we systematically analyzed all papers that met the inclusion criteria based on a qualitative content and thematic analysis. Of the 68 papers included in the systematic review, 55 used quantitative and 13 used qualitative methods. Through the analysis of the literature we found four key themes: (i) elements that affect access to healthy eating in individuals in urban poverty, (ii) food insecurity and urban poverty, (iii) risk factors for the nutritional status of urban poor and (iv) coping strategies to limited access to food. Based on the systematization of the literature on these themes, we then proposed a conceptual framework of urban poverty and nutrition. This systematic review identified distinct barriers posed by urban poverty in accessing healthy diets and its association with poorer nutrition outcomes, hence, questioning the “urban advantage”. A conceptual framework emerging from the existing literature is proposed to guide future studies and policies. PROSPERO Registration number: CRD42018089788 .

Connecting the Countryside via E-Commerce: Evidence from China

Abstract: This paper estimates the impact of the first nation-wide e-commerce expansion program on rural households. To do so, we combine a randomized control trial with new survey and administrative microdata. In contrast to existing case studies, we find little evidence for income gains to rural producers and workers. Instead, the gains are driven by a reduction in cost of living for a minority of rural households who tend to be younger, richer and in more remote markets. These effects are mainly due to overcoming logistical barriers to e-commerce, rather than to additional investments to adapt e-commerce to the rural population.

Rural household food waste characteristics and driving factors in China

Abstract: Household has been widely considered as the top contributor to food waste generation in industrialized countries. However, the characteristics and driving factors of household food waste generation in developing countries, particularly in rural areas, remain less understood. In the present work, we reported a case study for rural households in China, where food consumption structure has been undergoing rapid transformation, to explore the scales and drivers of rural household food waste generation. A direct-weighing method was used in a field survey for 207 rural households in 21 villages of 3 prefecture-level cities in Shandong province, northern China. We determined the average rural household food waste generation as 8.74 g/cap/meal (more than 90% was plant-based food waste in which nearly half was vegetable waste), a number much lower than that in high-income countries and the Chinese urban restaurants. We also found that such a number varies considerably by household (0–126.21 g/cap/meal), and almost half of surveyed households generated almost no food waste. Among the surveyed prefectural areas, food waste in Jinan was significantly higher than that in Dezhou and Weifang (P

The Integration of New-Type Urbanization and Rural Revitalization Strategies in China: Origin, Reality and Future Trends

Abstract: New-type urbanization and rural revitalization have gradually become national strategies, and are an objective requirement for China to be able to enter into a new era of socialism with Chinese characteristics and also an inevitable result of the integration of new-type urbanization and rural development in the new stage. This paper reviews the classic theories and cognition of the research on urban–rural relations at home and abroad, and outlines the stage evolution characteristics of urban–rural relations in China. It is believed that urban-biased urbanization has widened the development gap between urban and rural areas since reform and opening up. Under the guidance of the two strategies of new-type urbanization and rural revitalization, urban and rural areas have transitioned from “one-way flow” to “bilateral interaction”, and from “urban bias” to “urban–rural integration”. This paper puts forward a research framework and scientific issues regarding the integration of new-type urbanization and rural revitalization from multidisciplinary perspectives. The integration of these two major strategies will contribute to a new situation of the coordinated and high-quality development of urban and rural areas in the new era.

Rural-urban and within-rural differences in COVID-19 vaccination rates.

Abstract: Purpose COVID-19 mortality rates are higher in rural versus urban areas in the United States, threatening to exacerbate the existing rural mortality penalty. To save lives and facilitate economic recovery, we must achieve widespread vaccination coverage. This study compared adult COVID-19 vaccination rates across the US rural-urban continuum and across different types of rural counties. Methods We retrieved vaccination rates as of August 11, 2021, for adults aged 18+ for the 2,869 counties for which data were available from the CDC. We merged these with county-level data on demographic and socioeconomic composition, health care infrastructure, 2020 Trump vote share, and USDA labor market type. We then used regression models to examine predictors of COVID-19 vaccination rates across the USDA's 9-category rural-urban continuum codes and separately within rural counties by labor market type. Findings As of August 11, 45.8% of adults in rural counties had been fully vaccinated, compared to 59.8% in urban counties. In unadjusted regression models, average rates declined monotonically with increasing rurality. Lower rural rates are explained by a combination of lower educational attainment and higher Trump vote share. Within rural counties, rates are lowest in farming and mining-dependent counties and highest in recreation-dependent counties, with differences explained by a combination of educational attainment, health care infrastructure, and Trump vote share. Conclusion Lower vaccination rates in rural areas is concerning given higher rural COVID-19 mortality rates and recent surges in cases. At this point, mandates may be the most effective strategy for increasing vaccination rates.

