Transforming Rural Health Through Economic Development

Nov 17, 2021, 11:00 AM, Posted by

The challenges and opportunities for rural America are complex. While rural economic development has come a long way in the last 40 years, we still have a lot to learn. 

Aerial image of a rural town.

To mark National Rural Health Day, RWJF’s Maryam Khojasteh sat down with Janet Topolsky, executive director of the Community Strategies Group at the Aspen Institute, to talk about rural economic development, the challenges and opportunities facing rural America, and what the future holds for improving rural economies. Topolsky, who is stepping down after a 40-year career working on developing opportunities and capacity in rural America, oversees the development of the Thrive Rural framework, an effort begun by the Aspen Institute Community Strategies Group (Aspen CSG) in partnership with the University of Wisconsin Population Health Institute with support from the Robert Wood Johnson Foundation. The Thrive Rural framework aims to organize learning, strengthen understanding, and catalyze and align action around what it will take for communities and Native nations across the rural United States to be healthy places where everyone belongs, lives with dignity, and thrives.

Over your career, what are some ways in which community and economic development has evolved to foster health and equity in rural America?

There is a larger understanding of the mix and strength of what truly constitutes the basis for development, essentially the multiple assets in any community, beyond just financial capital. The individual assets or skills and health of individuals who are making decisions, working and providing services; the intellectual assets of what a place knows how to do; the natural assets like air and water and the health of natural resources that rural economies depend on; the built assets, including infrastructure; the cultural assets; the political assets; and the social assets and how well people work together. Every rural place and economy and community has a different variety and volume of assets—but they all have assets to build on.

There's also a growing understanding that the disparity in wealth is even greater than the disparity of income, and that the ability of families as well as communities to get ahead, depends more on wealth and having stocks of wealth than on income.

Janet Topolsky In many ways, rural America is an “essential worker” for the nation. It stewards natural resources in ways that are not compensated fairly and provides all kinds of resources the nation needs... —Janet Topolsky

There’s a tendency to lump rural America together and assume there's a one size fits all solution. What do developers, funders, policymakers, and the public, get wrong about rural places?

An appreciation for the diversity of what comprises the economic base in different rural regions. I love popcorn but I’m tired of photos of cornfields representing rural America. A larger percentage of rural workers are engaged in manufacturing than in agriculture, but we continue to depict rural America as mostly farmland.

People also don’t understand who lives there. One in five people live in rural areas, and 20 percent are people of color; many immigrants who are new to the country are living in rural areas.

In almost every racial category, the percentage of the population in poverty is higher in rural than in urban places. You can't address economic or racial disparities without focusing on rural places.

People also don't understand the interdependence of rural and urban. In many ways, rural America is an “essential worker” for the nation. It stewards natural resources in ways that are not compensated fairly and provides all kinds of resources the nation needs, whether it's food or energy or water; and it provides a lot of productivity and skilled workers and leaders in many sectors.

Finally, people don’t value rural places as sources of innovation. Rural too often is an afterthought baked into elements of policy and program design.

You've noted that development fails if it doesn't include everybody. How important is local ownership to this work or making sure those who are most affected are at the table?

This is human-centered design. If I'm trying to make something better, I can choose to imagine in my mind what the problem is and then deliver the solution that I think will work. But it likely will not work because I didn't ask the people the solution is supposed to help about what their real barriers are, and what design elements are essential to catalyze a solution that works.

You’ve heard the phrase "Nothing about us, without us." Another rephrasing of this that I've heard from a community activist is: "If it's for us, without us, it's not about us." We need to take that to heart. Can we consult? Can we share the power for co-designing? Can we respect the wisdom of the people we're trying to help? And can we meet people where they are?

How has Thrive Rural approached inclusion when it comes to working with tribal lands and nations under the broader definition of rural? How did you come to see these differences in practice and what they mean for rural development?

The Thrive Rural framework is a tool to organize learning, strengthen understanding and catalyze and align action around what it will take for all communities and Native nations across rural America to be healthy places where everyone belongs, lives with dignity, and thrives. The tool includes a specific focus on dismantling practices and behaviors and policies that—intentionally or unintentionally—discriminate against rural based on geography/size or race or class.

We've just released Thrive Rural Field Perspectives briefs—ideas and experience from practitioners and experts that offer new ideas for rural progress. One focuses on Native nation-building as a critical early–action element in improving tribal area economies, and why honoring and supporting nation-building, recognizing, and valuing tribal sovereignty and each tribe’s unique governance structure, and embracing their culture, traditions and practices is vital to rural development.

In a chapter in a book from the Federal Reserve Board and Federal Reserve Bank of St. Louis you discuss your turning points for doing rural development differently. What were they?

Every community has a different starting point. And you must learn how to connect and leverage their assets at that starting point. Start with local analysis and know-how in the room to identify the starting point of the assets in a place. How do people in the area interpret what's true about the community and what will unleash more action? And, bring more voices into the room who can share experiences and expand opportunities.

Then assess what do people and key actors in the region already know how to do or make—or what could they most likely adapt and what is the demand. Identify the action or resource gaps that can meet that demand, and fill in those gaps with local enterprise, build local capacity with new learning, and use local assets and energy to leverage in essential partners to help.

Finally, intentionally design with equity at the front end and measure for outcomes that strengthen, not significantly deplete (or destroy) local assets; increase equality; and build local ownership and control.

Can you discuss the role that Rural Development Hubs or intermediaries play in building wealth, increasing capacity and creating opportunities?

In rural places you've got dots of small communities that may be miles and miles apart, but they all think they're part of the same region. And that region is one they self-identify with, whether it's because of geographic similarities, a similar history, commuting patterns, industries, media markets or economic base. All kinds of things may make you feel like, “I live in The Thumb” in Michigan but there is no “government of The Thumb.” There's no one who develops or improves the region of The Thumb unless they create it themselves. There's logic to work regionally but no formal institution to do it.

Through an RWJF grant we talked to 45 of what Aspen CSG calls Rural Development Hubs to understand how they do this work and what are the challenges. We learned that there are various organizations that have, in some rural regions, taken up the mantle of working across a region on critical issues and bringing a region together to address them together. We've got to strengthen these hubs absent any other structure and create or catalyze them when they don't exist.

Looking down the road what are the key things you’d like to see for the rural development field going forward?

  • Coalescing in all fields around what the true outcomes of development should be, including how and what we measure for success. This is especially important for reducing health, wealth, social and racial inequity.
  • Organizing and leveraging a collective rural voice in the design of programs that affect people in rural places, at the local, state and national levels. People have started collaborating to benefit rural. That should be formalized.
  • Addressing climate and related natural disasters as an opportunity so local people can understand and act on. This is an opportunity for the future for improving health, future livelihoods and the economy, and all built and natural capital.

Learn more about Thrive Rural which aims to build stronger rural and regional economies, more inclusive rural communities and healthier rural people.

 

About the Author

Maryam Khojasteh focuses on developing, managing, and implementing rigorous and evidence-based research to advance health equity and promote a Culture of Health.