Harold F. Goldsmith, Dena S. Puskin, and Dianne
J. Stiles
Federal Office of Rural Health Policy 1993
[See note for information on
current information on the "Goldsmith Modification]
Synopsis
A strategy is presented in this paper that permits
a more equitable distribution of resources to develop and maintain
health services in rural areas than existing county based procedures.
Operationally, nonmetropolitan counties have been considered to
lack easy geographical access to the big cities and their suburbs
(central areas) of metropolitan areas. Under the usual market conditions,
central areas are most likely to have concentrations of health services.
Generally, this means that the residents of metropolitan counties
have easy access to the services in central areas, and that the
residents of nonmetropolitan areas do not have such access unless
services are encouraged and supported. However, some metropolitan
counties are so large that they contain small towns and rural areas
that like most nonmetropolitan areas, lack easy geographical access
to the central areas and consequently their health services.
This paper uses decennial census data to demonstrate
a method that can be used to identify small town and rural parts
of large metropolitan counties (counties with at least l,225 square
miles) that most likely do not have easy access to central areas.
Applying the methodology to 1980 decennial census data, it was found
that, of the slightly over 32 million persons who lived in large
metropolitan counties in 1980, approximately 2 million of these
persons lived in small towns and rural areas without easy geographical
assess to central areas. Because the procedures presented improve
the precision with which areas that lack easy geographic access
to the central areas of metropolitan counties can be identified,
it was recommended that they be more widely used in Federal and
State rural grant programs.
Notes
a. This monograph describes the methodology of the Goldsmith rural
modification for metropolitan counties designated by the U.S. Office
of Management and Budget.
b. The authors would like to express their gratitude
to Richard Forstall who carefully reviewed and evaluated the methodology
of the paper. They would also like to thank Jake Culp, Glenda Koby,
Ronald Manderscheid and Patricia Taylor for their helpful com ments
on earlier drafts of the paper.
Dr. Goldsmith, prior to his retirement, was Chief
of the Population Surveillance and Applied Demography Program, Survey
and Analysis Branch, Division of State and Community Systems Development,
Center for Mental Health Services, Substance Abuse and Mental Health
Services Administration, Rockville, Maryland. Dr. Puskin is Acting
Director, Office of Rural Health Policy, Health Resources and Services
Administration, Rockville, Maryland. Ms. Stiles is a consultant,
located in Adelphi, Maryland.
c. Minor edits to update this monograph were made
in 1997.
Improving the Operational Definition of
"Rural Areas" for Federal Programs
Problem
This paper describes a method that can be used to significantly
improve the operational definition of rural populations lacking
easy geographical access to health and mental health services (hereafter,
simply health services). The procedure, already being used to expand
the eligibility for one Federal program, an outreach grant program
sponsored by the Office of Rural Health Policy (see Federal Register,
Feb. 27, 1992), was developed because rural areas, with their small
populations, sparse settlement and remoteness, often needed Federal
government assistance in order to maintain a variety of essential
health services. Under usual market conditions, health and related
services tend to be concentrated in big cities and their suburban
areas (see United States General Accounting Office, Nov. 1992, and
Goldsmith et al. in press). Thus, residents of small towns or the
open country (rural residents) are considerably less likely than
the residents of big cities and their suburbs to have easy geographical
access to health services unless the development of such services
is encouraged and supported.
When Federal programs are implemented to provide
health services to rural areas, they immediately encounter the problem
that there are no operational definitions of "rural areas" which
precisely divide the population of the United States into "rural
residents" and "urban residents". The two most commonly used dichotomous
definitions are rural areas and urban areas, a Bureau of the Census
(BC) designation based on density, and metropolitan areas and nonmetropolitan
areas, an Office of Management and Budget (OMB) designation based
on the integration of counties with big cities (see Hewitt 1989,
and OMB 1990). Both definitions are useful but imperfect. Thus,
a sizable percentage of the population of metropolitan areas reside
in rural areas (in 1980, approximately 14 percent) and a sizable
percent of the population of nonmetropolitan areas reside in or
near large towns (in 1980, approximately 34 percent of the nonmetropolitan
population resided in counties with urban populations of 20,000
or more) (see Goldsmith et al., 1996, and Wagenfeld, et al., 1994).
Because of its ease of use, OMB's designation
of counties as either metropolitan or nonmetropolitan is the definition
in widest use by Federal programs providing aid to rural residents.
