Share Public Health Transcript: Rural Health, We’re All Connected

Season 2 Episode 15

Hannah Shultz:
Welcome to Share Public Health, the Midwestern Public Health Training Center’s podcast connecting you to public health topics, issues, and colleagues throughout our region and the country, highlighting that we all share in public health. Thank you for tuning into this series which focuses on rural health in the Midwest. Over 10 episodes, we talk with people in a variety of communities about their experiences and perspectives on rural life, employment, and health. Our aim is to deepen understanding about the complexity of rural life and celebrate rural areas. We’re so happy you’re listening and learning along with us.

Welcome back. I’m Hannah Shultz, your host and producer of this series on Rural Health in the Midwest. This is the final episode of this series. What a joy it has been for me to spend 10 weeks sharing stories of rural life and rural health with you all. This series has by no means been a comprehensive look at rural life or even rural life in the Midwest, or even rural life in Iowa. But through the stories we’ve shared, we hope to have shown a light on the diversity and complexity of rural experiences.

Today, we’re going to talk with five faculty members from the University of Iowa College of Public Health about why this was a series we felt compelled to produce. All of our guests today are active in rural health work and research and were involved in planning and guiding this series. Typically, I introduce our guests, but because we have five people today, I want to let them introduce themselves to give our a listeners an opportunity to hear their voices and connect their voices to their names. We’re going to start with Hans.

Hans Lehmler:
Yeah. My name is Hans Lehmler, I’m faculty in the Department of Occupational and Environmental Health. And one of the things I do within the college is lead a center that’s funded by the National Institutes of Health that promotes studies of environmental health sciences in particular, as it relates to the rural environment. And there are very few centers along those lines in the United States that really worry about environmental health in rural America, and particular, in the rural Midwest.

Rima Afifi:
I’m Rima Afifi. I am faculty in the Department of Community and Behavioral Health of the College in Public Health. And I lead a center that’s funded by the Center for Disease Prevention and Control, the Prevention Research Center for Rural Health.

Brandi Janssen:
Hi, my name is Brandi Janssen, I’m faculty in the Department of Occupational and Environmental Health at the College of Public Health. I also direct a state funded center, funded by the state of Iowa that focuses on occupational illnesses and injuries associated with agriculture. And most of my research has looked at alternative agriculture and local food systems in our state and in the Midwest.

Edith Parker:
I’m Edith Parker. I’m the dean of the College of Public Health. And previous to becoming dean, I was involved with the center that Rima directs, the Prevention Research Center and also I’ve worked with Hans and others on the Environmental Health Sciences Research Center on the Outreach Corps.

Diane Rohlman:
Hi, I’m Diane Rohlman. I’m a faculty member in occupational and environmental health, and I direct a center called The Healthier Workforce Center of the Midwest. And we’re focused on promoting the health safety, and most of all, the well-being of people working in our community.

Hannah Shultz:
All of us in this conversation are affiliated with the University of Iowa College of Public Health. We’re in a pretty rural state. We have several centers focused on rural health in some way, but I was still curious enough to ask our guests, why this was an important series for our college.

Rima Afifi:
So I think it’s very important to highlight the issues around rural health and well-being, because they get somewhat less attention overall in the public health field or other disciplinary fields. And yet there’s so much of our lives wherever we live nationally or globally that is affected by what happens in rural areas. So that was one part of it. The second part of it was that our location in Iowa means that many of us are engaged with rural communities in understanding and supporting rural well-being.

And it was an opportunity to highlight, I think, all the work that we’re doing in partnership with communities at the College of Public Health. And the third thing is I think that that experience that we’ve all had has shown us very clearly that the general attitude about rural, meaning mostly negative things, it’s very contrary to the experiences that we’ve all had and we wanted to show or to suggest a paradigm shift to see rural as very diverse and not sort of the one image that seems to come to mind when people think about rural, but also to highlight the amazing positive assets that are held within rural communities.

