October 2, 2025 • 31 mins
Rural communities are the backbone of America—growing our food, fueling our economy, and sustaining traditions that reach far beyond county lines. But in Pennsylvania, as in much of the country, rural health is under strain. Provider shortages, rising rates of chronic disease, and shrinking access to specialty services like obstetrics (maternal health) leave families and entire towns at risk.
Pennsylvania Office of Rural Health Director Lisa Davis has spent more than 30 years working to address these challenges. In this episode, Lisa shares how rural communities and state leaders are finding creative solutions to ensure care is within reach—from deploying community health workers to expanding telehealth and more. These strategies and innovations reveal a bigger truth: rural health is inseparable from the nation’s health.
Lisa Davis has directed the Pennsylvania Office of Rural Health since 1999, providing leadership on networking, coordination, and technical assistance across the state’s rural hospitals, health clinics, training programs, and community partners. She has previously held roles at Penn State’s Department of Health Policy & Administration. Her work history spans a range of public health fields, including nutrition, mental health, substance use recovery, and correctional health.
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Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
SPEAKER_04 (00:03):
When you think of public health, do you picture
big cities, large hospitals, avariety of doctors to choose
from?
What's your biggest concern?
Or even cutting-edge research?
For millions of Americans livingoutside of urban hubs, this
image looks very different.
SPEAKER_00 (00:24):
In recent years, rural hospitals have been
closing at a staggering rate,creating so-called medical
deserts.
SPEAKER_04 (00:31):
Access to care can be hours away, maternal health
services are disappearing, andsmall hospitals face complex
problems that too often lead toclosure.
This is a reality in many partsof Pennsylvania.
With one of the largest ruralpopulations in the country,
nearly 3.4 million people, thestate mirrors the struggles of
(00:51):
rural America as a whole.
SPEAKER_02 (00:53):
Pennsylvania as a whole has had some of the most
severe shortages of healthcareprofessionals in the nation.
SPEAKER_05 (01:07):
You know, a lot of parts of Pennsylvania are not
well serviced by physicians.
SPEAKER_02 (01:11):
It is interesting to note that roughly only 10% of
our doctors choose to practicein rural settings, despite more
than 20% of the U.S.
population living in ruralcommunities.
SPEAKER_04 (01:25):
For more than three decades, Lisa Davis has been at
the center of these challenges.
As director of the PennsylvaniaOffice of Rural Health, she's
worked to keep hospitals open,bring providers into underserved
communities, and support thepeople who make up the backbone
of rural life.
(01:54):
This is Empathy Affect, theForest Marsh Media podcast that
explores the human side ofgovernment.
I'm Melissa Szyzinski, and Lisajoins us today to break down the
real barriers ruralPennsylvanians face in
healthcare, her office's role inkeeping rural communities
healthy, and why rural healthmatters.
Not just for Pennsylvania, butfor all of us.
(02:24):
Thank you so much for having me.
I'm delighted.
Of course.
So you're a lifelongPennsylvanian and you began your
professional journey working inmental health, substance use
recovery, systems of care forpeople with disabilities,
nutrition, and even with thecorrection system.
So you've definitely seen abunch of different aspects of
(02:45):
public health.
So when and how did you realizethat amid all of this, that
rural health would become yourcalling?
How did those early experiencesin such diverse areas across the
state inform and ultimately leadyou to direct the Pennsylvania
Office of Rural Health?
SPEAKER_03 (03:03):
Well, thank you so much for asking.
All of my career prior to goingto graduate school was focused
on helping individuals who werequite vulnerable and being able
to access any type of thesupports that they might need,
whether that be mental healthtreatment or nutrition services
or even being able to go out andfind employment.
(03:24):
And I went to graduate schoolfocused on health policy and
administration with an emphasison public health.
And at the time, thePennsylvania Office of Rural
Health was in its infancy hereat Penn State.
And one of the faculty in ourdepartment was one of the
associate administrators.
(03:45):
And he apparently referred mefor a job to be the full first
full-time staff person here.
And I had sort of an idea ofwhat the Office of Rural Health
was and decided I would go onthe interview anyway, even
though I didn't think I wantedthe position.
And when I was beinginterviewed, I realized that
this was absolutely the perfectplace for me.
(04:08):
It combined everything I wantedto do and felt was important,
which was being able to addressthe needs of vulnerable
populations writ large.
So this would be all across thestate, and then eventually
across the nation with policyand regulation and so on.
And it also combined my interestin wanting to work with external
(04:30):
audiences all across the state,with the state agencies,
associations, and clinicaltraining programs.
So I have to say that when Istarted in rural health, I had
no idea even that there was atopic of rural health, even
though I had spent much of myhigh school time in rural
communities.
I didn't realize rural healthwas a thing.
(04:53):
And I can say that it has beenan extraordinarily rewarding
career.
And what has made it so is theability to be able to address
issues in communities and alsoat the state and national levels
and to work very closely withthe rural health community
(05:14):
advocates and educators and soon across the country, who are
essentially the brightest, mosteducated, and most passionate
people I have ever had thepleasure to know.
SPEAKER_04 (05:27):
Lisa's path set the stage for her career focused on
improving access to care inPennsylvania's rural
communities.
The Pennsylvania Office of RuralHealth was developed in 1991 to
do just that.
It connects rural hospitals,health clinics, and training
programs with the support theyneed, from recruiting providers
and keeping small hospitals opento partnering with state
(05:48):
agencies and community leaders.
At its core, the office servesas a bridge linking rural
communities with the resources,networks, and advocacy they need
to thrive.
SPEAKER_03 (05:58):
So the state offices of rural health were charged
with being a source ofcoordination, networking,
technical assistance,partnership development, and in
the recruitment and retention ofhealthcare providers, especially
primary care.
So our office fulfills all ofthose missions through the
partnerships that we have acrossthe state.
SPEAKER_04 (06:20):
And while every state has an Office of Rural
Health, Pennsylvania's is uniquein that it's based at Penn State
University.
