May 6, 2019
Partnerships with communities to improve health was the focus of the 20th annual Rural Health Conference hosted by The University of Alabama College of Community Health Sciences and its Institute for Rural Health Research.
The conference, “Partnering with Resilient Communities,” was held April 10-11 and included presentations about creating community networks and health care coalitions, and the impact of rural hospital closures on EMS response times.
The annual Rural Health Conference brings together health care professionals, community leaders, researchers, government officials and policymakers who hear from speakers in the field and share information and knowledge about rural health issues, as well as solutions to address those issues.
The Institute for Rural Health Research was established in 2001 and conducts research to improve health in rural Alabama.
The Black Belt Community Foundation works with 12 counties across the mid-section of Alabama, a culturally rich yet economically distressed area with a population of 212,000. Per capita income is $17,200, school systems are segregated, and in five of those counties hospitals have closed and two more struggle to remain open.
“This is the context within which we do our work,” said Felecia Lucky, the foundation’s executive director. “We have a lot of work to do.”
The foundation strives to improve health care and wellness, education and economic development, and to promote arts and culture. Among its efforts: serving more than 300 families and children in Choctaw, Dallas, Marengo and Wilcox counties through head start programs; the Black Belt 100 Lenses project, through which children from the 12 counties document their communities via photos and provide opportunities for residents to develop pride in their communities and for children from public and private schools to interact, some for the first time; and working with university researchers, including with UA’s Institute for Rural Health Research on Project Export, which included developing a community garden at a school in Hale County and providing information to Head Start children and families about the qualities of good food.
“It’s difficult to take the time to reach out and work with communities. It requires a little extra work. You have to build trust, then build your work from there,” Lucky said. “Not everyone values community the same, but there are some who invite you to the table. The greatest opportunity for partnership is making people in areas who are uncomfortable feel comfortable.”
“We are really, really, good at responding to disasters, but that’s short-term. Then there’s this long-term recovery. How well are we prepared to bounce back in communities?”
That’s a question often asked by Dr. Laura Myers, director and senior research scientist for UA’s Center for Advanced Public Safety, who spends a lot of time studying and assisting communities in disasters.
“We need a better understanding of communities and what they face,” she said. “The big issue with resiliency is critical infrastructure. Can we prepare that infrastructure to be more resilient?”
There are common circumstances that occur with disasters – roads might not be passable, and power outages might eliminate traditional ways of communicating. Myer said there are other important considerations.
“Do people have the ability to take action in a disaster? Do they have the resources to evacuate? If people don’t have a way to get to shelters, they can’t go. Are there physical and mobility issues that impact their ability to evacuate? We’re telling people to evacuate and leave their homes and go out into the unknown.”
Myer said officials in communities need to know where their vulnerable populations live because these individuals and families might not have a way to get out.
There are health and safety issues in disasters. How will people manage chronic diseases? Debris on streets and curbs might expose people to mold. Physicians often lack public health and emergency awareness knowledge and expertise.
There’s also an economic impact. “People’s jobs could go away, and they’ll lose their ability to support themselves and their families,” Myer said.
She said an important component of resiliency is mitigation, and that means establishing connections in advance. Myer said communities need to develop “nodal networks,” which could include churches, community groups, doctors’ offices and pharmacies, and they need to use these networks to get disaster information to communities. Strategies are also needed in advance to mitigate impacts on health.
“Start before a disaster and start with networks,” Myer said. “Talk with people and provide information and resources in advance.”
Since 2010, five rural hospitals have closed in Alabama. Nationwide during that time, 89 rural hospitals have closed and 674 are considered vulnerable.
“That leaves a lot of people without access to care in these rural communities,” said Dr. Thomas English, assistant professor of management at UA’s Culverhouse College of Business.
He and Dr. Todd Smith, assistant professor of nursing instruction at UA’s Capstone College of Nursing, are studying six rural hospitals in Alabama that have closed – Randolph Medical Center, Southwest Alabama Medical Center, Hartselle Medical Center, Elba General Hospital, Chilton Medical Center and Florala Memorial Hospital.
Financial problems, and challenges recruiting doctors and other health care providers, were among the reasons for closure. Hospital closures hit rural communities hard, Smith said.
“In rural communities, hospitals are a major economic income. When a hospital closes, per capita income decreases, unemployment increases, there’s less access to medical care, especially specialty care, and doctors leave,” he said.
But Smith and English also found that many residents living where the six hospitals were located often traveled to neighboring cities and counties for care, even when the hospitals closer to home were still open.
Hospital closures have had a significant impact on EMS service. Wait times, transfer times and turnaround periods increase, and mortality rates are often greater for heart attacks and trauma, Smith said.
English and Smith are also studying Pickens County Medical Center in Carrollton, Alabama, which is struggling but still open. One thing they have found is that the hospital might not be in the best location in the county.
“A lot of people live in a place in the county that is closer to DCH Regional Medical Center hospitals in Northport and Tuscaloosa, or Baptist Memorial Hospital in Columbus, Mississippi,” English said. “What if the solution is not building a new hospital, but a new road to get people there more quickly.”