Edith Parker:
Rural health is one of our collective areas of excellence in the college. And I think that we have so much going on that sometimes we don’t even stop and pat ourselves on the back about it. And through these different centers and activities and research and engagement that we have, I think we’ve also been able to kind of work across our different centers and research projects to harness that. And I think with the growing up, I think Rohlman is right, too much in public health, we take a deficit approach and not a strengths-based.
So it’s really important that we highlight the strengths in rural areas, but I also think we need to acknowledge that there is a growing concern about the health disparities that exist in rural areas just by being a resident or being born in a rural area. And so that’s something that we really want to bring attention to our colleagues across the country and in public health and then not in public health.

Hannah Shultz:
We didn’t define rural in this series, poor Midwest. And throughout this series, we haven’t usually taken health head-on or defined it, but it’s been a theme throughout, no matter who we’ve talked with, Hans does an excellent job explaining why it’s important to have a holistic understanding of health.

Hans Lehmler:
I think it’s important to discuss briefly, how do we define health? And if you look at the World Health Organization, they define it very broadly. They talk about the physical, the social and the mental health being. So a lot of the topics that are covered in the podcasts and all the different series, they in some way touch on these various aspects.
So if you are not connected to the rest of the world, because you live in a rural place where you don’t have broadband access, you’re at a disadvantage from a social perspective. You cannot participate like people that live in coastal areas and in big urban areas. And so that in some ways from that perspective affects indirectly your well-being. And so from that perspective, I think it’s important to see that when we’re talking about this, is there something that you need to go and see the doctor for? It’s much broader how would we should look at health.

Diane Rohlman:
I think one of the goals of the podcast was to let people define rural themselves. And so the podcast presented a snapshot of different viewpoints and different scenarios, and being able to listen to those, it might expand your definition of rural, but it might also contract that too. But the point is I don’t think there is one definition of rural, that it can be defined in many ways whether you use economic metrics, whether you have a Walmart, the number of people living there, and how you define it will indicate how you’re going to act on them. So not defining it, I think that’s the point of this, is to let you draw your own conclusions.

Rima Afifi:
I think that rural means very different things to very different people. And in fact, a lot of people that we may consider live in rural areas themselves don’t, and that came out in the interviews quite a bit. I didn’t think I was in a rural area until I went to… It’s almost relative in a sense. They went somewhere else and they realized, or they now live in a rural area, but lived in a rural area that was much smaller and so now they don’t think they are.

It’s such a relative term, and one of the things that comes out in the literature a lot is that, we rarely in defining rural, ask people that live in rural areas themselves, what they consider to be rural and what about it they enjoy. We always are falling back on these quantitative measures that are mostly economic employment measures rather than the breadth of what’s important and beautiful about rural through asking people themselves.

Brandi Janssen:In a few classes that I’ve taught that have focused on rural issues, the first day I have make all the students line up in a single line from most rural to most urban. And I say “You can’t stack on top of each other. You have to be… And you have to make those decisions.” And this is before I give them any of those quantitative measures, this is day one. And then it is so fascinating to watch them sort themselves out and figure it out, especially that kind of, there’s a big chunk of them. There’s always these kids, who are in the Chicago suburbs, right? And whoever is closest to the city gets the most urban designation.
And then on the rural end of the spectrum, right? These tiny little, sometimes unincorporated towns, but then there’s this bit in the middle, and there’s a lot of negotiation. And I remember one instance in particular where two people said, “Well, our towns are about the same size, and so I wind up being the more urban one because my town has a Walmart and hers didn’t.” So you think about what your resources are, what your connections are, and then they had to define it themselves, right? I didn’t give them any definitions. It’s a fun exercise, everybody should do it.

Hannah Shultz:
The more people I talk to in this series and the more hours I spent going back through and relistening to the interviews, the more I became aware of how my rural upbringing is a big part of my identity. I grew up in a small town, but I left half my life ago. And yet I know I still view a lot of things through that small town lens. Rurality can be identity and a point of pride.

Brandi Janssen:
I think one thing, it’s interesting you have talked to people who’ve left or who’ve left and come back or who’ve gone on to work in fields that are not typical in rural areas in the way it distances you a bit from your origins, but you still maintain them. I guess, there’s always, for those of us who do work in public health, part of our job is to develop rapport with people and think about what we have in common with them. And I know for myself that I fall back on my rural upbringing, a fair amount, way more than I ever do my academic credentials, which mean very little to most of the people I work with. Good for them.