Metropolitan counties are socially and economically integrated on
a daily basis with big cities or their suburbs, whereas nonmetropolitan
counties are very likely to contain small-town and open-country
regions that generally lack easy geographical access to services
that are concentrated in big cities and their suburban areas (collectively
central areas). (1)
While the designation of counties as either metropolitan
or nonmetropolitan has proved to be a useful procedure for identifying
areas with and without easy geographical access to health services
in central areas, the strategy may be viewed as unfair to the rural
residents of geographically large metropolitan counties. Some metropolitan
counties are so large that one cannot assume that all residents
of the county have easy geographical access to services in central
areas. Thus, even though the most populous part of a geographically
large metropolitan county may be metropolitan in character, other
parts are clearly not integrated with central areas. San Bernardino
County, California, is a good example of a such a county. This county
stretches from the city of San Bernadino, approximately 50 miles
from the Pacific Ocean, through the Mojave Desert to the Nevada
border over 150 miles away. While San Bernardino covers over 20,000
square miles, the densely settled parts of this county, including
the city of San Bernardino, are in a comparatively small area in
the southwestern corner of the county. The remainder of the county
consists of sparsely settled desert and mountains. It is unlikely
that residents of the sparsely settled areas have easy geographical
access (less than 30 minutes) to the city of San Bernardino or its
suburbs.(2)
Thus, some residents of small-town and open-country
parts of large metropolitan counties (LMC's) are in a similar position
to residents of nonmetropolitan counties, i.e., have limited geographical
access to health services concentrated in the central areas of metropolitan
counties. Recognizing this fact, the Office of Rural Health Policy
decided late in 1991 to expand rural health outreach grant eligibility
to include parts of LMC's that do not have easy geographical access
to the central areas. This paper describes how this task was accomplished
and underscores the value of continuing and expanding such efforts.
Methods
The data for this analysis are from the 1980 Health Demographic
Profile System (1980 HDPS). This is a general purpose Statistical
Analysis System (SAS) data base developed by the National Institute
of Mental Health in cooperation with the National Center for Health
Statistics and the U.S. Department of Agriculture. It provides a
wide range of 1980 social and economic decennial census data for
subcounty areas (census tracts, minor civil divisions), counties,
States and the nation. (See Goldsmith, et al., 1984 for a detailed
description of the data base).
Using the 1980 HDPS, the task was to identify
the parts of LMC's that were small town or open-country without
easy geographical access to central areas. This was accomplished
by first identifying LMC's, then identifying small town and open
country areas (rural neighborhoods) within these LMCs, and last
identifying the rural neighborhoods with limited geographical access
to central areas of these counties (isolated rural neighborhoods).
The specific steps in this process are summarized below:
- Large Metropolitan Counties (LMCs). Using
the OMB's 1983 designations of metropolitan counties (see Beale
1983), an LMC was defined as one with at least 1,225 square miles.
The designation of a metropolitan county with at least 1,225 square
miles as a LMC was based on the suggestions of demographers and
health professionals, as well as an empirical examination of potential
LMC's.(3) In 1980,
there were 73 such counties (see Table 1, and also see Goldsmith,
et al., 1992). It should be noted that by 1990, 4 additional counties
designated by OMB as metropolitan counties had sufficient geographic
area to be labeled LMC's (see Table 1). (Between 1990 and 1996,
12 of the counties newly designated by OMB as metropolitan counties
had sufficient geographic area to be labeled LMC's (see Table
3).
- Rural Parts of Large Metropolitan Counties.
The rural status of small subcounty residential areas was based
on an evaluation of 1980 census tracts. Census tracts (i.e., comparatively
homogeneous subcounty areas typically with populations of 3 to
4 thousand persons) in LMC's were classified as open-country or
small town (rural neighborhoods) if there were no persons living
in central areas (operationally, a city of 50,000 or more persons
plus the surrounding densely settled suburbs, i.e., urbanized
areas) or in cities of 25,000 or more persons.(4)
The remaining tracts--those containing a part of the urbanized
area or a city of 25,000 or more--were excluded from further consideration.
- Tracts with Large Institutional Populations
or No Population. Rural Census tracts with a large number of persons
in institutional or group quarters (75 percent or more) were excluded
from the analysis. This was because the populations of such tracts
were not likely to use the services of the central areas and because
detailed decennial data were not available for persons in institutional
group quarters. In addition, tracts with no population were excluded
from the analysis.
