Rural Heart Health and Community Partnerships, with Jennifer Conner, Jessica Black, and Dianne Connery

Organizations and resources mentioned in this episode:

• American Heart Association
  • Call to Action: Rural Health: A Presidential Advisory From the American Heart Association and American Stroke Association
  • Health Equity Research Network (HERN) on Hypertension Prevention
  • Kids Heart Challenge
  • HeartCorps, Public Health AmeriCorps at the AHA
  • Rural Health Summit
  • Rural Health Care Outcomes Accelerator
  • Get With the Guidelines
• SNAP-Ed Connection, U.S. Department of Agriculture
• Cooperative Extension System
• FFA
• 4-H
• Pottsboro Area Library Health Services
• National Rural Health Association

Transcript

Andrew Nelson: Welcome to Exploring Rural Health, a podcast from the Rural Health Information Hub. My name is Andrew Nelson. In this podcast, we'll be talking with a variety of experts about providing rural healthcare, problems they've encountered, and ways in which those problems can be solved. Today, joining us from the American Heart Association is Dr. Jennifer Conner, Vice President of Rural Health Southwest Region, and Jessica Black, National Vice President of Community Health. Also joining us is Dianne Connery, who's the director of the Pottsboro Texas Area Public Library. She's also an American Heart Association Rural Advisory Committee member.

Jennifer, can you tell us how we have seen health in rural communities changing in the last three decades or so, and what are some of the specific disparities AHA has been focusing on?

Jennifer Conner: That's a great question. If we think about the big picture of our rural communities, we do have some of our rural areas that are seeing significant rates of out-migration. And we know that kind of out-migration has a real potential impact on the overall community volatility and economy of those. All of that has a domino effect and really does relate to our health. We're seeing more closures and consolidation of our critical infrastructure in our rural communities. And what I mean by that is our hospitals, our schools, our grocery stores,the basic infrastructure that we need to live in our rural communities and how that impacts our health. And if we think about specific to our cardiac health and cardiac events, we know that on average, some of our rural communities have at least a 30- to 40-minute response time.

And so as we're thinking about the hospital closure, we're adding even more time to that critical situation in the event of an emergency. We also know that there are other factors such as transportation and sufficient broadband, affordable housing — all of that can really influence our health — and rural areas can struggle with this. So you put all that together, and the resulting impact is that there are greater disparities in our rural areas for cardiovascular health and maternal health and mental health. And all of those are focal areas for the American Heart Association.

Jessica Black: I might add just big picture, through the '80s, the rural communities and the urban communities were tracking pretty closely, when we look at things like morbidity and mortality. As we've moved out since then, we've seen that disparity grow. So the disparities between rural and urban or suburban have increased pretty significantly over the past 20 to 30 years, where now life expectancy among people who live in rural America is actually three years less than people who live in urban or suburban areas, even when we match for other factors. So we know this is a growing and not a subsiding trend, and thus something we really need to be engaged in.

Dianne Connery: And from my perspective, I had never lived in a rural community until I moved to this community in 2010. And one of the things I learned when I moved here is, our emergency responders are volunteers in many cases. And so taxpayer funding is not providing the resources in our rural communities. In our case, we actually have an annual fundraiser held in a horse barn to raise money to buy the equipment for the emergency responders. Some of the services that are available in suburban and urban areas just do not exist in rural areas.

Andrew Nelson: It seems like awareness of some of those issues and the ability of people to network and find solutions to those problems is improving. Of course, some of those disparities are also increasing at the same time, so I'm sure it can be challenging to keep up.

Jessica, in 2020 AHA and the American Stroke Association published a rural health presidential advisory. Can you tell me about some of the concerns that were in that advisory?

