Rural Health

Outstate Community Health Resources

Helping patients close to home

Hailey Baker and Mahtahn Jenkins

A literature review conducted to examine the continued shortages in rural healthcare determined five primary themes: (1) provider shortages, (2) maldistribution, (3) quality deficiencies, (4) access limitations, and (5) inefficient utilization of health care services. The first four are well documented and are often the targets of advocacy and policy efforts. Inefficient utilization of health care services, such as community programs,  is a contributor ripe for intervention to improve rural health care and health outcomes.

Rural counties with a community health center had significantly fewer uninsured emergency department visits.

The 1.25 million people currently living outside of Minnesota’s urban areas receive care at 100 health clinics, 77 critical access hospitals, and 17 federally qualified health centers. From International Falls down to Harmony, rural Minnesotans provide for the agricultural and natural resource needs of the nation. Similar to their patients, rural physicians go the extra mile to provide for the needs of others. These physicians provide obstetric/gynecologic, oral, pediatric, and mental health services at higher rates than their urban counterparts, and are excellent examples of what it means to practice full-scope medicine. In the face of service discontinuation and hospital closures, the need to more efficiently utilize health care services, the fifth theme of the aforementioned literature review, becomes even more necessary.

Utilizing Community Resources

Contributing factors preventing the efficient utilization of health care services include gaps in insurance coverage and a lack of local access to care. Community-based resources are an important component in addressing these gaps, and ensuring that neighbors, friends and family members are receiving the services they need. Defined as supports and services offered within the community, community-based resources include offerings such as health fairs, peer support groups, social programming, community health centers, food pantries and more. These resources can be provided through a health care system, faith-based organization, community members themselves or any combination thereof. These programs address social determinants of health through various approaches and mechanisms, including improving healthcare access, economic stability and social support.

While some community-based resources focus on the typical services one imagines when thinking about health and health care, like free or reduced-cost health screening, community-based resources have the capacity to increase the holistic care of patients. Community-based resources can address underlying social determinants of health of a population, a challenge that is difficult, if not impossible, for a physician to address alone. Many physicians and health care systems work to address the social needs of their patients, but there is a disconnect between addressing the issue on an individual level and on a community level.

The use of community-based resources can increase access to care. They can also address needs tailored to the community in which they are found.  Variations in rural population demographics, available health care infrastructure, community priorities, and more drive the implementation and effectiveness of community-based resources. In Minnesota, rural residents are likely to have issues with timely primary care appointment access – a key contributor to costly emergency department visits. A study in the Journal of Rural Health found that rural counties with a community health center had significantly fewer uninsured emergency department visits by providing care to help prevent emergency situations. Similarly, community-based resources such as health fairs can provide care to those who are uninsured, addressing some of the needs of the roughly 5% of non-elderly rural Minnesotans without health care coverage.

Providing Social Support

For a rural community in which health care access readily available, social support may be an area of higher need. Social support is associated with better health outcomes, but workforce shortages limit the amount of time and types of support physicians and facilities can provide. Community resources such as peer support groups and social programming may provide these important social supports, contributing to not only the physical but also the mental health of rural residents throughout the state.

Physicians have a role to play in the utilization of community-based resources.

Communities might also prioritize access to affordable, nutritional food, which rural Minnesotans too often lack due to higher poverty rates and food deserts. Residents of rural Minnesota have higher rates of poverty (9.1%) compared to urban areas (8.0%), and more than three out of four people living in rural households have incomes below the statewide median income. According to the Minnesota Department of Health, one in ten households experience food insecurity, with 24 counties having 100% of their census tracts federally recognized as food deserts. Most of these are in rural areas. Implementation of local nutritional resources, such as food shelves, community gardens, and meal delivery systems is another way community-based resources can be used to bolster public health. It is possible, and even likely, that rural areas have multiple or even all of these overlapping challenges. Community-based resources could alleviate some of the burdens preventing individuals from experiencing better health.

Accessing Resources

There are a variety of ways physicians can ensure community-based resources provide the best possible benefit to rural Minnesotans. Become familiar with local community-based resources through available resource directories, such as those provided by social services, community liaisons, and guides such as “Resourceful” (https://resourceful.findhelp.com/) – tools that are available to connect to health, food, housing, and more services within your practice area. Patients and community events are also great opportunities to learn about new resources or ones that are not widely known. When relevant in practice, facilitate connections between patients and community-based resources and seek input from patients regarding resources they have used or know of. In addition to understanding what is available locally, physicians can garner ideas from initiatives based in other communities that have helped provide care.

