New Jersey Primary Care Association (NJPCA), in collaboration with the New Jersey Department of Health, community partners, and Federally Qualified Health Centers, continue to strive for healthcare equality among diverse populations. Our goal is to make changes in policies, systems, and environmental surroundings in urban and rural communities to encourage healthy living for individuals of all ages and backgrounds. By implementing appropriate evidence-based interventions and initiatives, we can achieve this goal by improving population health and the quality of health services in these communities.
FEDERAL DEFINITIONS OF RURAL HEALTH
The federal government defines “rural” by using the U.S. Census Bureau and the U.S. Office of Management and Budget definitions along with other available definitions. However, neither the U.S. Census Bureau and the U.S. Office of Management and Budget provide any specific definitions of what can be considered a rural area. They designate all areas that are not easily identifiable as urban areas.
As per the Census Bureau definition, an area comprised of less than 2,500 people could be considered a rural area. The two identified types of urban areas are Urbanized Areas (UAs) of 50,000 or more people and Urban Clusters (UCs) that are considered populations between 2,500 and 50,000 people. In fact, “rural” is considered all population, housing, and territory not included within an urban area. The Census Bureau recognizes that densely settled communities outside the boundaries of large incorporated municipalities are just as urban as the densely settled population inside those boundaries. The definition does not follow city or county boundaries, and so it is sometimes difficult to determine whether an area is considered urban or rural. Under this definition, about 21% of the US population in 2000 was considered rural but more than 95% of the land area was classified as rural. In the 2010 Census, 59.5 million people, 19.3% of the population, was rural while more than 95% of the land area was still classified as rural.
The U.S. Office of Management and Budget (OMB) designates counties as Metropolitan, Micropolitan, or neither. A Metro area contains a population with a core urban area of 50,000 or more, and a Micro area contains a population with an urban core of at least 10,000 (but less than 50,000). All counties that are not part of a Metropolitan Statistical Area (MSA) are considered “rural”. Micropolitan counties are considered non-Metropolitan or “rural” along with all counties that are not classified as either Metro or Micro. Under this definition, about 17% of the population in 2000 was considered Non-Metro while 74% of the land area was contained in Non-Metro counties. After the 2010 Census, the Non-Metro counties contained 46.2 million people, about 15% of the total population and covered 72% of the land area of the country. For more information on Metro areas, please see the United States Census Bureau Metropolitan and Micropolitan Statistical Areas Main Page.
NEW JERSEY STATE DEFINITION OF RURAL HEALTH
New Jersey has a population of about 9 million residents, of which, 10 percent live in rural areas. The New Jersey State Office of Rural Health defines rural counties and rural communities as those having a population density of fewer than 500 people per square mile. This agrees with the 2010 Census definition of areas outside urban areas or urban clusters. In New Jersey, 7 of the 21 counties meet the density definition of rural and are located in the northwestern and southern sections of the State. These counties are Atlantic, Cape May, Cumberland, Hunterdon, Salem, Sussex, and Warren.
NEW JERSEY’S RURAL HEALTH CENTERS
CompleteCare Health Network (CCHN) offers patients of all ages a wide range of healthcare services. Most of these services are offered under one roof and all are connected through electronic health records. CompleteCare has a Migrant Outreach Program that links migrant and seasonal farmworkers with healthcare services. This program begins in the spring and continues until the fall, which is during the period of peak migration of farmworkers and their families into Cumberland, Gloucester, and Cape May Counties.
The Migrant Outreach Program provides the following services:
- On-site visits to the migrant camps to inform families about CCHN Medical, Dental Services, and Specialty Services
- Health Information Materials
- Referral services such as walk-in access to the CCHN RiteCare site
- Provides blood pressures and blood glucose level checks
- Disease and Illness Prevention Education
- Chronic Disease Management Services
- Conduct follow-up visits requested by CCHN providers
- Dispersal of CCHN posters and brochures in common areas of camps, lunch areas, fisheries, and migrant housing developments
- Free Pregnancy Tests for women on the camps, and if positive, prenatal follow-up appointment assistance
- Outreach services are provided to camps, nurseries, and fisheries during lunch hours as well as Tuesday evenings from 5:00 pm-7:30 pm on area camps.
Ocean Health Initiatives, Inc., (OHI) has developed a health campaign to make accessible healthcare services a priority to migrant workers and residents in rural communities. The campaign focuses on preventive measures that would help monitor and educate the population on what diseases and health issues can be avoided or managed. These services include vaccinations, diabetes, cancer screenings, and dental care. In order to address these barriers to care, OHI hosts educational events, and screenings on their Mobile Medical Unit (MMU) and provides free vaccination events during outbreaks in the community.
During the months of November 2018 and April 2019, OHI hosted multiple measles vaccination events to the communities of Ocean County when a measles outbreak was dramatically affecting the area of Lakewood, NJ. Free educational materials and access to other vaccinations, such as Flu shots were also provided. Over the course of those months, nearly 1500 Flu and MMR vaccinations were administered.
OHI continues to be a leader in community-based care in rural communities and will carry on holding education and preventive medicine events to build upon healthy communities and minimize health disparities.
The need for health services to migrant and seasonal agricultural workers was the basis for developing the original primary care service program for Southern Jersey Family Medical Centers, Inc. (SJFMC) Today, this program remains a priority to SJFMC.
SJFMC operates a network of multi-service community health centers where medical professionals provide low-cost, high-quality medical and dental services to migrant agricultural workers and low-income residents of South Jersey.
