It’s time to think differently about investing in rural America and the way we approach health and equity across its diverse communities. New research and resources show the critical connection between health, rural community and economic development.
Thursday, November 21, was National Rural Health Day. You might expect the paragraphs that follow to be about hospital closures or opioids, struggling dairy farmers and falling life expectancy among rural women. These phenomena are true, so we could do just that. However, we want to challenge conventional wisdom and prompt fresh thinking about rural America, the drivers of health, and the role of community and economic development in both. From what we are learning, this broader lens is central to realizing health equity and a better rural futures.
In our predominantly urban nation, the words “rural America” often conjure images of farm country, small towns and white people living in places that once boomed and have since busted. But the real rural America is far more diverse and complex. Dr. Veronica Womack, a political scientist, advocate for black farmers, and RWJF Interdisciplinary Research Leader, whose work has helped bring new research and investment to her rural region, is case-in-point. Womack grew up in Greenville, Alabama—population 8,000—which is part of the “Black Belt,” a largely rural region in the coastal low-land south where black folks outnumber white folks. Economic opportunity is hard to come by—and health suffers as a result—in this region where poverty, racist policies and discrimination along with systemic disinvestment persist.
All the same, Dr. Womak grew up with the idea that you give of what you have, to help those around you. No matter if what you have is not much. In Dr. Womak’s words: “If you’re not willing to share it and work for the betterment of the community, then you know, why even have it?” Womak’s experience growing up with her single mom, who worked as a nurse and spent her weekends bringing medicine and other care to elders around the community, didn’t jive with how the nation viewed her region and her people. Where others saw deficits, Womak could see assets—people willing to work hard and support each other, strong ties, and innovative ideas to get things done.
Dr. Womak was featured in the opening episode of The Homecomers, a new podcast from Sarah Smarsh, journalist and author of Heartland: A Memoir of Working Hard and Being Broke in the Richest Country on Earth. Smarsh fills her new podcast with voices of people “fighting for the place that feels like home.” If we better understand rural places and their diversity, complexity, strength, innovation, and resilience, perhaps we can be better equipped to invest in their future leveraging each community’s unique assets to realize health equity and create economic opportunity for more people for generations to come.
“Rural America” is Not a Monolith
Here are two more projects that reveal a truer picture of “rural America” and what’s top of mind for the people who live there.
The American Communities Project’s “A New Portrait of Rural America,” helps to shed light on the diversity of places we call “Rural America," which includes Native American Lands, the African American South, Aging Farmlands and more. History, geography, demographics, economy, and policies—good and bad—all play a role in the differences between these places. For example, the median income for rural counties analyzed in this report—$46,600—is lower than the national median of $57,600. But these disparities mask some deeper complexities of race, class and place. In St. Francis County, Arkansas, a part of the African American South in this report, the median household income for blacks is only about $28,300, while the figure for whites is more than $10,000 higher at $39,500. While some rural places are thriving, others have experienced radical economic transition or decades of disinvestment; all too often these places are also low-income communities and communities of color where discrimination and lack of economic opportunity are compounding factors that persist.
The Life in Rural America polls, produced in partnership with the Harvard T.H. Chan School of Public Health and NPR, similarly revealed complex rural realities. The poll also provides disaggregated data by race and place—for example, while drug addiction or abuse is the biggest overall community problem cited by whites living in rural America (27%), economic concerns are the most cited problem by African Americans (24%) and Latinos (22%).
Responsibility for Improving Health and Healthy Equity is Broadly Shared
There is more to health than health care. Whether our towns are walkable, the water is clean, residents are connected to one another and the local economy works for everyone—all of this has an impact on our opportunity to be healthy. Since health outcomes are closely tied to social, economic and physical conditions where we live as well as to income, wealth and education, health disparities are numerous and often intertwined with race, class and place. This means architects, economic development directors, city planners, city managers, county commissioners, businesses and civic-sector organizations of all stripes all play a role in creating opportunities for health—in rural places and across the country.
The Role of Community and Economic Development in Realizing Health Equity
If we see rural places in all their diversity and complexity and we see responsibility for realizing positive health outcomes as shared, then rural community and economic development becomes central to realizing health equity. Health outcomes in rural places lag less because of challenges in health care or individual behaviors than because of transformation in technology and the structure of the economy, systemic disinvestment, racism, structural inequalities and an outdated approach to economic development.
There is an urgent need to modernize policy and spread best practices proven to create vibrant and sustainable communities that enable people to reach their full potential and live healthy lives. We see signs of hope in communities across the country where innovation is underway and two specific projects provide insight on what’s working:
Rural Development Hubs: Strengthening America’s Rural Innovation Infrastructure, by the Aspen Institute Community Strategies Group, looks at the role of a specific set of rural and regional intermediary organizations—Rural Development Hubs—and finds them to be both at the heart of positive community and economic development practice and also an essential entry point for those looking to work or invest in rural places. The report finds Hubs to be the main players “doing economic development differently.” In addition to helpful primers on rural America and rural history, the report explains the importance of these civic-sector actors, what they do that sets them apart and articulates some of the challenges that Hubs and other rural institutions face that can stymie success. The report includes a set of recommendations for improving rural development policy and practice and realizing a better rural America that range from rethinking ‘impact’ to overhauling outdated federal policies.
Partners for Rural Transformation is a group of six trail-blazing regional organizations (great examples of the Rural Development Hubs mentioned above) focused on eliminating persistent poverty and advancing prosperity. Their paper, Transforming Persistent Poverty in America: How Community Development Financial Institutions Drive Economic Opportunity, highlights the ways in which race, place, and persistent poverty are inextricably linked; and how community development is strengthening local economies, generating wealth that sticks, and building power among those living in some of the most disinvested parts of our country. The report calls for increased philanthropic, bank, and federal investments in rural persistent poverty regions across our nation.
This year, in honor of National Rural Health Day, question any preconceived notions you may have about rural America and whose responsibility it is to improve health in America. Then consider how rural community and economic development policy and practice are essential to realizing health equity. Ready for action? Dive into the projects and resources we’ve highlighted in this blog and hone in on their recommendations for public, private and civic sector actors. For more ideas and a truer picture of the range of place, culture, people and economy in rural America, try outlets like the Daily Yonder, America’s Rural Opportunity Series of talks, Indian Country Today, and rural stories from the Solutions Journalism Network, and RWJF’s rural health page.
We hope you’ll continue to follow our work as it evolves—and keep an eye on new learning and coordination efforts across those working nationally and regionally to advance social and economic conditions in rural communities, which ultimately lead to better health and well-being. Those efforts will be led by the Aspen Institute Community Strategies Group, working closely with RWJF and the University of Wisconsin Population Health Institute.
About the Authors
Katrina Badger, MPH, MSW, is a program officer with the Robert Wood Johnson Foundation focusing on efforts supporting work building healthy, equitable communities.
Katharine Ferguson, MPA, is associate director of the Aspen Institute Community Strategies Group (CSG) and director of CSG’s Regional and Rural Development Initiatives.