Jessica Black: Going into 2020, AHA made a major commitment to address disparities across the country. And one of the areas of focus was looking at rural America. And so we pulled together a group of experts across the country to really dive into what were those disparities, what was driving them, and what needed to be done to address them. And out of that came the 2020 Rural Health Presidential Advisory. And the big areas that were noted within that were access to care, quality of care, and then risk factors. And if we dive a little more deeply into that relative to access to care, there are workforce shortages across rural America. We know there's been risk of hospital closures or other clinic outlet closures just due to low population volumes. It's hard in our current context to meet the need in sort of traditional ways.

Jessica Black: And so one of the issues was looking at, “How do we address that? How do we make up for that so that people don't have so much distance to the care they need, and that we can really get the workforce that we need in those communities when places exist?” From the quality lens, the disparities in access and what we're able to have in rural communities in terms of providing that kind of ready assistance for needs — be it emergency assistance or emergency care, or care for chronic diseases, ongoing things, specialty care — all of those things are really hard to distribute across rural communities. So how can we improve that connectivity, either between rural sites or more metro centers where we have more concentrated care opportunities? How can we support those rural hospitals in meeting guidelines and offering the best care possible and working within the constructs of the staff turnover they may be facing, et cetera.

And then when we think about risk factors, those are all the things that are driving our health that aren't necessarily happening within healthcare. So that may be smoking and vaping; that's nutrition, which isn't just whether I'm eating healthy, but really whether I have access to affordable, healthy foods and how I'm accessing that; that's around physical activity; but it's also other, what we call broadly social determinants, housing security, safety, clean air, clean water. There's a huge list of things that are in many cases not evenly proportioned across rural communities. And so the advisory was really around saying, “We need to address this. We need to address quality, we need to address access, and we need to reduce the risk factors in rural communities.” And it really called on AHA, on our stakeholders, on our collaborators and sort of on policymakers across the board to prioritize this work and these populations.

Andrew Nelson: Can you tell us a little bit on how the Health Equity Research Network has played, and is continuing to play, a part in improving rural determinants of health?

Jessica Black: One of the big places that AHA operates when we're talking about addressing health is in research; both in sort of basic science research, but also translational research. How are we bringing what we know about what needs to be done to the communities in which we work? And so the Health Equity Research Network, or the HERN, as we call it in shorthand, is dedicated funding. It's $20 million of research funding really focused exclusively on how to improve rural health and how to close these disparities. So that just launched via competitive grant program this past summer. And now we have these five networked research operations taking place simultaneously to investigate things like, “How do we improve diagnosis and treatment of cardiovascular care in rural communities? How do we leverage technology to better connect primary care, specialty care, special needs care across rural and urban communities? How are we working with special populations or populations that historically there hasn't been as tremendous an investment in, such as our Native populations across the country, and making sure that we're addressing health disparities in those communities?” So those are now funded projects. They work collaboratively, sharing their results as a learning collaborative, working with one another. One of the other really important things about that particular HERN is that it requires community participatory research. So it means the voices of the community are being integrated and lifted up into that work. So it's not just experts sitting in academic centers, but rather people who are experiencing the care, who are also informing the research questions as well as sort of the process and solutions. And it also requires connectivity with centers, with academic centers or local organizations or nonprofits who are working directly with the population. So again, not just sitting necessarily at academic centers that may be a little bit removed from that rural care, but partnering with those delivering the rural care. So really trying not just to drive for solutions, but to drive for solutions that will ultimately resonate with the communities in what's working.

Andrew Nelson: Certainly. Jennifer, can you give us a little bit of an overview of some of the ways in which the American Heart Association has been able to provide educational opportunities by working with various community organizations?

Jennifer Conner: Absolutely. So we know that the AHA alone cannot do this work in rural. So it's very important that we build these community partnerships. And so we worked again with rural libraries, with senior centers, with 4-H, with FFA, [Cooperative] Extension, all of our partners that are in the rural space. And we've found that together and collectively that we have the opportunity. And I'll give Extension, for an example. A lot of our Extension services are already doing SNAP-Ed education. And so how then, if AHA is doing nutrition security, can we come together? So for example, if someone is receiving SNAP benefits, then how can we come alongside and say, “What is the cardiovascular component to that? How can we provide healthy recipes? How can we make sure that our food pantries actually have healthy donations?”

