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July/August 2005

Inside This Issue:

 

Research Provides Options to Improve Public Health Infrastructure in Rural Areas
Pennsylvania’s local public health infrastructure needs a shot in the arm, according to research conducted by Dr. Alberto Cardelle of East Stroudsburg University. The research was sponsored by the Center for Rural Pennsylvania.

Currently, none of Pennsylvania’s 48 rural counties has a local health department (LHD), which is an agency of local government that develops and administers programs and services for maintaining a healthy community.

The lack of a public health infrastructure in rural Pennsylvania is quite significant when considering the number of primary care physicians and dentists in rural Pennsylvania.

According to the most current data from the Center for Rural Pennsylvania, there were 76 primary care physicians for every 100,000 rural residents, while urban areas had 153 primary care physicians for every 100,000 residents. Also, rural areas had 44 dentists for every 100,000 rural residents, and urban areas had 74 dentists for every 100,000 residents.

According to the U.S. Department of Health and Human Service’s Health Resources and Services Administration (HRSA), Pennsylvania has the lowest ratio of public health workers to population in the nation at 37 workers per 100,000 people, compared to a national average of 138 workers per 100,000 people.

According to Cardelle's research, Public Health Infrastructure for Rural Pennsylvania, this level of health care professionals in the public health infrastructure exists in spite of state legislation that provides state funding for the creation and operation of LHDs. Act 315 of 1951 was passed to improve local health administration throughout the commonwealth by authorizing thecreation, establishment and administration of single-county or joint-county departments of health in all counties. Under Act 315, county health departments may receive state funding of up to 50 percent of total expenditures but no more than $6 for every person within the jurisdiction of the local health department. Act 12, a 1976 amendment to Act 315, authorized the commonwealth to pay local health departments an additional annual grant of up to $1.50 per resident for environmental health services. Therefore, local health departments may receive up to $7.50 per resident.

With this information in mind, Cardelle conducted the research to learn more about the issues that influence the establishment of LHDs in rural counties and the financial issues that may impact the establishment of these organizations. As part of the research, Cardelle also developed viable LHD models for rural counties.

County Models for Rural Areas

The researcher developed single-county, bi-county and tri-county LHD models for four regions of rural Pennsylvania to examine feasibility.

Research results
From the research, Cardelle found that funding for public health has steadily decreased since the 1980s, which has created significant gaps in services and increased vulnerability to the spread of disease. The threat of bioterrorism and the preparedness that has followed since 2001 has highlighted these gaps. Various federal level studies have shown a lack of communication between public health agencies and complete voids in certain areas of the country.

The research also showed that, relative to this national trend, the local public health infrastructure in Pennsylvania is weak, with only five county health departments, five municipal health bureaus and a network of state clinics in the remainder of the state.

Despite the existence of laws, which provide locales with per capita funding for public health and environmental services, much of the state’s municipal areas lack a local public health department. The areas of the state with local health departments have demonstrated a very good capacity to use both state and federal funding to provide an array of public health services. These existing LHDs have been able to grow their locales’ capacity to provide public health services by using not only the state formula grants but also federal and other state categorical grants.

Nonetheless, the research highlighted critical policy and financial issues that locales must satisfy in the process of establishing these LHDs. Among the most critical are the requirements to identify initial start-up funds, the potential tensions with local municipalities over the jurisdiction of certain service areas, and the need for a catalytic agent to initiate the process.

Cardelle’s financial analysis of different LHD models for rural counties helped demonstrate that the relatively high levels of local funds required to establish LHDs would be a major financial undertaking. The three models, which included single-county, bi-county and tri-county models, would require an average of $16 per capita annually in local funds since rural counties must cover wide geographical areas and have relatively small populations.

The model analysis showed that population, geographic area, and the availability of primary care services drive expenses. Although rural counties do not have very dense populations, they cover broad geographic expanses and suffer from chronic lack of primary care services. This means that LHDs covering rural counties will have to cover a very large geographic area, a critical cost driver especially for environmental services, such as water supply testing, and will be pressured to provide personal health services in areas that have a limited number of primary care providers. The result is very high expenses, which means that rural areas will have to generate significant amounts of local funds to operate LHDs.