- Isolated Rural Census Tracts. For rural
tracts in LMC's (see 2 above), isolated rural census tracts were
identified using a measure of the volume of the labor force of
a tract that commuted to central areas and a measure of the average
time that it took such persons to commute. The volume of commuting
indicator (i.e., percent of the labor force of a tract that commutes
to central areas) was selected as a variable because commuting
is a key criterion used by the OMB and the Bureau of the Census
to determine if counties are socially and economically linked
to big cities (see Forstall and Fitzsimmons, 1991). In this study,
the county criterion was adapted to census tracts. Accordingly,
in a manner similar to counties, tracts in which comparatively
few persons commuted to work in the central areas (less than 15
percent) were considered to be isolated rural tracts (i.e., not
socially and economically integrated with central areas).(5)
Of the approximately 7,000 tracts in 1980 LMC's, 390 were classified
as isolated rural tracts on the basis of a low percent of the
labor force commuting to work in the central areas.
Often, few employment opportunities exist
in rural communities. Thus, it is possible that a large percent
of the labor force of the remaining rural tracts would be willing
to spend a significant amount of time commuting to work in central
areas. Taking this possibility into account, if a high percentage
(15 percent or more) of the labor force of a tract commuted
to work in central areas, and commuting time was high (over
45 percent of the labor force commuted 30 minutes or more to
work), a tract was considered a likely candidate to be designated
as an isolated rural tract in LMC.(6)
One additional criterion was employed. It was also necessary
for a tract to be outside the Ranally Metropolitan Areas (RMA's)
(see Rand McNally 1990). Like New England metropolitan areas,
RMA's are based on subcounty units such as minor civil divisions.
Consequently, the RMA's are unlikely to be overbounded (include
area not really integrated with central areas). It was felt
that this additional step guaranteed that the population of
rural tracts with a large volume of their labor force commuting
for long periods of time to central areas did have limited geographical
access to the central areas.
For the counties that became LMC's between
1983 and 1990, a slightly different procedure had to be used
to identify isolated rural tracts. Detailed census tract data
were not available in the l980 HDPS for these tracts. Accordingly,
in these four counties, a tract was considered an isolated rural
tract if it was outside l980 central areas, did not contain
part of a city of 25 thousand or more persons, and was outside
an RMA.
Results
The results of this analysis are summarized in Table 2. An examination
of this table reveals that slightly over 32 million people lived in
LMC's in the 20 States with at least one such county, and that 6.2
percent of the population of LMC'S (approximately two million persons)
resided in isolated rural areas. This represents an increase of nearly
4 percent in the number of persons considered to be residing in areas
eligible for a Federal outreach grant to develop health services for
rural communities (from approximately 54 million persons when only
the residents of nonmetropolitan counties are so considered to about
56 million when the isolated rural residents of metropolitan counties
are included). The largest number of isolated rural neighborhoods
in LMC's (nearly one million) was in California and the smallest was
in Wyoming (nearly three thousand).
Conclusion
This paper demonstrated that 1980 decennial census data can be used
to identify parts of LMC's that, like nonmetropolitan counties in
general, lack easy geographical access to central areas. Given the
concentration of services in central areas, the strategy developed
permits a more equitable distribution of outreach grant funds to
persons living in rural areas. Prior to this analysis, funds were
made available only to that part of the population of rural areas
that lived in nonmetropolitan counties. This paper demonstrates
that it is feasible to identify, in a practical manner, the isolated
rural residents of LMC's. This permits such areas, also, to be eligible
for Federal rural grant programs.
In conclusion, it should be noted that this analysis
was possible because a data base (the 1980 HDPS) existed that was
both easy to use and contained the county and subcounty indicators
necessary to identify the isolated rural parts of metropolitan counties.
While a similar data base for 1990 has not yet been prepared, the
requisite data can be extracted from existing 1990 decennial census
tapes. To maintain the same equity of access to grant funds for
health services that was achieved using the procedures outlined
in this paper, it is suggested that methods presented in this paper
be applied to 1990 decennial census data. Further, modifications
in the original procedures should be considered that would improve
the identification of isolated rural areas. Such revisions might
include identification of isolated rural areas in all metropolitan
counties (not just the LMC's), and identification of nonmetropolitan
counties that are very metropolitan in character (contain fairly
large cities).
EndNotes
(1). The designation of
counties as being metropolitan or nonmetropolitan in character is
made officially by the Office of Management and Budget, with the
technical support from the Bureau of the Census, on the basis of
size of the largest urban aggregation in a county and patterns of
commuting between counties. Generally, counties socially and economically
integrated with an urban cluster of at least 50,000 or more persons
have been designated as metropolitan counties and the remainder
as nonmetropolitan counties (Federal Committee on Standard Metropolitan
Statistical Areas, 1980. Also see Forstall and Fitzsimmons, 1991).