So it’s something I think about a lot just as it’s wherever you wind up going, even if you leave, you’re usually like, most people I find are like, “Oh yeah, if you’re from a small town or a little community, or you’re from a farm kid, you connect across those lines regardless of where you’re from. And even if it’s many years later in your often in urban area, it stays with you.”

Edith Parker:
You know Brandi, that’s interesting and a non-empirical, but rather a life experience of having grown up in what I now know is a large town of 7,000, but a high school that was pretty small. Thinking about the advantages of when I then got my first job at Michigan and people were talking about the high schools of 3,000 students, and then there’s some real concerns about even if a student wanted to be on the athletic team, it was nearly impossible and the kind of opportunities that rural schools have.

By the time I got to college, a friend of mine was looking at a year book and said, “Are you everywhere because you were the editor?” I said, “Well, that helped.” But I think it was just because there was opportunity to do everything from sports to student council, et cetera. And how that does shape, I think people’s sense of civic engagement and involvement, whereas in more urban areas, it’s just so hard to competition, to have all of those different experiences is something I’m not really thought about that I think really does mark you going forward.

Rima Afifi:
I think also what came out was the sense that there is community, and at least those that are living in rural areas really value the community that comes from living in that rural area. That they know their neighbors, that they get together for potlucks or that there’s this sense of community and caring about each other as part of their identity. I think as part of the identity of what they consider to be identity and culture, I’d say.

Hans Lehmler:
So I wanted to throw something out, which is maybe more of an international perspective. Now, I guess some of the listeners have picked up on my accent, have placed me that I’m not US born. I’m originally from Germany, and I lived in a big town, but I also lived on the countryside in Germany. And in many ways, a lot of the problems that we talked about, they apply there as well. That there was probably on the countryside, a stronger community that you’d go to the big celebration at the fire department. You didn’t do that necessarily in the city.

Environmental health problems are the same. They also produce manure, maybe not from pigs since it’s cows, but a lot of these issues, they’re the same, they’re everywhere on the planet, probably very, very similar to the identity issues. Conflicts there are the same. And so in some ways in that regard here in Iowa, we’re not unique in that regard. Other people are walking in the same shoes as well.
So I thought it’s just something I want to throw out there, and that maybe it’s actually good sometimes to look at some of the solutions elsewhere. And actually we could talk about being sustainable or regenerative. Germany also is a country with a lot of wind energy like Iowa, and some of the listeners probably heard David Osterberg talk about this, where we are in Iowa and that we’re doing very well with renewable energies, whether it’s solar or wind. So again, there’s another similarity that applies globally. So we should look elsewhere and maybe use the best ideas that are out there.

Hannah Shultz:
In the field I was trained in, human rights and peace building, we commonly talk about the concept of othering. Othering is essentially the idea that the more we talk about differences, the more we focus on what sets us apart, the easier it is for us to not recognize our shared humanity or to put it simply us versus them. I asked most of our guests in the last nine episodes, what some misperceptions of their communities were. And I was constantly thinking back to this idea of othering. Real or perceived, misperceptions can be powerful. Our guests today, weigh in on how misperceptions affect our ability to work together.

Diane Rohlman:
When you talk about stereotypes, I always get a little concerned when we try to categorize people in black and white. And we’re not black and white, we’re multi shades of color with our personalities, with our lifestyles, with our interests. And I hope that this series… The point of this series is to show that variety, and help us to see similarities.

Everybody wants that sense of connection, whether you live in a small town or a big city. So when you characterize small towns as being more friendly and big cities, you can’t make friends. I don’t think that’s true. I think you can have that and how you find that connections, maybe it is easier when you have a smaller number of students in your high school or a community where you see the same people over time.
But even in large cities, we can build that sense of community. But I think the podcast series really is showing maybe some of the similarities and saying, “Well, we’re not all that different and we all believe in the same thing. We care about people, we want to have value in our life and our work. We want to help our environment. We want to help our communities.” So I always caution when we try to dichotomize people, instead of trying to say, “Wow, we have a lot in common.” That’s maybe a more productive approach.