Policy considerations
While the research shows that barriers to a robust public health infrastructure exist, it also uncovered policy consideration that may help to overcome those barriers. Some of the considerations include establishing secondary formulas for calculating Act 315 and Act 12 funds for rural counties; increasing awareness and knowledge among local government officials about Act 315 and Act 12; amending certain provisions in Act 315 that would allow local governments to use funds to support existing infrastructures; considering the provision of additional funds under Act 12 for environmental health services; and considering the provision of start-up funds for local health departments to help lower the financial threshold that local governments must meet to establish an LHD for the first year.

Want more information?
For a copy of the full report, Public Health Infrastructure for Rural Pennsylvania, call the Center for Rural Pennsylvania at (717) 787-9555 or visit www.ruralpa.org.

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School Enrollment Projections Show Decline for Most Rural Schools
As Pomp and Circumstance played softly in the background, some 37,800 rural high school seniors received their diplomas this past June. This fall, 34,100 rural kindergartners will join their teachers in singing their ABCs. This 3,700 difference between the class of 2005 and the class of 2018 demonstrates a cycle of declining enrollment that may affect many rural schools over the coming years.

Data on rural school enrollment show the majority of rural schools have had either stagnant or declining enrollments over the past 10 years. Enrollment projections from the Pennsylvania Department of Education (PDE) suggest that this trend will continue for at least another 10 years.

To better understand rural school enrollment trends, the Center for RuralPennsylvania looked at 10 years of enrollment data, from 1992 to 2002, to identify the trends in and characteristics of schools with significant changes in enrollment. The Center also analyzed enrollment projections through 2012 to understand the likely impact these trends will have on rural school districts.

Enrollment trends
From the analysis, the Center found that, over the past 20 years, enrollment in rural schools peaked in the early 1980s with 562,100 students. This period represented the tail end of the Baby Boomer generation, or those born between 1946 and 1964, who graduated from high school.

As the 80s continued and rolled into the 90s, enrollment in rural schools declined. The lowest period was in 1990 when enrollment bottomed out at 514,446 students, an 8 percent decline from 1982.

Then, during the 1990s, rural school enrollment slowly increased. Between 1990 and 1998, the number of students attending rural schools increased 4 percent. Starting in 1999, enrollment began to decline again, and, by 2003, the number of students attending rural schools had decreased 2 percent.

Projected declines
Over the next 10 years, rural school enrollment is projected to continue its decline. Between 2005 and 2014, enrollment in rural schools is projected to decrease 9 percent.

The most significant decline is projected to be in western Pennsylvania, where rural school districts may have a 17 percent decline in enrollment. Rural districts in eastern Pennsylvania are projected to have a 1 percent decline in enrollment.

According to the enrollment projections from PDE, 115 rural school districts are projected to have a significant decline in enrollment (15 percent or greater). In general, these districts are geographically larger than the average rural school district and have smaller populations. They also are less affluent and have significantly lower birth rates and in-migration rates than other rural school districts.

These school districts encompassed an average area of 157 square miles, and had an average population of 11,800 in 2000. Sixty-five percent were in western Pennsylvania.

Projected increases
Ten rural school districts are projected to have a significant increase in enrollment (15 percent or greater), according to the enrollment projections from PDE.

In general, these districts are geographically smaller than the average rural school district, but have larger populations. They also are more affluent and have significantly higher birth rates and migration rates than other rural school districts.

These rural districts are in northeastern and south central Pennsylvania, cover an average area of less than 129 square miles, and had an average population of 25,400 in 2000.

Mixed picture
The Pennsylvania Department of Education’s enrollment projections present a mixed picture for the state’s rural school districts. Forty-nine percent of rural districts are likely to see only a marginal change in enrollment between 2002 and 2012.

However, for 115 districts, there likely will be significant declines in the number of students, and for 10 districts, significant increases.

For those districts projected to have significant declines, the root causes appear to be very low birth and in-migration rates. Reversing these demographic forces will be extremely difficult given the age of the population and the limited economic opportunities in rural areas.

More information
For the complete fact sheet, Trends in Rural School Enrollment: A 20-Year Perspective, call the Center for Rural Pennsylvania at (717) 787-9555 or visit www.ruralpa.org.

