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Nonmetropolitan and totally rural areas have greater unmet health needs and fewer health resources than urban areas. Blacks, American Indians, migrants, and Appalachians have specialized rural health care needs as a result of cultural isolation, poverty, and discrimination. The reversal of the rural to urban population migration has increased the strain on the health care system in all nonmetropolitan areas where the per capita distribution of physicians, medical specialists, services, and quality of facilities is significantly lower than in metropolitan areas. Communities need to develop specialized emergency medical transportation and communication, establish satellite clinics, and increase part-time physicians and midlevel health practitioners. A positive development has been the federal government's recognition of rural needs and design of eight programs to ameliorate rural health care problems: Community Health Centers, Migrant Health Centers, National Health Service Corps, Health Underserved Rural Areas, Rural Health Initiative, Rural Health Clinic Services Act, Loan Repayment, and Community Facilities Loan Programs. Under any national health insurance it will be important to recognize rural residents' health needs. The report compares four factors indicative of the condition of the health care system in both areas and shows that rural areas' lower incomes, larger aged populations, hazardous occupations, and lower educational levels contribute to poorer health care conditions. (NEC)

Members of the farm related population generally lag behind their nonfarm related counterparts in the number of school years completed, number of persons completing high school and college, functional literacy rates, participants in adult education, and labor force status. In 1975 White farm males trailed metro and nonmetro nonfarm males by 1.2 and 0.8 years respectively in median school years completed. Black farm males and females trailed their metro counterparts by 5.7 years for men and 4.0 years for women. Functional illiteracy for Black farm males remained about the same (40 percent) while illiteracy among Black farm females rose from 23.1 to 31.9 percent. Farm-related youth are not seeking post-secondary schooling at a level approaching that for metro youth, and older farm-related people are less inclined to pursue adult education opportunities. Thus, many members of the farm related population lack the formal education needed to improve chances for success in complex modern farming as well as in professional career fields elsewhere. Census data from between 1968-1975 are used in this study on the educational characteristics of two farm related population components: nonmetro farm residents and farmers and farm laborers. The educational status of subpopulations (Blacks-Whites, males-females, younger-older persons) is particularly emphasized. (Author/DS)

Emphasizing developmental problems caused by the rapid population and employment growth in rural America during the 1970's, this document describes social, economic, and governmental trends in rural America and suggests some federal policy choices that might be made in support of rural development. Problem areas and policy suggestions are presented as follows: (1) diversity and isolation cause rural poverty to differ from urban poverty, and policy development must acknowledge this difference; (2) changing patterns in rural growth and settlement necessitate the application of new forms of organization and technology for more effective planning and services in rapidly growing isolated areas; (3) the increasingly nonagricultural character of rural areas effects rural economy (therefore, economic development policy should address the needs of the entire rural population); (4) economic and political natures of local governments must be understood in order to correlate their actions and effectiveness in the framework of federal capacity building; and (5) 1976 analysis of federal spending in rural America illustrates difficulties in assessing the equity of federal spending for rural health, education, and manpower programs. More study is needed regarding urban bias and federal policy for adequate rural programs. (JD)

Nonmetro (rural) blacks continue to lag behind metro (urban and suburban) blacks and whites of all residence categories on rates of graduation from high school and college, functional literacy, preprimary and college enrollment, and adult education. Nonmetro blacks are also less likely to be in the labor force, hold white collar jobs, or have incomes above the poverty level, probably as a result of obtaining less education. Economic development of nonmetro areas, improvement of educational services, career/vocational training programs, and employment training programs are policy directions to be examined to improve the educational status of nonmetro groups. (Author/MK)

Substate regional organizations (defined as those public bodies that provide planning, economic development, and service coordination for local governments) are discussed, and the major issues pertaining to substate regionalism are explored in this overview. The background and setting of the substate regional movement is traced, from its inception in 1954 when federal aid for regional planning began, through present federal programs in the fields of economic development, employment, health, law enforcement, and transportation. The role of the U.S. Department of Agriculture, one of the federal agencies supporting multicounty substate regional activities, is described, and its leadership in promoting regional solutions to problems of rural development and natural resources conservation is acknowledged. Differences in problems and functional focuses of regional councils in nonmetropolitan areas (from those in urban regions) are discussed. Thirty-nine federal programs which supported substate regional activities during 1977-1979 are described, including both the "generalist", multipurpose areawide units and the multicounty single-purpose areawide units. Selection criteria, program identification, and program characteristics are reviewed. (JD)

Planners in multicounty rural areas can use the Rural Development, Activity Analysis Planning (RDAAP) model to try to influence the optimal growth of their areas among different general economic goals. The model implies that best industries for rural areas have: high proportion of imported inputs; low transportation costs; high value added/output ratio and value added/labor ratio; low percentage of labor skill that is most scarce; and low capital/output ratio. The model likewise suggests that conversion of agricultural land from the land use pattern of lower income farms to that of higher income farms is always desirable in a region. The linear programming model was specifically applied, in this report, to a region of northwest Arkansas comprising Benton, Madison, and Washington Counties (BMW region). Alternative objectives included the following: regional balance-of-trade surplus, regional balance-of-payments surplus, gross regional product, local value added, and a regional rate-of-return index. Data were obtained for 1960-70 to compare growth of employment by industry in the model with the actual growth in the area. Because a portion of the BMW region has recently been designated a Standard Metropolitan Statistical Area (SMSA), this study can provide a vehicle for examining how an area might be developed optimally from a rural to a more urban status. (AH)