When we consider what it takes to improve the health of rural Americans and address rural health disparities, there's no one size fits all solution. Because, as the saying goes, if you’ve seen one rural community, you’ve seen one rural community.

 

In our latest podcast series, we are digging into rural health: the challenges, and the opportunities. We’re highlighting the diversity of rural communities and addressing common misconceptions..

 

In today’s episode, Health Disparities podcast host Sarah Hohman checks in with three people who work in rural hospital leadership and administration, doing incredibly important work, often with limited resources:

 

• Michael Calhoun, Chief Executive Officer/Executive Director for Citizens Memorial Healthcare, an integrated healthcare system serving over 130,000 residents in southwest Missouri. 
• Mandy Shelast, the  President of Marshfield Clinic Health System’s Michigan and Southern Regions, and the President of the National Association of Rural Health Clinics.
• Dr. John Bartlett, a practicing primary care physician and the Vice President of Medical Affairs for the Michigan Region of Marshfield Clinic.

 

Some of the biggest challenges are related to the health care workforce and staffing, in particular for specialty care.

“If we lose a chemo nurse in a town of 10,000 there's not five other ones looking for that job,” Bartlett says. 

“What I'm concerned about is just our aging population and how we're going to be able to train a workforce enough to be able to care for all the people that need it, that's a real concern,” Calhoun says. 

All three guests addressed common misconceptions about rural America, and emphasized the benefits of rural, including a slower pace of life and having providers who are passionate about the mission of providing excellent, personalized health care.

“The patients that we care for are our friends and our family and our community members,” Shelast says. “We take care of them on the very best days of their life — maybe when they're welcoming a life into the world — and on the worst days, when they're having a medical emergency or they've received a terminal diagnosis, and it is just such a great experience to be able to go up to that person and say, 'I'm here for you.’”

Never miss an episode – be sure to subscribe to The Health Disparities podcast from Movement Is Life on Apple Podcasts, YouTube, or wherever you get your podcasts.

People in rural areas have higher rates of certain chronic conditions and disabilities and can expect to live a couple years shorter, on average, compared to people in urban areas. The health disparities facing rural Americans stem from many factors – including geographic, economic, social, and systemic issues. 

But in the midst of all this, there is hope. There’s greater awareness of the importance of rural health care and public health resources, and a growing number of federal agencies dedicated to supporting data-driven solutions aimed at addressing rural health challenges.

Two individuals behind some of those efforts join the Health Disparities podcast to discuss rural health challenges and opportunities:

• Tom Morris, Associate Administrator for the Federal Office of Rural Health Policy at HHS
• Diane Hall, Director for the Office of Rural Health in CDC's Public Health Infrastructure Center

“There's been a lot of focus on access to health care in rural areas, which is absolutely incredibly important,” Hall says. “But I also think we need to really pay attention to the public health infrastructure, which has also been decreased because of budget issues [and] because of the impact of the pandemic.”

Addressing rural health needs is a bipartisan issue, says Morris.

“There may be disagreements about how you get to the outcome, but there's no disagreement about what the challenges are,” Morris says. “...The partisan divide sort of falls apart when you dive into the issues.”

Morris and Hall speak with Health Disparities podcast host Bill Finerfrock about the priorities of their respective offices, common myths about rural America, and what gives them hope as they consider the future of rural health.

Never miss an episode – be sure to subscribe to The Health Disparities podcast from Movement Is Life on Apple Podcasts, YouTube, or wherever you get your podcasts.

Artificial Intelligence is transforming health care. The promise of this technology is enormous and is already being realized to increase the accuracy of diagnoses, promote patient engagement, increase efficiency in health care and lower costs.

It’s even being used to identify patients at risk of disease and predict patients who might be good candidates for medical procedures. 

Done well, AI tools can help ensure patients with the greatest need for orthopedic surgery are prioritized for care, and help reduce health care disparities, says Luke Farrow, an orthopedic and trauma surgeon and clinical researcher at the University of Aberdeen in Scotland. 