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Chairman’s Message
Health care is a subject that has been making headlines for many years. Whether it is stories on the cost of staying healthy or the benefits of exercise and diet, the news media is replete with ideas to share with consumers. Like pieces of a puzzle, every factor that goes into a healthy community fits together to form our total health care system. To take a closer look at the delivery systems in place in rural Pennsylvania, the Center funded a research project in 2003 on public health infrastructure and the role of local health departments. The results of that research, conducted by Dr. Alberto Cardelle of East Stroudsburg University, provide more insights into the issues that influence the establishment of local health departments in rural counties and the financial issues that may impact the establishment of these organizations.

In his research, Dr. Cardelle found that the local public health infrastructure in Pennsylvania is weak, despite the existence of laws that provide locales with per capita funding for public health and environmental services. The research also highlighted critical policy and financial issues that locales must satisfy to establish local health departments and offers several policy considerations on how to create a more robust public health infrastructure. I hope you enjoy our Rural Perspectives feature article.

Even though it seems like summer has just begun, we are already hearing “back to school” advertisements broadcast on radio and television. As the students enjoy a few months away from the classroom and homework, school administrators are turning their attentions to the upcoming academic year and the challenges and changes it will bring. For many rural school districts, shrinking and expanding enrollment figures have the potential to test the resources of already stressed districts. While the 2005-2006 state budget has increased direct support to public schools by $291 million for a total of $7.95 billion, some school districts are finding it hard to make ends meet due to increased enrollments as populations shift.

While data on rural school enrollment from the Department of Education show the majority of rural schools have had either stagnant or declining enrollments over the past 10 years, the Center for Rural Pennsylvania wanted to know what enrollment may look like over the next 10 years. In the article that begins on page 1, we review the Center’s analysis of school district enrollment data to identify any trends and develop a potential 10-year outlook for rural districts. From the analysis, we learned that enrollment projections show a mixed picture for rural districts. While many will be experiencing enrollment declines, a few will see population gains. For the in-depth fact sheet on school enrollment projections, contact the Center at (717) 787-9555 or email info@ruralpa.org.

We salute another Rural Works project in this issue. As you will read on page 4, the Bridging Communities project has helped three rural communities in Susquehanna County achieve some common goals. More importantly, it has helped the communities to develop stronger relationships and work together more closely.

With summer in full swing, I hope we all get the chance to enjoy the beauty of Penn’s woods. Listen to the quiet and absorb the sounds of nature as it welcomes you.

Representative Sheila Miller

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Rural Works: Project Helps Bridge Communities in Susquehanna County
This article is part of a series that demonstrates how communities are tackling issues at the grassroots level in rural Pennsylvania. Thanks to those who shared the details of their projects with us. Now, we can share them with you so that we can all learn how rural works in Pennsylvania.

A new bridge has been built between Hallstead Borough, Great Bend Township and Great Bend Borough in Susquehanna County, says Debra Dissinger of Hallstead. Yes, the new concrete bridge over the Susquehanna River is much safer than the old 550-foot long steel truss bridge that was built in 1926. But, according to Dissinger, it’s the other bridge, the one that has been fostered between the three rural municipalities, private businesses and nonprofit organizations, that is proving to be the real connector.

Building gets underway
In May 2000, as the state Department of Transportation (PennDOT) prepared for a $6.5 million bridge replacement project along U.S. Route 11 over the Susquehanna River between Hallstead Borough and Great Bend Township, members of these rural communities formed a committee to address pedestrian safety issues and potential enhancements along the bridge that would benefit all municipal residents and visitors.

“The committee was a union of private businesses, local governments and nonprofit organizations that wanted to make their communities better,” says Dissinger, who works for a local bank and helped to spearhead the committee’s formation.

As the construction project proceeded, the committee worked to build consensus among the communities on how to tackle the safety and enhancement concerns. The committee outlined the following objectives for its “Bridging Communities” project: provide safe pedestrian walkways along the bridge; improve the communities’ main streets; and rebuild the Hallstead and Great Bend Veterans Memorial Park, which had to be removed for the new bridge construction.

The committee first focused on building safe walkways along the bridge since many pedestrians used the bridge. In 2002, the committee secured $30,000 from two local banks and the three municipalities to complete an engineering study. With the help of Great Bend Township as the lead sponsor, the committee also applied for and received $172,000 in federal Transportation Enhancement funding, which is administered by PennDOT.

