Rural Women's Health Conference
Summary Report
Summary Report (PDF File, 1.82 Mb)
August 13 -15, 2007
Omni Shoreham Hotel, Washington DC |
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Opening Plenary
The opening plenary session included three presentations.
First, Lori Arviso Alvord, M.D., Associate Dean
of Student and Multicultural Affairs at Dartmouth-
Hitchcock Medical Center,
offered her perspective on rural
women's health gained from her
work as a Stanford University trained
surgeon and her heritage as
a Navajo woman. Second, Hilda
R. Heady, M.S.W., Associate
Vice President for Rural Health
at the Robert C. Byrd Health
Sciences Center of West Virginia
University, discussed some of
the valuable lessons that can be
learned from rural women and the
resilience of their spirits. Third,
Marcia Brand, Ph.D., Associate
Administrator for Health Professions, and Director of the
Office of Rural Health Policy at the Health Resources and
Services Administration in the U.S. Department of Health
and Human Services, presented a practical four-step
process for addressing the issues rural communities face.
The Scalpel and the Silver Bear:
A Navajo Woman Surgeon's Story
Keynote speaker Lori Arviso Alvord, M.D., began her
presentation by discussing her interest in two disciplines,
psychiatry and surgery—the life of the mind and the life
of the body. She explained how, although it seems that
psychiatry and surgery should be connected, the two
disciplines do not speak to each other. Yet psychiatry and
surgery are incredibly dependent on each other. People's
mind states are very relevant to their physical well-being
and vice versa. She said there is one system of medicine
that has never separated the two disciplines—Navajo
medicine.
Dr. Alvord spoke about the
roles women and elders play
in Navajo culture. In her
father's and grandfather's
generations, there were no
Navajo physicians, attorneys,
or engineers. During that
time, people who worked in
those professions were typically
white. However, even though
people did not have physicians
or engineers as role models,
they had guidance from the
strength of Navajo women.
People had "the voice of the
wisdom of the grandmothers." According to Dr. Alvord,
"This is missing in American society. If we are lucky,
we hear it once in a while in a segment on Oprah. Our
women and our elders have so much to show and offer us,
if we listen."
Dr. Alvord went on to discuss her experience growing up in
Crownpoint, New Mexico, where books were her only access to the
rest of the world. She said the term "culture clash" cannot adequately
describe the stark contrast between her childhood experience in rural
New Mexico and her experience attending college at Dartmouth, which
was 2,500 miles from her home.
At Dartmouth, Dr. Alvord earned a double major in sociology (Native
American studies) and psychology. After college, she worked in a
laboratory at New Mexico University and was encouraged to apply to
medical school. Ultimately, she was accepted at Stanford University.
During medical school, she was advised to specialize in primary care
so that she could go back to New Mexico and help her people. Her
perspective changed, however, when she met a Native American
surgeon and witnessed how he was able to help patients using American
medicine and still honor their heritage as Navajo people. This image
carried her through medical school and shaped her into the surgeon,
and woman, that she is today.
RAW Spirit: Resilience and the Rural American Woman
Plenary speaker Hilda R. Heady, M.S.W., opened her presentation
by noting that she was the 2005 President of the National Rural
Health Association (NRHA), a nonprofit, non-partisan membership
organization that aims to serve as the voice for rural health care. She
went on to explain that one of the purposes of her work as a rural health
advocate is to focus on what is right about rural America, instead of
focusing on what is wrong. According to Ms. Heady, in order to address
the "new frontier" in improving health care and access for rural women,
people need to consider and connect with the "old frontier," and learn
from the strengths and challenges of rural culture.
Ms. Heady outlined the three main points of her presentation:
- Rural women's values make them and their culture special.
- Rural women's experiences and values guide their passion in all
that they do.
- Resilience is a hallmark reflection of rural culture.
Ms. Heady then explained her points. She noted that rural women
have a natural affinity for putting people first. Whether rural women
are factory workers or homemakers, they put people first—in advocacy,
policy, work, and service. For these reasons, rural women have a lot to
offer as teachers. According to Ms. Heady, "It is important to go into
situations with rural women and expect to be taught before we expect to
teach."
