Access to rural healthcare is bigger than hospitals – and North Carolina is leading the way

A lot of people hear the phrase “rural health” and automatically think about hospitals.

They think about how North Carolina facilities are struggling to keep their doors open or about maternity wards shutting down. Widespread shortages of physicians and nurses, or the long drives to see a specialist, probably come to mind too.

Those are all valid concerns. Rural hospitals are essential to their communities and are struggling. North Carolina is right to invest in them through the Rural Health Transformation Program.

But hospitals are only part of the rural healthcare access story.

People aren’t healthy just because they live near a hospital. They are healthy when they can access nutritious food, have stable housing, and have transportation to their medical appointments, community support services, and jobs.

Health begins long before someone steps foot in a doctor’s office. Public health experts call these factors the social determinants of health. If you don’t have a balanced diet or access to nutritious foods, your health suffers. If you are worried about keeping a roof over your head, your stability suffers. If you can’t find childcare so you can go to work, your well-being suffers. The challenge for healthcare providers and community support systems is figuring out how to address those needs.

Fortunately, North Carolina is making important progress.

The state’s “Healthy Opportunities” pilot programs, built on a platform from software and data infrastructure company Unite Us, connect healthcare providers with community organizations working to meet basic needs like food, housing and transportation. These efforts, which were recently restarted thanks to funding in North Carolina’s new state budget, recognize that coordinating both medical and non-medical services is more effective than treating them as completely separate systems. Already, the approach is producing results.

One pilot in western North Carolina focused on people living with chronic health conditions who also faced food insecurity. Through a coordinated network that helps ensure that clinical and community-based service providers are connected to avoid gaps in care, organizations like Meals on Wheels provided participants with healthy food and tailored nutrition support. By helping people better manage their chronic conditions through nutrition, health outcomes improved.

Not surprisingly, improving access to nutritious food, transportation, and other basic supports makes it easier for people to stay on top of their health. Data show that those who received meals experienced an incredible 67% decrease in the risk of hospital readmission.

And, overall, Healthy Opportunities achieved $164 in Medicaid savings per person each month—all while making them healthier. Imagine if this impact could be scaled to the 3 million North Carolinians who rely on Medicaid.

Importantly, some of our communities face steeper obstacles than others. Rural and minority communities are more likely to suffer from chronic illnesses and poorer health outcomes due to less access to healthcare and social support programs. For Black North Carolinians facing the most troubling health disparities, those gaps reflect decades of opportunity gaps and inequities. Hospitals and physicians can’t solve those problems on their own.

We can’t talk seriously about health equity without talking about the conditions people live in. That’s why I hope state leaders view the Rural Health Transformation Program as more than an investment in hospitals. Instead, we must see it as a generational chance to strengthen the community networks that help people stay healthy.

Successful programs are too often treated as temporary experiments. A pilot demonstrates results, but then funding runs out, and everyone moves on to the next idea. However, the underlying needs will grow without sustained commitment from state leaders.

The Rural Health Transformation Program can help address those challenges and make North Carolina healthier. But state leaders should not stop there.

North Carolina should keep investing in and scaling the community programs and care coordination networks that are already improving lives across the state. Programs like the Healthy Opportunities Pilot should continue to be well-funded and set up to be a more permanent part of the state’s infrastructure of care.

Rural health won’t improve by building stronger hospitals alone. It will improve because we recognize that health is shaped by what happens at home, in neighborhoods, and in communities every day.

That’s where real health transformation begins, and I look forward to following the trail North Carolina blazes on the path to wellbeing.

Julianne Malveaux, president emerita of Bennett College for Women, is an economist and author and currently serves on the boards of the Economic Policy Institute, the Recreation Wish List Committee of Washington, DC, and the Liberian Education Trust. She is also president of PUSH Excel, the educational branch of the Rainbow PUSH Coalition.