But without proper considerations, “you can ultimately end up with AI systems that worsen those health disparities, which is obviously the last thing we want. And there is definitely evidence out there to suggest that does happen if we're not careful.”

Health Disparities podcast host Dr. Mary O’Connor spoke with Farrow about AI and health equity, and about his ongoing research on the use of AI to help general practitioners in the UK know when it is appropriate to refer patients to orthopedic surgeons for consideration of hip and knee replacement surgeries. 

Never miss an episode – subscribe to The Health Disparities podcast from Movement Is Life on Apple Podcasts, YouTube, or wherever you get your podcasts.

Physician Assistants are a relatively new specialty created in response to the shortage of primary care physicians in rural areas, and the PA profession is now well established with over 100,000 graduates of accredited PA programs.

Orthopedist Dr. Eric Santos sees a diverse range of patients in his two Texas practices in Corpus Christi and McAllen, which have very different patient populations. He works hard to provide culturally competent healthcare services to his Hispanic patients, which includes providing consultations in both Spanish and English.

Rural Wyoming is a beautiful place to live, but those wide-open spaces on the frontier create a number of health disparities, with the presence of Native American reservations, COVID-19, and hospital closures adding more complexity.

Operation Change is a community intervention designed to address chronic health conditions and to mitigate some of the related social determinants of health, for women in mid-life and later-life. A fundamental part of the program is to help participants find their own sources of motivation for creating a healthier lifestyle.

Operation Change provided Lynn with invaluable knowledge and a new support network. In her 70s and busy in retirement with volunteer work, Lynn became more conscious of her diet, her physical activity levels, and she became a FitBit enthusiast.

Mt. Vernon, N.Y. resident Olivia found new motivation to take care of her own health by learning about health disparities in her community.

Bringing clinical research to Latinx communities has become a joint mission for today’s podcast guests, Dr Fabian Sandoval and Dr Gustavo Corrales.

The relatively low uptake of flu vaccinations in Black and Hispanic communities is a longstanding health disparity and a public health concern. What if this pattern is repeated for the coronavirus, which is already having a disparate impact?

Meet Freda from St. Louis. Over many sedentary years Freda experienced chronic conditions such as back pain, diabetes and high blood pressure and she found it difficult to follow her doctor’s directions to exercise and lose weight. “I desperately needed to garner better health habits, or I would have deterioration in my conditions and need […]

Meet Sonja from St. Louis. Sonja was intrigued when her husband brought home a flyer describing a health education program soon to start nearby.

For too many people in the U.S., health care is unaffordable and not accessible. Even patients who have health insurance coverage can be confronted with barriers that keep them from accessing the health care that they need.

And research shows health disparities are rampant, with health care access — and outcomes — worse for people of color and other marginalized groups.

The new State of Patient Access report from the PAN Foundation breaks down these disparities and highlights next steps for creating more equitable access to care. 

“Our goal with the project was really to understand the challenges that adults living with chronic conditions every single day face accessing the care they need,” says Amy Niles, the PAN Foundation’s health policy expert and Chief Mission Officer. “More importantly, our goal was to understand what disparities exist, and there were some significant disparities between various groups and communities.”

To learn more about the report, and what can be done to help overcome barriers to care for underserved communities, Health Disparities podcast host Dr. Ramon Jimenez spoke with  Niles, along with Adrianna Nava, president of the National Association of Hispanic Nurses.

Meet Laura from San Diego. Like many women of retirement age, she has experienced the joys of building a family and the challenges of staying healthy.

Dr. Elena Rios has dedicated her career to improving the health of Latinx communities. In 1994, she co-founded the National Hispanic Medical Association based in Washington DC which represents approximately 50,000 Hispanic physicians across the United States.

When Congressman Anthony Brown was Lt. Governor of Maryland, he implemented a new model for reducing health disparities: the creation of Health Enterprise Zones.

