Rural America — A Generational Struggle for Health Equality
As Government Struggles to Find Solutions, Private Citizens, NGOs and Companies Step Forward
Songwriter and folk singer Woody Guthrie captured the expansive and diverse nature of rural America in his classic ballad This Land is Your Land:
This land is your land, this land is my land
From California to the New York island,
From the redwood forest to the Gulf Stream waters;
This land was made for you and me.
That Guthrie song, with its heartfelt words, offered conflicting images of a nation’s greatness and the great strife of its people — the never-ending tension between grander and affliction. The power of his lyrics — with verses too conveniently edited out to make the song a patriotic hymnal rather than the composer’s original intent — is a call to social consciousness. The classic 1940s folk song was written to spark a social impact edge to address the needs of overlooked citizens. The poverty Guthrie saw as he crisscrossed America’s dustbowl states continues. The reasons may be different; however, the suffering remains.
In a recent New York Times opinion piece, Tony Pipa, a senior fellow at the Center for Sustainable Development at the Brookings Institution, who leads the Reimagining Rural Policy Initiative, working to transform U.S. policy to enable equitable and sustainable development across rural America, writes:
“Too often policymakers mistake agricultural policy for rural policy. Farming now accounts for just 7 percent of rural employment. Service jobs, retailing, manufacturing and government employment all outweigh agriculture. And while $163 million of the relief the Trump administration distributed during the peak of the trade war with China went to high-income farmers making more than $900,000 annually, small-scale and family farmers are increasingly taking off-farm jobs just to get by.”
Today, more than 46 million Americans live in rural communities. On average, rural locales lag behind non-rural communities on every measure of prosperity, from poverty rates to employment opportunities. This land may have been “made for you and me,” yet, when it comes to access to care, rural Americans live hours away from basic medical care, emergency services, and specialist providers. Their well-being — survival — often hangs on a limited broadband connection. The system to address their needs is usually based on urban and suburban expectations.
Rural community populations trend older than urban and suburban regions, and while age is an invitation to health risks, rural areas have 20 percent fewer primary care physicians. Rural counties often do not have a psychiatrist to deal with mental health needs, and 81 percent do not have a psychiatric nurse practitioner.
LOSE THE IMAGE OF A WHITE FARMER ON A TRACTOR
Rural America’s needs are a bi-partisan issue impacting blue and red states. Congress has prioritized the rural communities’ needs for many good reasons. People of color — often the most vulnerable in the health system — comprise 24 percent of the rural population. This includes rural Native Americans and more than half of impoverished Black Americans. That compares with 18 percent of rural whites.
While politicians look for fixes to the problem, physicians, payers, private citizens and retailers are stepping forward to help address the care in access and quality gap.
Earlier this year, Walmart and Medscape released Healthcare Professionals’ Perspectives on Healthcare in Rural America, the most extensive survey to assess barriers and solutions to care delivery from the perspectives of professionals on the front lines of health care in rural and non-rural communities. More than 10,000 primary care health care professionals (HCPs) shared opinions that quality care is the most significant concern in their day-to-day efforts for their communities, particularly for people with chronic care and mental health concerns.
FORGET TECH — THE GAP IS ABOUT QUALITY CARE
Rural healthcare professionals are already utilizing telehealth and tapping into electronic medical records to improve quality care delivery. While there is plenty of buzz about remote patient monitoring and digital health technologies as tools that will enhance access to care, the biggest concern among physicians on the frontlines of addressing patient needs is clinical training and financial assistance to keep community hospitals operating.
Physicians cite building on what they already utilize to care for their remote patients: state-of-the-art medical equipment, 5G internet service, and expanding use of electronic health records to guide their patients on self-care strategies. While technology helps with a care connection, it can only measure and monitor the substandard status quo.
PHYSICIANS IN RURAL AMERICA SEEK UPSKILLING
“We have known the systematic problems within the current health care system for decades. The Walmart-Medscape report emphasizes how health care professionals, like their patients, are most concerned about the quality of care, and we can no longer wait for old models to work,” said John Whyte, Chief Medical Officer at WebMD and Medscape and a Medika Life contributor. “This underscores the need for innovative solutions that look beyond the walls of the doctor’s office, similar to how Walmart is innovating in the space, driven by those who live and work in communities they serve.”
Often people in rural communities want to be cared for by people they know and trust and understand their local challenges and needs where they live and work. Experts addressing rural health needs know that staying well requires additional components beyond a physician visit. The advocates seek to tackle social determinants of health, improved clinical care, and environmental factors.