So, if X percent of the population that a food pantry is serving is diabetic, how then can we come along those local partners like Extension and really make sure that the assistance that they have available to them is helping their condition and not just addressing the food insecurity, but the food insecurity needs relative to their diagnosis? So that's kind of one way we know that 4-H, FFA has great youth engagement. We also have space for our youth market and working with our Kids Heart Challenge. And so just like our workplaces with our adults, we know that schools are a great opportunity for us to come in and start teaching at a very young age what our heart is, how it operates, and then how a lifelong healthy heart can give us the best outcomes as we become adults.

Jessica Black: I would note that I think Extension is such a phenomenal potential partner in the rural space because it's the one government operation that we have in every county in the country, right? Everyone has a USDA Extension officer in every county in the country. And so they do tremendous work connecting the dots in rural communities. And we, as the AHA, have partnered with Extension in many locations on our nutrition security work, connecting people with educational resources, with things in the nutrition space, but there's also a real interest in the Extension community around addressing disparities more broadly and sort of how to integrate that work. And so I think there's a lot of potential moving forward. I haven't mentioned HeartCorps, which is our AmeriCorps service program that perhaps we'll talk about a little bit later. But we've also partnered with some Extension offices to be hosts for HeartCorps members. So in other words, to connect to grow the bandwidth of Extension, so they can be more present in these communities that they serve too. So just a great potential partner as we're thinking about who's in rural communities, who really works with rural communities and is doing amazing work.

Jennifer Conner: And so I think those are great examples. Libraries, amazing partners, often the hub of the community as I like to say, they're the Kinkos, the Starbucks, the online education. Often in rural areas, our libraries are the staple of our community. And Dianne will probably speak to this, but traditionally it may have just been books, but it's an opportunity then to become more than just books and really that hub and health information. And so in some of our work with libraries, I've heard librarians say, “Oh, I had cookbooks that never really got checked out, but as we started health initiatives, then the cookbooks get more circulation.” And so how then do we see working with libraries as a place to check out books and CPR kits and bikes and all the other amazing things that we're doing. And also telehealth. We know that they have the facilities and the ability then to be a telehealth hub for us.

Andrew Nelson: As Jennifer mentioned, Dianne, you have firsthand experience doing this kind of thing at a local level. Can you tell us about how your library partnered with AHA to improve local health outcomes?

Dianne Connery: Yes, I'm talking to you from our Pottsboro library, the telehealth room. Early in the pandemic, we recognized that transportation was such a barrier to healthcare, that we were able to launch the telehealth room in our library. And one thing leads to another. I've learned that, and COVID taught me that there are national organizations that want to serve rural communities, but may not have had the connection to the people who live there. And that's exactly what libraries do; we're the living room of the community. So we would see on a daily basis the needs of people in the community, yet we lacked the funding. Oftentimes rural organizations are underfunded, understaffed. So through partnerships like with the American Heart Association, we were able to increase our capacity. Libraries are about information and connection with resources.

And so it's only through partnerships that we're able to have the kind of impact we do. So the partnership with American Heart Association has been from very practical to much bigger-picture. We started with checking out blood pressure kits that the Heart Association donated. So people can check out the kits for three weeks at a time. They come with logs so that they can track their blood pressure and recipes, healthy recipes. The Heart Association said, “What else can we do for you?” And so they helped us establish ourselves as a summer meal site for people 18 and under. And it requires no proof of need. People don't even have to sign in, just come get nutritious meals throughout the summer here. And then we are also able throughout the rest of the year to provide snacks to kids after school.

And I think maybe on the big picture level, what it has helped us do is some networking: getting outside of our silo and through being on some calls, and the Rural Health Summit for sure, connected me with other people who are trying to achieve the same kind of outcomes that we are. And it just helped me connect with those people who are trying to do the same work and we're all working towards the same goal, and we can go farther together by meeting up with each other and finding out what each one of us is doing.

