Weaving the Basket Tightly: Delivering Resources for Health Equity in Rural America

Written by Equity Advisor Bobby Cochran

What is rural? The definition isn’t as simple as you might expect. The US Department of Agriculture had to write 100 pages to untangle all the definitions of ‘rural’ it uses. Sometimes rural can mean a small town (e.g., less than 10,000 people or less than 50,000 people), or it can mean ‘rural character’. Part of why that definition is hard is that rural America is diverse. It includes Tribal communities from Alaska to Florida, colonias along the US-Mexico border, farms, forests, and ranches from Maine to Kansas to California, and US-affiliated islands from Guam to Puerto Rico. For me, rural means places where families and food grow, kids and rivers run, and people know and look out for each other. I have had a chance to work with rural places in the Northern Sierras in California, Southwest China, and now here from my home in the Pacific Northwest. And there is one refrain that I hear time and again…

“We have to get underneath it all and lift it up all at once.”- Michael Howard.

Here in the western United States, the mythology and narratives of rugged individuals battling nature don’t recognize the history of interconnectedness and reliance on neighbors that are required to survive and thrive in our region. Instead, the metaphor of weaving a tight basket–the interconnections of story, spirit, and each other–that’s a narrative that provides a pathway for rural and Native prosperity.

Shift Health Accelerator makes it easier for community health leaders to access the resources they need to achieve these kinds of integrated visions of health. And Shift has just begun convening a rural cohort of Robert Wood Johnson Foundation Culture of Health Leaders, Clinical Scholars, Health Policy Research Scholars and Interdisciplinary Research Leaders to open up doors to resources that can be difficult for rural and Native leaders to access. 

The exciting news is that there are significant resources available at the federal level from the Bipartisan Infrastructure Law and the Inflation Reduction Act–not for everything, but for significant investments in infrastructure, climate resilience, energy transitions, and community development. And many of those funds have prioritized investments in ‘disadvantaged’ communities who have been marginalized, underserved, and overburdened by pollution. Or put in a different way–remote rural, communities of color, low income, Native, and other communities. Significant funds were also set aside to provide technical assistance to help these communities access federal funding.

As of today, the US Environmental Protection Agency just announced a round of technical assistance funding for Environmental Finance Centers and will be setting up Environmental and Energy Justice Centers–both with an explicit priority for rural and Native communities. These centers are also linked to supports around energy and transportation. The White House developed a playbook for rural places to access funding. Federal funding also includes more flexibility important to rural places–more funding will go out as grants instead of subsidized loans, more funding is available to nonprofit and community-based organizations, there is more flexibility to invest in early community visioning and not just ‘shovel-ready’ construction projects. About 60% of the funds from the Bipartisan Infrastructure Law and Inflation Reduction Act will be distributed by formula through states–this means that how states define rural and how flexible states make their funds for communities is an important area for accountability and advocacy. For example, if a state only defines ‘disadvantaged’ by median household income or location in a rural area, they could miss those areas where inequalities intersect (e.g., farmworker housing, mobile home parks, mining towns).

Shift’s rural cohort has the capacity to engage a broad cross-section of rural leaders in ‘weaving a basket’ of prosperity in new ways. The exact kinds of networks, skills, and lived experiences these leaders hold is who government has said they have difficultly reaching. Well…No better time than today to make new friends 🙂 I look forward to watching how the government re-crafts its relationship with rural and Native American communities. It’s time for that overhaul–one where communities are given access to the tools and resources they need to weave the elements together where everyone thrives–no exceptions.