Brandi Janssen:
I do think on both sides, if you will, there’s a lack of understanding about how rural and urban areas are really connected to each other structurally, economically, et cetera. I do think that’s something maybe that rural people understand as the folks who tend to be working in extractive industries and in food production and manufacturing and producing goods that wind up in urban areas. But it’s this cyclical and really tightly integrated relationship that we miss particularly if we dichotomize big versus small or us versus them.

And I think thinking across the whole, if it’s economic, you think along the whole supply chain, if it’s in terms of health, thinking across all of the systems and thinking about everybody’s health and well-being, no matter where they are in the world urban continuum and also thinking about how they’re connected to each other and actually the health of one improves the health of the other. It’s not like pie, I get a piece, you don’t get one. That’s not how it works. So I think thinking along those lines is like to answer it a lot more productive. But I think both urban areas and rural areas could remember more often that they’re connected to each other in important ways, and that seems to be a universal as well that we forget those connections.

Hans Lehmler:
I’m listening to some of the things I’ve just heard, and I think a lot of things is this applies to the global scale, but for state like Iowa, that there are certain experiences as humans we don’t have. And so we can’t relate to that. Working on a farm is very different than working at a university, which is something I appreciate very well. And this is quite different from being a software engineer that maybe you can work remotely with everybody around the world because we have the technology, presumably that makes that possible.

So I think there are a lot of things that just because we’ve never walked the other shoes that we can’t really relate to those people that walk in the shoes, and that creates then a lot of, well, they’re different, right? Something is different there, and it really is not. And that applies to people living maybe in Chicago versus somebody in a small town in Iowa, whatever a small town is, right? And then that applies to also if we go to other places on the planet.

And so I think that world of a continuum, I think is important to keep in mind in this context. There’s a whole spectrum, and it doesn’t matter where you live, we’re all ultimately human beings. We need the same things and can give the same things. Really and understanding how our environment influences us. Yeah, I think that is an important factor if you’re living in a big city, there you have a very different environment and you’re living in an area where you don’t have a lot of traffic, you don’t have a lot of houses, you don’t have a lot of people living there.

And that certainly affects our well-being on several levels. There’s probably a social component to it. There’s, what we would call, exposure to the things that are in our air, in our water, in our food that’s going to be different. And that will have an impact on health. And that will be quite different depending on where you live. That so much has something to do with fitting in a category, rural or urban or something like this. I doubt that, that’s necessarily true. There are probably cities that are clean and urban parts of the world that are quite dirty, and where you may not want to live because it’s not going to be healthy for you and for your children.

And so I think that’s important to keep that in mind, and particular from the scientific perspective for looking at specific problems. It really comes down to looking at that through the lens of the people that we ultimately want to help to address an environmental problem, as Brandi pointed out. We need to engage with the community and think about, what do they want? And that then informs how we can help them potentially. And it’s not somebody coming in from the outside and tells somebody what to do. Again, that’s probably something that applies to humans everywhere on the planet.

Edith Parker:
To add on that, Hans, what I’ve been struck having initially for the first 15 years of my academic career, worked on urban areas, mostly around environmental health and then coming to more rural area, is that connection of sources of air pollution, to find out in Detroit that most of the sources, they were mobile sources, but the point source submission was coming up from rural areas, coal fire plants down in the Tennessee Valley that goes all the way up.

So rural does impact urban. And I think we also know in terms of water sources and some of the run outs of nitrate that are now ending up down in New Orleans, a little bit further source of everybody who’s on the Mississippi. And it goes all the way of urban sources of air pollution, et cetera, that go out in water to rural areas. And I think it’s just a pretty tangible example of how it goes both ways and how interconnected we are for health and well-being.

Hannah Shultz:
Remember how I said earlier, we didn’t really define health or tackle it head on, well, here’s an example. One of the most recurring themes throughout this series was the threat of limited or non-existent access to broadband. Guess what, we think that’s a public health issue.

Brandi Janssen:
I think the sort of overall theme of connections between things when you’re in a space that is a broadband gap, you lack connections in some ways, and that can have really direct effects on health, right? Like I can’t access a provider I need, but also the more nuanced, I can’t really connect me with the people. Thinking about the pandemic and all of that. Well, get on Zoom and have your Thanksgiving. Well, that doesn’t help if your broadband won’t support a Zoom meeting.