A bump in the bridge
In late 2003, the bridge construction, which included roadway approach work, drainage and guide rail improvements, was completed.

In 2004, because of concerns with congestion along the corridor, PennDOT said it would need to complete additional studies and that the Bridging Communities project would have to be put on hold.

While the committee and the communities were disappointed that the first phase of their project was delayed, they were eager to keep the momentum going with the overall Bridging Communities project.

The committee met with all stakeholder groups, reworked its plans and redirected its focus on its second objective of installing sidewalks in Hallstead and Great Bend boroughs to improve the communities’ main streets.

“Everyone agreed that this was something that would benefit all communities,” Dissinger says.

The work continues
Over the past several months, Dissinger says the committee has been working to secure funds to complete the second engineering study for the sidewalks. The Transportation Enhancement funding will be used to install the sidewalks by the spring of 2006.

While the committee and the communities had hoped to be further along in their Bridging Communities project by this time, they are pleased with the goodwill and community pride that has been generated because of the project.

Dissinger says a tremendous amount of community cooperation now exists and she is optimistic that it will continue.

“People are willing to work hard and stay focused to accomplish some specific goals,” she says. “The enhancements to the communities will be visible for a long time and, hopefully, the camaraderie will live on to accomplish more great things for these picturesque little towns.”

Rural Works Breakdown: Bridging Communities
Goals/Mission: To create a safe and inviting public space for both residents of and travelers to the Hallstead and Great Bend area by providing safe pedestrian walkways, improving the appearance of our main streets and rebuilding the Hallstead and Great Bend Veterans Memorial Park.

Funding and In-Kind Support: $30,000 from local municipalities and two local banks for engineering study; $172,000 Transportation Enhancement funding through the Pennsylvania Department of Transportation.

Manpower: Committee made up of representatives from Great Bend Township, Great Bend Borough, Hallstead Borough, Susquehanna County Commissioners, Pennsylvania Environmental Council, Endless Mountains Business Association, Veterans of Foreign Wars, American Legion, Hallstead-Great Bend Lions Club, Great Bend Hose Company, Hallstead Hose Company, Peoples National Bank, and Pennstar Bank. A core group of about five people represent the committee at meetings with stakeholder groups.

Measurable Outcomes: Secured $30,000 in private monies for initial engineering study and $172,000 in Transportation Enhancement funding. Working to secure additional funds to complete engineering study to install sidewalks in Hallstead and Great Bend boroughs.

Challenges: Raising the additional funds for the second engineering study.

Advice for Replication: “We would encourage any group who wants to do something like this to nominate a key person or persons who will keep on top of the project and oversee the communication among the many partners.” Debra Dissinger

Contact Information: Debra Dissinger, phone (570) 879-2175.


Members of the Bridging Communities committee were joined by Senator Roger Madigan, Representative Sandra Major, Representative Tina Pickett, and representatives of Great Bend Township, Great Bend Borough, and Hallstead Borough and other state and local officials at a ribbon cutting ceremony to mark the completion of the new bridge in October 2003. A new boat launch near the bridge on the Hallstead side of the river was also dedicated.


Before and after: the bridge connecting Hallstead Borough and Great Bend Township.

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Follow-up Survey Reveals Little Change in Demographics of Small-Town Government Officials
In March 2005, the Center for Rural Pennsylvania conducted a demographic survey of small town government officials to follow up a 1999 survey of the same group. The 2005 survey results were quite similar to the 1999 results, showing a consistency in governing in Pennsylvania small towns.

Survey results
The 2005 survey was sent to a random sample of 3,500 township supervisors and borough council members in municipalities with less than 2,500 residents. The response rate was 35 percent with a margin of error of 2.5 percent. The survey found that the average municipal official was 57 years old and has been in office for a little more than 10 years. The survey also found that only 15 percent of elected officials were female and more than 73 percent of officials have lived in their municipality for more than 20 years.

These results are very similar to the 1999 survey, which showed that the average official was 56 years old and had served for about 10 years. The 1999 survey also found that less than 15 percent of elected officials were female and more than 77 percent had lived in the same municipality for more than 20 years.