SJFMC provides the following services to better care for their rural communities:
- Bilingual Interpretation Services
- Bilingual and Multicultural Interpreters readily available to provide services
- Migrant Health Outreach Team/Farm Worker Campsite Support
- The Outreach Department maintains close relationships with the migrant and seasonal agricultural worker communities
- During the six-month period from mid-April through mid-October, Migrant Health Promoters visit farm workers in over 150 camps
- Outreach workers regularly visit each camp in the area to offer the following on-site services:
- Health Screenings
- Individual Health Consultations
- Disease Prevention and Health Promotion Education
- Case Management
- Additional Health Services
- Transportation Services
- Pick up and drop off transportation services are available for community members who require assistance going to and from the Health Center
- Transportation services are available for patients with specific medical needs such as acquiring prescription medications at the pharmacy, medical specialists’ appointments, and emergency room visits.
- Lay Health Promoter Program
- ESL/Survival Skills classes
Zufall Health Center provides the following services to migrant and seasonal agricultural workers in Morris and Warren counties:
- Medical appointment assistance
- Transportation services for workers and their families to appointments
- Prescription medication pick-up assistance
- Language translation during medical and dental visits
- Diabetes Community Health Worker and Farmworker Outreach Personnel conduct Diabetes Risk Assessments for agricultural workers
- On-site CEED (Cancer Education and Early Detection) Education is provided to agricultural workers.
- The New Jersey Cancer Education and Early Detection (NJCEED) Program provides comprehensive outreach, education and screening services for breast, cervical, colorectal and prostate cancers. Click here for more information about the NJCEED program.
For more information about Zufall Health Center services, please call (973) 328-9100 ext. 323 or email to firstname.lastname@example.org.
THE NEW JERSEY RURAL HEALTH SYMPOSIUM
In 2016, the first New Jersey Rural Health Symposium was convened to address disparities and recognize ways to improve health and access to care in rural communities. The day-long event was designed to benefit and inspire those who are dedicated to bringing quality healthcare services to the underserved populations in New Jersey. Through collaboration with the Department of Health and New Jersey’s Rural Health Advisory Committee, the symposium provided opportunities for networking and information sharing, educational and engaging workshops, and presentations from subject-area experts across the State. The New Jersey Rural Health Symposium is held every two years to educate and inspire Federally Qualified Health Centers, rural health practitioners, private practices, hospitals, public health professionals, social workers, policymakers, advocates, and community health workers to improve health outcomes and access to care in rural communities. The next New Jersey Rural Health Symposium will be held in the Spring of 2020.
Additional Rural Health Resources:
- United States Department of Agriculture: Rural-Urban Commuting Area Codes (RUCA)
- National Organization of State Offices of Rural Health (NOSORH)
- National Rural Health Association (NRHA)
- Rural Health Information Hub
*HEALTH CENTER MEMBERS ONLY: Grants & Funding Opportunities
HUMAN TRAFFICKING IN NJ: HOW DO RURAL AND URBAN CARE SYSTEMS RESPOND WEBINAR
On October 24, 2019, NJPCA, NJDOH Office of Primary Care and Rural Health, and Horizon NJ Health hosted a statewide online webinar regarding human trafficking. Over 70 participants attended the webinar and received information regarding the impact of human trafficking in New Jersey and how rural and urban healthcare systems can respond. The webinar was led by a four-person panel, including Psychiatrist, Dr. Mariam Garuba; New Jersey Coalition Against Human Trafficking Consultant/Speaker Advocate, Gina Cavallo; New Jersey Division of Criminal Justice Human Trafficking Task Force Program Coordinator, Kathleen Friess; and Center for Family Services Anti-Trafficking Program Coordinator, Stacey Foote.
Given her experience as a psychiatrist working with human trafficking victims, Dr. Mariam Garuba provided tools that healthcare professionals can use to identify potential victims; guidelines when a victim is identified; the health problems associated with human trafficking; and interventions that can be used with survivors. Gina Cavallo shared her own heart-wrenching life story of how she became a victim of human trafficking and her work today as an advocate for change. Ms. Cavallo explained how she mentors other survivors and educates the public on key behavioral red flags that may indicate sex trafficking. Kathleen Friess discussed the current laws and policies that are in place to combat human trafficking in the state. Ms. Friess highlighted the State’s new law that eliminates the need to prove force, fraud or coercion if the victim is a minor used in sex trafficking. Ms. Friess also discussed the factors that contribute to New Jersey being described as “a major hub” for human trafficking, including its location, population density, and access to several major highways. At the end of the webinar, Stacey Foote provided resources, information, and community outreach strategies for participants to implement and utilize in their community. Ms. Foote also highlighted the Center for Family Service’s program, Services Empowering Rights of Victims (SERV), and its role in helping victims of human trafficking through two grant-funded programs. These programs, Look Beneath the Surface (LBS) and Domestic Victims of Human Trafficking (DVHT), operate exclusively in Cumberland, Camden, and Gloucester counties and provide numerous services to support victims of human trafficking.
To view the video recording of each expert panelist, please click the links below:
If you suspect someone is a victim of human trafficking, please use the following resources:
- Call 9-1-1, if the victim is at risk of imminent harm.
- National Human Trafficking Resource Center Hotline: (1-888-373-7888) | Text to 233733
- NJ Human Trafficking 24/7 Hotline: 1-855-END-NJ-HT (1-855-363-6548)
- Victim Services Hotline: (1-800-225-0196)
For additional information, please utilize the following websites:
- Blue Campaign
- Office of Trafficking In Persons (OTIP)
- New Jersey Human Trafficking Task Force
- New Jersey Coalition Against Human Trafficking