This article is part two of a six-part blog series with Dr. Brad Jones.
How do health challenges differ across rural, urban, and suburban areas?
Unfortunately, there is a lack of evidence-based research and information about what works and what doesn’t work in rural areas. This is because researchers, policymakers, and funders often do not give as much attention to rural areas due to their small population sizes and densities. Quite frankly, many major influencers in the healthcare space simply do not believe they will get as much “bang for their buck” by concentrating their efforts in rural areas as opposed to urban or suburban areas. Nevertheless, approximately 20% of the nation’s population lives in a rural area and, while that does not nearly constitute a majority, it does represent a significant minority. In fact, I like to refer to people who live in rural areas as “geographic minorities,” regardless of their racial/ethnic background. Consequently, a lot more work can and should be done to learn what can work, what might not work, what we can adapt from urban and suburban areas to rural areas, and what really needs to be rural-defined and developed due to the unique nature of rural cultures.
It is fascinating to examine socio-cultural similarities and differences across the different rural regions of the United States, and to think about how they might be leveraged and applied to promote health and wellness. For example, in the lower Mississippi Delta region (counties in states on both sides of the Mississippi River from approximately the Missouri Bootheel region south to New Orleans, Louisiana) there has been a well-documented history of health disparities, poor health outcomes, persistent poverty, etc. There is a well-documented history of health disparities, poor health outcomes, and poverty the US/Mexico border region as well; however, the Mississippi Delta and US/Mexico border regions are two totally different cultures. Consequently, developing culturally-relevant approaches to chronic disease prevention and health promotion in those rural settings would likely require two totally different approaches.
I’m very interested in understanding what those socio-cultural dynamics and relevant socio-cultural indicators are and then applying those in the research, development, implementation, and evaluation of programs. It’s important to thoroughly analyze the data, really understand what metrics are appropriate and relevant from a geo-cultural perspective, and then apply those in strategic planning, community assessment, program implementation and evaluation, etc.
What mindset do you see from leaders in these health systems?
The types of organizations I’ve worked with (Medicaid and FQHC) are well-aware of the social determinants of health, and so are most people in the public health and population health arenas. Perhaps what has been missing – and something that I am excited to bring to the advisory team of Truitt Health – is the ability to link relevant social determinants of health data and community indicators with available EHR and claims data to develop more complete and robust portraits of community health statuses across the nation.
Which social determinants of health indicators are most critical? Are they different in different parts of the nation? By answering those kinds of questions, we can expand our concept of what a social determinant of health is. For example, broadband connectivity in rural areas, including the rural south, remains a major issue. Therefore, while telehealth has been gaining a lot of momentum lately, if there is a barrier of broadband connectivity preventing or hindering its implementation, then that would constitute a critical social determinant of health that would need to be addressed and incorporated into any kind of a telehealth-related strategic plan.
[Look for part three of this six-part blog series next week!]