The most consistent priority of the Robert Wood Johnson Foundation, dating back to its earliest days, has been to expand access to medical care for underserved individuals, a disproportionate number of whom live in rural areas. Although 20 percent of the U.S. population lives in rural areas, only 9 percent of America's physicians work there. Because the 60 million people living in rural areas tend to earn less than people living in or near cities, health problems associated with poverty, such as infant mortality and many chronic diseases, are often more serious in rural areas.
The federal government is the key player in attempting to improve health care services in rural areas. Its efforts include the Health Resources and Services Administration's rural health and community health centers; the Indian Health Service's programs, which are largely, but not only, rural; and the National Health Service Corps, which forgives loans made to physicians and other health professionals practicing in underserved areas. State governments, too, have developed programs to attract health care professionals to rural areas.
The Foundation has employed a number of approaches to improve health services for people living in rural areas. The Practice Sights program, for example, supported states' efforts to attract health care professionals to rural areas. The Reach Out program encouraged physicians to volunteer their services to people living in underserved areas, many of which were rural. A variety of efforts provided training of and encouragement to nurses, nurse practitioners, and physician assistants practicing in rural areas. The Foundation has provided scholarships to medical students from rural areas (on the assumption that they were likely to return to practice there), promoted rural hospitals, and developed rural perinatal care networks and rural physician group practices.
In this chapter, the award-winning author and frequent Anthology contributor Digby Diehl looks at a program designed to improve access to medical care for people living in some of the nation's most underserved areas—the rural South of the United States. The Southern Rural Access Program addressed some of the most important barriers that keep physicians from locating in rural areas of Alabama, Arkansas, Georgia, Louisiana, Mississippi, South Carolina, East Texas, and West Virginia. In this chapter, Diehl chronicles the ways in which the grantees went about attracting health care professionals to rural practice and the many challenges they faced, including the devastation wrought by Hurricanes Katrina and Rita. Even after the program ended in 2006, the infrastructure that it had established in Louisiana and Mississippi provided a foundation for some of the post-hurricane reconstruction efforts.