That means that Lisa and herteam have the flexibility to act
quickly and a built-in networkthrough the university's 67
county extension offices.
It's a model that connects themdirectly to local communities,
but it also keeps them closelytied to state policymakers.
(06:42):
That broad vantage point hasgiven Lisa a clear view of the
obstacles rural Pennsylvaniansface every day.
SPEAKER_03 (06:49):
The problems and challenges facing rural
Pennsylvanians very much mirrorthe issues that are nationwide.
When I started in rural health31 years ago, healthcare
workforce was the number oneissue.
Healthcare workforce, Lowiesmany years later, is the number
one issue.
So one of the areas that all ofus in rural health work toward
(07:14):
is ensuring that we have enoughprimary care and specialty
providers in rural communitiesto be able to provide
comprehensive health care.
And that has been a challengefor many years, whether it's
physician services or specialtyservices or dental care, those
(07:35):
are the most challenging.
We do find that being able toprovide nursing care and also
care through physicianassistants and advanced practice
nurses, such as nursepractitioners, can often be
easier to address.
But the healthcare deliverysystem still very much is a
(07:55):
physician-centric system.
The other area that we have realchallenges with, and this is
especially true, unfortunatelygetting a lot of attention now,
is access to labor and deliveryand OBGYN services.
In fact, in Pennsylvania, wehave had several hospitals that
have been forced to close theirlabor and delivery units simply
(08:20):
due to finances.
And we now have an area innorthwestern Pennsylvania that
is without any labor anddelivery services, and that area
is the same size as the state ofConnecticut.
So we have the workforce issues.
We also have challenges withsmall rural hospitals.
One reason why rural healthbegan to get such attention was
(08:44):
in the 80s when thereimbursement system changed to
what was called at one time wasa cost-based reimbursement
system to something calledprospective payment.
There were about 400 small ruralhospitals across the country
that closed in a very shortperiod of time.
And that made Congress sit upand take notice and to begin to
(09:07):
authorize and appropriatefunding to try and keep small
rural hospitals open.
And as I said earlier, here inPennsylvania, we have anywhere
from 48 to 62 small ruralhospitals.
And we are very focused ontrying to keep those open.
And one reason, well, there aretwo main reasons why small rural
(09:29):
hospitals should remain open.
One is because they are veryoften the hub of healthcare in
that community.
Just as physicians are the hubof healthcare for the provider
community, the rural hospitalserves in that role for overall
health care.
(09:50):
And when a hospital closes, ittakes a bit of life out of the
community.
And what we have heard fromcommunities where a hospital has
closed is basically they don'tthink we matter.
So the other reason is thathospitals not only are the hub
of healthcare, but they are alsoconsidered to be an economic
(10:14):
anchor institution, meaning thatwithout a hospital there, it is
challenging to have a robustgrowing economy for several
reasons.
One is that every job inhealthcare and in a hospital is
estimated to produce 1.6additional jobs in the
(10:34):
community.
The other is that it is veryhard to attract and retain other
types of workforce if you don'thave a place for individuals to
go for care.
So those are probably the twomain issues.
SPEAKER_04 (10:49):
Since hospital closures have been impacting
rural areas nationwide, how doyou see this affecting
Pennsylvania as well?
You were mentioning that ruralhospitals tend to be anchors for
many communities economically interms of providing access.
So as closures sort of happen,how is that affecting
(11:10):
Pennsylvanians?
And what strategies are beingused to try to maintain access
to care amid this trend?
SPEAKER_03 (11:18):
Well, Pennsylvania has been really fortunate.
We have had far fewer hospitalsclosed than have other states.
So we've had five closures inthe last five to six years.
Just recently, we've had twoclosures, but those have been in
urban areas and were as a resultof hospitals not being able to
(11:43):
survive financially.
What ends up happening,especially in rural communities,
when a hospital closes, thesurrounding community comes
together to try and providehealthcare services there.
For instance, in one communitywhere the hospital closed, the
federally qualified healthsystem in a neighboring county
(12:04):
has come in to fill that care.
They've been providing mobileclinics and rotating physicians
and other providers in thatcommunity and are planning on
establishing a site there.
So that's one way in which theyare trying to address issues.
In other communities, what wesee is, for instance, in one
(12:27):
community where the hospitalclosed, one of the local
businesses that has been therefor generations invested
significantly in the facilitywhere the hospital was located.
And they have opened up aprimary care and behavioral
health and soon-to-be dentalhealth clinic in that hospital.
(12:51):
So while these closures haveoccurred, we work very hard to
make sure that the facilitiesthat are there are receiving the
support that they need, that arebeing considered in terms of
when federal or statelegislation and regulation is
(13:12):
being passed.
In Pennsylvania, we mirror otherstates also in that we have a
number of very large healthcaresystems.
And so we've seen significantconsolidation over the years,
and that has helped small ruralhospitals be able to stay open.
So there are a number of ways inwhich we are focused on that.
SPEAKER_04 (13:34):
But even when the hospital doors stay open, the
health conditions thatPennsylvanians face still loom.
One of the biggest public healthchallenges for Pennsylvania
overall is the burden of chronicdisease.
Conditions like diabetes,obesity, and heart disease
affect rural Pennsylvanians athigher rates than their urban
counterparts.
And the barriers to manage thoseconditions can be steep.
SPEAKER_03 (13:57):
I would say that chronic disease prevention and
treatment is one of the highestpriorities of every healthcare
delivery system in Pennsylvania.
Rural, urban, hospital, clinic,it is one of the highest
priorities, especially because athird of Pennsylvanians are
overweight, and we have a higherpercentage of young kids who are
(14:18):
also overweight.
So I think facilities andcommunities are very much
focused on addressing thesekinds of issues.
Also looking at chronic diseasein terms of diabetes and trying
to manage diabetes incommunities, and also looking at
(14:40):
cardiovascular disease and soon.
