Rowitz On Leadership

    I recently returned from a trip to the Amazon in Peru. As my wife and I sailed a flooded river, we saw thatched roof houses along the river which were partially submerged for more than three months. Yet, families still lived in these houses without electricity, gas, or running water. They could not farm because of the water. The families fished, gathered fruits from inland trees and bushes in unflooded areas, and took their dugout canoes once a month to a small town several hours away where there was a large open market. They traded and sold fish, fruit from high trees, handicrafts to the tourists in the town, and whatever else they could sell. The families were large and yet they the family members seemed happy. Why do I tell you about these people in these remote sites? Rural people and rural areas are not homogenous. Rural communities take many forms and people learn to survive in whatever the natural elements present to them. Rural communities in our country struggle on a daily basis. Health care is often not readily available. Long distances may be the only way to get needed health care.

    Meit and Knudson recently struggled with the question of why rural public health is important(Journal of Public Health Management and Practice,15, 3, May-June 2009,185-190). Our small rural public health departments struggle on a daily basis with gaps in our health service system that need to be addressed in order to promote the health of our rural citizens. There is no uniformity in these health departments as there is no uniformity in the public health systems of our fifty states. Rural public health leaders have unique challenges as they try to address the health and prevention needs of their populations. Health disparities exist in rural area. There tends to be higher smoking rates among teenagers and adults, fewer dental care visits, lack of health insurance coverage, high death rates for unintentional injuries generally and motor vehicle injuries specifically, exodus of young adults from rural to more urban areas, and higher death rates for young people.

    Rural public health leaders in these small health departments have to do more with less—less money, less staff with minimal training, sometimes geographical isolation, limited technical resources, poor salaries, and few community partners. Leadership issues involve problems in collaboration, lack of financial resources, difficulties in carrying out the public health core functions and essential services which will complicate accreditation possibilities, too few staff, old equipment, fear of the local board, hard to get and pay consultants, migrant issues during harvesting season, untrained staff without time to get training, preparedness challenges, bilingual and cultural issues, aging populations, community assessment difficulties, lack of a coordinated health care system, border health concerns in border states to Canada and Mexico. Some possible leadership strategies include the building of social capital with yhe county board or the Board of Health if one exists, assets planning with other community agencies such as schools, more partnership building utilizing a regional model, and building coalitions utilizing different meeting modalities such as rotating meeting throughout the county or teleconferences or other distance technology(The Internet). Synergistic leadership skills need to be developed to create relationships that allow for collaboration when few health organizations exist. It is necessary to build public health infrastructure so that more results can be gotten in resource deprived communities. Many of these important rural issues were covered in the seminal 2004 report from the University of Pittsburgh Center for Rural Health Practice, Building the Health Divide: The Rural Public Health Research Agenda.  www.upb.pitt.edu/crhp.aspx     Also look at the report HARD TIMES IN THE HEARTLAND at    www.healthreform.gov