(2). Commuting 30 minutes
or more to a big city or its suburbs (center areas) is a time period
considered to index areas that have limited access to the employment
or health services that tend to be concentrated in central areas
(see Federal Register, November 17, 1980).
(3). A number of demographers
and health professionals familiar with census geography were asked
what they would consider to be large metropolitan counties. They
included in their list such counties as Riverside (7,214 square
miles), San Bernardino (20,064 square miles), and San Diego (4,212
square miles) Counties in California; Collier (1,994 square miles)
and Dade (1,955 square miles) Counties in Florida; St. Louis County
(6,125 square miles) in Minnesota; Herkimer County (1,416 square
miles) in New York; and Lycoming County (1,237 square miles) in
Pennsylvania. The smallest of these counties had approximately 1,225
square miles. An empirical examination of counties with at least
1,225 square miles suggested that they tend to be at least 25 by
50 miles and that commuting time between their rural and small town
areas and their central areas was often 30 minutes or more. As noted,
this is a time period that was considered to index areas that had
limited access to the employment or health facilities of central
areas (Federal Register, November 17, 1980). Based on the above
conditions, the selection of 1,225 square miles to indicate LMC's
appeared to be reasonable.
(4). Just as for central
cities and urbanized areas, cities of 25 to 50 thousand residents
were included in the criteria that designates rural neighborhoods
because such cities are often designated as sub-metropolises (see
Hewitt 1989, King 1984). While the volume and range of service in
such cities may not be as large as that available in central areas,
they still are likely to have significant amounts of health and
related services located within their boundaries.
(5). One of the criteria
for a county to be considered socially and economically integrated
with the county that contains a central city is that "15 percent
of the workers living in the county work in the county or counties
containing the central cities of the [MSA]" (Forstall and Fitzsimmons
1991). Some modifications in the criteria for designating metropolitan
counties were made in 1990 (see Forstall and Fitzsimmons, 1991).
(6). The statistic "over
45 percent of the labor force commuting 30 minutes or more to work"
was considered to index high commuting time between central areas
and rural tracts for several reasons. First, the statistics approximates
an average commuting time of 33 to 35 minutes. This time period
exceeds the period considered to index limited access to the employment
or health services of central areas -- i.e., 30 minutes. Second,
most residents of metropolitan areas commute less than 30 minutes
to work (see Bureau of the Census, 1984).
References
Beale, C. "Rural-Urban Continuum Code 1980." Unpublished
material prepared in the Economic Development Division, Economic
Research Service, U.S. Dept. of Agriculture. 1983.
Bureau of the Census. 1980 Census of Population,
Detailed Population Characteristics, United States Summary: Section
A. March 1984.
Federal Committee on Standard Metropolitan Statistical
Areas, 1980. Documents relating to the metropolitan statistical
area classification for the 1980s. Statistical Reporter 80(ll):335-384.
Federal Register. Notice: "Criteria for
Underserved Areas," November 17, 1980.
Federal Register. Notice: "Rural Health
Outreach Grants Programs", Vol. 57, No. 39, February 27, 1992, pp.
0725-0730.
Forstall, R.L. and Fitzsimmons, J.D. "Metropolitan
Areas: Definitions with l990 Census Data and A Reconsideration of
Underlying Concepts for the Future." Paper presented to the Census
Advisory Committee on Population Statistics. Alexandria, Virginia,
April 25-26, 1991.
Goldsmith, H.F., Jackson, D.J., Doenhoefer, S.M.,
Johnson, W., Tweed, D., Barbani, J., and Warheit, G. The Health
Demographic Profile System's Inventory of Small Area Social Indicators.
NIMH Series BN No. 3, DHHS Pub. No. (ADM)84-1354. Washington, D.C.:
Supt. of Docs., U.S. Govt. Print. Off. 1984.
Goldsmith, H.F., Stiles, D., and Puskin, D. "Identification
of Isolated Rural Areas in Large Metropolitan Counties." Paper presented
at the 1992 Annual Meeting of the Southern Demographic Association,
Charleston, S.C., October 1992.