Retailers like Walmart are partnering with health plans, advocacy groups, and third-party health associations like the American Heart Association to fill these gaps. Major retail pharmacies such as Walgreens are showing commitment by investing in efforts to address health drivers such as food insecurity, maternal and infant health, diabetes and hypertension solutions to reduce health disparities.
PRIVATE CITIZENS SEEK TO TRANSFORM RURAL COMMUNITIES
“Challenges to rural Americans cause suffering, which drives despair and feeds discord. Dialogue that elevates awareness of people’s difficulties is an important step in providing a remedy, and communication is the first step in providing viable solutions,” said Peter Finn, who founded, with his wife Sara Finn, a Foundation to address the pressing needs within his Upper New York State community of Hunter. Finn taps communication and creativity to make a difference and transform rural communities.
“I have been a long-time resident of Hunter, one of the far too many rural communities struggling in Upstate New York. The town was economically depressed and quickly deteriorating, but rather than abandon Hunter and shut our eyes to what was happening. We chose to get involved by raising awareness and mobilizing others to create the Catskill Mountain Foundation,” he adds.
The Foundation calls upon the arts — music, creativity and dance — to draw people into the community all year round. Today, Hunter’s streets are lined with inns, restaurants, antique shops, and art galleries. Visitors come to enjoy the fall foliage, hike, and ski. The example of Hunter, New York, and other living laboratories proves how volunteering spirit, creativity and caring about rural community needs can shift the tide of events.
Others are contributing their talents to give voice to the diverse challenges rural Americans face. “Living in the heartland has become increasingly difficult for Americans, and with this unprecedented narrative podcast documentary, we will present noted policy, community, and industry leaders working to change this reality,” reflects Matthew Zachary, co-founder and executive producer of the award-winning podcast network of OffScrip Health.
Zachary, who is no stranger to tackling life-threatening issues, is looking to create the first audio documentary on the struggles of rural Americans, tapping into the network of companies, rural community leaders and government leaders who want to share how they are shifting from rehashing old issues to rolling-up their sleeves to solve problems.
CONFRONTING STIGMA — MENTAL HEALTH IN RURAL AMERICA
People with mental health needs face stigma. That remains among the biggest hurdles to seeking care — the thought of “What will people think?” For people in rural communities, anticipating the negative reactions of family and community is an added emotional challenge that keeps people from seeking the care needed. Like any illness with progressive influence, failure to treat mental illness has life-threatening possibilities. Suicide rates increase as population density decreases. According to the Centers for Disease Control, suicide rates among people living in rural areas are as much as 68 percent higher than in large urban areas.
Jeff Winton is the Founder and Chairman of Rural Minds, a nonprofit organization working to end the suffering, silence and stigma surrounding mental illness in rural America. He is a part of the multigenerational farm Wall Street Dairy, LLC — a working dairy farm in Chautauqua County, New York — and founder of a major communications firm that addresses health issues.
In his opinion piece appearing on the National Alliance on Mental Illness (NAMI) website, Winton writes:
“Increasing awareness that mental illness is a health condition — just like cancer, heart disease, or diabetes — is one way to help overcome the stigma in rural communities. In addition, talking openly with others about lived experiences with mental health challenges helps to normalize the conversation and diffuse the stigma surrounding mental illness. The simple act of sharing stories can be an important first step for people to seek help for their own mental health challenges and encourage others to admit that they are struggling.”
The physical and mental health challenges to rural Americans cause suffering, which drives despair and feeds discord. Dialogue that elevates awareness of people’s difficulties is essential in providing a remedy, and awareness is a crucial step toward viable solutions.
OVERCOMING DESPAIR, DISEASE AND DEATH
Apathy and poverty double team are the domino of rural health killers. Walmart and Walgreen and other major retailers are engaged. Individuals with passion are leaning into the challenge and inviting others to join in their efforts. Health organizations such as the American Heart Association, American Telemedicine Association, Blue Cross Blue Shield, National Rural Health Association, and many others have joined the effort to raise quality and ensure access to care.
Rural America is vast, with a remarkably diverse population and needs. The biggest problem isn’t decision-makers’ willingness to dedicate money or their readiness to align blue and red forces in bipartisan action to the challenge. The government often seeks big solutions to significant challenges. However, the image we have long held onto of rural America — the proud and industrious farmer in a ballcap sitting on a tractor — is as outdated as the stoic, proud tiller of the land. These citizens need our help urgently. How do we resolve these problems? We start by recognizing that a one-sized solution does not fit all.
Woody Guthrie, while some verses of your ballad were conveniently edited out, we know your question:
As they stood there hungry, I stood there asking,
Is this land made for you and me?
Yes, it is! Woody, we still remember.