I will say on the flip side and thinking back to Edith’s comment about taking a strengths-based approach, it also does mean that connections in rural areas do have to happen in real life sometimes. And I think that was one of the the arts and culture, session episode was really powerful in that way, thinking about how music and theater and storytelling and those elements are actually often really strong in rural areas in ways that people don’t know. And sometimes the lack of access or the lack of constant attention to broadband may facilitate some of those things. So I think it’s always worth looking at the other side of it as well.

Diane Rohlman:
I guess I’ll build off of what Brandi said is, when we think about… So a lot of my work is looking at small employers, and how do we help them have safe workplace to just keep their workers healthy and be productive, because we want to keep them in business. And a lot of times, smaller players don’t have the resources that are available in large organizations, but also that you can get we stick with the broadband with some of the connectivity. So it means that people need to do different jobs.

So as an owner, you may also be the human resource person. You may also be the safety person. You may be the wellness person. And Brandi was talking about with the arts, how does interactions occur in a person? And you have to be creative, We see that in small businesses too. So when you are in a community, you need to look at community resources and what’s available. And when the college has gone out to communities to talk and learn from their business leaders, that’s what we hear, is we see partnerships between the hospitals that are there, between the schools, between different employers, and it’s a chance to share solutions that have worked, but also commonly address problems. And it’s a unique, it’s different from a situation where all those resources are under one roof.

Edith Parker:
I think the other thing about broadband, is it’s a symbolic of the lack of investment in rural areas, and that’s not the case around the world. I remember we were talking to somebody who was visiting Cedar Rapids, who was a resident of Thailand and wanted to do a visiting stamp with us. And we both agreed after she was Zooming with me.

This was a few years ago from Cedar Rapids, and we both agreed after a few minutes that we’d wait till she got back to Thailand because the connection was so bad and sure enough, two weeks later it was picture perfect. And you have to ask, “Why do we not have that?” And she was in a rural area outside of Cedar Rapids. So why do we not invest in our own country and in rural areas to give them that infrastructure? And that’s just one example. I’ll think of others that are not there.

Rima Afifi:
I think back to the podcast on the comprehensive wealth framework, where they talked about the eight capitals. And I think we could consider any one of those capitals to be strong and very interesting in important ways in rural areas because of the social connections that we’ve heard, but also potentially limited by the lack of access to broadband. Whether that’s no access to the healthcare professionals that they ought to have access to in those areas and therefore need to have the connection to be able to do the more remote access to healthcare providers or through cultural capital or through any of those potential capitals.

Hannah Shultz:
Thinking back a couple of weeks ago to the service delivery episode, telehealth was a big part. You can’t have a telehealth appointment without internet.

Diane Rohlman:
I think that’s really been the silver lining of the pandemic, is that we really had to stop the way we were doing things and say, “Well, how can we do this differently?” And all of us have had to rise to that challenge. And it’s amazing what we’ve accomplished. The telehealth no-show rate is awesome. The fact that schools can continue it, and you can give access to people that maybe had difficulty leaving their homes. There’s just so many positives, and fortunately it was a long road to get here, but I think stopping and thinking about how we connect is a positive. And we need to just keep going with that and not fall back to our old ways, but look forward and say, “What else can we do? What else is out there?” And that’s the exciting part.

Hannah Shultz:
The ability to make a difference in your community is much different in a small town than in a city. We heard this repeatedly. I asked our guests to connect this to health.

Brandi Janssen:
No, it’s when you think about taking a community engaged approach and research or engagement and you do this scan of who are… regardless of the size of the community, who are decision-makers, who are local leaders, who do I need to connect with to help answer my question or help facilitate answering their questions, et cetera? And in rural areas, it’s really interesting because those networks tend to be very tight and they overlap a lot.

You were just talking about local control and I was internally thinking about what that means in a small community, where these circles of ownership and power honestly, can be really small and tight. And in some ways, that really helps you understand maybe a broader scope really quickly, just because of the size of it. On the other hand, you realize that there’s still these pockets of knowledge in social and cultural capital to go back to the capitals that are present.

