“[Monona County] is illustrative of many rural communities experiencing population loss but attempting to leverage what capacity it has to provide resources for health.”
—RAND Corporation
RWJF Culture of Health 5-Year Community Landscape Report: Monona County, Iowa
Report Feb-01-2022 3-min read
Table of Contents
Table of Contents
Report Publish Date: February 1, 2026
This report summarizes Monona County, Iowa's health, wellbeing, and equity journey from 2016 to 2021, as part of RWJF’s Sentinel Communities Surveillance project.
Primary Takeaways
“Monona County’s community capacity to promote health and wellbeing has shifted over the past five years with the consolidation of public health services under the authority of the local health system and transitions within local coalitions,” the authors write. “Regional and state organizations that include Monona and neighboring counties also provide important capacity to promote health and wellbeing, as do a small set of social service agencies and nonprofits.”
County residents tend to view health as an individual issue, though the authors noted a growing focus on mental health, food, and recreation access.
Overview and Objectives
Begun in 2016, RWJF’s Sentinel Communities Surveillance project tracks how a Culture of Health is developing in 29 communities across the country. The authors wanted to describe key challenges, opportunities, and insights in Monona County.
Hypothesis or Approach
For this report, the authors conducted 29 hourlong, semi-structured interviews between the middle of 2017 and fall 2021. Interviewees came from a number of different types of organizations and sectors.
How This Influences Change
“Many of the priority wellbeing and equity issues in Monona County, including substance use, chronic disease, and poverty, are deeply entrenched, and transitional public health leadership over the past five years has been working to establish a strategic direction within the healthcare system to address them,” the authors write. “And the community will likely continue to be challenged by a prevailing mindset that individuals are responsible for their own health and by a hands-off, risk-averse approach on the part of local government officials.”
Research: Go Deeper
Monona County is a very rural community in western Iowa with a declining population and residents who have been struggling for many years with poor health outcomes and high rates of poverty relative to the rest of the state. The community has been unable to leverage the momentum generated during recovery from a 2011 tornado to make headway on these challenges. Over the past five years, however, a couple of local coalitions have been making improvements to walkability around the community and creating opportunities for service providers to share information with one another. The county public health department dissolved in 2019, and public health authority was absorbed by the local healthcare system, Burgess Health, which now coordinates most of the activity for health in the community, and like many other local stakeholders, relies heavily on programs, resources, and data developed by regional and state organizations. While the community is tight-knit and committed to a shared future, most residents and organizations still think of health as an individual responsibility. There have been additional efforts in recent years to address mental health. Efforts to improve equity are limited to efforts to advance economic development, with some attention paid to mobility and access to healthy food. New federal funding opportunities for infrastructure require local governments to consider equity and may bring some needed attention to lingering housing, water, and transportation infrastructure challenges and to developing a local narrative around equity.
Robert Wood Johnson Foundation, February 2022
Research Team
This study and report was conducted and created by:
- RAND Corporation
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