Andrew Nelson: I keep hearing stories about the roles that rural libraries are able to play in their communities as hubs of information about health, or helping to connect people with resources or providers. It's just so valuable to be able to use that platform where people are already coming to the library; everybody already knows where the library is, but then you can just continue on and expand those services that you're offering to your community.

Dianne Connery: Yes. One of the things that lot of people, when they hear the name “library,” they have a very traditional view of what a library offers. And many rural libraries are these community anchor institutions that meet so many more needs than the traditional library did. And so, by checking out blood pressure kits, we also have a library of things where we check out non-traditional items such as bicycles and outdoor games and camping gear. So in addition to that, some durable medical equipment, wheelchairs and walkers, that sort of thing. The blood pressure kits help the community not only meet their needs, but understand that the library is access to all kinds of resources. And so all of it works together. It's this whole ecosystem that we develop. Digital equity was our first focus. And then with the onset of COVID, it became sort of a subset of public health initiatives.

And as I said, one thing leads to another. So we started with the telehealth, but then also some of those other social determinants of health. And we started a community garden. So it provides access to food. because we could see people coming into the library who didn't have access to healthy food, nutritious food. One of the examples I think of is a young family who would come here every day, and the kids would come in hungry after school. And when I talked to the parents about providing a snack for the kids, the next day they came back with a bag of marshmallows. And what they explained to me is that they didn't have transportation to get to a grocery store, but they could walk to the dollar store, which of course only has processed foods. And that kind of broke my heart.

And so from that, we got cargo bicycles in our library of things so that they could reach the grocery store, but then also with the community garden, they had access to growing their own organic produce. And one of the gardeners went on to lose 90 pounds, which she credited with the community garden, giving her access to fresh produce, and then also the ability to get out and do that kind of physical labor herself. This morning, I had a call and we're talking about getting children out in nature. While I'm usually all about technology, I've also been inspired that getting kids outside is a thing that's really good, both mental health and physical health. So it all works together to help people lead healthier lives.

Along with our community garden, as a library, we're able to offer programming that coordinates with it. And so we could have a person come in who teaches canning, for instance. So those things, people have grown in their garden, then they're able to can it, and then through our library of things, we lend out canning supplies. So it's sort of this whole cycle from growing it to them being able to preserve it for their own needs… and we have a dehydrator as well. So lots of people are growing herbs so that they can dehydrate all those herbs.

Andrew Nelson: Yeah, I can see how there could be multiple determinants of health that are being improved. Not only are people getting that nutrition, but they're getting social benefits as well, and it just feels great to have a garden and grow things and to be able to eat things that you've grown yourself. So that can help to create a sense of community investment and fulfillment. I just think that's very cool.

Ensuring people have access to the highest quality care is a critical part to closing some of the health disparities in rural areas. Jennifer, what can you tell us about the American Heart Association's “Get With the Guidelines” programs and the Rural Healthcare Outcome Accelerator?

Jennifer Conner: So the “Get With the Guidelines” is really our quality improvement effort. And we know that research is ever changing. There's always new technology, there's new information. So especially as our practitioners are out in the rural area, keeping up with the latest science, keeping up with the latest evidence, is super important. And so “Get With the Guidelines” is our modular-based program that we have. Specifically, we focus on stroke, heart failure, resuscitation science, AFib and coronary artery disease. And so these are modules that our in-hospital staff can really take a look at, incorporate into their systems of care, and then really track, are they following the latest guidelines? What is their data showing them about the care and the quality of care that they are providing? So again, this is a great program where the latest information is really brought to you, packaged up and put into a way that is easily incorporated into your already-stressed rural system.

