Don’t Try to Fit Rural Health Into an Urban Box

In rural areas, lack of access to adequate care can be a matter of life and death. Transforming rural health requires creative, place-based solutions and a commitment to fostering local leadership.

The amputation was scheduled for that day. John’s* uncontrolled diabetes had stopped blood flow to his lower leg. With the tissue starting to die, it seemed inevitable that his foot would have to be removed to save his life.

Thankfully, a team I work with had recently helped bring telehealth services to the rural Colorado hospital where John had been admitted. A cloud-based video system connected to electronic health records enabled his doctor to consult with an infectious disease specialist hundreds of miles away in Denver. The specialist suggested one last “cocktail” of antibiotics, to be administered by I.V. The protocol worked. John kept not only his foot, but also his livelihood as a rancher: his ability to graze cattle, grow wheat, and provide for his family.

I wasn’t always bringing life-saving services to rural hospitals. At the beginning of my career, I was using music therapy to help patients recover from traumatic brain injuries. But as I helped individuals, I became increasingly concerned by larger systemic problems, especially by how a lack of access to care affects residents of rural areas. I saw too many people die simply because they could not get adequate medical attention. Inspired by my love for the people and places of the rural West, where my family roots run deep, I refocused my career on transforming rural health and health care.

Today I am executive director of the  Eastern Plains Healthcare Consortium, a new five-hospital collaborative. In this role, I help institutions improve health care delivery through various approaches like workforce sharing, telehealth services, and expanded access to broadband internet. Through the consortium, hospitals also pool resources to buy all kinds of supplies in bulk—from surgical gloves to anti-venom for rattlesnake bites—and then share them, reducing costs for everyone. These are game-changing measures for rural health. So is increasing access to affordable, healthy food, designing flexible place-based policies, and reintegrating human services into health care delivery so that all disciplines nurture the whole person.

Recommendations for Rural Health Equity

As vital as those interventions are, I devote much of my attention to the broader challenge of helping communities change the way they solve systemic problems. As a consultant, I work not only with hospitals but also with other nonprofits to help them shape solutions that fit the intricacies and individuality of diverse communities and circumstances.

My colleagues and I tackle a wide range of challenges, from helping resolve water-rights issues to working with clinics serving transgender people—many of whom are homeless—to assisting with the development of high-tech smart homes that help keep seniors safe by monitoring their vitals, medications, and more. The problem of rural health care access is a very intricate web. It can’t be solved in hospitals alone.

Having learned from failures and successes alike, I can offer these five recommendations for anyone interested in improving rural health access and equity:

1. Support local leaders and customized solutions. Every rural community is unique, faces particular challenges, and must shape its own solutions. Don’t ask people to conform to a model developed for an urban area or even another rural community. The key is finding champions in each community and helping them develop the skills they need to facilitate change.
2. Design for both community and individual. Every solution must be community-focused and must also help individual people. Legislation and tax credits, for example, can attract medical students to study in rural areas and provide incentives for health care professionals to stay. This builds community capacities while benefiting individual providers and patients.
3. Celebrate older generations. Older community members must be honored and included as key players in crafting local solutions. In working to overcome a community’s challenges, we need older generations’ wisdom. We need to know what has worked for that community in the past and then leverage that for the future.
4. Take the long view. As a society, we’re into quick solutions. That approach won’t work for most rural communities. What we need is broad, systematic change, and that’s going to take a long time and a lot of patience. I’m probably not going to see it all happen in my lifetime. It’s important to realize that we’re in this for the long haul. 
5. Respect and build on rural strengths. Every day, I see the pioneering spirit that built everything west of the Mississippi. I see people rising to meet the extraordinary challenges that come with living long distances from public services. Rural communities are good at capitalizing on existing resources in creative ways.

For there to be a serious investment in rural health leadership, we need to challenge stereotypes about people in rural communities. The rural folk I know are some of the most brilliant people and some of the most open-minded. We need to recognize and celebrate them as teachers with wisdom—as champions for their own places and for our country—and see how we can assist them in transforming systems of care and improving community health. It’s a crucial shift in perspective and approach.

I feel a responsibility not only to rural communities in the West, but to the rest of the country and beyond. So I am constantly thinking about how to help other communities build their leaders and capacity. I encourage you to think about this as well.

*A pseudonym.

Wherever you work, how can you apply the ideas outlined above to help bridge gaps and overcome barriers to access?

About the Author

Melissa Bosworth, an RWJF Culture of Health Leader, is Executive Director of the Eastern Plains Healthcare Consortium, Principal of Vertical Strategies, and Assistant Professor at Regis University where she aims to teach the next generation of health equity leaders.