Assessment of the sustainable development of rural minority settlements based on multidimensional data and geographical detector method: A case study in Dehong, China

Abstract: In a developing country, paying attention to the sustainable development of rural areas is conducive to the development of the entire country. Ethnic minority areas are an important part of China's economic and social development. Owing to a lack of relevant statistical data, most previous studies in this area have focused on the sustainable development of rural areas or the development of ethnic minorities, but have not studied the sustainable development of rural ethnic minorities. The development of rural ethnic minorities is worthy of attention. In this study, we took Dehong as the study area. First used toponyms to accurately identify the rural minority areas and then calculated a grid of settlement density. Second, we considered the digital number (DN) value of the visible infrared imaging radiometer suite (VIIRS) as a measure of the development of the region and digital elevation model (DEM), net primary productivity (NPP), normalized difference vegetation index (NDVI), and gross domestic product (GDP) data as the indicators of terrain, climate, ecological, and economic factors, respectively. Finally, linear regression and the geographical detector method were used to determine the weight of the factors for constructing a sustainable development index (SDI) to quantitatively analyze the sustainable development and influencing factors of each minority nationality. The factors evaluated using linear regression and the geographical detector method were ranked as follows: NDVI > elevation > GDP > slope > NPP > settlement density. The results demonstrate that of the five main ethnic minorities in Dehong, Dai and Jingpo have higher SDI, followed by Achang, Lisu and De'ang. In addition, we provide some suggestions for ethnic minorities in Dehong.

The Intersection of Rural Residence and Minority Race/Ethnicity in Cancer Disparities in the United States.

Abstract: One in every twenty-five persons in America is a racial/ethnic minority who lives in a rural area. Our objective was to summarize how racism and, subsequently, the social determinants of health disproportionately affect rural racial/ethnic minority populations, provide a review of the cancer disparities experienced by rural racial/ethnic minority groups, and recommend policy, research, and intervention approaches to reduce these disparities. We found that rural Black and American Indian/Alaska Native populations experience greater poverty and lack of access to care, which expose them to greater risk of developing cancer and experiencing poorer cancer outcomes in treatment and ultimately survival. There is a critical need for additional research to understand the disparities experienced by all rural racial/ethnic minority populations. We propose that policies aim to increase access to care and healthcare resources for these communities. Further, that observational and interventional research should more effectively address the intersections of rurality and race/ethnicity through reduced structural and interpersonal biases in cancer care, increased data access, more research on newer cancer screening and treatment modalities, and continued intervention and implementation research to understand how evidence-based practices can most effectively reduce disparities among these populations.

Providing diagnosis on diabetes using cloud computing environment to the people living in rural areas of India

Abstract: Diabetes is one of the major diseases prevalent today affecting around 400 million people worldwide. Approximately one in ten adult people worldwide have diabetes. Unfortunately, about half of them live in rural areas and are not aware about the severity of the disease. Treatment of diabetes is feasible, but also challenging and expensive. Our contribution is to develop a reference model in assisting rural people suffering from diabetes. It helps the rural people of India in characterizing the victims of diabetes 2 at the earlier stages. This model improves the communication and interaction between patients and doctors. The target of analysis made in the present research is to list the risks factors and correlation that exist among those risk factors. In this work, logistic regression, support vector machine, random forest, decision tree, Naive Bayes, K nearest neighbor classifiers are used for prediction, and their accuracy is compared to choose the better machine learning model. SVM provides higher accuracy (96.0) among the choosen algorithms.

Global mapping of urban-rural catchment areas reveals unequal access to services.