So I can say that just asworkforce has been an issue for
the last 31 years, so haschronic disease management.
And that has really, really comeforward in the last 15 years or
so as something we need to focuson.
So one model of care that wehave here in Pennsylvania that I
(15:02):
think other states do as well,we have a very robust community
health worker system.
And we have a whole training andcertification program here in
this state for trainingcommunity health workers and
getting them certified.
And what we find is thatcommunity health workers,
because they come from thecommunity and they understand
(15:23):
the community so well that theyare able to provide the
connections in communities tothe healthcare delivery system
and to overcome barriers tocare.
For example, if a person isgetting access at the emergency
department very frequently, thecommunity health worker could
(15:45):
come in and find out what theissues are.
Is it because that individual isnot able to get to the pharmacy
to get their medications or isnot able to have nutritious food
delivered?
They can overcome thosebarriers.
So there's lots of ways in whichwe are looking at addressing
(16:06):
chronic disease prevention andtreatment.
SPEAKER_04 (16:10):
Going back to just like the overcoming certain um
challenges to what are someinnovative approaches or success
stories that you've seendeveloping in rural health?
You were mentioningcommunity-based programs and
having those partners down atthe community level.
But also, I know telehealth is abig innovation.
(16:33):
What other things do you see outthere to sort of lead the way
forward in providing access inrural health?
SPEAKER_03 (16:40):
So telehealth is a great example of this.
And certainly telehealth becameenormously important during
COVID because so manyindividuals, you know, almost no
one was going to the physician,but almost everybody needed to
access healthcare services.
So what we see are withinhospitals, they have very
innovative programs where, forinstance, they they will have a
(17:03):
tele ICU or a teleemergencydepartment so that they can
overcome the challenges withhaving ED, their ED staffed by
ED docs 24-7, or their ICUstaffed 24-7 by physicians
because there are challengeswith that.
So they will connect up.
They have an automaticconnection to a tertiary care
(17:25):
facility that can provide thatlevel of care if needed.
We have telestroke programs thatare in rural communities that
are hooked up to the tertiarycare facilities and other kinds
of ways in which telehealth hasplayed a role.
We also are using telehealth todo a home assessment once an
(17:49):
individual has been discharged,or to do remote patient
monitoring, which certainlysaves the time and expense of
sending home health nurses outto patients' offices.
So there are lots of ways inwhich we are looking at that.
But also, again, I want to saythat communities are really good
at being able to develop theirown solutions.
(18:11):
So, as an example, I talkedabout the rural community where
the hospital had closed.
That facility was able to openbecause the local
well-established businesspurchased the building and
started to develop all of theprograms that are there.
We also work really closely withthe community and economic
(18:34):
development groups in ruralcommunities because they have
ways of bringing in funds forthose communities and being able
to make sure that there areservices available.
And we also look to externalorganizations such as USDA Rural
Development, which has beenterrific at being able to find
(18:55):
funds to bring in specialservices or special equipment to
organizations.
And right now we are workingwith the Penn State College of
Medicine.
They are focused on wanting toestablish a rural-based medic
program that would be a trainingground for individuals coming
(19:17):
out of high school, for veteranscoming back who might have been
in, you know, a medic in themilitary, or for older persons
who are retired but want to giveback.
So there's lots of ways thatwe're looking at creative
solutions.
And they're not all coming fromus, but we're fortunate to be
involved in many of them.
SPEAKER_04 (19:35):
Yeah.
I I feel really drawn to a lotof the community-based solutions
out there since rural areas sooften rely on those strong
community ties.
How else do you see communitypartnerships shaping solutions
to health disparities in ruralareas?
I know that faith-basedcommunity intervention is a big
(19:58):
boon, but how else are youseeing it manifest?
SPEAKER_03 (20:01):
One of the ways, I'm glad you mentioned faith-based,
one of the ways that we foundout about the importance of
faith-based messaging to overallhealth is a project that we had
done a number of years agolooking at agricultural
fatalities and the impact on thecommunities.
And what we heard when weinterviewed families who had
lost, it was all husbands andgrandfathers, unfortunately, to
(20:25):
a farm incident, they all said,you know, it it was their time,
it was their destiny.
We started reaching out tofaith-based groups because we
realized that in ruralcommunities, activities revolve
around the school and the churchand the service organizations.
And if we can have messagingcome from the pulpit about
(20:50):
strong, healthy behaviors, wefeel that that is a way that we
can get the message out.
So those have become animportant part of the community.
We also find that workingthrough the school districts and
either having school-basedhealth centers, which are
extremely important, or beingable to work with students who
(21:14):
take information home to theirparents, that that is another
way to spread the messaging.
You know, parents might notlisten to the messaging that
comes out over the radio or inthe newspaper or whatever, what
their doctor tells them.
But if their kid comes home andsays, We read that we had this
paper today on healthy eatinghabits and on, you know,
(21:34):
reducing tobacco use, theparents might that that might be
a form of messaging that thatmakes a difference.
We also see that in communitieswhere there are uh strong
service groups that they cometogether to raise funds.
I was just reading an articleabout volunteer fire
(21:56):
departments.
They rely 90% of their fundingcomes from fundraisers and bake
sales and other kinds ofcommunity events, you know,
where it will cost$750,000 tobuy a fire truck.
Well, that's pretty expensive.
And so the communities comearound and build that.
(22:17):
We also see Pennsylvania is astate that has a very large
Amish and Mennonite population,otherwise known as Anabaptists.
They are enormously supportiveof their communities and they
will donate land, they willbuild facilities and clinics.
We actually have several clinicshere in Pennsylvania that focus
exclusively on the Amishpopulation and on kids who may
(22:41):
have some genetic issues thatare specific to Amish and
Mennonite groups.
SPEAKER_04 (22:47):
Yeah, um I love those different stories.
And speaking of which, you'vebeen serving as director for
quite a long time and have seenthe landscape evolve.