As part of her work promoting the positive aspects of rural America,
Ms. Heady coined the phrase, "Rural Beatitudes©." The idea behind the
phrase is that rural people learn life skills by dealing with things. Ms.
Heady presented a list of her "Rural Beatitudes©:
Blessed are the rural for ...
- They are collaborators and self-reliant. If they cannot solve a
problem on their own, they will band with someone else to get
it done.
- They value their families and are friendly people.
- They value individualism and are personable, independent, and
modest.
- They are authentic, direct, unpretentious, and honest.
- They are patriotic and go to war—and allow their children
to be sent to war. Ms. Heady noted that research shows rural
people and minorities serve in the military at higher rates than
the rest of the population. For example, she said 35.7 percent
of women in the military are African-American women, a figure
which is not proportional to the general population.
- They serve others without being asked.
- They make goods and products for everyone else.
- They have a deep faith, a sense of beauty, and a sense of humor.
- They all deserve high-quality health care.
In closing, Ms. Heady noted that resilience is imbedded
early and must be nurtured. "We must remember our
special obligation to the next generation," she said. "Our
faith in the human spirit is to know that its own sense of
innate health can guide us in all our endeavors. Our efforts
to define community are less important than our search for
common unity."
What Can You Do About Issues
Rural Communities Face?
Plenary speaker Marcia Brand, Ph.D., began her
presentation by providing an overview of HRSA ORHP,
which was established in 1987. ORHP was created to
address problems that arose from the implementation of
the Inpatient Prospective Payment System, which led to
the closure of an estimated 400 rural hospitals. Today,
ORHP advises the Secretary of Health and Human
Services on rural healthcare issues.
Dr. Brand outlined several reasons the country has rural
healthcare issues:
- There is limited access to primary care and
specialty care. In particular, it is difficult to obtain
oral health care and mental health care.
- The healthcare system is limited by infrastructure,
including hospitals and clinics, providers, and
emergency medical services. For example, in
Washington, DC, emergency medical services
are paid positions; while in rural America, they
literally hold bake sales to fund these services.
- The country is also limited by financing.
One result of this limitation is that people are
challenged to create economies of scale and to
co-locate businesses. An example is the "lose it/
tone it/tan it" business that is a nutritional store,
workout facility, and tanning salon, all in one.
- The country is limited by the special challenges
rural communities face. These limitations include
geography, population (the population is older
with greater health disparities), Federal funding
that is population-based, and cultural and social
barriers.
Dr. Brand continued by stressing that healthcare providers
must try to work directly with communities for a number
of reasons:
- There are many different ways to be rural; one
solution doesn't fit all of the challenges.
- Limited financial and technical expertise
makes engaging local, State, tribal, and Federal
governments difficult.
- Rural communities cannot afford to make
mistakes or engage in programs that will not work
for them—they must get it right the first time.
- Often, the Government does not hear from the
rural communities.
With these reasons in mind, Dr. Brand outlined four
simple steps healthcare providers can take to accomplish
working directly and effectively with communities.
Step 1: Have the information
Dr. Brand explained there are numerous resources
available for finding the information you need. One is
the Rural Assistance Center at www.raconline.org. A
second resource is ORHP—it can be accessed through
www.hrsa.gov by clicking on Rural Health. Another
extremely important resource that ORHP encourages
people to use is the appropriate State Office of Rural
Health. Dr. Brand noted that you can locate each State's
Office of Rural Health by accessing the ORHP site and
clicking on States.
Step 2: Decide if it is a policy or
resource issue and at what level
If the issue is a policy issue, Dr. Brand explained you need
to determine on what level it exists—Federal, State, tribal,
or local. For example, if you do not know whether your
area is in a Health Professions Shortage Area (HPSA),
that is a Federal policy issue. If Medicaid does not pay for
dental care, that is a State policy issue. If the county is no
longer providing obstetrics and gynecology services, that is
a local policy issue.