Goldsmith, H.F., Wagenfeld, M.O., Manderscheid,
R.W., and Stiles, D.J. "Geographical Distribution of Organized Mental
Health Services in 1983 and 1990." In Manderscheid RW and Sonnenschein
MA, eds., Mental Health, United States, 1996, Ch. 9. Center
for Mental Health Services, DHHS Pub. No. (SMA)96-3098. Washington
DC: Supt. of Docs., U.S. Govt. Printing Office, 1996.
Hewitt, M. "Defining "Rural" Areas: Impact on
Health Care Policy and Research." Staff paper, Office of Technology
Assessment. Washington D.C. Supt. of Docs. U.S. Gov. Print. Office,
July 1989.
King, L.J. Central Place Theory Beverly
Hills: Sage Publications, 1984.
Office of Management and Budget. Revised Standards
for Defining Metropolitan Areas in the l990s. Federal Register,
March 30, 1990 (Revised May 10, 1990).
Rand McNally and Co. Commercial Map. Chicago,
Illinois: Rand McNally 1990.
United States General Accounting Office. Rural
America Faces Many Challenges, A Symposium on Rural Development.
GAO/RCED-93-35. Washington, D.C., Nov. 1992.
Wagenfeld, M.O., Murray, J.D., Mohatt, D.F., and
DeBruyn, J.C. Mental Health and Rural America 1980-1993: An Overview
and Annotated Bibliography. Rockville, Md. Office of Rural Health
Policy, HRSA, and Office of Rural Mental Health Research, NIMH,
NIH, 1994. NIH Publication No. 94-3500.
Table 1.
Large 1980 Metropolitan Counties[Counties in 1980 Standard Metropolitan
Statistical Areas (SMSAs) with at least 1,225 square miles]
Federal Information
Processing System
(FIPS) Codes |
County/
Parish/Borough |
Metropolitan
Statistical
Area |
State |
01 003 |
Baldwin |
Mobile |
Alabama |
01 097 |
Mobile |
Mobile |
|
125 |
Tuscaloosa |
Tuscaloosa |
|
02 020 |
Anchorage |
Anchorage |
Alaska |
04 013 |
Maricopa |
Phoenix |
Arizona |
04 019 |
Pima |
Tucson |
|
06 007 |
Butte |
Chico |
California |
06 017 |
El Dorado |
Sacramento |
|
06 019 |
Fresno |
Fresno |
|
06 029 |
Kern |
Bakersfield |
|
06 037 |
Los Angeles |
Los Angeles-Long Beach |
|
06 053 |
Monterey |
Salinas-Seaside-Monterey |
|
06 061 |
Placer |
Sacramento |
|
06 165 |
Riverside |
Riverside-San Bernardino |
|
06 071 |
San Bernardino |
Riverside-San Bernardino |
|
06 073 |
San Diego |
San Diego |
|
06 077 |
San Joaquin |
Stockton |
|
06 083 |
Santa Barbara |
Santa Barbara-Santa Maria-Lompoc |
|
06 085 |
Santa Clara |
San Jose |
|
06 089 |
Shasta |
Redding |
|
06 097 |
Sonoma |
Santa Rosa-Petaluma |
|
06 099 |
Stanislaus |
Modesto |
|
06 107 |
Tulare |
Visalia-Tulare-Porterville |
|
06 111 |
Ventura |
Oxnard-Ventura |
|
08 001 |
Adams |
Denver-Boulder |
Colorado |
08 041 |
El Paso |
Colorado Springs |
|
08 069 |
Larimer |
Fort Collins-Loveland |
|
08 101 |
Pueblo |
Pueblo |
|
08 123 |
Weld |
Greeley |
|
12 021 * |
Collier |
Naples |
Florida |
12 025 |
Dade |
Miami-Hialeah |
|
12 083 |
Marion |
Ocala |
|
12 097 |
Osceola |
Orlando |
|
12 099 |
Palm Beach |
West Palm Beach-Boca Raton-Delray
Beach |
|
12 105 |
Polk |
Lakeland-Winter Haven |
|
20 015 |
Butler |
Wichita |
Kansas |
22 079 |
Rapides |
Alexandria |
Louisiana |
22 109 |
Terrebonne |
Houma-Thibodaux |
|
27 137 |
St. Louis |
Duluth |
Minnesota |
27 145 |
Stearns |
St. Cloud |
|
30 013 |
Cascade |
Great Falls |
Montana |
30 111 |
Yellowstone |
Billings |