So how do the stories of ruralresidents you've met over your
career shape the way youapproach policy and leadership
in this space?
SPEAKER_03 (23:05):
Well, the important thing is to understand what that
messaging is.
And as an example, thePennsylvania Rural Health
Association just published thefirst standalone rural health
plan in the state since the year2000.
So we have the 2025-2030 RuralHealth Plan.
(23:27):
The next steps for that are todevelop town hall meetings where
we can go out and actually hearfrom residents.
We love to hear from thehealthcare delivery systems and
we love to hear from theadvocates because you know those
are the folks who we normallyintersect with.
But the importance of hearingfrom someone who lives in a
(23:47):
rural community is absolutelythe most important piece because
they are the ones who access thehealthcare system.
They are the ones who are havingthe challenges or the successes.
So they shape just abouteverything that we do.
And what we encourage both thehealthcare providers to do and
those who live in thecommunities is to talk to their
(24:09):
policymakers, talk to yourcounty supervisors, talk to your
county commissioners, talk toyour elected uh representatives
and senators, both at the statelevel and at the national level.
We tend to come to thosemeetings with data and
information and graphs andcharts, and all of that is
(24:31):
important.
What really makes the differenceis when a policymaker hears from
an individual about theirspecific experience.
So we we hope and we encourageeveryone to tell their story.
SPEAKER_04 (24:47):
Absolutely.
I'm wondering, I and I get thesense it's the people who you
know are driven behind this orand the patients you feel like
you're a steward of in yourposition.
But what gives you hope aboutthe future of rural health in
Pennsylvania?
SPEAKER_03 (25:05):
Well, first of all, I think that very excitedly, in
the last two years, rural healthhas received a lot of attention
here in our state, and I wouldalso say nationally.
And there are so many who arecommitted to working together to
overcome barriers.
One project that we are going tobe involved in that I think most
(25:26):
states will be involved in isthe$50 billion in funding that
is coming out from HR1, which isthe one big, beautiful bill that
was signed into law on July 4th.
So every state is asked tosubmit a rural health
transformation plan.
And we've already had ruralhealth transformation here in
(25:48):
the state, funded through CMSabout 15 years ago, but those
programs are sort of windingdown now.
So now we are able to look atrural health transformation
essentially 2.0.
And this will be bringingtogether all of the stakeholders
in the state, from communitiesup through the state agencies,
(26:08):
to develop pathways to ensuringthat we have the workforce
needed, that we have thefacilities needed, and we also
have the creative opportunitiesto look at different models of
care in the state that we hopewill actually transform health
care in rural Pennsylvania.
SPEAKER_04 (26:28):
Yeah.
Is there anything that you hopewill come out of this movement
with the bill and the funding itmay provide or the strategies
that you may be able toimplement?
SPEAKER_03 (26:40):
Well, I think we're going to be looking at new
models of care.
So whether or not that's mobilecare or that is different types
of clinical training programs ornew ways in which hospitals can
partner even across healthsystems.
I think those will be reallyexciting.
I think being able to look atthe funding that is available
(27:00):
for increasing telehealthservices will certainly be very
helpful.
I know that AI is getting agreat deal of attention, and I'm
a novice with AI, but there aremany who are out there who are
quite savvy with it.
So I'm hopeful that AI will beable to provide exceptional
training opportunities forproviders and hospitals and also
(27:22):
in communities.
And, you know, we need to belooking at health care across
the continuum, from cradle tograve, as far as patients are
concerned and consumers areconcerned, but also across the
continuum from prevention toemergency care to acute care
services to chronic diseasemanagement and then to long-term
(27:44):
care.
So we need to make sure that allof those systems are integrated
so that it should be seamlessfor the patient to intersect
into the healthcare deliverysystem.
We've had something calledpatient-centered medical homes
for a very long time, and theyhave been quite successful where
they have been implemented.
(28:04):
And I think we need to take thatidea and put the patient and
ensure that the patient isalways at the center of the care
and that the care then wrapsaround that patient so that they
are getting the right care atthe right time for the right
price.
SPEAKER_04 (28:22):
One last question on my end.
If you could share one messagewith policymakers or the public
about the importance ofsupporting rural health, what
would it be?
SPEAKER_03 (28:32):
I am so glad you asked that.
(29:24):
So as I say to folks, if you hadbreakfast this morning, you have
rural to thank.
If you woke up in a building,you have rural to thank.
If you have clothing on, youhave rural to thank.
And so many of our traditionsare rooted in rural culture and
rural activity.
So it is absolutely essentialthat rural health is sustainable
(29:50):
because without rural health, wehave very challenged rural
communities, and without ruralcommunities, we will have
challenges in Being able tofeed, clothe, and house America.
SPEAKER_04 (30:04):
Couldn't have said it better myself.
Lisa, is there anything else youwanted to add before we wrap up
today's conversation?
SPEAKER_03 (30:10):
No, just to say thank you so much for this
opportunity.
And thank you to everyone outthere who is listening and who
is supporting their ruralcommunity and their rural
healthcare delivery system.
SPEAKER_04 (30:24):
Well, thank you so much.
It was such a pleasure to haveyou here and bring light to the
landscape of rural health inPennsylvania and elsewhere and
helping us think about how weshould be serving the well-being
of our rural communities.
It was a pleasure to have you.
One thing I'm taking away fromthis conversation is that rural
(30:46):
health is more than just apolicy issue.
It's a lifeline.
As Lisa reminded us, ruralcommunities grow our food and
power our economy.
But they also face uniquebarriers that can't be ignored,
from hospital closures toprovider shortages to the
growing burden of chronicdisease.
Lisa and her team have worked toensure that these communities
(31:06):
aren't left behind.
And, as we heard today, thelessons from Pennsylvania
resonate far beyond the state'sborders.
Rural health matters, not justfor the people who live there,
but for all of us.
Thank you for tuning in toEmpathy Affect.