But I think that what you often find is if you have a champion for one issue, you have a champion for several issues, and that maybe that one individual then is tied to all these other things that they’re very interconnected, which makes sense to us, I think in public health, because we know that everything is about public health. But it also maybe motivates people who are living there as well.

Diane Rohlman:
I think Brandi, that that’s one of the nice things is you can find the champions in rural communities to work with. And in some ways things can move fast because they often play multiple roles in leadership and with the communities. And so they can make a phone call or talk to someone and things can happen really fast.

Rima Afifi:
To build on that, I mean, there are people that have lived in these communities for a very, very, very long time, and they are so well connected in their communities to both the formal leadership, but also the informal leadership that exists in every community. So if you can do the community engaged work and understand who those people are, then the opportunity to partner with the decision makers, both in formal and informal positions becomes much richer and quite a lot easier.

On the, I think the last part that Brandi said, which is about the one issue in many issues, I’m reminded of the second episode, I think, community coalition or community committee. And it started off as a Latino Community Committee, and it didn’t quite get off the ground. And then they shifted from that when there was all the raids to having a huge peace rally, that 500 people showed up at. And then they kept going back to trying to do these committees. And it was generally the same group of people that was coming together to try to organize, but they kept wanting it to be bigger than themselves, and eventually it did become bigger than themselves and took off.

So again, it’s that idea of a core group of people that may be quite invested in just the well-being of people in their communities. I think back to this idea of the strength of rural areas, and they really want to work to bring people together and try not to push a particular agenda unless the community wants that agenda.

Edith Parker:
Brandi mentioned the strengths in rural areas, sometimes of social networks and maybe due to broadband or whatever issues. But I do think for public health interventions that may be trying to use social networks, it’s oftentimes easier to identify those in our rural network, just because of the density in the number than is in urban areas. And certainly having tried some peer help will delay health models in rural areas versus urban areas. You find that it’s a whole different thing in more urban areas and perhaps in rural areas.

Hannah Shultz:
All right, here’s another topic we heard a lot: climate change. The fifth episode of this series was all about the environment. Why does climate change threaten health and rural life?

Hans Lehmler:
Well, if I think in terms of Iowa, there are, I think a number of things that happened since I moved to Iowa in 2003, that were for me like, “Oh, wow, that’s almost a life changing event.” It was this flood in 2008, which was a big deal. Well, last year we had the storm that I still can’t pronounce the name, that nobody’s ever heard of, and I honestly, I do not want to learn the name because it was a pretty big deal and it damaged a lot of properties and so forth.

And I know here where I live, some of the damage still not repaired, I hope people will be okay over the winter because they’re always damaged. And for some reason they needed to wait until the spring to fix it. But the key thing is that these severe weather events, if this is big flooding events, if these are storms or other severe weather events, really high temperatures for long periods of times in the a hundred plus degree Fahrenheit.

That’s what climate change, what the models are telling us. This is what’s going to happen more and more often. We’ll have more of these weird weather events. And that is from any perspectives not a good thing, right? I know that I’m not a farmer, but I know soil moisture is really important when you’re growing corn and having too much moisture is not good for your yields. And so if there’s flooding or too much rain, it’s not good and vice versa. Not having that critical element available for the crops to grow is a big problem.

And so as this becomes worse over the next decades because of global climate change, I think this is a fundamental problem on many levels, just because of these severe weather events that we’re seeing. And then as it gets warmer here, and I was just showing this in class the other day that climate-wise and moving to where Texas is right now with their climate. And that has also a lot of implications from a farming perspective that there are new pests that are moving up north, right?

For me, from a research perspective, that’s really interesting. Also now they need to use pesticides to fight new pests that suddenly in Iowa, that hasn’t been here before. And what does that do? Is it moving around in the environment? Does it get into people? And does it have any health effects? But it poses a lot of different challenges. So I think there are a lot of challenges that we’re going to face with what we’re seeing is now happening as a result of climate change.

