In Rural America, Community-Driven Solutions Improve Health

Nov 15, 2017, 2:55 PM, Posted by

There’s no one-size-fits-all solution to improving health. A lot is being done across the country to make rural places healthier and thriving, with state and national policies enabling local innovation.

Dirt road cuts through agricultural fields.

I grew up in southwestern Ohio, surrounded by woods, corn and soybean fields down the road from a small town. Although my childhood home fits what some might see as a stereotypical description of small town America, I never thought of it that way. Now, as a program officer at the Robert Wood Johnson Foundation (RWJF) working to promote healthy, equitable communities, I’ve had the opportunity to travel to a number of rural places and small town across the United States and see the vast diversity of these places and the people who live in them.

Encompassing about three quarters of our nation’s land and home to about 15 percent of the population, rural and small town America is not just one kind of place. It includes the Midwest like the area where I grew up, and nearby Appalachia. It’s also places like the Mississippi Delta and the “Black Belt” of fertile land in the South, unincorporated colonias and many places along the U.S.-Mexico border, remote and geographically isolated “frontier” areas across the West, and Native lands across the country.

The rich diversity of history, culture, and racial and ethnic populations across rural America is an asset not only to those places, but also our nation. Rural economies are diverse, too, each with its own mix of industries—such as manufacturing, service industries, and goods production like farming, forestry, fishing, and mining.

Many rural communities share strengths such as a spirit of collaboration, resilience, interconnectedness, and interdependence. But many have also experienced common obstacles, including generations of isolation from opportunity, a lack of investment in infrastructure, and economic shifts that have led to high unemployment rates.

Each of these factors have a deep impact on the health and well-being of rural people and places, which is about much more than what happens in the doctor’s office. Last year, the annual County Health Rankings Key Findings Report, a project of RWJF and the University of Wisconsin Population Health Institute, illustrated that rural counties have had the highest rates of premature death for many years, lagging far behind urban and suburban counties. More people are uninsured, fewer people graduate college, and more children live in poverty.

This National Rural Health Day, people across the country are celebrating their commitment to work within their rural communities and regions to address and resolve their most challenging issues that impact health and well-being. These people know that just as there’s no “typical” rural place, there’s no one-size-fits-all solution that fits every local context. Strong state and national policies that enable local innovation by, for example, providing funding, technical assistance, and standards give a “boost” to the great things communities are already doing to respond to their local needs and priorities.

Here are a few examples of innovative local solutions in rural communities awarded the Robert Wood Johnson Foundation Culture of Health Prize for their efforts to help people live the healthiest lives possible:

Nurse visits with mother and daughter who participate in Healthy Families Garrett County, an early care program for families and newborns.

Decreasing poverty

Garrett County, Maryland’s 2-G, or two-generation program, which aims to improve outcomes for children and economic security for families, has been lauded by many, including the state's Governor. This year, he moved to create a commission that will study the approach as a model for the state. Families work with staff to develop a “pathway plan” that includes at least one goal related to education, employment, or financial management.



A family working together in an orchard.

Working regionally, and inclusively

When health leaders in the vast Columbia Gorge Region—larger than the state of Connecticut with a population of 75,000, straddling the Oregon and Washington border—decided on the makeup of the 15-member Community Advisory Council mandated by a change in Oregon’s Medicaid system, they made sure to represent the community. They included individuals who rely on Medicaid for their health care, residents and parents of children with developmental disabilities. The community also benefits from growing leadership from the region’s expanding Latino population, including a transportation district seat.


A press operator teaches students at Wolf Tech High School.

Involving business

In Algoma, Wisconsin, Jamie Spitzer, founder of Precision Machine Inc., is among the business owners who have embraced the spirit of Live Algoma, a community-wide health and wellness initiative. Among the steps he’s taken: making the food for sale at his factory more nutritious, inviting a community nurse to counsel employees on nutrition, buying his employees wristband devices for tracking their daily steps, and offering a special health insurance that rewards members for health improvements. Spitzer also has worked with Algoma High School's Wolf Tech training center to help prepare more students for careers in technology-driven manufacturing.


John Redeye finishes a dugout canoe which he made in the traditional style from white pine.

Preserving earth, water, and sky

Seneca Nation of Indians in western New York has taken a strong stand on conservation and sustainability in their territories, with the goals of preserving their land, water, and native plants and animals and keeping alive their traditional connection to nature. Among the initiatives the Nation has launched are a native plants policy requiring that new landscape planting in public spaces on Seneca lands is exclusively comprised of native species. The Nation also conserves local river animals, such as the hellbender salamander and walleye, and is moving toward energy independence via a 1.5-megawatt wind turbine and a 1.9-megawatt solar array.

At the Foundation, we are excited to see these types of community-driven solutions happening across the nation as well as the state and federal policies and programs enabling this local innovation and action.

We’d like to hear from people in rural areas and towns across the nation: What are you doing or have you seen done to create health and well-being where you live? Share your stories in the comments below.   

Rural Health Resources

Here are a few of the resources to inform and support efforts to improve health and well-being in rural places.

Learn more about how you can apply to one of our newest leadership development programs to find solutions for better health care delivery in rural America.

About the author

Katrina Badger

Katrina Badger, MPH, MSW, is a program officer with the Robert Wood Johnson Foundation focusing on efforts supporting work building healthy, equitable communities. Read her full bio.