Cara V. James, PhD, President and CEO, Grantmakers In Health
Last month I had the distinct pleasure of visiting Georgia and North Carolina with key partners in rural health. Our “rural road trip” was a refreshing journey that provided inspiration for philanthropy’s work and a reminder that ensuring better health for all must engage all rural communities.
The rural road trip continues a tradition that I participated in during my tenure at the Centers for Medicare and Medicaid Services (CMS), when I joined colleagues from the Federal Office of Rural Health Policy (FORHP) and the National Rural Health Association (NRHA), on a visit to rural stakeholders in Wisconsin. We spent a couple of days talking to rural providers from around the state, learning about collaborations, innovative programs, and the unintended consequences of programs and policies developed without applying a rural lens. The trip was incredibly valuable to our work. Future visits took us to North Dakota and Tennessee and brought new federal partners along for the ride each time. These deep dives into the rural experience have provided a more complete understanding of the challenges facing rural America, offered insight into what’s making a difference in these communities, and strengthened connections between those of us working at a national level and the rural communities we seek to help. This year’s trip, my first since joining GIH, gave me the chance to learn more about how health funders are supporting rural communities, additional opportunities for philanthropic organizations interested in rural settings, and how we can strengthen public-private partnerships.
My travels in rural areas have introduced me to inspiring examples of strength and optimism in the presence of great adversity. Many people are familiar with the challenges facing rural communities, including decreasing life expectancy; high rates of substance use disorders, overdoses, and chronic disease; income inequality that disrupts social stability; and fewer philanthropic resources. These challenges are often worse for rural communities of color. Health care in rural communities is hampered by geographic barriers, lower coverage rates, a payment system that favors volume of care, and hospitals that frequently have negative operating margins. The maldistribution and supply of health care workers is a common challenge to the provision of rural health services. Rural communities also experience inequities borne from stigma and bias and face challenges in understanding and partnering with increasingly diverse populations. Even against this backdrop, it was not hard to find inspiring rural leaders in Georgia and North Carolina who are rolling up their sleeves, stretching resources, and creating solutions that work for their communities. Nor was it hard to see where health funders are making a difference.
Our first stop was with partners in an HRSA-funded opioid response project that was a collaboration between three rural counties in northern Georgia and Morehouse School of Medicine. Local health care and behavioral health providers described their cross-sector work to build clinical and community-based supports for people in recovery. We also visited a pediatric rural health clinic in Dahlonega, Georgia. The clinic is led by a sole provider with a drive to adapt to her patients’ ever-changing needs. They recently planted a small garden to teach their patients and families about nutrition. I was impressed by the creativity and resilience of her and her team, as well as their dedication and to desire to learn more to help support their community.
Next, we drove to North Carolina, where colleagues from the North Carolina Office of Rural Health met us. They served as our guides for the remainder of the trip. We spent the morning at the Cherokee Indian Hospital, where we were impressed by a clear patient-oriented approach to health care and community partnership. According to their CEO, every aspect of their beautiful facility—and their entire care delivery system—has been designed to reduce stress for patients and families, truly integrating care that responds to the community’s traumatic experience. Physical structures, clinical processes, and administrative resources enable health care providers to build meaningful relationships with patients. This has helped increase trust between the tribe and the hospital. Tribal self-governance, an organizational culture informed by tradition, and a continuous learning approach by hospital executives and tribal leaders, have enabled innovation that supports financial viability for the hospital and better health for the community. For example, they launched the first Indian Managed Care Entity in the country, opened satellite clinics in other parts of the community, and are advocating for policy changes that would improve their ability to address community needs.
Later, we headed to Asheville, where we dug into Western North Carolina’s health care workforce issues. The Mountain Area Health Education Center (MAHEC) channels an array of training, placement, and retention services to rural health care providers throughout the region. Leaders at Mountain Community Health Partnership, a Federally Qualified Health Center, credited MAHEC with helping maintain a steady supply of physicians in a variety of disciplines. It seemed clear, however, that the supportive environment in the clinic, and skilled management that’s attuned to the community, helps retain the providers who find their way to such a remote and economically distressed area. They also referenced the important role local health funders such as the AMY (Avery, Mitchell, Yancey) Wellness Foundation, Cannon Foundation, Dogwood Health Trust, Duke Endowment, and Kate B. Reynolds Charitable Trust have played in their ability to serve the community.
Finally, we had the opportunity to participate in a listening session on maternal health with a variety of stakeholders including maternal health providers, policy experts, health funders, academics, and local politicians. This conversation was one of many that have taken place across the state during the last year. The initiative is supported by Dogwood Health Trust, a GIH Funding Partner, and the year long series is credited with helping some lawmakers understand the vital role Medicaid plays in rural communities.
I ended my trip by meeting with the team at Dogwood. Headed by Susan Mims, Dogwood is a relatively new conversion foundation focused on health and wellness, economic opportunity, education, and housing. Having a positive impact on rural communities is important to the team at Dogwood, as is engaging in policy and advocacy and learning from other place-based conversion foundations focused on rural areas.
As I reflect on these travels, several things have stuck with me. These trips remain incredibly valuable and enriching experiences because of the education and connections. Second, the benefit of time spent traveling with key partners cannot be overstated. GIH has long partnered with FORHP and NRHA on our annual Public-Private Collaborations in Rural Health event. Colleagues from CDC joined the collaboration and our road trip in 2019, as CDC expanded its work on rural health, and this year we were accompanied by leadership from the Indian Health Service at the U.S. Department of Health and Human Services. The road trip provided a chance to deepen that work. On a more philosophical level, we need a shared vision for rural health care in America and we need to align the system and resources to support that vision. The communities we visited are doing great work with limited resources, and they are working to patch together the funding and staff to provide critical and, in some cases, basic services. We need to ask ourselves why this is necessary, what is happening in communities with fewer supports, and how can we change the system.
I encourage philanthropic organizations to consider taking their own road trips to rural communities. As GIH moves forward with our new strategic plan, population health—including rural health—is one of five focus areas for our work. We’ll continue to reflect on our rural experience, incorporate the lessons learned in our work, and share the information with Funding Partners supporting efforts to improve rural health and well-being.