Rural Health Preparedness and Response: A Q&A with Alan Morgan

Preparedness, Part 2 

September 24, 2020

With underfunded rural health systems, inequitable access to quality health care, and high rates of chronic health conditions among residents, COVID-19 has posed a substantial threat to rural communities. In an effort to learn more about the present and future health needs of these communities, we discussed pandemic and disaster preparedness and response in rural settings with Healthiest Cities & Counties Challenge advisory council member Alan Morgan of the National Rural Health Association. 

As you know, September is National Preparedness Month. In your experience, what does emergency preparedness and response currently look like for rural health systems?

 The issue with COVID-19 in rural areas is that the uniqueness of each individual community and unevenness of infection spread makes it very challenging to respond to. What makes response even trickier is that you can’t apply urban solutions to rural systems; rural is not a small version of urban.

Cases of COVID are decreasing in urban areas and increasing in rural areas, so rural areas are where we really need to be worried about. It’s rural small towns that have a high percentage of elderly people, individuals with multiple chronic health conditions, workforce shortages, and fewer health service providers. These individuals don’t always have access to insurance, or if they do, they have insurance policies that have high copays and deductibles, making them even more reluctant to seek care.

Preparedness is difficult in that context, and it’s these same communities that also have yet to buy into masks and social distancing. It’s a perfect storm of varying factors that has made COVID difficult to respond to in rural communities.

So, what are the solutions to some of these barriers that you’ve expressed and what opportunities exist for rural communities to improve policies and procedures related to emergency preparedness and response to increase access to care during a disaster like COVID-19?

Solutions have to happen at the community level. There has to be vocal communication and outreach to these communities about the issues that exist within their communities and how they can be addressed.

The Challenge gets to the heart of this. It’s easier to implement innovation and change in small systems. All of the innovation that we have seen in the health care system began in rural towns because they are operationally smaller and can easily innovate. They can directly apply solutions. As a result, communities have become innovation hubs for policy and healthcare delivery. For example, the concept of community health workers came from rural communities. And during COVID, it is this same community health worker concept that has taken a whole different line of importance.

Finally, there needs to be strong linkages and collaboration between urban and rural cities. With COVID, we have seen cooperation between rural and urban hospitals as a result of hospital surges. That type of coordination is necessary. You can’t work in silos; you have to realize the importance of rural cities in addition to urban ones.

Do you have some relevant emergency preparedness and response resources or examples of model policies that you would recommend to rural communities?

First, we have a NRHA COVID-19 TA Center on our website. There are two professionals there that help with testing, tracing, and financial resources. Secondly, we have an emergency preparedness resource page for rural communities. Finally, we are also updating a policy paper on rural preparedness that talks about policy barriers and opportunities for emergency services.

What would be your number one piece of advice to the Healthiest Cities & Counties Challenge teams as they plan for recovery after COVID-19?

To keep working together to redesign a sustainable rural health system, one that is a health care system and not a sick care system. When you get to a point where your community is working to keep you outside of the hospital and is providing you with tools to keep yourself healthy, that’s the ultimate goal. That’s what the Challenge works to accomplish.

Alan Morgan is currently the Chief Executive Officer of the National Rural Health Association. Morgan obtained a bachelor's degree in journalism from the University of Kansas and a master’s degree in public administration from George Mason University. With over 27 years of health policy experience, Morgan has worked for U.S. Congressman Dick Nichols and former Kansas Gov. Mike Hayden. His public health experience also includes work with various organizations like Vizient, Inc., Heart Rhythm Society, and American Society for Clinical Pathology. 

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