If you enjoyed today's episode,go ahead and share it with a
friend, and make sure to followand give us a review wherever
(31:26):
you get podcasts.
I hope you'll join me next time.
Thanks, y'all.
SPEAKER_01 (31:33):
Empathy Effect is a product of Forrest Marsh.
You can reach us at Forest MarshMedia at Forzmarsh.com with any
feedback, questions, orinquiries.
If you want to know more abouttoday's guest, are interested in
participating with ForrestMarsh, or becoming part of our
community, check out our shownotes for more information.
When you think of public health, do you picture
big cities, large hospitals, avariety of doctors to choose
from?
What's your biggest concern?
Or even cutting-edge research?
For millions of Americans livingoutside of urban hubs, this
image looks very different.
SPEAKER_00 (00:24):
In recent years, rural hospitals have been
closing at a staggering rate,creating so-called medical
deserts.
SPEAKER_04 (00:31):
Access to care can be hours away, maternal health
services are disappearing, andsmall hospitals face complex
problems that too often lead toclosure.
This is a reality in many partsof Pennsylvania.
With one of the largest ruralpopulations in the country,
nearly 3.4 million people, thestate mirrors the struggles of
(00:51):
rural America as a whole.
SPEAKER_02 (00:53):
Pennsylvania as a whole has had some of the most
severe shortages of healthcareprofessionals in the nation.
SPEAKER_05 (01:07):
You know, a lot of parts of Pennsylvania are not
well serviced by physicians.
SPEAKER_02 (01:11):
It is interesting to note that roughly only 10% of
our doctors choose to practicein rural settings, despite more
than 20% of the U.S.
population living in ruralcommunities.
SPEAKER_04 (01:25):
For more than three decades, Lisa Davis has been at
the center of these challenges.
As director of the PennsylvaniaOffice of Rural Health, she's
worked to keep hospitals open,bring providers into underserved
communities, and support thepeople who make up the backbone
of rural life.
(01:54):
This is Empathy Affect, theForest Marsh Media podcast that
explores the human side ofgovernment.
I'm Melissa Szyzinski, and Lisajoins us today to break down the
real barriers ruralPennsylvanians face in
healthcare, her office's role inkeeping rural communities
healthy, and why rural healthmatters.
Not just for Pennsylvania, butfor all of us.
(02:24):
Thank you so much for having me.
I'm delighted.
Of course.
So you're a lifelongPennsylvanian and you began your
professional journey working inmental health, substance use
recovery, systems of care forpeople with disabilities,
nutrition, and even with thecorrection system.
So you've definitely seen abunch of different aspects of
(02:45):
public health.
So when and how did you realizethat amid all of this, that
rural health would become yourcalling?
How did those early experiencesin such diverse areas across the
state inform and ultimately leadyou to direct the Pennsylvania
Office of Rural Health?
SPEAKER_03 (03:03):
Well, thank you so much for asking.
All of my career prior to goingto graduate school was focused
on helping individuals who werequite vulnerable and being able
to access any type of thesupports that they might need,
whether that be mental healthtreatment or nutrition services
or even being able to go out andfind employment.
(03:24):
And I went to graduate schoolfocused on health policy and
administration with an emphasison public health.
And at the time, thePennsylvania Office of Rural
Health was in its infancy hereat Penn State.
And one of the faculty in ourdepartment was one of the
associate administrators.
(03:45):
And he apparently referred mefor a job to be the full first
full-time staff person here.
And I had sort of an idea ofwhat the Office of Rural Health
was and decided I would go onthe interview anyway, even
though I didn't think I wantedthe position.
And when I was beinginterviewed, I realized that
this was absolutely the perfectplace for me.
(04:08):
It combined everything I wantedto do and felt was important,
which was being able to addressthe needs of vulnerable
populations writ large.
So this would be all across thestate, and then eventually
across the nation with policyand regulation and so on.
And it also combined my interestin wanting to work with external
(04:30):
audiences all across the state,with the state agencies,
associations, and clinicaltraining programs.
So I have to say that when Istarted in rural health, I had
no idea even that there was atopic of rural health, even
though I had spent much of myhigh school time in rural
communities.
I didn't realize rural healthwas a thing.
(04:53):
And I can say that it has beenan extraordinarily rewarding
career.
And what has made it so is theability to be able to address
issues in communities and alsoat the state and national levels
and to work very closely withthe rural health community
(05:14):
advocates and educators and soon across the country, who are
essentially the brightest, mosteducated, and most passionate
people I have ever had thepleasure to know.
SPEAKER_04 (05:27):
Lisa's path set the stage for her career focused on
improving access to care inPennsylvania's rural
communities.
The Pennsylvania Office of RuralHealth was developed in 1991 to
do just that.
It connects rural hospitals,health clinics, and training
programs with the support theyneed, from recruiting providers
and keeping small hospitals opento partnering with state
(05:48):
agencies and community leaders.
At its core, the office servesas a bridge linking rural
communities with the resources,networks, and advocacy they need
to thrive.
SPEAKER_03 (05:58):
So the state offices of rural health were charged
with being a source ofcoordination, networking,
technical assistance,partnership development, and in
the recruitment and retention ofhealthcare providers, especially
primary care.
So our office fulfills all ofthose missions through the
partnerships that we have acrossthe state.
SPEAKER_04 (06:20):
And while every state has an Office of Rural
Health, Pennsylvania's is uniquein that it's based at Penn State
University.
That means that Lisa and herteam have the flexibility to act
quickly and a built-in networkthrough the university's 67
county extension offices.
It's a model that connects themdirectly to local communities,
but it also keeps them closelytied to state policymakers.
(06:42):
That broad vantage point hasgiven Lisa a clear view of the
obstacles rural Pennsylvaniansface every day.
SPEAKER_03 (06:49):
The problems and challenges facing rural
Pennsylvanians very much mirrorthe issues that are nationwide.
