A family s ability to meet basic human needs has a tremendous impact on community life and viability. As a society we have created public and private institutions to guarantee individuals the right to opportunities the opportunity to learn and better oneself, the opportunity to be safe in one s community, the opportunity to have a job. 

Our religious, social service, government, and educational institutions are struggling to maintain these opportunities in a world of rapidly changing policy. Welfare is very different today from what we knew only a year ago. What do the changes mean for people who become ill and can t work, or people who live in an area where jobs are hard to come by? What does a quality education mean for our young people? Are we content with the systems we have 
created to take care of each other?

Food, shelter, healthcare, transportation and education were some of the core human needs listed at the 1996 Meeting Basic Human Needs workshop held in Corning. We asked: What would determine a basic quality of life within our region? From a list of 11 potential indicators, we selected two to share with you.

Available and Affordable Housing

Background
Every person needs shelter to survive. In a sustainable community each family would have affordable and adequate housing in which to live. Community members would make sure that rent is reasonable and homes are in good shape. Substandard homes that need repairs and renovation would receive attention immediately. No one would be homeless, because the area would apply available resources to provide decent shelter for all.

The Focus of the Indicator
There are dozens of ways to track housing stock in the region, and each county produces a Community Housing Improvement Strategy (CHIS) that details the housing needs and conditions of the county. Using available, easily accessible data, we contacted the Metropolitan Housing Authorities (MHA) in each county to discover the numbers of people waiting to receive housing from them. The MHAs maintain rolling lists of, among other indexes, families waiting for adequate homes and those who currently live in substandard conditions or have no housing at all. The lists are not fully accurate and fluctuate because they are based on how many people return MHA surveys and how many people even know the MHAs exist, but they still offer a glimpse into the needs of the region.

What We Found
Athens County MHA reported approximately 540-550 families on its housing waiting list in the fall of 1997. Due to this high number, families stayed on the waiting list an average of two years. In Athens County, 420 families were living in substandard housing, were homeless, or were about to be homeless. In Perry County, the MHA had 52 families on its public housing waiting list, and an additional 53 families that needed financial help were waiting for assisted housing. In Vinton County, 55 families were on the MHA waiting list, and 18 of those families lacked homes or lived in substandard housing. Lower numbers in Perry and Vinton Counties reflect the much lower populations of those counties, not necessarily a reduced need.

Another measure of affordable housing in our area is the "housing cost burden," which measures the cost of housing as a proportion of household income. In 1990, according to the Athens County CHIS study (Tri-County Community Action and the Institute for Local Government Administration and Rural Development, October 1993), 44 percent of households with incomes below $10,000 paid more than 35 percent of their income for housing, up from 32 percent in 1980. Similarly, 12 percent of all households with incomes ranging from $10,000-$19,999 paid more than 35 percent of their income for housing, up from 2 percent in 1980.

Working Conclusions 
The federal government has recently reorganized the Housing and Urban Development (HUD) program, resulting in significant losses in construction funding along with a failure to renew Section 8 vouchers, certificates, or project-based subsidies. Section 8 vouchers provide renters a subsidy that is paid to their landlords, making their housing affordable. As funding for subsidized housing has been squeezed at the federal level, local housing providers have a difficult time keeping up with the need. For example, Rural Action s Housing Team, which performs emergency housing repairs, served 30 houses in 1996-97, with roughly 100 other households on the waiting list. The following year, the program served 36 houses, but the waiting list expanded to over 150. For 1998-99, the waiting list has again grown, now past 200; but funding has been cut, and the program will probably be able to serve only 25 houses this year.

The county MHAs also lack the means to immediately serve the housing needs of our region, at least partially because of the decreasing availability of funds from the federal government. Concurrently, according to Tim Foran, one of Athens County s five Federal Public Housing Commissioners, our area is plagued by an underdeveloped infrastructure for housing needs. Because access to sewer and water are very limited, even when agencies are ready to build it is often difficult to find an appropriate spot. Other agencies, such as Habitat for Humanity, Tri-County Community Action, Rural Action Housing, and Three Rivers Housing Corporation try to fill in some of the gaps and provide help in housing and emergency home repairs throughout the area; but their resources are scant compared to the need, and their waiting lists are long as well.

Connections
The quality of housing in a community is a reflection of many other aspects of a community s life. When a local economy doesn t offer enough jobs to keep families out of poverty, people will not live in adequate, affordable homes. Poor housing can affect the health of residents and the property values of surrounding homes. Good housing stock invites families to settle in an area, makes a community attractive, and keeps families healthy and intact. 

Housing development also impacts the environment. While new housing construction is made more difficult because water and sewer lines are not in place, the extension of these utilities is diminishing our region s farmlands. Where we place our homes, out of what materials we build them, and who can afford them are several questions that link housing to the environment and to social and economic development.

