Over the past few months, I have spent a lot of time traveling and focusing on rural health, including barriers to healthy living and strategies to bridge clinical-community partnerships. Through my travels, I am reminded of the vastness of a state such as South Dakota and how truly rural much America is. Recent findings from the 2012-2016 American Community Survey report that rural areas cover 97 percent of the United States (US), but only 19.11 percent of the US population lives in them. Population shifts since 2010 from rural to urban areas have shed light on the changing landscape. Urban and rural areas are both affected by disease associated with social, environmental, and economic specific those areas, however rural America is disproportionately affected by health disparities when compared to urban areas.
Rural America suffers from higher rates of a chronic disease, mortality and lower life expectancies (Rural Health Information Hub, 2012-2018). Recent findings from Garcia, Faul and Massetti (2017) found that rural America is “more likely to die from five leading causes, including heart disease, stroke, chronic lower respiratory disease, cancer, and unintentional injury, than their urban counterparts, highlighting a critical gap between rural and urban Americans”. Much of the gap of health outcomes in rural areas compared to urban areas is associated with socio-economic and environmental factors specific to rural areas, including low or no access to health care services, healthy foods, or physical activity opportunities, geographic isolation, limited job opportunities, and poverty. As the saying goes, backed by research, “zip code is a stronger predictor of health than genetics”. This mean social, economic, and environmental factors where a person lives, work, learns and play defines health outcomes.
While the reality of rural health may now sound dim, the reality is that rural communities across America are addressing and improving the health of their communities to reduce these health disparities. Funding agencies are taking notice of the health needs in rural America and that efforts at the local level are one of the keys to positively move the needle on health outcomes.
So just who is “they”? They include residents, albeit coalitions, decision makers, or individuals affected by disease, committed and passionate about ensuring their community is healthy. One of those residents that can advocate for change and health improvement, is a community champion. A community champion can be a public official, community leaders, concerned citizen or a volunteer, and who is committed to leading the charge in addressing the health of their community (Center for Community Health and Development, 2018). The notion is that a community champion lives in and understands the community and has established relationships with key stakeholders in the community who are integral to addressing those social, economic and environmental factors that affect rural health outcomes. Imagine where you live and an outsider who does not know your community wants to come in and improve access to healthy foods, not knowing the community, any historical challenges with community collaboration, and who the residents are. While the outsider will eventually gain an understanding the community, identifying a community champion to help lead these efforts will increase likelihood of success.
Communities across the US have had success in addressing these factors with the support of a community champion. For example, South Dakota State University Extension has worked with rural South Dakota communities with high obesity rates to identify community champions to help lead efforts to address access to physical activity opportunities and healthy foods through evidence-based approaches focused on improving health behaviors and reducing death and disease. These community champions live in those communities and have the ear of key stakeholders and residents important to support local needs assessment and implementation of evidence-base approaches to address priority health issues.
So, if you live or work in a rural community and want to move the needle on health outcomes, find a community champion who can advocate for change.
Center for Community Health and Development, University of Kansas. (2012-2018). The Community Tool Box. Retrieved from https://ctb.ku.edu/en
Garcia MC, Faul M, Massetti G, et al. Reducing Potentially Excess Deaths from the. MMWR Surveill Summ 2017;66(No. SS-2):1–7. DOI: http://dx.doi.org/10.15585/mmwr.ss6602a1.
Health Resources and Services Administration. (2002-2018). Rural Health Information Hub. Retrieved from https://www.ruralhealthinfo.org/