As Jessica has mentioned, we're trying to keep hospital doors open. And so how do you balance providing that care but making sure that you're keeping up with the latest guidelines? So again, the Rural Healthcare Outcome Accelerator is specifically for our Critical Access Hospitals, our hospitals in the most remote and rural areas. Tracking that data, giving that information can be a very laborious process. So this is the AHA's commitment to saying our rural hospitals matter, the quality of care that we're providing in those rural areas really matters. And so then how can we provide solutions? How can we provide guidelines? How can we provide checklists very easily to implement instructions so that it doesn't matter which hospital you're going to, you are following the latest, best practices that we have?

Jessica Black: Yeah, and I would just add that with our Rural Health Outcomes Accelerator, one of the things that's so terrific about it is that it comes at no cost to the rural health centers that are participating. So typically, when we do our “Get With the Guidelines” work in bigger health systems, the health systems have to sort of help cover the cost. There's no income generation, but to help cover that cost of the technology and the technical assistance and the feedback loop. In the case of the Rural Health Outcomes Accelerator, we have made a commitment that they don't cover that cost, because we recognize that one of the challenges in rural healthcare settings is that the cost is a burden. And so as a result, they can participate for free. We encourage wide participation, and in addition to being able to track their data, get that feedback, make sure that they are delivering on up-to-date guidelines, there's also technical assistance that comes from our national team who has expertise in this arena.

And then also learning collaborative. So pulling together those rural healthcare centers and those hospitals and those Critical Access Hospitals, as Jennifer noted, to talk about what's working, what's not, how people are troubleshooting things. You know, a lot of this we're figuring out in real time. So also helping connect those participants so that they can learn from one another, and we can ultimately accelerate the solutions, which sort of helps explain the title as well. So we really encourage healthcare systems, hospitals, those that are interested in that space to be in touch. They can find more information on the website and apply to be a part of that process.

Andrew Nelson: On kind of a broader scale, we know that agriculture is often one of the top industries in rural areas. How does the American Heart Association work to engage with those groups?

Jennifer Conner: So I'll take that one on. This is Jennifer. As you said, agriculture is big. It's everything from the production side to the consumption side. So the AHA is specifically looking at, you know, “What are the unique needs of our agricultural industry?” So we know that farming and ranching can mean working from sunup to sundown. There also may be a lack of insurance. And so that's uninsured, self-insured, or not having access to enough insurance. And so specifically in our rural space, we've looked at, “How do we engage this population?” So we mentioned a little bit earlier, working with our Extension partners realizing that there's 4-H, there's FFA, there's the agriculture and natural resources side of Extension. And so I always say the health and wealth of our farmers is the health and wealth of our food system.

And we know that farm stress has been a big issue for most of our farmers. And there is the corollary between heart disease and stress. And so how then are we even looking at some of the stress issues related to farming? So specific to that, we have been working with ag shows. So coming up next week for instance, we'll be at the Arkansas Growing Conference working with our specialty crop farmers. And there's a CPR issue here as well. So as we're thinking not only of the mental and physical health, but what's the farm safety aspect of the work that we're doing and, and how that fits into the AHA space. So I just mentioned earlier, we know that some of our rural residents are 30 to 40 minutes, if you're out on a farm, you could be even further, if you're on the backside of the farm or the ranch there may be no one in sight. And so how then are we thinking about our cardiac emergency response planning for our farmers and ranchers as well? So I think it lends itself to a lot of the work that the AHA is doing, and it's a very exciting space. I'm coming to you from the Fort Worth Stock Show and Rodeo. So we know that the western culture, western lifestyle is very important. We just had our first rodeo engagement, I can say our first rodeo, where we were specifically able to screen for blood pressures and provide a hands-only CPR demonstration. So something unique, and meeting the needs of our rural communities where we are, those local county fairs are a place that we go. And so how can the AHA place themselves; what you've heard this whole conversation is place-based solutions. So we're going to where we know that our rural folks are already gathering.