Living in rural Kentucky has its challenges, and Deanna at 74 was feeling unhappy that she had constant back pain and her health seemed in decline.

We revisit our Operation Change series with a trip to Hazard, Kentucky. Wanda initially thought an 18-week health education program was a huge time commitment, and that maybe it was too late to make changes.

Five young health professionals and an experienced mentor make the future look brighter as they share insights and experiences of overcoming bias and racism.

Despite progress, heart disease remains the #1 cause of death in America. Not only does heart disease have a disproportionate impact on different populations, it also has a direct bearing on the severity of COVID-19 infection.

It’s a well-known fact that women do better with female doctors, and minorities do better with doctors that look like them, but both demographics are underrepresented in surgical medicine.

Dr. Augustus White is a pioneering African American physician and Harvard Professor and a leading researcher and writer about unconscious and implicit bias in medicine.

There are 574 federally recognized Native American tribes in the United States, all of which were promised healthcare and other services as part of resettlement programs. But having limited democratic power and leverage, health services for Natives have been neglected over many decades.

Mental health is an important part of our overall health, but many people confront barriers that keep them from accessing the mental health care they need.

A program in Boston aims to  address mental health disparities by disrupting traditional health care models. The Boston Emergency Services Team, or BEST, is led by Dr. David Henderson, chief of psychiatry at Boston Medical Center. 

BEST brings together mental health providers, community resources, law enforcement, and the judicial system to deliver care to people in need of mental health services.

Henderson says bringing mental health providers alongside police responding to calls for service for mental health needs has helped reduce the number of people with mental illness ending up in jails and prisons.

“The criminal justice system has, by default, become one of the largest mental health systems … around the country as well,” Henderson says. “People with mental illness are in jails and prisons, at a percentage that they really should not be.”

Henderson speaks with Health Disparities podcast host Hadiya Green about what it takes to ensure people in need of mental health services get the help they need, why it’s important to train providers to recognize unconscious biases, and what it means to provide trauma-informed and culturally sensitive care.

With Florida emerging as the new epicenter of the COVID-19 pandemic, care providers in Jacksonville knew they had to intervene decisively with a testing plan for all populations, including the most vulnerable.

Operation Change Chicago was the prototype of this community intervention program, and has run numerous series that have enabled the model to evolve.

Historic St. Louis was the location for an Operation Change program led by Darlene Donegan, an educator and yoga teacher who is very active in her community.

Every iteration of Operation Change has a unique aspect. There may be certain chronic health conditions that are common to urban, suburban and rural communities, but the needs of different communities vary greatly.

In this podcast program leader Hazella Rollins LaVar shares some insights into the content and impact of the Operation Change initiative at Grace Baptist Church, New York. Grace Baptist is in Mount Vernon, Westchester County, on the fringes of New York City.

Based in the Salvation Army Kroc Center in eastern San Diego, Miriam Rodriguez and her team used their local connections to build the first Operation Change program to be delivered in the Spanish language.

Chicago community leader Christin Zollicoffer discusses how Operation Change has evolved and explores some of the profound and life-changing experiences she has witnessed working with her local participants.

Dr. Yashika Watkins details some of the underpinnings of the Operation Change program and shares insights into how the program can be replicated. This is the first in a series of podcasts exploring the Operation Change program, which will include testimonials from program leaders and participant case reports.

Every month millions of patients visit Orthoinfo.org, a patient oriented orthopedics website from AAOS. Dr. Stuart Fischer leads the editorial team, which produces the content and translates articles into multiple languages.

A multitude of key health disparity indices show that we have not seen significant progress in narrowing the gap between minority and majority populations since the landmark report “Unequal Treatment” in 2003.

Former U.S. Surgeon General Dr. Jerome Adams has the following message for health equity advocates: forge respectful relationships with people with different viewpoints — and pay close attention to the words you use.

“We need to learn to speak in a language that resonates with folks,” Adams says. “When that happens, you will get better policy making.”