Suggestions for Additional Research
The County Housing Improvement Strategies are excellent collections of information. For sustainable development, studies of alternative forms of housing and of housing policies that make implementing alternatives difficult, and studies in alternative technologies, like biological wastewater treatment, would be valuable. Rural Action produced a literature review and analysis of such water treatment systems, especially geared towards the Appalachian region. This study is available from the Rural Action office for the cost of copying.

Health Care

Background
The quality of a region s health care depends on the health system s ability to meet the needs of the population. Sustainable health care would provide services that promote health as well as prevent, cure, and rehabilitate health problems. All citizens would have equal access to affordable, quality care. To achieve that we must understand the social and economic causes of poor health and find adequate numbers of skilled and caring health care professionals to serve the basic health care needs of the area. Ideally, comprehensive health care would include family practice, internal medicine, obstetrics and gynecology, pediatrics, optometry, dentistry, podiatry, nutrition, and social work services, along with transportation to make these services accessible. Heart disease, cancer, stroke, chronic obstructive pulmonary disease (emphysema, asthma, etc.), and nonvehicular accidents are Ohio s five leading causes of death. In Southeast Ohio problems like lack of insurance, poverty, unhealthy lifestyles, and shortage of physicians increase these premature causes of death.

The Focus of the Indicator
We reviewed a study published by the Corporation for Ohio Appalachian Development (COAD), the Health Care Position Statement (1994). This study compares the health of people in Appalachian Ohio with the rest of the state and describes the ratio of health care professionals to the population.

What We Found
COAD s study reveals that citizens in Appalachian Ohio have poor health relative to the rest of the state (t should be noted that neither mental and behavioral health nor substance abuse and addictions were included). The study found that 24 of the 60 Health Professional Shortage Areas (HPSAs) in Ohio are in the Appalachian region. An HPSA is an area in which there is fewer than one physician for every 3,000 persons in need of basic medical care and coverage. 

The COAD study adopted a lower ratio of 1,500 persons per doctor to reflect the higher health care needs of the region and rural barriers to care such as transportation. The lower ratio has also been adopted by the American Medical Association and is now the industry standard for a population s medical coverage. However, this indicator continues to use the HPSA ratio of 3000:1 because that is what is required to become or remain a federally designated HPSA. Even at this higher ratio, a clear need is evident in our region. The data is now five years old and is presently being updated.

In Athens County, the population of medically indigent persons (determined by counting the number of people in the population with incomes below 200% of the poverty level and subtracting those who are eligible for Medicaid enrollment) is 16,187, with only 0.2 full-time physicians (eight physician-hours per week). This means a maximum of only 600 people can be adequately served, leaving 15,587 people without adequate care. The suggested minimum number of additional physicians needed is 5.2, with each professional caring for 3,000 people. 

The entire population of Perry County (31,557 people) falls into the HPSA classification. There are 8.8 physician FTEs (full-time equivalent) in the county. Based on 3,000 patients per doctor, 5,157 people go un-served unless 1.7 more physicians are added. Vinton County s population (11,098 people) has only 0.7 of a full-time health care professional present (one person working 70% of the time to meet the needs of the population). With only 2,100 people able to receive sufficient care, the other 8,998 need 3 additional doctors if enough health care for all is desired within the county.

Working Conclusions 
There is a shortage of health care available to low-income residents in Appalachian Ohio. In each county, more full-time physicians are required to adequately serve the health care needs 
of the population. Private physicians who try to help are not subsidized for their work and face a financial burden. Providing treatment to the uninsured is also a burden on rural hospitals that do not refuse care through their emergency rooms.

Prevention of life-threatening diseases or afflictions through early detection, monitoring, management, treatment, and healthy lifestyles are impossible when the majority of people in Athens, Vinton, and Perry counties do not have access to medical care. People have little chance to live healthy lives when they are torn between either paying a physician and buying medication or purchasing food and clothing, because they cannot afford to do both.

Connections
The well-being of a community is directly linked to the health of its residents. Better health allows people to have more energy, more general happiness, and more ability to be involved in their community. In order for a community to be sustainable, parents must be confident that their children will grow up healthy, with doctors and medical facilities available to help them along the way. People in good health can work more productively, with fewer days absent from their jobs. Health care provides economic benefits directly in the form of new, good-paying jobs, and indirectly by creating a healthier workforce with less absenteeism.

Suggestions for Additional Research
Studying the number and quality of medical outreach programs in the area can tell us how people in need are being reached, as could surveys by consumers in locations that are underserved. Studies and community discussions about wellness and prevention are also needed so that individuals and families can take charge of their health and find ways to reduce the chances of disease. Continued feasibility studies for free or reduced-fee clinics finding ways to make health  care accessible and affordable are desperately needed.

Suggested Basic Human Needs Indicators Affordable Housing Community-Centered Media Comprehensive Health Care Accessibility Community Celebrations Community Internet Access Democratic Classrooms Recreation Activities Education Options Environmental Education Program Environmental Organizations Watershed Improvement Projects

 
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