Ensuring Rural Kids are Part of the Health Equity Conversation

Decreasing child health disparities and advocating for equitable health outcomes is the cornerstone of PolicyLab’s research portfolios. As PolicyLab continues to expand our research to support these goals, I would like to highlight a population that often gets lost in the conversation about health equity and geography: children living in rural communities.

People living in rural communities experience disparities in health outcomes that are avoidable, unfair and unjust. Rural children especially face socioeconomic, geographic and environmental barriers that influence their health conditions, outcomes and behaviors. Access to health care services plays a large role, but so too do intersecting shortcomings in physical infrastructure, broadband internet, transportation, housing, education and just economic systems. Rural children of color—particularly in the South, along the U.S./Mexico border and on Native land—battle discrimination, racism and marginalization that continues to contribute to the worst health disparities in our nation.

CHOP’s Rural Reach

Though PolicyLab is based in Philadelphia, many of our readers may not realize that several of our projects, like the home visiting program evaluation in Pennsylvania, assess programs operating across wide geographic spectrums including rural areas. Children’s Hospital of Philadelphia’s (CHOP) Care Network, too, extends far beyond the borders of Philadelphia, serving children from suburban and rural communities.

Because of CHOP’s broad reach and my involvement evaluating health services for rural families, I recently attended the National Rural Health Association’s Annual Rural Health Conference in New Orleans where I had the opportunity to learn about the most recent research and practice on improving health and well-being in rural communities. This experience was an excellent opportunity to showcase our research on home visiting’s broader benefits in rural communities, while also learning from other researchers and practitioners in the field.  

Linking Community, Practice and Research to Improve Child Health in Rural Communities

The conference was full of examples of how interdisciplinary groups are uniting to change the narrative around rural child health and well-being. I wanted to share a few specific highlights of how rural communities, providers and researchers are partnering to pioneer care for children and families:

1) Integrating providers and the community: St. Luke’s Miners Rural Health Clinics, serving Hometown and Nesquehoning, Pennsylvania, are dedicated to reaching their community through health promotion initiatives that help kids. They have creative programming like their Medical Oral Expanded (MORE) Care initiative that integrates family medicine and dental care in their in-hospital clinic setting. Walk with a Doc brings their family practitioners out of the clinic and into the community, encouraging community members to take a walk with their doctor and learn about health in a low-key setting. Their Adopt-a-School program brings care to rural schools providing vision care and preventative care, in addition to education on mental health care, substance abuse and tobacco cessation. These efforts contributed to them being honored with the NRHA’s Outstanding Rural Health Organization Award at the conference.

2) Bridging research and practice: Hillsboro Area Hospital (HAH) President and CEO Rex Brown and Dr. Sameer Vohra and Heather Westrick from Southern Illinois University School of Medicine’s new Office of Population Science and Policy shared details on their collaboration developing the Little Leaps Program. Little Leaps created take-home bags of toys, books and educational information that improve brain development in 11 different age groups. These bags are provided free of charge to families in the Hillsboro community through HAH. Efforts like the Little Leaps collaboration demonstrate how rural hospitals can contribute to improved population health and community well-being in their rural homes. In an era where rural hospitals have struggled to remain financially viable, HAH has transformed itself into the center of their small community by hosting a community center, Fusion Fitness and Aquatics and Hillsboro Community Childcare Development Center. Through their engagement in community initiatives, educational services and hometown recruitment programs, they prioritize not just the health of their patients but the well-being of the greater community.

3) Engaging communities in research: There are numerous generative and creative efforts to improve rural determinants of health and expand on rural community assets. Many of these efforts happen under the radar, which is why community/research partnerships can play a big role in documenting and sharing successes. The Walsh Center for Rural Health Analysis recently engaged communities across the country to document their efforts to improve rural health equity. The resulting report, ‘Exploring Strategies to Improve Health and Equity in Rural Communities,’ describes how numerous rural communities are leveraging their organizational, associational, cultural and historic assets to improve health equity. Much of these activities incorporate health into more expansive community and economic development efforts. 

To Improve Rural Health Equity We Must Build a Strong Evidence Base

Rural communities consistently demonstrate innovative strategies, like the ones described above, which bring the whole community on board to improve health for children. Yet, these activities often don’t receive attention because they are not well documented due to lack of funding for evaluation, dissemination and translation. Without this important formally-evaluated evidence base, these successes aren’t assessed, shared or scaled.

Researchers at PolicyLab are aware of this shortcoming and are preparing to act. We know the myriad ways in which child health equity is effected by geography and community, and we recognize the barriers rural communities have in measuring and sharing success; that’s why rural health is an area of interest for PolicyLab’s Health Equity Portfolio. As we move into our tenth year of charting new frontiers in child health, we look forward to sharing our research highlighting innovation in rural communities.