With stark images of urban hospitals overrun with patients, the national media coverage of COVID-19 has focused largely on cities. Less discussed and less understood is the impact on rural communities, which have been grossly underprepared for a pandemic. As we contemplate an additional wave of the virus, now is the time to assess how rural communities can achieve greater resilience.
We now know that having an adequate supply of ventilators, testing, and PPE is essential, but this alone won’t be enough. Just as important are the structures we have in place — specifically, community partnerships around health. In hindsight, it is increasingly clear that communities that developed relationships within their health network were able to respond faster and more effectively than communities where organizations operated in isolation.
Given the realities facing rural America — physician shortages, a dearth of health care resources, and a population that’s highly vulnerable to chronic disease — these partnerships were always important, but increasingly so during a pandemic. This virus has served as a wake-up call to strengthen these partnerships and tackle rural health challenges in a more committed and enduring way.
Building more resilient rural communities means maximizing existing resources, staging health interventions that address root causes, and thoughtfully sharing information. Partnerships are at the core of these interventions. We must find ways to incentivize and support community health networks that include health care providers, local and national nonprofits, businesses, and local government officials. Such partnerships, whether they are formal or informal, can help rural America whether the next wave of the virus and address underlying health challenges.
Fundamentally, rural health partnerships enable communities to more effectively address social determinants of health. As America’s experience with the pandemic has made clear, populations that were already experiencing health disparities have fared worse than those that were not. Rural health partnerships can help address social determinants of health that lead to disparities and remove some of the strain from health care providers.
When community health organizations band together to holistically address social determinants of health — as we have seen in Orange County and Daviess County, Ind., through the development of community health improvement plans — we can free up practitioners within the formal health care system to do what they do best. When patients are receiving help gaining access to housing or food from community partners, doctors and nurses are able to concentrate on treating the most serious cases. In rural America, where the proportion of providers to the general population is far below the federal recommended level, this type of coordination is especially needed.
Such coordination also applies to sharing resources like in-demand PPE between community health organizations. As we prepare for a potentially prolonged economic downturn, we need to extend this model to address other social determinants of health. If one community’s food pantry stock is bare, another town may have a surplus. We need to expand rural health partnerships to enable this type of coordination.
The impact of rural health partnerships can also be felt in less obvious ways. One of their most important functions is information sharing. Rural health practitioners often wear many hats and lack the ability to focus deeply on any one area of their practice. Health partnerships can ease this burden by delivering customized solutions. The Indiana University Center for Rural Engagement and Southern Indiana Community Health Care recently developed a new app to track the spread of COVID-19 in consultation with local physicians and public health leaders. Moving forward, it will provide surrounding communities with advance warning of an outbreak.
Information sharing can be as simple as sending daily or weekly updates and COVID-19 safety recommendations. Other groups have developed an online directory of financial and physical resources such as food and medication delivery services for individuals and families. Some respond directly to inquiries and manage social media channels dedicated to informing organizations and residents and supporting local needs.
Rural health partnerships yield tremendous value that we cannot afford to ignore. As we expand our work, we need local governments and community-based organizations to help us better shape our approach to fit individual rural communities. But this is just a start. We need continued investment and partnership from government to strengthen rural health networks.
If necessity is the mother of invention, then crisis is the mother of adoption. Rural health partnerships were providing value for rural Americans before COVID-19. Now that the pandemic is here, such partnerships are indispensable and should be greatly expanded.
Dr. Priscilla Barnes, Ph.D. is an associate professor at Indiana University Bloomington School of Public Health and an affiliate faculty member at the IU Center for Rural Engagement.
Dr. Yolanda Yoder, M.D. is a physician of family medicine at Southern Indiana Community Health Care.