Creating a Culture of Wellness in Rural Communities
by Sally Buck, associate director, and Kami Norland, community specialist, Rural Health Resource Center-Duluth, Minnesota
During 2008, the Rural Health Resource Center developed a multistate initiative to improve the health of individual communities and their economies through a pilot called the Culture of Wellness. The Northwest Area Foundation funded this initiative to help rural communities in its eight-state region design and implement broad based strategies to optimize the health of their diverse populations, and reduce poverty. Moose Lake and Madelia, Minnesota, and four locations in Idaho and Montana were selected for participation in the pilot. Selection was based on previous community organizing success, health leadership, the presence of a Critical Access Hospital, a population under 5,000, and the level of community poverty.
Health is a Community Asset
America is facing a health care crisis. Our waistlines and chronic disease rates have exponentially increased over the last 25 years adversely affecting our health, our communities and our economy. Traditional thinking on health focuses on illness rather than wellness, pills rather than healthy eating and exercise, downstream treatment rather than upstream prevention and is primarily driven by reimbursement and money. These factors led to the current health trends of a rise in obesity, diabetes and heart disease. Eighty percent of all chronic disease is caused by three preventable behaviors: poor nutrition (overeating, yet being undernourished), physical inactivity and smoking. These factors combined with poverty, skyrocketing health insurance costs, and inaccessibility to health care, puts an economic strain on families and their communities.
The Culture of Wellness helps communities identify their most important health needs and develop community goals and strategies to address their concerns. It builds on local perspectives, strengths and expertise so each community is working to address its own health needs.
The individual health of citizens is often an overlooked community asset. Improved health is linked to increased employability and reduction in poverty. When people are well, they are able to gain and maintain employment, which circulates revenue. School and work absenteeism rates are less for healthy individuals, which translates into greater production and economic security.
It is also optimal to keep health care dollars within the local community. While the vast majority of health care can be provided locally, rural citizens often drive to large medical centers, making health care and non-health care purchases. It is estimated that within a typical rural community, millions of dollars of revenue are lost in this way. This revenue could be retained by enhancing local access to health information and services thereby improving community health and economic growth. Embracing a Culture of Wellness will improve the overall function of the health care system and reduce health care costs and improve the economic viability of rural communities.
Developing a Culture of Wellness
The Rural Health Resource Center begins the Culture of Wellness initiative by identifying community liaisons at Critical Access Hospitals (CAH). These leaders are drawn from a variety of positions within the CAH, including administrators, marketing directors, quality directors, and at one hospital the physical therapist. Next, a Community Council is recruited from city leaders, chamber of commerce members, school superintendents, principals, hospital and clinic board members, senior advocates, the media, local health care providers, public health, youth, representatives from the economic sector and business owners. Together, the Community Council, the hospital liaison, and staff from the Rural Health Resource Center identify assets and needs in the health care system using a community health survey, secondary data analysis, focus groups and an economic impact assessment conducted by the Office of Rural Health and Primary Care.
The group creates community health goals using a systems approach to increase success and sustainability. This enables communities to address health goals from multiple perspectives: community assets, services, partnerships and the economy. The Culture of Wellness health initiative is unique because it frames health goals using a strategy map to unite the community’s vision and provide direction in goal development. Each community can customize the Culture of Wellness strategy map template, which offers a holistic view for addressing health goals.
A Community Health Scorecard is then created to articulate the community’s health goals and action steps, which measures and monitors success, identifies gaps in performance, and facilitates communication and partnerships. The Community Health Scorecard is a framework for aligning people, processes and resources to improve individual, community and economic health. This alignment comes through understanding the community health vision and identifying each citizen’s role in the health goals.
Community Health Goals
Creative thinking through the Culture of Wellness can generate opportunities for rural residents to access resources beyond the traditional health care delivery systems of medical clinics, dental clinics and hospitals. Prevention and wellness resources, without traditional funding rules and constraints, could be placed in non-medical and clinical settings, such as “health resource workers” in libraries and community centers, community health workers rotating at daycare centers, or oral hygiene products and services in schools and senior centers. These alternative methods create local job opportunities that don’t require extensive years of training, but enhance access and delivery of health care to more diverse populations.
The Rural Health Resource Center has also been assisting Culture of Wellness communities develop directories to promote education and awareness of local health services. The next step for the Rural Health Resource Center is to develop a leadership curriculum geared toward rural hospital administrators, boards, physicians and community members for a combined effort in building a Culture of Wellness in rural areas throughout the nation.
For more information on the Culture of Wellness health initiative, contact Kami Norland at the Rural Health Resource Center, in Duluth, Minnesota, at 1 (800) 997-6685 extension 223 or by email at firstname.lastname@example.org.