Health equity in your rural community begins with you

Systemic barriers like limited or no access to broadband, transportation, and housing impact the health of rural residents. The negative health impacts of these systemic barriers are evident in the data. What is missing from the data, however, is the power of the collective strength, ingenuity, resources, and resiliency of the people living in our rural communities. These very attributes and the relationships and interdependence they foster have the power to positively impact our rural community’s health equity.

What is health equity and how can you help move it forward in your community? Our definition of health equity is adapted from the Robert Wood Johnson Foundation. Health Equity means that everyone has a fair and just opportunity to be healthy and thrive. It requires actively removing obstacles to health that drive health disparities rooted in structural racism and economic inequity, such as poverty, discrimination, and their consequences, and gaining equal access to power, money, and resources. It means actively building the conditions for health, including good jobs with fair pay, high quality education and affordable housing, safe environments, and quality and culturally responsive health care.

Health Equity means that everyone has a fair and just opportunity to be healthy and thrive.

While Heath Forward champions health equity in multiple counties in Missouri and Kansas, we are committed to developing strategies that help our rural residents overcome challenges and disparities unique to their communities. In particular, health care access and workforce challenges, economic development, Medicaid expansion, transportation, and the well-being of migrant workers and their families.

In addition to our support of medical, behavioral, and oral health services in Cass, Lafayette, and Allen counties in 2023, we were pleased to support capacity building for small, community-based nonprofit organizations serving rural areas. We believe that those closest to a situation, with lived experience, are best equipped to understand which solutions work best to address these situations in their communities, making non-profit organizations and their leaders vital in the efforts to advance equitable policies, practices, and resources focused on health equity. These grants are intended to invest in the effectiveness of nonprofits to achieve their mission.

Public policy has played a key role in creating existing systemic barriers to health equity, including structural urbanism — policies and practices that disadvantage rural communities. But policy can also play a key role in dismantling those inequities and creating new, inclusive policies as we move forward. The shaping of public policy that supports health equity requires intentional and active civic engagement and political will across public, private, and philanthropic stakeholders, advocacy, and legislative leadership. Health Forward is committed to partnering with our rural communities in contributing to the development of public policies that benefit and strengthen their residents.

Public policy has played a key role in creating existing systemic barriers to health equity, including structural urbanism — policies and practices that disadvantage rural communities.

Historically, Health Forward has advocated for policies that increase access to care and boost economic growth, such as Medicaid expansion in both Kansas and Missouri. In Missouri, leveraging the initiative petition provision in the state constitution, we strongly advocated for Medicaid expansion and defended its passage via a ballot initiative in 2020. In Kansas, we still fight within the traditional legislative process. We continue to support the Alliance for a Healthy Kansas and other efforts to expand Medicaid for 150,000 hard working Kansans.

The evidence is indisputable. Medicaid expansion significantly reduces uncompensated hospital care costs and stabilizes rural hospitals, helping them to keep their doors open. Rural hospitals in non-expansion states are six times more likely to close than rural hospitals in states that have expanded Medicaid.  

In Kansas, 34 rural hospitals are at immediate risk of closing, and 36 rural hospitals are at high risk of closing. That means 70 of the 104 rural hospitals in Kansas are at risk of closing their doors. In addition to compromising the health of rural residents, a hospital closure causes job loss, declining economic activity, and loss of vibrancy and quality of life in rural communities. Medicaid expansion results in improved hospital financial performance, improved operating margins, and a lower likelihood of closure, especially in rural communities.

Medicaid expansion results in improved hospital financial performance, improved operating margins, and a lower likelihood of closure, especially in rural communities.

In addition to advocating for Medicaid Expansion, this year we funded rural and statewide organizations that advance civic engagement and support advocacy coalitions.

A sampling of these efforts include the Health Care Collaborative of Rural Missouri’s work in supporting conference registration, travel, and membership for staff participation in advocacy; The Voter Network’s work in recruiting, empowering, and equipping Kansas stakeholders to effectively organize low-propensity and historically disenfranchised voters in year-round civic education and engagement efforts; and LeadMO Action’s work recruiting racially, regionally, and economically diverse Missourians, building skills and networks needed to effectively engage in the political process.

Additionally, we are partnering with Allen County Rural Health Initiative’s work focused on telehealth expansion, provider recruitment, care coordination, and transportation to achieve improved health outcomes for Allen County, Kansas, residents. And in Lafayette County, Missouri, we are proudly partnering to increase the capacity and reach of the public health department, supporting the launch of the Maternal and Infant Health (MaIH) Center, a new birthing center that will work to improve birth equity and maternal health outcomes in the county, and continuing longstanding support of the Migrant Farmworkers Assistance Fund, which supports migrant farmworkers and their family members who work in Lafayette County, Missouri, for the fall apple harvest, and seasonal farmworkers living there year-round with holistic culturally responsive support.

Civic engagement and community advocacy leads to increased wellness, economic stability, and viability for rural communities and the residents who live and work there. We’re not alone in understanding the connection between civic engagement and health: the American Academy of Families Physicians also stresses the connection between the two. Investing in this work continues to be a core strategy of Health Forward Foundation.

Civic engagement and community advocacy leads to increased wellness, economic stability, and viability for rural communities and the residents who live and work there.

While there is much work to be done, we know it can be done, and the first step begins with you. Community leaders must focus on how to strengthen their communities to create better systems and eliminate health injustice. Intentional and meaningful engagement with community voices to devise the solutions to address health equity in your community is essential. No one is better suited to inform the solutions needed in our health care and public health systems than the people who are battling the systemic barriers every day. Begin these conversations within your own organization and community-at-large today.

By addressing the most salient issues our rural communities face, we improve the conditions for everyone. Better schools, affordable housing, digital inclusion all result in healthier, economically stable neighbors, expanding what is possible for everyone in our rural areas.

Everyone should feel seen, safe, respected, heard, and believed when it comes to their own well-being.

Health Forward wishes you much success, courage, and accountability as you pursue health equity for those you serve. We know it can be done.