North Central Nebraska’s Journey to Promote Health, Well-Being, and Equity
Five years into the Sentinel Communities Surveillance Project, North Central Nebraska’s capacity to promote health, well-being, and equity has remained relatively stable under the leadership of the North Central District Health Department (NCDHD) and critical access hospitals.
Regional and state organizations, a small set of social service agencies, economic development organizations, and nonprofits also contribute capacity. NCDHD continues to coordinate most of the efforts around health and well-being in the community, though social services agencies also help to support healthy housing and food access, and stakeholders concerned specifically with mental health have expanded their efforts. Considering the role of healthcare access and health in general in their future economic viability, regional stakeholders have continued efforts to build the local healthcare workforce and promote economic development (with health as a piece of that). The rugged individualism that pervades the ranching and farming culture in the region has meant that health has been viewed as an individual responsibility by many. Stakeholders in the region have not historically prioritized health equity, though some social service and public health stakeholders have started to label their efforts to provide access to healthcare and health-promoting resources (food, income support) as health equity activities over the past five years.
Health Priorities and Narrative
NCDHD is the public health agency for the region, while a small set of critical access hospitals and clinics provide healthcare services.
State and regional organizations provide programming via offices in the region and access to resources and broader networks.
NCDHD continues to lead health promotion efforts and safety net services with a focus on substance abuse, dental health, and infectious disease.
Many North Central Nebraska communities are concerned about their future viability, focusing on economic development with health opportunities and healthcare as part of that.
Health Priorities and Narrative
The perception that good health is an individual responsibility is still widespread, and most health leaders still have the same priorities: access to care, substance use, and healthy behaviors.
The region is fairly racially homogeneous, though a portion of it overlaps with the Santee Sioux Nation, and it is home to a small population of Latino community members.
While health equity is still not a term discussed broadly in the community, some community organizations consider their work to have equity implications.
Lessons Learned: Where is North Central Nebraska Five Years Later?
North Central Nebraska is illustrative of many rural communities struggling to remain viable as economic and generational shifts challenge existing structures and paradigms.
Crises, such as the 2019 floods and the COVID-19 pandemic, have revealed the strong community ties in the region, but also the tendency to resist government intervention in favor of individual action.
Non-health stakeholders are beginning to put effort and investment into well-being, recognizing that things such as good mental health, access to childcare, and healthy, affordable housing, access to healthy food options, and opportunities for physical activity are critical to the community’s future viability.
Other communities can learn from North Central Nebraska’s approaches to make these changes, as well as the challenges they encountered, to inform their own journeys. And as COVID- 19 recovery continues, with historic funding flowing to local communities, future research could consider the ways in which momentum around health, equity, and well-being influences community health narratives and decisions moving forward.
In its efforts to improve health and well-being, North Central Nebraska has leveraged external resources to supplement a lack of local funding and organizational capacity. Strong interpersonal connections and a desire to sustain their communities into the future have motivated community engagement for health and well-being. Yet, barriers remain in the vast, rural, aging community. Service areas are large, and health is seen as an individual responsibility and is thus underfunded, inhibiting collaboration, innovation, and impact.
State-level interest in rural futures
External data capacity
Access to health information in the media
Strong ties between residents
Positive, future-orientation inspires community engagement
Large service areas for regional organizations
Health as an individual responsibility
No formal cross-sector health collaboratives
Limited state and county funding for health
Within-region variability in activity for health
Lack of engagement of individuals with low incomes, populations of color