Improving rural children's health will require both increased public health surveillance and research that creates solutions appropriate for rural environments, where health care professionals may be in short supply. Most importantly, solutions must be multisectoral, engaging education, economic development, and other community perspectives as well as health care.

ognize and meet their needs in an emergency. As it is widely used within disaster services and the emergency management field, the term special needs generally includes an extremely broad group of people, including people with disabilities, people with serious mental illness, minority groups, non-English speakers, children, and the elderly (Centers for Disease Control and Prevention [CDC], 2004). Other lists add single working parents, people without vehicles, people with special dietary needs (Federal Emergency Management Agency [FEMA], 2004), pregnant women, prisoners, people who are homeless, and others. While there appears to be little consensus on exactly who should be included in the special needs category, these groups represent a large and complex variety of concerns and challenges for disaster planning and response. Many of these groups have little in common beyond the fact that they are often left out of programs, services, and emergency planning (Kailes, 2000; National Council on Disability, 2005).We conducted a demographic analysis to estimate the size of the special needs category. For consistency, we used the decennial Census 2000 data. The total of the most typical groups of special needs populations-people with disabilities, including people with serious mental illness; people who do not speak English or do not speak English well; children, ages 15 years and under; and people 65 years old and over-was almost 141 million people, 49.99% of the population. Table 1 shows the categories used, with age ranges for each. Everyone in the ages 15-years-and-under and ages 65-years-and-older categories was included. Because people with disabilities wereThe 2005 hurricane season in the United States reinforced the need to discontinue the use of all-inclusive labels such as special needs for disaster planning. Combining groups too broadly translates into imprecise planning and, as a result, emergency response failures. As the term is typically used, the special needs population makes up at least half of the U.S. population. The label special needs generally incorporates people whose functional needs include assistance with communication, medical needs, maintaining functional independence, supervision, and transportation (C-MIST). Not receiving C-MIST support when it is needed can have severe consequences for those who need it. As a result, to ensure that the needs of this large segment of the population receive necessary attention, it is vital that disaster preparation include a plan for operationalizing support for the population's needs.The purpose of this article is to begin to identify the groups included in the population of special needs that require specific disaster planning above and beyond the average person. In addition, we explore a framework for disaster planning based upon identifying and addressing functional needs through the use of functional supports, leadership, service delivery, and training. Who Are People With "Special Needs"?Identifying the demographics of who is included in the term sp...

Disability, as a product of person-environment interactionexample, disasters do not respect governmental jurisdictions-hurricanes cross state lines, floods don't stop at the city or county limits, volcanic ash and radioactive fallout carry across oceans, a flu epidemic can be global. A disaster that crosses jurisdictions-more than one town, or county, or state, or country-also reveals variations in administrative responses to the same event. When significantly varied responses are evident in different affected jurisdictions, the differences in policy environments become more obvious. A geographic information system (GIS) can play a role in identifying spatial differences in response patterns. Retrospective analysis, with identification of best and worst practices, can lead to lessons learned, operational systems changes, and broad-based policy realignment.

Public transportation is a critical part of a community's infrastructure for people with disabilities. Section 5310 of the Transportation Equity Act is a Federal program of capital assistance to address the mobility needs of the elderly and persons with disabilities. We identified 4,835 Section 5310 recipients in 49 states and the District of Columbia, and randomly selected 750 for a mail survey. The majority were organizations serving senior citizens or individuals with developmental disabilities. Only one was a tribal entity. Overall, Sec. 5310 vehicles made up 32 percent of the respondents' fleets and 75 percent were lift equipped. More Sec. 5310 resources went to those organizations serving a mix of urbanized and rural areas than went to organizations serving rural-only areas. Ten percent of the respondents reported being faith-based organizations; more of these were in urban than rural areas. Almost half of the respondents participated in some form of cooperative system but less than 5 percent participated in a consolidated system. This study provides a baseline against which to measure changes following the implementation of the Transportation Act of 2005.