And really the thing that we need to deal with is going forward. A, how do we keep it to a point that it doesn’t really destroy the planet? That would be the worst case scenario, I guess, but really how do we adapt to what is actually going on right now? And I’m sometimes thinking now when I’m sitting at home and the storm is blowing outside, “Well, what’s going to happen to my roof?” And I think of the time when I actually applied for a position in Florida, where you talk about hurricanes and how you’re building maybe the house in a special way that that doesn’t happen and where. Ultimately this had to happen, because you’re building to be hurricane proof.

Now, do we need to think about things like this in Iowa as well, or how do we adapt to that? And how do we adapt to that in a way that’s global? And so from that perspective, it is something that will affect us here in Iowa. It will affect the United States and it will affect the entire world. And since we’re all connected, things that happen in one part of the world, they will have some effect here in Iowa as well.

Brandi Janssen:
I think too, thinking about climate change in rural areas is, it’s particularly poignant in part because rural communities tend to be the home of some of the extractive industries that contribute to climate change. Both think about energy extraction but also agriculture and modern agricultural practices often contribute. But there’s also potential for the solutions there too.

So I hope that the conversation can move to a more solution-based approach and in ways that go back to local control, empowers local people to manage land in ways that can store carbon and the new term as, regenerative agriculture, right? Re-engaging and rebuilding carbon systems. And I think there’s a lot of potential for that. I think we have some communication work to do there, but there’s a lot of opportunity for rural areas to lead in combating climate change, I think.

Hannah Shultz:
We’ve just released nine episodes about public health in rural areas. All episodes were recorded, produced and released during the COVID-19 pandemic. Yet we only really addressed the pandemic directly in two episodes. We’ve obviously learned a ton about COVID in the last year and the rhetoric around COVID in rural areas has changed an incredible amount. Early in the pandemic, many people thought rural areas would be naturally protected from the wrath of COVID because we have lower population density among other things.

Brandi Janssen:
So I remember the rural areas will be protected because they’re lower population densities or comments like, agricultural workers who work outside are protected, they naturally socially distance, I heard that a lot. Farmers like to socially distance, that’s why they’re farmers, right? And that sort of language, which is all fine and well, but of course we forgot and paid no attention to the meat packing industry and other industries until it was just absolutely dire, which was tragic.

And I think too, we learned a little bit. Early on, I was asked by a few journalists predictions for what’s this going to mean for the food chain, and my thought at the time was, “Well, the large scale national and the global food chain has a lot of protections.” Which is true, right? There’s a lot of structural support. There’s a lot of financial support. And we saw those like they were rolling them out, but it’s such a efficient system that one little tweak in the wheel, and you throw everything off the rails, which we saw with backups and processing here in Iowa, et cetera.

Now, the other hand, we saw local food system that is presumably based on face-to-face relationships that actually did very well and people were able to adapt and move really quickly. And so I guess I’ve been thinking about those differences as lessons for small and regional systems and how nimble they can be and how responsive to things like this they can be. We still saw issues with like, yeah, the access and hospital capacity, et cetera. But I think there are lessons to be learned and smaller scale production systems that it can shift really quickly and can actually make some lemonade out of lemons in this case and try out new options that worked really well.
And the large scale system, that was not the case because we think we have no margin for error, we have no room to move in those systems. So it was intellectually interesting to watch this play out. Of course, it’s also tragic as we watch the death count continue to climb and it’s hard to see silver linings in it.

Diane Rohlman:
When I think about the pandemic, I think about the impact on employers who are trying to figure out what to do. Everything changed so rapidly, and there had to be such a quick response, that information was flying all around. And one of the hard things was to try to sift through that information and figure out what really is a good solution and what should I do? What do I have to do? What do I want to do? What can I do? Kind of those sorts of things.

For employers, in a sense, you’ve got to get that information to them quickly. And they need to know that there’s resources out there to sift through that and how to make it apply to their specific organization. There really is a need, you could talk about broadband, and that if you don’t, if you can look up information, you have the time to search on it. That’s really good. I look at our jobs as occupational safety and health professionals are.

Our job is to translate research into practice. So how do we take that? How can we facilitate that and make it useful? Many of our employers are small and they don’t have those resources that the larger organizations do. When you talked about the food chain Brandi, you’re talking about those large organizations that [inaudible 00:43:02] talking about a broader thing than just one organization, but they have a lot of people who think about health and safety on a regular basis and a lot of companies don’t.

