Title: Hilda R. Heady, MSW Associate Vice President for Rural Health West Virginia University 2005 NRHA Pre
1Myths, Magic, and The Real McCoy Insights into
Rural and Appalachian Culture
- Hilda R. Heady, MSWAssociate Vice President for
Rural HealthWest Virginia University 2005 NRHA
President
2- Presented for the
- The Robert C. Byrd Health Sciences Center
- At West Virginia University
- Faculty Development Noon Series
- February 7, 2007
- John E. Jones Conference Center
3Objectives
- Discuss the many varied definitions of rural and
Appalachia. - Discuss the values of rural people and how these
values make rural special and not just different
due to disparities. - Learn why it is important for policy makers and
health care providers to understand these
concepts. - Learn about policy differences and disparities
between urban and rural health care policy and
delivery.
4- Effective cultural competence is characterized by
the appreciation and understanding of ones own
and anothers culture - and the similarities and differences of the
culture of the two and the many
5Know and appreciate your Cultural roots and
those of others
6Just Different?
or Special
7Rural Beatitudes
8Blessed are the rural for they are collaborators
and are self-reliant
9Blessed are the rural for they value their
families
and are friendly folks
10Blessed are the rural for they value
individualism and are personable, independent,
and modest
Blessed are the rural for they are independent
and modest
11Blessed are the rural for they are
patriotic, and they go to war
12Blessed are the rural for they serve others
without being asked
13Blessed are the rural for they work the earth
And they make stuff for everyone else
14- Blessed are the rural for they have a deep
faith, - a sense beauty, and a sense
- of humor
15- Blessed are the rural for they ALL
- deserve high quality health care!
16Our efforts to define community are less
important than our search for common
unity. Hilda R. Heady
17Health Care Delivery, Interventions, and
Education
- Require more than addressing cultural competence
- They require the grace of understanding.
18Rural is.
- Defined by tradition and history
- Defined by geography and politics
- Defined by legend and myth
- Defined by culture and values
19Appalachia is.
- A geo-political region
- A mythical place
- A manufactured idea (Jones)
- A complicated notion (OBrien)
20Appalachia and Rural
- Most densely populated rural area in the US with
a geo-political definition - A recognized rural mountain culture
- Urban Appalachia exists and with rural
Appalachian neighborhoods
21Commonalities of Definitions of Rural
- Rural is defined by what it is noturban
- Rural is defined by geography and population
density (census blocks not in urban areas or
urban clusters 1,000 per square mile is urban 6
per square mile is frontierrural is just about
everything else) - Rural is an objective quantitative measure
- Rural is a subjective state of mind
22Geo-Political Appalachia
- 1961 President Kennedy formed the Presidents
Appalachian Regional Commission - 1964 report showed that incomes were 23 to 25
lower in Appalachia - Health and educational status below national
norms - Designated as targeted region in federal
legislation in 1965 under President Johnson
23Geo-Political Appalachia
- 200,000 square miles
- 23 million people
- 42 are rural
- 410 counties, all of WV, and portions of other 12
states - Alabama, Georgia, Kentucky, Maryland,
Mississippi, New York, North Carolina, Ohio,
Pennsylvania, South Carolina, Tennessee, Virginia
24Southern Appalachia
- Identified as having the most acute needs
- 200 counties in Alabama, Georgia, Kentucky, North
Carolina, Tennessee, Virginia and West Virginia -
a total of 80,000 miles - 6 million people
- Largely Caucasian from primarily Scotch-Irish or
British heritage
25 Mythical, Manufactured Appalachia
- Reinforced Stereotypes
- The Real Beverly Hillbillies
- Poverty always breeds fatalism
- Rustic, quaint, charming
- Fatalism and ignorance are rural and Appalachian
values
26How we shoot ourselves in the foot
- We send confusing messages because we can laugh
at ourselves but you cant - We have toothless millionaires
- We cherish the streams and mountains we sometimes
pollute - We sometimes believe the stereotypes others hold
for us
27A Complicated Appalachia
- We know who we are yet we still try to define
ourselves within the mainstream culture - We leave Appalachia yet we always want to go
home - Our existentialism is our Appalachian fatalism
dressed up for town (OBrien) - Our desire for freedom and solitude is both our
strength and our undoing (Jones)
28Appalachia is complicated by its own economic and
social history
- A colonial and extractive economy
- Class struggles defined by economics not
necessarily ethnicity or race - Missionary work and socialism cut their teeth on
Appalachian woes
29- Culture and
- Lifestyle
- Which has the greater impact?