Abstract: Using travel time to cities of different sizes, we map populations across an urban–rural continuum to improve on the standard dichotomous representations of urban–rural interactions. We extend existing approaches by 1) building on central place theory to capture the urban hierarchy in access to services and employment opportunities provided by urban centers of different sizes, 2) defining urban–rural catchment areas (URCAs) expressing the interconnection between urban centers and their surrounding rural areas, and 3) adopting a global gridded approach comparable across countries. We find that one-fourth of the global population lives in periurban areas of intermediate and smaller cities and towns, which challenges the centrality of large cities in development. In low-income countries, 64% of the population lives either in small cities and towns or within their catchment areas, which has major implications for access to services and employment opportunities. Intermediate and small cities appear to provide catchment areas for proportionately more people gravitating around them than larger cities. This could indicate that, for countries transitioning to middle income, policies and investments strengthening economic linkages between urban centers and their surrounding rural areas may be as important as investing in urbanization or the rural hinterlands. The dataset provided can support national economic planning and territorial development strategies by enabling policy makers to focus more in depth on urban–rural interactions.

Can Social Innovation Make a Change in European and Mediterranean Marginalized Areas? Social Innovation Impact Assessment in Agriculture, Fisheries, Forestry, and Rural Development

Abstract: Social innovation (SI) impacts are long-term changes that affect different dimensions of territorial capital (i.e., economy, society, environment, governance) for the territory in which SI occurs. Yet, systematic empirical evidence and theoretically sound assessments of the impacts of SI are scarce. This paper aims to fill the gap and assess the different aspects of SI’s impacts in European and Mediterranean areas that are characterized by marginalization processes. To assess the impacts of SI in marginalized areas, we use the evaluation framework developed within the Social Innovation in Marginalized Rural Areas (SIMRA) Horizon 2020 project and apply it to nine SI initiatives related to the fields of agriculture, fisheries, forestry, and rural development. Our findings show that SI produces cross-sectoral (societal, economic, environmental, and governmental) and multi-level impacts (on individuals, community, and society), which have improved the societal well-being, and contributed to the reduction of certain forms of marginality, mainly inside the territory in which SI occurred.

Rural-Urban Disparity in Mortality in the US From 1999 to 2019

Abstract: This study analyzes all deaths occurring in the US using the US Centers for Disease Control and Prevention Wide-Ranging Online Data for Epidemiologic Research database from 1999-2019 and the National Center for Health Statistics Urban-Rural Classification Scheme to create population categories per the 2013 US Census classification (large, small- or medium-sized, and rural areas).

Spatial Accessibility Assessment of COVID-19 Patients to Healthcare Facilities: A Case Study of Florida.

Abstract: During the COVID-19 pandemic, healthcare facilities worldwide have been overwhelmed by the amount of coronavirus patients needed to be served. Similarly, the U.S. also experienced a shortage of healthcare resources, which led to a reduction in the efficiency of the whole healthcare system. In order to evaluate this from a transportation perspective, it is critical to understand the extent to which healthcare facilities with intensive care unit (ICU) beds are available in both urban and rural areas. As such, this study aims to assess the spatial accessibility of COVID-19 patients to healthcare facilities in the State of Florida. For this purpose, two methods were used: the two-step floating catchment area (2SFCA) and the enhanced two-step floating catchment area (E2SFCA). These methods were applied to identify the high and low access areas in the entire state. Furthermore, a metric, namely the Accessibility Ratio Difference (ARD), was developed to evaluate the spatial access difference between the models. Results revealed that many areas in the northwest and southern Florida have lower access compared to other locations. The residents in central Florida (e.g., Tampa and Orlando cities) had the highest level of accessibility given their higher access ratios. We also observed that the 2SFCA method overestimates the accessibility in the areas with a lower number of ICU beds due to the "equal access" assumption of the population within the catchment area. The findings of this study can provide valuable insights and information for state officials and decision makers in the field of public health.

Trends in the Geospatial Distribution of Inpatient Adult Surgical Services across the United States.