When I started in rural health31 years ago, healthcare
workforce was the number oneissue.
Healthcare workforce, Lowiesmany years later, is the number
one issue.
So one of the areas that all ofus in rural health work toward
(07:14):
is ensuring that we have enoughprimary care and specialty
providers in rural communitiesto be able to provide
comprehensive health care.
And that has been a challengefor many years, whether it's
physician services or specialtyservices or dental care, those
(07:35):
are the most challenging.
We do find that being able toprovide nursing care and also
care through physicianassistants and advanced practice
nurses, such as nursepractitioners, can often be
easier to address.
But the healthcare deliverysystem still very much is a
(07:55):
physician-centric system.
The other area that we have realchallenges with, and this is
especially true, unfortunatelygetting a lot of attention now,
is access to labor and deliveryand OBGYN services.
In fact, in Pennsylvania, wehave had several hospitals that
have been forced to close theirlabor and delivery units simply
(08:20):
due to finances.
And we now have an area innorthwestern Pennsylvania that
is without any labor anddelivery services, and that area
is the same size as the state ofConnecticut.
So we have the workforce issues.
We also have challenges withsmall rural hospitals.
One reason why rural healthbegan to get such attention was
(08:44):
in the 80s when thereimbursement system changed to
what was called at one time wasa cost-based reimbursement
system to something calledprospective payment.
There were about 400 small ruralhospitals across the country
that closed in a very shortperiod of time.
And that made Congress sit upand take notice and to begin to
(09:07):
authorize and appropriatefunding to try and keep small
rural hospitals open.
And as I said earlier, here inPennsylvania, we have anywhere
from 48 to 62 small ruralhospitals.
And we are very focused ontrying to keep those open.
And one reason, well, there aretwo main reasons why small rural
(09:29):
hospitals should remain open.
One is because they are veryoften the hub of healthcare in
that community.
Just as physicians are the hubof healthcare for the provider
community, the rural hospitalserves in that role for overall
health care.
(09:50):
And when a hospital closes, ittakes a bit of life out of the
community.
And what we have heard fromcommunities where a hospital has
closed is basically they don'tthink we matter.
So the other reason is thathospitals not only are the hub
of healthcare, but they are alsoconsidered to be an economic
(10:14):
anchor institution, meaning thatwithout a hospital there, it is
challenging to have a robustgrowing economy for several
reasons.
One is that every job inhealthcare and in a hospital is
estimated to produce 1.6additional jobs in the
(10:34):
community.
The other is that it is veryhard to attract and retain other
types of workforce if you don'thave a place for individuals to
go for care.
So those are probably the twomain issues.
SPEAKER_04 (10:49):
Since hospital closures have been impacting
rural areas nationwide, how doyou see this affecting
Pennsylvania as well?
You were mentioning that ruralhospitals tend to be anchors for
many communities economically interms of providing access.
So as closures sort of happen,how is that affecting
(11:10):
Pennsylvanians?
And what strategies are beingused to try to maintain access
to care amid this trend?
SPEAKER_03 (11:18):
Well, Pennsylvania has been really fortunate.
We have had far fewer hospitalsclosed than have other states.
So we've had five closures inthe last five to six years.
Just recently, we've had twoclosures, but those have been in
urban areas and were as a resultof hospitals not being able to
(11:43):
survive financially.
What ends up happening,especially in rural communities,
when a hospital closes, thesurrounding community comes
together to try and providehealthcare services there.
For instance, in one communitywhere the hospital closed, the
federally qualified healthsystem in a neighboring county
(12:04):
has come in to fill that care.
They've been providing mobileclinics and rotating physicians
and other providers in thatcommunity and are planning on
establishing a site there.
So that's one way in which theyare trying to address issues.
In other communities, what wesee is, for instance, in one
(12:27):
community where the hospitalclosed, one of the local
businesses that has been therefor generations invested
significantly in the facilitywhere the hospital was located.
And they have opened up aprimary care and behavioral
health and soon-to-be dentalhealth clinic in that hospital.
(12:51):
So while these closures haveoccurred, we work very hard to
make sure that the facilitiesthat are there are receiving the
support that they need, that arebeing considered in terms of
when federal or statelegislation and regulation is
(13:12):
being passed.
In Pennsylvania, we mirror otherstates also in that we have a
number of very large healthcaresystems.
And so we've seen significantconsolidation over the years,
and that has helped small ruralhospitals be able to stay open.
So there are a number of ways inwhich we are focused on that.
SPEAKER_04 (13:34):
But even when the hospital doors stay open, the
health conditions thatPennsylvanians face still loom.
One of the biggest public healthchallenges for Pennsylvania
overall is the burden of chronicdisease.
Conditions like diabetes,obesity, and heart disease
affect rural Pennsylvanians athigher rates than their urban
counterparts.
And the barriers to manage thoseconditions can be steep.
SPEAKER_03 (13:57):
I would say that chronic disease prevention and
treatment is one of the highestpriorities of every healthcare
delivery system in Pennsylvania.
Rural, urban, hospital, clinic,it is one of the highest
priorities, especially because athird of Pennsylvanians are
overweight, and we have a higherpercentage of young kids who are
(14:18):
also overweight.
So I think facilities andcommunities are very much
focused on addressing thesekinds of issues.
Also looking at chronic diseasein terms of diabetes and trying
to manage diabetes incommunities, and also looking at
(14:40):
cardiovascular disease and soon.
So I can say that just asworkforce has been an issue for
the last 31 years, so haschronic disease management.
And that has really, really comeforward in the last 15 years or
so as something we need to focuson.
So one model of care that wehave here in Pennsylvania that I
(15:02):
think other states do as well,we have a very robust community
health worker system.
And we have a whole training andcertification program here in
this state for trainingcommunity health workers and
getting them certified.
And what we find is thatcommunity health workers,
because they come from thecommunity and they understand
(15:23):
the community so well that theyare able to provide the
connections in communities tothe healthcare delivery system
and to overcome barriers tocare.