- Larger societal culture or
- The sub- culture or
- The culture clash
30Cultural Strengths..
31(No Transcript)
32(No Transcript)
33(No Transcript)
34And Cultural Weaknesses
35- We must move
- beyond
- Deficit-Based Advocacy
36Translating values into advocacy
37Understanding Values inAdvocacy and Framing
- Framing means using language that appeals to
standard concepts - Framing means appealing to mental constructs
38Framing
- Framing means using metaphors that most live by
- Successful framing leaves an impression and
mental image - Imbedding data within the story leaves an
impression
39Family Values
40 41How To Talk Rural Issues and Policy
- Publication by W.K. Kellogg Foundation prepared
by FrameWorks Institute (Food Systems and Rural
Development) - CD for Rural Advocates
- How to create messages based on how people
currently think about Rural America
42To Talk Rural Issues and Policy First Dispel the
Stereotypes and Myths
- Rural Utopia
- Poverty is ennobling
- Life is simple and chosen to be this way
- Rural will take care of themselves
- Rural Dystopia
- Rural people are backward
- They are Others
- They need to catch up with the rest of us
43To Talk Rural Issues and Policy First Dispel the
Stereotypes and Myths
- Rural needs protection from the outside from
urban-suburban (rural places are non-evolving so
we need to leave them alone) - Change is THE Rural problem (creating change in
rural causes problems)
44More Effective Frames
- Clear and concrete explanations of the causes of
problems - Fairness frame rural areas are not given a fair
share - Interdependence frame improving rural benefits
all - Simplify models using metaphors and analogies
45Dos and Donts in Rural Issues and Policy
Communication
- Do understand how to make the fairness argument
- Do use simple models, metaphors, analogies,
stories, anecdotes - Do understand how different frames impact
different audiences and target messages for the
audience - Do give people hope and solutions
46Dos and Donts in Rural Health and Policy
Communication
- Do promote empathy and identification with rural
by emphasizing the sameness not differences - Do show rural people engaged in positive change
- Do connect rural to the rest of the country
- Do establish our shared fate of the impact of
rural problems on the rest of the nation
47Dos and Donts in Rural Health and Policy
Communication
- Dont fall into the stereotypes and framing traps
they lay - Dont make change the enemy
- Dont promote sympathy for rural people based on
deficits - Dont make government the only solution
- Dont create a competitive mind-set for same
resources - Dont assume people know source of problems in
rural America
48Rural Policy influence in Health Professions
Education
- Tax Credits for doctors in HPSAs, 1000 monthly
for up to 5 years. (S. 824). - Tax credits for doctors in frontier areas (S.
2789). - Increase VA training of medical residents and
health professionals in rural areas (H.R. 5524) - Integrated Rural Training Tracks
49Urban-Rural Policy Disparities in Health Care
- Medicare reimbursement policy discriminates
against rural providers - Based on historically erroneous fiscal
assumptions - Based on greater political power of urban
providers and trade organizations - Health care access policies that do not consider
rural challenges
50Title VII and Rural Health Funding
- Extensive Hill visits to advocate for rural
health safety net providers and programs - Linked safety net provider needs and rural
community based health professions training - Joint visits with NRHA, NAO, HPNEC, NHSC
51Title VII and Rural Health Funding
- AHEC trained physicians presented at
congressional briefing on Title VII funding - Extensive grassroots advocacy across the country
52Medicare Payment Advisory Commission (MedPAC)
- Federal law requires that MedPAC representation
include a balance between urban and rural
representatives.
But only 1 out of 17 MedPAC Commissioners is
Rural!
53Where are we Now?
- House Budget Bill completed
- Level funding for Rural Health
- Some Title VII programs for rural areas still
eliminated, only one restored - Senate Labor-HHS-Ed bill out of committee
- Level funding for Rural Health
- No eliminated Title VII programs restored
54Look for Understanding and answers In the
simple and common places first.
55(No Transcript)
56 Our faith in the human spirit is to know that
its own sense of innate health can guide us in
all our endeavors. Hilda R. Heady