One of the biggest changes between the 1999 and 2005 surveys was the increase in educational attainment among officials. In 1999, 17 percent of local officials had a bachelor’s degree or higher. In 2005, 23 percent of officials reported this level of educational attainment.

Another change was the percent of officials with children living at home. In 1999, 32 percent had children living at home; by 2005, this percentage declined to 24 percent.

Between the two surveys, there was a slight increase in the percent of officials who were retired. In 1999, 30 percent of the elected officials were retired, while in 2005, 32 percent of officials were retired.

Other 2005 survey highlights are:

Other than an increase in educational attainment, the 1999 and 2005 surveys showed little change in the demographic makeup of officials who govern Pennsylvania’s small towns.

Complete survey results available
For a copy of the survey results, 2005 Survey of Small-Town Municipal Officials, call the Center for Rural Pennsylvania at (717) 787-9555 or visit www.ruralpa.org.

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Conference Emphasizes Local Solutions to Cultivate Sustainable Rural Communities
Researchers, practitioners, and policy makers from 46 countries, covering every continent but Antarctica, attended the 4th International Rural Network Conference held in Abingdon, VA on June 19–24, 2005. A staff member of the Center for Rural Pennsylvania attended the weeklong conference The Power of Place, which featured 20 plenary speakers, 75 workshops, and daylong mobile workshops.

The conference emphasized the similarity of rural issues, and the dialog about them, throughout the world and how rural advocates are using similar strategies to address challenges and opportunities.

Like many of those in Pennsylvania and the nation, rural areas in most regions of the world face higher poverty rates than urban areas, the loss of traditional sector jobs, aging populations, and the out-migration of young adults.

Conference participants discussed current strategies that are centered on local solutions, with an emphasis on assets-based development, to cultivate sustainable communities. Participants emphasized the pitfalls of solving regional problems through traditional government sector programs as a worldwide barrier to comprehensive rural development.

Conference participants learned that, through both government and grassroots efforts, rural development movements are forming in numerous countries.

For more information on rural development in the European Union, see the Center’s recent report “Rural Development in the European Union: Lessons for Pennsylvania,” which is available at www.ruralpa.org/rural_eu.pdf or by calling (717) 787-9555.

For more information on the 4th International Rural Network Conference, visit the conference website at http://irn.rupriconvene.org/ or contact Amy Gimbel, with the Center for Rural Pennsylvania, at (717) 787-9555 or gimbela@ruralpa.org.

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Just the Facts: Time to get away and shop!
Headed across the great state of Pennsylvania this summer? If so, remember to take in the adventure, the beauty and the merchandise of rural Pennsylvania. According to data collected by Global Insight, which analyzes the economic impact of tourism in Pennsylvania, rural Pennsylvania is a hotbed for tourist shoppers.

While Pennsylvania’s urban areas attract the most tourists, Pennsylvania’s rural areas also attract their fair share of tourists, who help add to the state’s tourism revenues. In both 2002 and 2003, close to one-quarter of Pennsylvania’s nearly $23 billion in tourism dollars were spent in rural areas.

Tourists visiting rural Pennsylvania appear to spend much of their money on entertainment (27 percent), such as amusement parks and sporting events, and shopping (26 percent). Monroe County, for example, received more money than any other rural county in the tourism entertainment sector bringing in more than $148 million in 2003.

Monroe and Franklin counties topped all rural counties in tourism shopping revenues, recording more than $100 million and $84 million, respectively, in 2003. From 2002 to 2003, Fayette County saw the greatest increase in tourism dollars of 7.4 percent; its tourism revenues topped $58 million in 2003.

Do tourism and shopping go hand-in-hand in rural Pennsylvania? At first glance, you might not think so. However, the data would suggest otherwise. Monroe and Franklin counties were both among the top 25 Pennsylvania counties in tourist shopping revenues in 2003. Rural Butler, Fayette, Clearfield, Centre, Schuylkill, Mercer, and Blair counties all generated more than $50 million in 2003.

Tourists also appear to make up a much larger percentage of consumers in rural counties. Urban Chester County, which brought in nearly $500 million in total tourist revenue in 2002, collected around $8 billion from its shopping industry in 2002, yet only $63 million of the revenues came from tourists. Comparatively, Monroe County brought in around $1.5 billion from shoppers in 2002 and more than $96 million came from tourists.

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