“Unless you’ve lived in a rural community, you won’t understand it.”
As someone raised in a rural community, I find that statement both obvious and profound.
Also, this description of rural life: “There are far spaces between people, and that gives a greater appreciation for the need to help each other, the need to reach out, the need to be there for each other.”
Both quotes come from medical doctor Monica Bertagnolli, director of the National Institutes of Health, during her keynote commencement speech to medical school graduates at the University of Utah last May. In her address, Dr. Bertagnolli said rural communities are often bypassed when it comes to economic development, educational attainment, and adequate health care. These issues tend to be viewed separately but are, in fact, inexorably linked, particularly when talking about health care and economic development.
In fact, the Washington, D.C.-based think tank, The Aspen Institute, delved into this issue in a June report entitled “Collaborative Strategies for Rural Health and Economic Prosperity.”
“Thriving economies and communities require healthy people, and people need strong economic and health systems to thrive,” says the report’s introduction. Again, something both obvious and profound. “Ideally, both fields are aligned and working together toward a common outcome: healthy places where each and every person belongs, lives with dignity, and thrives.”
However, as the report discovered, “it is all too common for stakeholders from health and rural development to work in silos, talk past each other, or even work against each other as they seek to implement their respective projects—mainly because their funding sources and operating structures do not encourage or reward collaboration across fields.”
Collaboration. It is the key that unlocks virtually every door leading to a better, more prosperous future for all communities, but more so for rural communities that will wither and die if they don’t do a better job of collaborating with their neighbours.
It is the same all across North America.
Although Canada and the United States have significantly different healthcare insurance systems, the problems facing the delivery of healthcare in rural areas – such as a lack of physicians, closure of clinics, and sporadic ambulance services – are the same. The mistakes made to address those problems are also strikingly similar.
“In many cases, traditional approaches to rural development and health aren’t working or equitable,” says the Aspen Institute’s report. “For example, reliance on attracting or retaining a single major employer or industry leaves rural communities vulnerable to boom-and-bust cycles, and one-size-fits-all health promotion programs may not have the desired impact in rural communities and Native nations with their own robust cultures and values.”
The Bottom Line
Those in the healthcare field and those in the economic field must work together; the success of one builds on the other. The benefits of a good, rural healthcare system are obvious when it comes to improving the life of residents. But we might sometimes overlook the economic benefits.
In December of 2022, the Canadian Journal of Rural Medicine published a report entitled, “The economic impact of rural healthcare on rural economies.”
Here is one of its findings: “In Canada, for every physician employed in an office setting, almost two jobs were needed to support their office Nearly 289,000 jobs (direct, indirect, and induced) can be tracked back to the physician's office. These findings underscore the importance of recruitment and retention efforts for both rural healthcare and communities, where physicians support care not just in the office setting, but are necessary for hospital care also, which expands the local jobs beyond those related to the office setting.”
It will probably come as a surprise to no-one that when it comes to the local economy, a doctor’s office is an economic driver. And losing a doctor is one more nail in the coffin for a community in decline: “a position paper by the Society of Rural Physicians of Canada found that in one small community, when doctors retired or relocated and were not replaced, nurses and lab technicians began looking for work elsewhere.”
But the report also comes to some less-than-obvious conclusions that could help rural communities fight back against the closure of healthcare facilities.
“One of the common arguments for closing local hospitals is cost. Larger hospitals can achieve economies of scale as research has shown that hospitals between 200 and 300 beds are most efficient,” says the report that points out even a small hospital can, in a sense, help pay for itself. “One study found that hospitals of 26–50 beds have a total impact of 334 employees and 21.2 million dollars (USD) in labour income. Additionally, the closure of hospitals forces rural residents to travel for medical services, which takes away related services such as lab testing, medical imaging, and pharmaceutical services from the local community, with associated job loss. Therefore, rural hospitals cannot be compared to their urban counterparts or simply measured in terms of efficiency at the hospital level, and policies need to be responsive to, and understand the importance of, rural healthcare services beyond efficiency and dollars spent at the hospital level.”
Of course, the big question is how do you attract and retain physicians to your community? How do you prevent a local hospital or clinic from closing? There is a chicken-and-egg scenario here: a prosperous economy will attract physicians who will help the economy prosper. The problem is obvious but the solution, as we all know, is not.
Dr. Monica Bertagnolli, whom I mentioned at the beginning of this column, says government is not the answer: “No one in Washington is going to figure out how to solve the problems of rural America. It’s got to be the people of rural America… It has to be us.”
I agree with her, to a point.
Rural residents are resilient and innovative. And they can come up with solutions to vexing problems. But providing healthcare is such a monumental task that governments have to be pushed and prodded into action.
One Solution
Move faster and spend as much money as needed to provide every rural community with high-speed connection to the internet. Besides the economic benefits, the internet will allow urban-based specialists to provide expert medical advice to rural physicians and residents.
In its conclusions, the Canadian Journal of Rural Medicine says, “it is imperative that more collaborative efforts are made across local, provincial and federal levels of government to support rural health care as local care delivery can also have positive economic effects on rural communities.”
When it comes to advocating for rural communities, residents can do it best.
After all, unless you’ve lived in a rural community, you don’t understand it.
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