For example, if a person isgetting access at the emergency
department very frequently, thecommunity health worker could
(15:45):
come in and find out what theissues are.
Is it because that individual isnot able to get to the pharmacy
to get their medications or isnot able to have nutritious food
delivered?
They can overcome thosebarriers.
So there's lots of ways in whichwe are looking at addressing
(16:06):
chronic disease prevention andtreatment.
SPEAKER_04 (16:10):
Going back to just like the overcoming certain um
challenges to what are someinnovative approaches or success
stories that you've seendeveloping in rural health?
You were mentioningcommunity-based programs and
having those partners down atthe community level.
But also, I know telehealth is abig innovation.
(16:33):
What other things do you see outthere to sort of lead the way
forward in providing access inrural health?
SPEAKER_03 (16:40):
So telehealth is a great example of this.
And certainly telehealth becameenormously important during
COVID because so manyindividuals, you know, almost no
one was going to the physician,but almost everybody needed to
access healthcare services.
So what we see are withinhospitals, they have very
innovative programs where, forinstance, they they will have a
(17:03):
tele ICU or a teleemergencydepartment so that they can
overcome the challenges withhaving ED, their ED staffed by
ED docs 24-7, or their ICUstaffed 24-7 by physicians
because there are challengeswith that.
So they will connect up.
They have an automaticconnection to a tertiary care
(17:25):
facility that can provide thatlevel of care if needed.
We have telestroke programs thatare in rural communities that
are hooked up to the tertiarycare facilities and other kinds
of ways in which telehealth hasplayed a role.
We also are using telehealth todo a home assessment once an
(17:49):
individual has been discharged,or to do remote patient
monitoring, which certainlysaves the time and expense of
sending home health nurses outto patients' offices.
So there are lots of ways inwhich we are looking at that.
But also, again, I want to saythat communities are really good
at being able to develop theirown solutions.
(18:11):
So, as an example, I talkedabout the rural community where
the hospital had closed.
That facility was able to openbecause the local
well-established businesspurchased the building and
started to develop all of theprograms that are there.
We also work really closely withthe community and economic
(18:34):
development groups in ruralcommunities because they have
ways of bringing in funds forthose communities and being able
to make sure that there areservices available.
And we also look to externalorganizations such as USDA Rural
Development, which has beenterrific at being able to find
(18:55):
funds to bring in specialservices or special equipment to
organizations.
And right now we are workingwith the Penn State College of
Medicine.
They are focused on wanting toestablish a rural-based medic
program that would be a trainingground for individuals coming
(19:17):
out of high school, for veteranscoming back who might have been
in, you know, a medic in themilitary, or for older persons
who are retired but want to giveback.
So there's lots of ways thatwe're looking at creative
solutions.
And they're not all coming fromus, but we're fortunate to be
involved in many of them.
SPEAKER_04 (19:35):
Yeah.
I I feel really drawn to a lotof the community-based solutions
out there since rural areas sooften rely on those strong
community ties.
How else do you see communitypartnerships shaping solutions
to health disparities in ruralareas?
I know that faith-basedcommunity intervention is a big
(19:58):
boon, but how else are youseeing it manifest?
SPEAKER_03 (20:01):
One of the ways, I'm glad you mentioned faith-based,
one of the ways that we foundout about the importance of
faith-based messaging to overallhealth is a project that we had
done a number of years agolooking at agricultural
fatalities and the impact on thecommunities.
And what we heard when weinterviewed families who had
lost, it was all husbands andgrandfathers, unfortunately, to
(20:25):
a farm incident, they all said,you know, it it was their time,
it was their destiny.
We started reaching out tofaith-based groups because we
realized that in ruralcommunities, activities revolve
around the school and the churchand the service organizations.
And if we can have messagingcome from the pulpit about
(20:50):
strong, healthy behaviors, wefeel that that is a way that we
can get the message out.
So those have become animportant part of the community.
We also find that workingthrough the school districts and
either having school-basedhealth centers, which are
extremely important, or beingable to work with students who
(21:14):
take information home to theirparents, that that is another
way to spread the messaging.
You know, parents might notlisten to the messaging that
comes out over the radio or inthe newspaper or whatever, what
their doctor tells them.
But if their kid comes home andsays, We read that we had this
paper today on healthy eatinghabits and on, you know,
(21:34):
reducing tobacco use, theparents might that that might be
a form of messaging that thatmakes a difference.
We also see that in communitieswhere there are uh strong
service groups that they cometogether to raise funds.
I was just reading an articleabout volunteer fire
(21:56):
departments.
They rely 90% of their fundingcomes from fundraisers and bake
sales and other kinds ofcommunity events, you know,
where it will cost$750,000 tobuy a fire truck.
Well, that's pretty expensive.
And so the communities comearound and build that.
(22:17):
We also see Pennsylvania is astate that has a very large
Amish and Mennonite population,otherwise known as Anabaptists.
They are enormously supportiveof their communities and they
will donate land, they willbuild facilities and clinics.
We actually have several clinicshere in Pennsylvania that focus
exclusively on the Amishpopulation and on kids who may
(22:41):
have some genetic issues thatare specific to Amish and
Mennonite groups.
SPEAKER_04 (22:47):
Yeah, um I love those different stories.
And speaking of which, you'vebeen serving as director for
quite a long time and have seenthe landscape evolve.
So how do the stories of ruralresidents you've met over your
career shape the way youapproach policy and leadership
in this space?
SPEAKER_03 (23:05):
Well, the important thing is to understand what that
messaging is.
And as an example, thePennsylvania Rural Health
Association just published thefirst standalone rural health
plan in the state since the year2000.
So we have the 2025-2030 RuralHealth Plan.
(23:27):
The next steps for that are todevelop town hall meetings where
we can go out and actually hearfrom residents.