Andrew Nelson: That can be huge, I think, because making an appointment and sitting in a waiting room in a doctor's office can just be so intimidating for so many people. It can be easy for them to tell themselves, “I feel fine. I'm probably fine. I don't think I have anything to worry about. I don't think I need to go to the doctor.” But being able to do what you're doing and coming to where people are, I think that does a huge service in terms of just making people more comfortable with accessing care and being more mindful of their health.

Jennifer Conner: During the COVID pandemic, telehealth and telemedicine was our norm. And for this, it really opened up the space for us in agricultural health because we could have the new norm of our farmers and ranchers doing their telemedicine visit from the tractor. Also we were able to do podcasts and health-related outreach that for the first time was piping through our tractors in our ag community. And so I think there's just an opportunity to take what we learned during the pandemic and use it as a mechanism to be able to strengthen our access. And we talked a lot about broadband and having the ability to reach folks. And so I think this just is a concerted effort to reach a subsection of the population and not interrupt our food system, which is what we need our farmers and ranchers producing.

Dianne Connery: And that gets at digital health equity. We have now two digital navigators, and digital health equity is a subset of what they do. People need to be able to know how to go online and look for authoritative health information, sign up for their health portals and check their explanation of benefits, make appointments. And so there really has been an impact for rural communities not being as well-connected as suburban and urban peers in health outcomes.

Andrew Nelson: I know that American Heart Association has recently launched a public health AmeriCorps service opportunity in rural communities. Can you tell us about that initiative and some of the things you've learned from it?

Jessica Black: We're so excited about our Public Health AmeriCorps opportunity. So AmeriCorps is a domestic service opportunity. It's been around many years, and calls on people to do service work across the country in various areas; health, education, environment, et cetera. Last year, post-pandemic, recognizing the need in our country, the Center[s] for Disease Control [and Prevention] partnered with AmeriCorps to launch Public Health AmeriCorps. So AmeriCorps service opportunity really focused on growing the public health and health workforce moving forward. We, as the American Heart Association, decided that was an area of focus for us as well, and applied to be one of the inaugural Public Health AmeriCorps hosts or service opportunities. And so we now have the opportunity for up to a hundred service members, but we really specifically decided to focus our work, which we call HeartCorps.

So people can join the HeartCorps in rural communities. So all of our host sites to date are in rural communities around about 26 states in the country, and people commit for about 1,100 hours. It's just under a calendar year. They can do full-time, they can do part-time. And during that time they work with local community organizations, in many cases, Federally Qualified Health Centers or HRSA-funded centers, in some cases, Boys and Girls Club, YMCAs. We've worked with housing developments, we're working with Extension, we're working with other hosts, community organizations, senior centers, places that perceive a need for added bandwidth. And those service members then come, they put together an action plan around where they think they can improve health in their community. In many cases, they're focused on helping people improve their blood pressure control. So both through screening and identification of the need, but then connecting people with self-monitoring resources, making sure they're connected with the medical providers they need to help control care.

But also working in nutrition security, working in CPR training, we know that there's a huge deficit in a number of people who are ready to provide CPR. We all can be lifesavers, every single person can save a life, but we all need to be trained and ready to do so. So spreading that opportunity throughout rural communities as well as addressing issues like tobacco and vaping, and making sure that people have the cessation resources they need if they need to change. So our members are serving different purposes and different communities. But we certainly encourage anybody across the age continuum older than 18. And that is really it. And interested in working and serving in a rural community. It's fantastic when people take the opportunity in their own community because they already have those connections and can really see the needs in their community. But in many cases, we have people commuting to partner in communities in order to do that, and really look forward to continuing that work in the years to come.

Everywhere in the country, we're forming partnerships from local to state, to regional, to national, in order to figure out how to work collaboratively. But we're extraordinarily grateful for some major funding partners, friends who have come to the table, who also recognize the importance of this work and have helped support it. So, for instance, AmeriCorps is a great supporter, but also the Helmsley Charitable Trust. They're a foundation dedicated to serving rural populations across the country. And we're really excited about the work we're doing with them, both in HeartCorps and in telemedicine and in survival in lots of ways. And similarly, we recently formed a partnership with the Hartford Foundation, who we're really excited about, they have a specific interest in supporting healthy aging in rural America.

