In the rural Columbia Gorge Region of Oregon and Washington, promoting better health for all means asking what community members need, listening to what they say, and including their ideas in programs and services.
The Columbia Gorge Region where I live is a vast rural area larger than Connecticut but with a population of only 75,000. While many people here are doing well, others live in poverty, or have to drive long distances to get to a doctor’s office. In this land of fruit orchards, one in five people regularly run out of food.
Mandi Rae Pope was once one of those people. A few years ago, during a difficult pregnancy at the end of her husband’s graduate studies, Pope says she was “counting pennies out of a Mason jar to pay for gas.” She struggled with migraines, and they were getting worse. In the midst of all that, our local Women, Infants, and Children nutrition program gave her a prescription for Veggie Rx, a program we started to provide free fresh fruits and vegetables to people struggling with food insecurity. This was a top concern that community members had identified. By using Veggie Rx, Mandi Rae was able to provide fruit to her toddler son, and the more nutritious diet also helped tame her migraines. Grateful for the help, she wanted to pay if forward and expressed an interest in promoting the program.
In Columbia Gorge, healthcare providers are collaborating to use a new state system for assessing medical needs to improve the health of residents.
What happened next exemplifies how we tackle health problems here: by reaching out to include everyone and engaging with people in an authentic way. In this case, a community health worker invited Mandi Rae to be part of a focus group that was giving participants cameras to document their experiences with Veggie Rx. In the focus group discussions she attended, Mandi Rae felt the community health worker moderating the sessions was really hearing the struggles that participants expressed, and then used what she heard to help them get the services they needed.
“We got down to the real emotional burdens that people carry around when you’re dealing with poverty,” Mandi Rae says.
Putting community needs front and center
Authentically engaging with people throughout your community is an important step toward giving everyone a fair and just opportunity to thrive. As you encourage these discussions, you have to commit to put front and center—the needs community members say they have—and keep them there. In Columbia Gorge, we do this in three ways.
First, we ask what community members need. A primary way we do this is through our Community Health Improvement Plan, in which we surveyed residents of the five counties (three counties in Oregon and two in Washington) that comprise the Gorge Region to identify priority issues.
Second, we value people as experts in their own lived experience, and we listen to what they say. Our Community Advisory Council was created to give feedback on current health services and programs, as well as input for new program ideas. Half of council members are Medicaid consumers, and the group’s monthly meetings are open to the community. In addition to formal surveys, focus groups, and individual conversations, the advisory council meetings have become the primary venue for gathering input and feedback from the eventual users of many of our programs.
This leads to the third step—doing something about what you’ve heard. Feedback from our advisory council has informed a full spectrum of ideas in the Gorge. These include specific processes in medical clinics, community-wide programs like Veggie Rx, and even the design and layout of a new federally qualified health clinic. We don’t just gather input during the planning process. When a program is up and running, we ask how well it’s working for the people it’s intended to help and then make changes as necessary.
We are also creating a common data collection and evaluation plan that includes a strong communications component. The idea is to share feedback and insights between programs. For example, we’ve learned that transportation is an issue for almost every program. Now, a large number of organizations in the Gorge are working together to develop a transportation program that will get people to/from the services they need.
Working for everyone
In all of this work, it’s a good idea to have a “neutral party” who can keep the lines of communication open and help everyone work together toward the common goal of meeting community needs. In the Gorge, I play that role. Because I work for the whole community, I am able to include all relevant voices and steer each project in the right direction.
For example, as we developed our region’s first school-based health center, I worked with a host of stakeholders: a local school district; primary care providers; the region’s mental health provider; the federally qualified health clinic; the region’s primary insurance payor; nonprofit providers; parents, and students—not to mention a construction team. Over the course of several months of planning, I was able to keep the sometimes competing interests focused on our ultimate goal: healthier students.
And that’s one of the key benefits of authentic engagement: everyone really is in it together. Rather than designing programs to fit the mission of a particular organization or agency, we’re making sure we are giving people access to needed services that will put the whole community on a path to better health.