Dr. Brand noted there are numerous avenues for finding
help with policy resources. On the Federal level, there are
ORHP, the Centers for Medicare and Medicaid Services,
other agencies in HHS, your Congressional delegation,
and national professional
organizations, to
name a few. On the
State level, there are
the Governor, State
legislature, State Office
of Rural Health, and
State organizations. On
the local level, there are
local government, local
hospital boards, civic
groups, and community
organizations.
Dr. Brand then explained, if the issue is related to
resources instead of policies, there are also several avenues
communities can access to improve rural health care:
- Rural Assistance Center (www.raconline.org) and
other Web-based tools
- ORHP's outreach and networking grants
- Health Center expansions
- National Health Service Corps, which is looking
for health professionals
- 3RNet—job placement service
- Area Health Education Networks
- Other HHS resources
- U.S. Department of Agriculture, which has
numerous non-agriculture resources
- Foundations
- State resources
Step 3: Determine who else cares about the issue
First, Dr. Brand noted, we must think beyond the
healthcare sector. Educators and business people can be
powerful allies. For example, if you are seeing children
with unmet mental health
needs, so are the schools.
There are allies all around.
Next, Dr. Brand stated, we
must put the "good guys"
out front. For example, if
dental caretakers are talking
about increasing access, it
will be seen as a business
proposition. But if you
put the Parent-Teacher
Association out in front, it
will be seen as positive. Finally, we should not be afraid to
"look up"—to both State and Federal officials.
Step 4: Set reasonable goals
Dr. Brand explained that when we are setting goals, we
first must remember that rural communities have limited
infrastructure. Next, we must be aware there is a "risk
averse" culture of health care—rural communities simply
do not take big risks. Finally, people must also think about
sustainability from the beginning—how to keep something
going even if the State or Federal dollars go.
After outlining the four steps, Dr. Brand concluded her
presentation by walking participants through the process
using a familiar healthcare issue as an example—the lack
of access to oral health care for adults and children in the
community.
Dr. Brand reminded participants that step one is to have
the information. For example, one-third of all adults have
untreated cavities. In addition, tooth decay is the most
common chronic childhood disease—it is five times as
common as asthma and seven
times as common as hay fever.
Children miss 51 million
school hours per year for dental
problems and dental visits, and
adults lose 164 million work
hours per year. In addition,
108 million Americans lack
dental coverage. For each adult
without medical coverage,
there are three without dental
coverage; and for each child
without medical coverage,
there are 2.6 without dental
coverage. In addition to these statistics, the scientific
evidence that poor oral health has a significant impact on
physical health continues to grow. In addition to this big picture
information, Dr. Brand noted that you also need
to gather information on other levels. For example, you
should be able to describe oral healthcare access in your
State and community.
After you have the information, Dr. Brand reminded
participants that step two is to decide if it is a resource or policy issue. She noted that oral healthcare access is both
a policy and resource issue. On the policy side, Medicare
does not pay for oral health care. On the resource side,
there is a lack of dental insurance, limited number of
providers, and limited infrastructure.
Dr. Brand then walked participants through step three,
which is to determine who else cares about the issue. In
the oral health care example, potential collaborators on
the local level may include employers, educators, provider
groups, and especially local hospitals, considering the
frequency of dental-related ER visits. On the State level,
collaborators may include employers, educators, provider
groups, hospital associations, the
State rural health association,
the State legislature, and State
government. On the Federal
level, collaborators may again
include employers, educators,
provider groups, and hospital
associations, as well as the
NRHA, Congress, Federal
Government, American
Association for Retired People,
and the Children's Defense
Fund, to name a few.
Finally, Dr. Brand reviewed step four, which is setting
reasonable goals. She noted that this may include
establishing a mobile clinic; recruiting an additional
healthcare provider; getting other healthcare providers to
perform some basic dental services, such as varnishes; or
providing service through schools or nursing homes.
In closing, Dr. Brand stated that these are four
straightforward strategies for thinking about rural health.
Current as of October 17, 2008
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