People across the country formed long lines for free meals and groceries at food pantries and social service centers after SNAP benefits were suddenly cut off because of the ongoing government shutdown. Others were shocked by the double digit increase in their health insurance when they opened their new plans this weekend. In this time of rapid change, rural communities across the United States — including those in New Hampshire — are confronting even greater substantial challenges that threaten the fabric of their health care systems, social service organizations and economic security.
The future wellbeing and resilience of rural New Hampshire depends upon our collective ability to respond strategically to these unprecedented changes. This opinion piece presents a comprehensive, people-centered framework to respond to the challenges, which could lead to a healthy and resilient rural New Hampshire.
To ensure that rural communities not only survive but flourish, it is crucial for decision- makers — including health care leaders, policy makers and government officials — to join forces with rural leaders and community-based organizations. Together, they could construct a shared charter: a collaborative set of goals, values, strategies and practices designed to address the new realities facing health care, economic development and social and civic wellbeing in rural New Hampshire.
Planners must ensure that community leaders, residents and their community-based organizations are at the center of the change process. When those living in the community are empowered to shape their community’s future, the likelihood of successful, sustainable outcomes significantly increases. Trusting community members with meaningful roles in shaping solutions ensures that systems are designed to be truly patient and community focused. When the voices and experiences of community stakeholders are genuinely valued, the resulting approaches are more relevant, accessible, and effective for everyone.
The framework centers on fostering comprehensive and meaningful partnerships between the community and planners. By actively engaging a wide array of groups — including faith leaders, social and civic organizations, law enforcement, housing advocates, small business owners, trade associations and educators — solutions become more robust and reflect the community’s shared values, collective experience and economy. By integrating the perspectives of all sectors, who understand the unique culture and needs of their community, solutions are more likely to be embraced and sustained.
Thirdly, the more policy makers and planners address multiple community factors simultaneously recognize their interconnectedness in their planning, the more likely solutions will effectively meet community needs. For example, one must understand that rural hospitals, health centers and mental health facilities are not only vital health resources but also major economic drivers. They provide jobs for local residents and support local businesses by sourcing services and supplies locally. Many providers are neighbors of those living in the community. A closure of any one of these services can be dramatic: the community suffers not only from decreased access to health care but also from economic decline, as workers may be forced to relocate, decreasing population, reducing the tax base and straining the social fabric as friends leave.
In addition, consider:
- Infrastructure gaps, such as limited broadband hampers telehealth and digital health monitoring, along with other technology shortages that limit effective communication with specialists.
- Disparities in health outcomes, as rural residents often experience higher rates of chronic illness, shorter life expectancies, and delays in seeking care due to geographic distance or financial limitations.
- Rural communities need specialty services to address issues faced by older adults, children and youth, pregnant and new parents, mental health and substance use disorders.
- Using community health outreach workers to help meet clinical staffing shortages and/or for coordinating care and health navigators to assure rural residents understand and get access to the appropriate health insurance.
- Connections between community-based organizations and health providers to address the social determinants of health.
- Promoting transparency and regular communication to build trust between all stakeholders.
This proposed framework encourages building trust and urging decision-makers to recognize and harness the strengths of local rural leaders and their organizations in the planning process. Utilizing authentic engagement and collective action, New Hampshire can not only address current challenges but lay the groundwork for a healthier, more prosperous future — ensuring that our rural communities continue to thrive.
Michael J. Cohen is a principal consultant at MJC Health Solutions, LLC. He is a member of the Board of Directors of the NH Association of Conservation Commissions. He lives in Amherst.