We love to hear from thehealthcare delivery systems and
we love to hear from theadvocates because you know those
are the folks who we normallyintersect with.
But the importance of hearingfrom someone who lives in a
(23:47):
rural community is absolutelythe most important piece because
they are the ones who access thehealthcare system.
They are the ones who are havingthe challenges or the successes.
So they shape just abouteverything that we do.
And what we encourage both thehealthcare providers to do and
those who live in thecommunities is to talk to their
(24:09):
policymakers, talk to yourcounty supervisors, talk to your
county commissioners, talk toyour elected uh representatives
and senators, both at the statelevel and at the national level.
We tend to come to thosemeetings with data and
information and graphs andcharts, and all of that is
(24:31):
important.
What really makes the differenceis when a policymaker hears from
an individual about theirspecific experience.
So we we hope and we encourageeveryone to tell their story.
SPEAKER_04 (24:47):
Absolutely.
I'm wondering, I and I get thesense it's the people who you
know are driven behind this orand the patients you feel like
you're a steward of in yourposition.
But what gives you hope aboutthe future of rural health in
Pennsylvania?
SPEAKER_03 (25:05):
Well, first of all, I think that very excitedly, in
the last two years, rural healthhas received a lot of attention
here in our state, and I wouldalso say nationally.
And there are so many who arecommitted to working together to
overcome barriers.
One project that we are going tobe involved in that I think most
(25:26):
states will be involved in isthe$50 billion in funding that
is coming out from HR1, which isthe one big, beautiful bill that
was signed into law on July 4th.
So every state is asked tosubmit a rural health
transformation plan.
And we've already had ruralhealth transformation here in
(25:48):
the state, funded through CMSabout 15 years ago, but those
programs are sort of windingdown now.
So now we are able to look atrural health transformation
essentially 2.0.
And this will be bringingtogether all of the stakeholders
in the state, from communitiesup through the state agencies,
(26:08):
to develop pathways to ensuringthat we have the workforce
needed, that we have thefacilities needed, and we also
have the creative opportunitiesto look at different models of
care in the state that we hopewill actually transform health
care in rural Pennsylvania.
SPEAKER_04 (26:28):
Yeah.
Is there anything that you hopewill come out of this movement
with the bill and the funding itmay provide or the strategies
that you may be able toimplement?
SPEAKER_03 (26:40):
Well, I think we're going to be looking at new
models of care.
So whether or not that's mobilecare or that is different types
of clinical training programs ornew ways in which hospitals can
partner even across healthsystems.
I think those will be reallyexciting.
I think being able to look atthe funding that is available
(27:00):
for increasing telehealthservices will certainly be very
helpful.
I know that AI is getting agreat deal of attention, and I'm
a novice with AI, but there aremany who are out there who are
quite savvy with it.
So I'm hopeful that AI will beable to provide exceptional
training opportunities forproviders and hospitals and also
(27:22):
in communities.
And, you know, we need to belooking at health care across
the continuum, from cradle tograve, as far as patients are
concerned and consumers areconcerned, but also across the
continuum from prevention toemergency care to acute care
services to chronic diseasemanagement and then to long-term
(27:44):
care.
So we need to make sure that allof those systems are integrated
so that it should be seamlessfor the patient to intersect
into the healthcare deliverysystem.
We've had something calledpatient-centered medical homes
for a very long time, and theyhave been quite successful where
they have been implemented.
(28:04):
And I think we need to take thatidea and put the patient and
ensure that the patient isalways at the center of the care
and that the care then wrapsaround that patient so that they
are getting the right care atthe right time for the right
price.
SPEAKER_04 (28:22):
One last question on my end.
If you could share one messagewith policymakers or the public
about the importance ofsupporting rural health, what
would it be?
SPEAKER_03 (28:32):
I am so glad you asked that.
(29:24):
So as I say to folks, if you hadbreakfast this morning, you have
rural to thank.
If you woke up in a building,you have rural to thank.
If you have clothing on, youhave rural to thank.
And so many of our traditionsare rooted in rural culture and
rural activity.
So it is absolutely essentialthat rural health is sustainable
(29:50):
because without rural health, wehave very challenged rural
communities, and without ruralcommunities, we will have
challenges in Being able tofeed, clothe, and house America.
SPEAKER_04 (30:04):
Couldn't have said it better myself.
Lisa, is there anything else youwanted to add before we wrap up
today's conversation?
SPEAKER_03 (30:10):
No, just to say thank you so much for this
opportunity.
And thank you to everyone outthere who is listening and who
is supporting their ruralcommunity and their rural
healthcare delivery system.
SPEAKER_04 (30:24):
Well, thank you so much.
It was such a pleasure to haveyou here and bring light to the
landscape of rural health inPennsylvania and elsewhere and
helping us think about how weshould be serving the well-being
of our rural communities.
It was a pleasure to have you.
One thing I'm taking away fromthis conversation is that rural
(30:46):
health is more than just apolicy issue.
It's a lifeline.
As Lisa reminded us, ruralcommunities grow our food and
power our economy.
But they also face uniquebarriers that can't be ignored,
from hospital closures toprovider shortages to the
growing burden of chronicdisease.
Lisa and her team have worked toensure that these communities
(31:06):
aren't left behind.
And, as we heard today, thelessons from Pennsylvania
resonate far beyond the state'sborders.
Rural health matters, not justfor the people who live there,
but for all of us.
Thank you for tuning in toEmpathy Affect.
If you enjoyed today's episode,go ahead and share it with a
friend, and make sure to followand give us a review wherever
(31:26):
you get podcasts.
I hope you'll join me next time.
Thanks, y'all.
SPEAKER_01 (31:33):
Empathy Effect is a product of Forrest Marsh.
You can reach us at Forest MarshMedia at Forzmarsh.com with any
feedback, questions, orinquiries.
If you want to know more abouttoday's guest, are interested in
participating with ForrestMarsh, or becoming part of our
community, check out our shownotes for more information.
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