Leonel Vela, M.D., M.P.H., Vice President for Rural & Communtiy Health, The Marie Hall Chair in Rural Health, Texas Tech University Health Sciences Center, Lubbock, Texas

On behalf of the Texas Journal of Rural Health (TJRH) editorial board and staff, I want to extend a Happy New Year and Happy New Millennium wish to our entire readership. This first TJRH edition of the year 2000 contains articles that address a diversity of interests. We will continue our commitment to publish high quality articles containing current and relevant information on rural health. We thank you for your continued support and interest.

It is unfortunate that one significant concern still plaguing some rural communities is the uncertain future of their hospitals. Although the circumstances jeopardizing the viability of these hospitals are complex and diverse, one potential option for these hospitals comes in the form of "The Critical Access Hospital Program." This program, which was established through the Balanced Budget Act of 1997, is the focus of Richard Hoeth's article. Through his article, Mr. Hoeth addresses many of the questions that have surfaced regarding this program.

In a previous editorial I have espoused on the importance of addressing the health problems faced by rural communities on the United States/Mexico border. The article by Barbara D. Adams et al. discusses a project that focuses on preparing health professions students to assist in accomplishing the goal of improved health and well being for border communities. Preparing these students to respect and understand the linguistic and cultural factors they will encounter as health care practitioners on the border will serve them and the border communities well. In many border communities, some important and critical members of the health care team are the lay community outreach workers, or promotoras. The article by Lorenza Zuniga et al. discusses the role of promotoras and how their training prepares them to provide significant and ongoing benefits to the communities they serve.

As we enter the New Millennium, inadequate funding continues to pose a significant obstacle to addressing rural health priorities. In his article, Roberto Anson urges each state's rural health and public health advocates to take an active role in assuring that "tobacco settlement" funds target rural health. He indicates that funds be specifically allocated to target rural health needs in tobacco cessation, health education, and also prevention.

Rural communities are not uniform, but rather comprised of various population groups with their own specific health care needs. In the case of older rural adults, more research is needed to better ascertain their health status and gaps in access to health care services. The article by Bette Ide concerns a pilot study undertaken to evaluate utilization of services by older adults as a function of Health-Related Hardiness, overall health and functioning.

Diabetes is a chronic disease that unfortunately remains quite prevalent in this country, including in rural communities. Certain population groups are particularly at risk for this disease. The article by Paul Villas et al. reports on a study to evaluate how screening for a skin condition known as "acanthosis nigricans" in children may help predict risk for the future development of health problems, including diabetes.

The lack of adequate emergency medical services in many rural communities throughout the United States continues. In many communities the physician provider is a Family Practice Physician who responds to a multiplicity of medical needs. One significant challenge is the preparation of those primary care providers to respond to situations that necessitate intervention by an emergency-medicine-trained physician. The article by Kim Bullock et al. is the first of a two-part series that discusses an innovative program that blends training in Family Medicine and Emergency Medicine. The focus of this program is to prepare physicians that can address the primary care and emergency medicine needs in rural communities.

As the articles in this TJRH edition reflect, rural health remains a dynamic and exciting field that requires a proactive response to its many challenges. In that light, the Office of Rural and Community Health (ORCH) at the Texas Tech University Health Sciences Center (TTUHSC) embarked on a strategic planning process in the Fall of 1999. The ORCH is the "home" office for the Texas Journal of Rural Health, and as the Vice President of this office I was motivated to proceed with a strategic planning process before the start of the New Millennium. A diverse group of participants (council of governments representing rural counties, rural county judges, health science deans, researchers, and state and federal officials) was invited to participate in the one-and-a-half day facilitator-led session. The focus of the session was on identifying future directions for the TTUHSC as the institution carries out its service, education, and research mission to benefit rural populations.

What most impressed me about the strategic planning session, beyond the work that was accomplished, was the participants' genuine, wholehearted commitment to improving the well being of rural communities. I realized that this national cross-section of rural health advocates accurately represented our TJRH readership, and the multitude of others, who unselfishly give their time and talents in the service of others. This level of commitment, in partnership with rural communities, holds great promise for setting the stage for a better tomorrow in the New Millennium.