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Title: Hilda R. Heady, MSW Associate Vice President for Rural Health West Virginia University 2005 NRHA Pre


1
Myths, 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

3
Objectives
  • 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

5
Know and appreciate your Cultural roots and
those of others
6
Just Different?
or Special
7
Rural Beatitudes
8
Blessed are the rural for they are collaborators
and are self-reliant
9
Blessed are the rural for they value their
families
and are friendly folks
10
Blessed are the rural for they value
individualism and are personable, independent,
and modest
Blessed are the rural for they are independent
and modest
11
Blessed are the rural for they are
patriotic, and they go to war
12
Blessed are the rural for they serve others
without being asked
13
Blessed 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!

16
Our efforts to define community are less
important than our search for common
unity. Hilda R. Heady
17
Health Care Delivery, Interventions, and
Education
  • Require more than addressing cultural competence
  • They require the grace of understanding.

18
Rural is.
  • Defined by tradition and history
  • Defined by geography and politics
  • Defined by legend and myth
  • Defined by culture and values

19
Appalachia is.
  • A geo-political region
  • A mythical place
  • A manufactured idea (Jones)
  • A complicated notion (OBrien)

20
Appalachia 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

21
Commonalities 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

22
Geo-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

23
Geo-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

24
Southern 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

26
How 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

27
A 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)

28
Appalachia 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

30
Cultural Strengths..
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34
And Cultural Weaknesses
35
  • We must move
  • beyond
  • Deficit-Based Advocacy

36
Translating values into advocacy
37
Understanding Values inAdvocacy and Framing
  • Framing means using language that appeals to
    standard concepts
  • Framing means appealing to mental constructs

38
Framing
  • Framing means using metaphors that most live by
  • Successful framing leaves an impression and
    mental image
  • Imbedding data within the story leaves an
    impression

39
Family Values
40
  • Values Family

41
How 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

42
To 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

43
To 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)

44
More 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

45
Dos 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

46
Dos 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

47
Dos 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

48
Rural 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

49
Urban-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

50
Title 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

51
Title VII and Rural Health Funding
  • AHEC trained physicians presented at
    congressional briefing on Title VII funding
  • Extensive grassroots advocacy across the country

52
Medicare 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!
53
Where 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

54
Look for Understanding and answers In the
simple and common places first.
55
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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
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