|
32 003 |
Clark |
Las Vegas |
Nevada |
32 031 |
Washoe |
Reno |
|
35 013 |
Dona Ana |
Las Cruces |
New Mexico |
35 049 * |
Santa Fe |
Santa Fe |
|
36 043 |
Herkimer |
Utica-Rome |
New York |
38 015 |
Burleigh |
Bismarck |
North Dakota |
38 017 |
Cass |
Fargo-Moorhead |
|
38 035 |
Grand Forks |
Grand Forks |
|
38 059 |
Morton |
Bismarck |
|
40 113 |
Osage |
Tulsa |
Oklahoma |
41 005 |
Clackamas |
Portland |
Oregon |
41 029 |
Jackson |
Medford |
|
41 039 |
Lane |
Eugene-Springfield |
|
42 081 |
Lycoming |
Williamsport |
Pennsylvania |
46 103 * |
Pennington |
Rapid City |
South Dakota |
48 029 |
Bexar |
San Antonio |
Texas |
48 039 |
Brazoria |
Brazoria |
|
48 201 |
Harris |
Houston |
|
48 215 |
Hidalgo |
McAllen-Edinburg-Mission |
|
48 451 |
Tom Green |
San Angelo |
|
48 479 |
Webb |
Laredo |
|
49 049 |
Utah |
Provo-Orem |
Utah |
53 005 |
Benton |
Richland-Kennewick-Pasco |
Washington |
53 021 |
Franklin |
Richland-Kennewick-Pasco |
|
53 033 |
King |
Seattle-Everett |
|
53 053 |
Pierce |
Tacoma |
|
53 061 |
Snohomish |
Spokane |
|
53 073 |
Whatcom |
Bellingham |
|
53 077 |
Yakima |
Yakima |
|
55 031 |
Douglas |
Duluth |
Wisconsin |
55 073 |
Marathon |
Wausau |
|
56 021 * |
Laramie |
Cheyenne |
Wyoming |
56 025 |
Natrona |
Casper |
|
* Large counties in metropolitan
areas established after 1983 but before 1990. |
Table 2.
The Distribution of All Persons and Persons in Isolated Rural Areas
in Large Metropolitan Counties (LMCs), 1980
State |
Populations in LMCs |
Number |
Percent of total |
Alabama |
580,804 |
50,870 |
8.76 |
Arizona |
2,040,484 |
41,277 |
2.02 |
California |
15,817,264 |
987,928 |
6.28 |
Colorado |
953,962 |
59,673 |
6.26 |
Florida |
2,695,864 |
165,906 |
6.15 |
Kansas |
44,782 |
23,256 |
51.93 |
Louisiana |
229,675 |
21,251 |
9.25 |
Minnesota |
330,286 |
126,211 |
38.21 |
Montana |
188,731 |
18,500 |
9.80 |
Nevada |
656,710 |
22,188 |
3.38 |
New Mexico |
96,340 |
6,355 |
6.60 |
New York |
66,7l4 |
34,33l |
51.46 |
North Dakota |
234,335 |
24,352 |
10.39 |
Oklahoma |
39,327 |
25,063 |
63.73 |
Oregon |
649,601 |
7l,250 |
10.97 |
Pennsylvania |
118,416 |
3,700 |
3.25 |
Texas |
4,034,613 |
158,720 |
3.93 |
Washington |
2,854,750 |
128,776 |
4.59 |
Wisconsin |
155,580 |
30,305 |
19.48 |
Wyoming |
140,505 |
2,767 |
1.97 |
United States |
31,928,743 |
2,002,679 |
6.27 |
Table 3.
Large Metropolitan Counties (Excluding Counties in New England)
Designated as Metropolitan Counties between January 2, 1990 and
June 23, 1996 that Contain Rural Areas per the Goldsmith Rural Modification*
State |
County |
Sq. Miles |
Arizona
| Coconino |
18,608 |
|
Mohave |
13,285 |
|
Pinal |
5,343 |
|
Yuma |
5,510 |
California |
Madera |
2,145 |
|
Merced |
1,944 |
|
San Luis Obispo |
3,008 |
Colorado |
Mesa |
3,309 |
Minnesota |
Polk |
1,981 |
Nevada |
Nye |
18,155 |
New Mexico |
Sandoval |
3,707 |
Utah |
Kane |
3,898 |
* For the grant programs of the Federal Office of Rural Health
Policy, the tract or BNA designations used in applying the
Goldsmith rural modification to these 12 counties are from
the 1990 census.
Note: For a current list of areas
inside of Metropolitan Counties that are considered rural,
see Geographic
Eligibility for Rural Health Grant Programs.
|
|