If policy and service are of interest, make an impact by advocating for the creation and the funding of community-based resources. Whether it is building partnerships between the health care system and community organizations, pursuing funding opportunities for local initiatives, or providing insight to what resources could be used to address common challenges seen in the clinic or hospital, physicians have perspectives and resources vital to the improvement of their communities. The U.S. Department of Health and Human Services Health Resources and Services Administration (HRSA) has created “A Guide for Rural Health Care Collaboration and Coordination”, a tool that emphasizes engagement with local partners and considering the needs of the community in decision-making. Some physicians in rural Minnesota lead directives for community-based resources, while others volunteer their time to deliver  services that improve the health of their communities. Whatever individual capacity may be, physicians have a role to play in the utilization of community-based resources.

Rural populations and health care systems face unique challenges that impact the health of communities. Community-based resources are underutilized solutions to addressing rural health care shortages, and reducing health inequities between rural and urban Minnesotans, and all rural Americans. Physicians have strong roles to play in improving both use and prevalence of community-based resources while empowering local residents to improve the health and lives of those in their community.

Hailey Baker is a second-year medical student at the University of Minnesota. She has a research interest in obstetric and gynecologic care for rural and American Indian/Alaska Native populations.

Mahtahn Jenkins is a second-year medical student at the University of Minnesota. Growing up in Two Harbors provided interest in rural health care. He is  pursuing radiology as a specialty.

Minnesota’s Community-Based Resource Spotlight

Rural Minnesota offers a wide range of community-based resources that will improve patient health. There are numerous examples and here are three, all of which are serviced by independent health care systems.

Cook, MN. also known as the Gateway to Vermillion, is a small town of 489 people located in northern St. Louis County. Though relatively small, the Cook community is rich with community-based resources. The local Baptist Church hosts a grief-sharing group weekly for those grieving the loss of a loved one, providing a much-needed mutually supportive social network for patients who may not have one readily accessible. Peer-groups, such as the one in Cook, are a manageable and effective resource, having been shown to have lasting benefits for those in attendance. Additionally, Scenic Rivers Health Services in Cook has created exercise programs, such as the Bone Builders program. The Bone Builders is led by community members, with the intent to improve and strengthen the mobility of local residents. Alongside these two resources, Cook Hospital also hosts an annual health fair and thrift store to further benefit their community and address a variety of community needs.

Onamia, MN. Located in Mille Lacs County in central Minnesota, Onamia has a population of just over 900 people and houses the Mille Lacs Health System. Onamia was built on the shores of Lake Onamia, just south of Mille Lacs Lake - the second largest inland lake in Minnesota. The Mille Lacs Area Health Foundation System sponsors an Operation Community Connect, which invites all local resources and programs to meet with those in need of services. This demonstrates an excellent way to encourage knowledge of community resources for physicians, healthcare staff, and community members all around. This year at the Operation Community Connect, Mille Lacs County collected school supplies and winter boots to distribute among community members, serving 389 individuals with needed goods and services. The two primary sponsors of Mille Lacs Health System are the Foundation and the Auxiliary (or volunteer group), which raise funds for local health initiatives to make them possible.

Staples, MN.  Initially a midpoint of the railroad system that brought travelers between Minneapolis and Fargo, the city of Staples in central Minnesota is home to over 2,500 people. The Lakewood Health System, the primary health provider of the largely agricultural community, developed Lakewood Engage, an initiative to improve the health and well-being of their community. Staples has had challenges with maintaining access to healthy foods due to the focus on the production of feed for livestock; it is a federally-designated food desert. In order to address this, Lakewood Engage hosts a variety of food access initiatives, including the “Food Farmacy,” a pharmacy that distributes healthy foods to families, and “Fresh Delivered,” a home based healthy food program connecting seniors with food in their homes. The “Food Farmacy” reaches over 500 individuals each month and “Fresh Delivered” is currently serving about 200 seniors every year. In addition, the Lakewood Health System in Staples, MN, publishes a Local Food Access Guide showcasing local food shelves, wholesale groceries, and emergency food resources available for those in need. These initiatives are excellent examples of the use of community-based resources in order to address barriers to health, making a positive impact on generations of rural Minnesotans.