Rural Health Equity Roundtable: What we’re learning

Shift Health Accelerator, in collaboration with Vertical Strategies and Interwoven, and with financial support from the Community Change Leadership Network (CCLN), hosted a virtual rural roundtable discussion on October 14, 2022, in which a network of community health leaders were invited to propose innovative efforts to propel commitments to community-led and owned investments in health in rural areas across the United States. The main goal of this roundtable was to better understand various challenges that the leaders are facing in advancing a community-rooted vision of health equity and accessing healthcare dollars to achieve the vision. The diverse group of grassroots leaders then brainstormed strategies for effectively combating those key barriers to community-led change in rural communities. Various Robert Wood Johnson Foundation (RWJF) leaders including Culture of Health Leaders, Clinical Scholars, Health Policy Research Scholars and Interdisciplinary Research Leaders attended the roundtable to explore solutions to multiple challenges related to accessing healthcare equity dollars, collaborative decision-making processes and rural community empowerment.

The roundtable was framed around the following three questions: 

1. What community challenges do you feel are not being heard in rural spaces?
2. How are you approaching access to health equity dollars in rural spaces?
3. How are you thinking about collaborative decision-making processes in rural spaces and how do you approach community ownership and power?

Key takeaways 

Challenges not being heard

• Need for funders to support capacity building, sustainability planning and operational infrastructure and not just program implementation.
• An opportunity to reframe social needs through the lens of the community members.
• Disaggregated data at the sub-county level to have a better understanding of community perspectives, needs and opportunities.
• Need for policy solutions to be advocated for and implemented, and formulating channels to approach governing bodies and persuade them to invest in rural health.

Accessing health equity dollars

• Allocation of healthcare dollars on a reimbursement/monthly basis is viewed as a hindrance for organizations with small budgets. 
• Revision of criteria for eligibility of certain fundings only to rural communities with a population of more than 100,000 tends to prioritize some areas while disregarding the needs of smaller and frontier communities.
• Need for long-term support and consistent operational funding to promote community-led initiatives.
• Deepen opportunities by healthcare organizations identifying and incorporating rural champions to leverage intergenerational wisdom and networks in rural spaces. 

Collaborative decision-making processes

• Decisions being made by a small group of people in positions of power can make or break key resource and policy decisions.
• Mistrust of institutions and systems among rural communities as they are not actively involved in decision-making processes.
• Need for community leaders to actively participate in the formulation of policy decisions and bridge the gap between policymakers and implementers.

The roundtable commenced with the prompt question of one urgent matter that the leaders wanted the panel to be aware of. Various issues were raised, including access to healthcare, the need for quality rural reproductive health services, food insecurity in rural communities, the transition from volume-based to value-based healthcare, the impact of social determinants of health in establishing health equity, the framework of legal policies, and the need for evidence-based interventions.