Symposium explores rural health care

Valley News Staff Writer
Published: 11/7/2022 10:34:30 PM
Modified: 11/7/2022 10:34:01 PM

FAIRLEE — Dartmouth Health cannot alone address the inequities that result in residents of Claremont having an average life expectancy 10 years shorter than residents of Hanover, officials said at a Monday event.

Instead, they said they hope that a new Center for Advancing Rural Health Equity will bring together community members involved in providing health care, social services, research and education to address wide-ranging barriers to good health such as transportation, internet access, food security, housing, child care, classism, ableism, ageism, sexism, homophobia and transphobia and racism.

“The health system used to think they had to do it alone,” Dr. Joanne Conroy, DH’s CEO, said during her remarks at the beginning of Monday’s launch event, held at Lake Morey Resort in Fairlee and titled “Working Together to Improve Health for Rural New England Communities.”

But Conroy, who took on leadership of DH in 2017, said that as she spoke with community partners in the Upper Valley she heard comments from leaders of other Upper Valley organizations such as Sara Kobylenski, the former director of the Upper Valley Haven.

“You don’t get homelessness,” Conroy recalled Kobylenski telling her. “You should leave it to  the experts.”

As the country’s most rural academic medical center — about 170,000 people live within 30 miles of Dartmouth Hitchcock Medical Center in Lebanon — Conroy said the hospital is well positioned to study the health challenges people in rural areas face. The next most rural academic medical center, in Rochester, Minn., has about 250,000 who live within 30 miles, Conroy said.

The new center is staffed by DH employees, who are devoting some or all of their time to the project, Dr. Sally Kraft, DH’s vice president of population health, said in an interview following the session. It’s being funded through a grant from an anonymous donor and $448,000 brought to New Hampshire by Sen. Jeanne Shaheen, D-N.H., through the congressionally directed spending process. The effort is being led by a leadership council, currently chaired by Rudy Fedrizzi, the director of the White River Junction Public Health Services District. The work also will be informed by a community advisory council.

In his remarks, Fedrizzi said he expects the new center’s journey will be long, but he hopes it will be “action and solution-oriented.”

During a keynote, “Working Equitably to Assure an Equal Opportunity for All to Thrive,” on Monday, Dr. Trinidad Tellez, a principal at (Health) Equity Strategies and former director of the Office of Health Equity at the New Hampshire Department of Health and Human Services, said that just about 20% of health outcomes are tied to the medical care people receive. The rest has to do with with downstream effects, known as the social determinants of health, that include the environments where people live and work, as well as governmental policies and those of large organizations.

To move toward equity, Tellez said, clinicians and others need to “Be sure not (to) perpetuate the traditional ways of operating that have produced harm.”

Doing so, she said, will “require a willingness to be vulnerable” and centering the patient in conversations about their own care and health.

It also will require that “people with power” be “willing to give up some of that power and share it so we can be in partnership,” she said.

Tellez said she had worked in Lawrence, Mass., one of the poorest communities in the country, which has often been studied by Boston-based institutions. At the time Tellez worked there, she said the community was tired of “helicopter researchers” who came to town to conduct studies and then left without fixing anything.

Tellez encouraged researchers to work with communities as partners to determine answers to questions such as who owns the data produced by the research, who’s going to collect it and how the funding for the research will be shared. She also encouraged those present to remember marginalized populations when considering who to involve in the work.

“Everyone is here,” she said of the region. Including “people we may not have remembered to remember.”

Another element of change that the project’s participants seek to address is how to fund efforts to improve their health.

Rich Grogan, executive director of Northern Border Regional Commission, said the commission aims to direct federal money to projects that are important to communities in northern New York, Vermont, New Hampshire and Maine. Traditional forms of economic development, which focused on infrastructure and attracting large employers to create local jobs, aren’t sufficient, he said. Funders also must look to invest in people, or “human capital,” such as efforts to sustain child care centers that make it possible for parents to work.

On the health care front, the Northern Border Regional Commission is hiring a health care program specialist to work on developing a J-1 visa waiver program aimed at addressing the shortage of qualified physicians in the region, he said.

The topic of the ongoing workforce shortage also came up during the question and answer portion of the event’s opening session.

Amanda Jordan Smith, Volunteers in Action coordinator at Mt. Ascutney Hospital and Health Center in Windsor, said she feels that the challenge for Black, brown and queer people isn’t in drawing them to the Upper Valley, but keeping them here. So for employers, it’s an issue of retention, not recruitment.

Conroy acknowledged that retention can be challenging for the health system, whether for challenges employees face at work or outside the workplace. In an effort to address that, she said DH has created employee resource groups on various topics to help people find a “sense of belonging” and also to educate others. The measurement of the success of that effort will be in the organization’s success in retaining people of all backgrounds, Conroy said.

In response, Smith, a former member of the Windsor Selectboard, said the role of the employee resource groups is a “big job” for employees to shoulder.

“Racism is a public health emergency now,” Smith said. “...Delayed justice is oppression.”

Pointing to issues such as reproductive and trans rights, Smith asked that officials not use the term justice if they’re not willing to fight for it.

She criticized the layout of the forum, which had the speakers seated on a raised platform.

“Who is speaking?” she asked. “Who is elevated?”

The launch event was slated to run all day with breakout sessions and panels focused on topics such as maternal and family health; health and housing; food and nutrition; how to hear from those whose voices are often missing; how to build trust; and how to determine if the work is making a difference.

Nora Doyle-Burr can be reached at or 603-727-3213.

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