Abstract: OBJECTIVE The aim of this study was to define trends in the geographic distribution of surgical services in the United States to assess possible geographic barriers and disparities in access to surgical care. SUMMARY BACKGROUND DATA Despite the increased need and utilization of surgical procedures, Americans often face challenges in gaining access to health care that may be exacerbated by the closure and consolidation of hospitals. Although access to surgical care has been evaluated relative to the role of insurance, race, and health literacy/education, the relationship of geography and travel distance to access has not been well studied. METHODS The 2005 and 2015 American Hospital Association annual survey was used to identify hospitals with surgical capacity; the data were merged with 2010 Census Bureau data to identify the distribution of the US population relative to hospital location, and geospatial analysis tools were used to examine a service area of real driving time surrounding each hospital. RESULTS Although the number of hospitals that provided surgical services slightly decreased over the time periods examined (2005, n = 3791; 2015, n = 3391; P<0.001), the number of major surgery hospitals increased from 2005 (n = 539) to 2015 (n = 749) (P<0.001). The geographic location of hospitals that provided surgical services changed over time. Specifically, although in 2005 852 hospitals were located in a rural area, that number had decreased to 679 by 2015 (P<0.001). Of particular note, from 2005 to 2015 there was an 82% increase in the number of people who lived further than 60 minutes from any hospital (P<0.001). However, the number of people who lived further than 60 minutes from a major surgery hospital decreased (P<0.001). CONCLUSIONS Although the number of rural hospitals decreased over the last decade, the number of large, academic medical centers has increased; in turn, there has been an almost doubling in the number of people who live outside a 60-minute driving range to a hospital capable of performing surgery.

How does financial literacy impact on inclusive finance

Abstract: Inclusive finance is a core concept of finance that makes various financial products and services accessible and affordable to all individuals and businesses, especially those excluded from the formal financial system. One of the leading forces affecting people's ability to access financial services in rural areas is financial literacy. This study investigated the impacts of financial knowledge on financial access through banking, microfinance, and fintech access using the Bangladesh rural population data. We employed three econometrics models: logistic regression, probit regression, and complementary log–log regression to examine whether financial literacy significantly affects removing the barriers that prevent people from participating and using financial services to improve their lives. The empirical findings showed that knowledge regarding various financial services factors had significant impacts on getting financial access. Some variables such as profession, income level, knowledge regarding depositing and withdrawing money, and knowledge regarding interest rate highly affected the overall access to finance. The study's results provide valuable recommendations for the policymaker to improve financial inclusion in the developing country context. A comprehensive and long-term education program should be delivered broadly to the rural population to make a big stride in financial inclusion, a key driver of poverty reduction and prosperity boosting.

Determinants of rural-urban differential in healthcare utilization among the elderly population in India.

Abstract: Population aging poses a demographic burden on a country such as India with inadequate social security systems and very low public investment in health sector. This challenge of accelerated demographic transition is coupled by the rural-urban disparity in access to healthcare services among the elderly people in India. An important objective of India’s National Health Policy (2017) is to “progressively achieve universal health coverage” which is posited upon mitigating the sub-national disparity that necessitates identifying the drivers of the disparity for targeted policy intervention. This study, therefore, makes an attempt towards the exploration of the prominent contributory factors behind the rural-urban gap in utilisation of healthcare among the older population in India. The analysis has been done by using the unit level data of Social Consumption: Health (Schedule number 25.0) of the 75th round of the National sample Survey conducted during July 2017–June 2018. Two binary logistic models have been proposed to capture the crude and the adjusted association between health seeking behaviour and place of residence (rural/ urban). To compute the group differences (between rural and urban) in the rate of healthcare utilization among the elderly population in India and to decompose these differences into the major contributing factors, Fairlie’s decomposition method has been employed. The logistic regression models established a strong association between place of residence and likelihood of healthcare utilisation among the Indian elderly people. The results of the Fairlie’s decomposition analysis revealed considerable rural-urban inequality disfavouring the rural residents and health care utilisation was found to be 7 percentage points higher among the older population residing in urban India than their rural counterparts. Level of education and economic status, both of which are indicators of a person’s Socio-Economic Status, were the two major determinants of the existing rural-urban differential in healthcare utilisation, together explaining 41% of the existing rural-urban differential. Public health care provisions need to be strengthened both in terms of quality and outreach by way of greater public investments in the health sector and by building advanced health infrastructure in the rural areas. Implementation of poverty alleviation programmes and ensuring social-security of the elderly are also indispensable in bringing about equity in healthcare utilisation.