Adams recounts his experience – both as the 20th U.S. Surgeon General and as the former state health commissioner for Indiana – in an interview with Health Disparities podcast host Claudia Zamora.

He also discusses his new book, Crisis and Chaos: Lessons From the Front Lines of the War Against COVID-19, explains why diversity in medicine matters, and talks about the importance of dismantling stigma to increase access to mental health care and addiction treatment.

Dr Rahn Bailey discusses how for decades discrimination has played a central role in health disparities, and how gun violence compounds the problem through traumatic experiences, chronic stress and behavioral consequences.

Reverend Willis Steele hosts a discussion about the impact of COVID-19 in Southern states with Dr. Pernessa Seele, the CEO and founder of The Balm in Gilead, a faith-based organization that provides support to people and their families with chronic diseases such as diabetes, as well as working for the prevention of HIV and AIDS.

Speaking at the university where she was the only female and only African American student in her class, and in the auditorium named for her, Healing Hate conference keynote speaker Dr Vivian Pinn reflects on progressing her career during eras of segregation, discrimination, and civil rights.

Bill Finerfrock, Executive Director at the National Association of Rural Health Clinics, hosts an in-depth discussion about rural health disparities with a panel of experts from across the US.

Christina Jimenez, Ph.D. is an Associate Professor at the University of Colorado, and an expert in the processes of privilege that can both limit and promote opportunities for individuals, dependent on factors such as race, ethnicity, gender and class.

Medical anthropology may not be the first discipline we associate with public health, but it provides perspectives that are vital to understanding the many and complex intersections at the root of health disparities.

Professor Dayna Bowen Matthew is a leader in public health who focuses on structural and racial disparities in health care. In this podcast she discusses vast inequalities we see in health access and health outcomes between majority and minority populations, which she says are derived from systematic segregation, discrimination and racism.

Privilege is when a person or group enjoys an unearned advantage over other(s). As the COVID-19 pandemic has dramatically highlighted, those with less privilege often pay the ultimate price in times of crisis.

Marking National Nurses Week 2020 and the bicentenary of Florence Nightingale's birth, nurse advocates and leaders from across the U.S. meet to celebrate the nursing profession and discuss many topics, including its diversity, future aspirations, and their nursing heroes. Featuring Rose Gonzalez, Millicent Gorham, Charla Johnson, Julie Kneedler, Doreen Johnson, and Mary Behrens.

Alameda County is home to 1.7M diverse Californians who have long experienced health disparities. Alameda Hospital System (AHS) CEO Delvecchio Finley takes us inside the workings of AHS as they adapt to the COVID-19 outbreak.

There’s a long history of racism in both education and health care. But some health equity advocates — including Michellene Davis, President and CEO at National Medical Fellowships — are holding onto hope that real change is possible.

“The only reason why I like the name, the title ‘social determinants of health,’ is because anything that has been socially constructed can be socially deconstructed,” Davis said. “Health disparities do not naturally occur in nature, they have been manmade, right? So now it's time for us to unmake them.” 

In this week’s episode, host Dr. Tamara Huff speaks with Davis, along with Jennifer Holmes, Senior Counsel with the Legal Defense Fund, who works on cases that advance racial justice in the areas of educational equity, economic justice, and voting rights.

The disproportionate impact of COVID-19 on people of color is rightly making headlines. Reverend Dr. Franklyn Richardson of Grace Baptist Church in New York, a national leader for social justice, has seen his online church attendance blossom from 2,000 to 9,000 live-streams, and his church is feeding at least 500 families very week.

As a physician interested in health policy, UPMC orthopedic surgeon MaCalus Hogan MD, MBA, has helped develop cutting edge approaches. The University of Pittsburgh payer-provider model enables innovations in technology and delivery models, including value-based approaches that pre-date the Affordable Care Act era.

The circumstances around early childhood development have ramifications throughout a person’s life. Ronnie Musgrove, Governor of Mississippi between 2000 and 2004 discusses his conviction that early intervention is vital to good outcomes across education, health and the local economy.