So it’s really important to think about how we move information and how we can decide what’s appropriate. And I think the pandemic showed us we can do some things really well and other things not so well, but we need to maybe pause and reflect and think about what we want to take forward.

Rima Afifi:
One of the things that I think is also important is to connect COVID-19 to changes that we’re seeing in the climate as well. So a lot of these topics that we’ve talked about are interconnected in many ways. We’ve said that, I think through the series, but COVID-19 it’s not different than a lot of other topics. And that it is as an infectious disease interconnected to a lot of the other issues that we’ve talked about through the series.

Hans Lehmler:
Well, I think that the big lesson of COVID 19 is we’re all connected. And so something that happens in a different part of the world can profoundly change all life. And it doesn’t matter if we’re considering ourselves living in a big town or a small town or in a really rural part of the world, it can affect us. And COVID-19 in many ways has driven this home, but we’re still connected in things that are in our food that we’re buying at the grocery store, maybe coming from a place where there is a chemical hazard in there that can potentially affect our health.

And so it matters where that is coming from. The same thing applies to our air and maybe to a lesser extent to the water, but our water and we’re putting in the water, it will affect somebody else. And so I think that’s important to keep in the back of our mind. And in some ways COVID-19, this whole pandemic was a very hard lesson for us to learn that again and maybe see it very vividly. I guess the other thing that’s really important that we’re learning here, public health actually matters.

Rima Afifi:
Back to the definition of health, I think COVID-19, it has confirmed what the definition of health is to public health professionals. So as you said, Hannah, this series covers a lot of things, some of which some people would consider health and others might not. But in public health, we look at a very broad range of determinants of health and a critical aspect of those determinants are social and environmental, and COVID-19 has helped us see the interaction between all of that, but employment and health, oppression and health. I mean, all these things that we talk about often in public health as health, and we can see through many health conditions, not only COVID, but COVID has just brought it up very starkly.

Hannah Shultz:
I asked our guests for their final thoughts as we wrap up this series.

Brandi Janssen:
I hope that this series helps people understand the importance of earlier [inaudible]. I get most worried, I guess, when I hear or read in my elite coastal literature that I consume, the news papers and stuff that, the let it go my graph, there aren’t that many people there, that’s why we’re so worried about it. That actually worries me more than anything else, I think. This willingness to let whole communities go by the wayside and be seen as unimportant, especially when they make considerable contributions to food and energy systems that actually most people rely on.

So I hope that people have a better understanding of that from the series. I’m also very interested in the arts and culture that come out of rural areas. Thinking about the pandemic and the way that’s changed thing in the way that live performances, live music, even little events go away. There was just a big piece this morning about some folks in the Ozarks who have had a jam for decades and decades, these old guys, people I knew. And it’s been put by the wayside because of COVID.

So they’re listening, that’s the first thing. They are socially distancing and they’re doing the right things, but it really means that there’s whole catalog of knowledge that isn’t being shared. And so that feels very disruptive. You can’t pick that back up on the internet in the same way, even if they did have broadband. So that’s where those face-to-face things matter. So, yeah, I hope that it helps people understand the role that the rural communities play in the overall systems that we all rely on.

Hannah Shultz:
Thank you so much for listening, as we wrap up this 10 week series. Share Public Health, is going to take a break next week. Come back in two weeks to learn about the amazing public health work that a library in Brooklyn is doing. Thank you for tuning into this episode of Share Public Health. Thank you to the Injury Prevention Research Center, Iowa Center for Agricultural Safety and Health, the Healthier Workforce Center of the Midwest, the Heartland Center for Occupational Health and Safety, the Great Plains Center for Agricultural Health, the Midwestern Public Health Training Center, the Prevention Research Center for Rural Health and the Rural Policy Research Institute.

The theme song for this series is Walk Along John. It’s performed by Al Murphy on fiddle, Mark Janssen on mandolin, Brandy Janssen on banjo, Warren Hamlin on guitar and Aletta Murphy on bass. Al learned these songs from a fiddler named Albert Spray, who is from Kahoka, Missouri. A transcript, evaluation and discussion guide for this episode are available at mphtc.org and in the podcast notes.

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