We know there's a disproportionate number of aging Americans in rural communities. And so really thinking about the intersection of that work and how to make sure that we're eliminating ageism and that we're providing those best opportunities for people to thrive across the age continuum. And we also have a terrific relationship with the [National] Rural Health Association and some terrific work that they're doing across the healthcare spectrum as well from outpatient to inpatient and other opportunities there. And working with Extension on that front. And then certainly libraries and other community partners. So I'll defer to Jennifer and Dianne for more examples, but lots of great organizations on the national and local level.

Jennifer Conner: Yeah. And I'll just add, we are working, again, with a lot of our state organizations that are like community health workers. We talked about the value of community health workers. And so we have several states for which their associations are really looking at the connection between cardiovascular and mental health, cardiovascular and stress, and how community health workers can really continue to promote that message, that it's not just our traditional blood pressure that we think about, but how does all of the work and all of our life events really come together to impact cardiovascular health. Jessica mentioned earlier about the USDA; we're working with our state departments of ag[riculture] and the USDA again, realizing that there is a connection with our food systems.

And not only food that we're producing, but going back to what I said earlier, the farmer's health. So we need producers and farmers to be able to do that. And we talked about the state rural health associations. And so we know, for example, the needs of East Texas might be different from West Texas. So working with those state associations allow us to look at the geographic differences that some of our regions of the country face and how we can really do those place-based solutions in a way that makes sense. And whether that we're working with some of our tribal communities and some of our agricultural communities. How can we take the best approach to make sure that our partnerships and our solutions match the needs of our communities?

Dianne Connery: So many opportunities out there, and in rural communities, there are many needs. And so there are a lot of places we can go. The needs are great, but I think any individual in their community who wants to be part of the solution, one of the beauties of living in a rural community is one person can really make a difference. And for me, it's just about saying “yes” to things, and you start out and then who knows where it will lead? It leads to amazing things. And that is done through partnerships like what we have with the American Heart Association.

Jessica Black: I would say one of the amazing things — we've talked a lot about disparities and other issues — but the reality being rural communities are amazing. I mean, they have the highest levels of social cohesion of any of our communities. There are amazing strengths and assets and opportunities within our rural communities. And so a lot of what we're focused on is figuring out how do we sort of support and work with and provide the resources and opportunities that those committed individuals need and want — people like Dianne and others — so that rural communities can really build that sustainable opportunity to keep people healthy and thrive and live their best life, which is what we all want everyone to be able to do. We want them to be able to age in place and enjoy their community and their loved ones and really be a part of that.

And so we're always looking for new partners and new opportunities and ideas for how we can leverage our strengths and assets and our resources, our people, our grassroots, our research, our science, those things, in ways that really are in synergy with the amazing things happening in communities and the amazing people living in those communities. And so, whether that be something like HeartCorps — if anybody's interested in joining, if they have flexibility or capacity or looking for a pivot in their life and think it might be really interesting, we encourage you to come to the website and explore that opportunity and potentially apply. If there are hospitals or health centers that really want to improve quality and are looking for added support in doing that, consider exploring the opportunities with the Rural Health Accelerator and seeing if that's a good fit.

If there are other libraries or community centers or senior centers who are thinking, “I would love to be more involved in this health space, but I'm not sure where to start,” or, “We don't necessarily have the capacity to do that,” we would encourage you to reach out, come to the website, let us connect you with those of us who might be more local and think through where we might be able to work together. Because I think there's incredible opportunity. And it's really so often just a matter of us partnering and bringing our resources together to find those sustainable solutions.

Jennifer Conner: I know Dianne and I have had this conversation, but just telling the story. So I think that, you know, AHA is a partner. The value of other partners is that there are strengths and you know, there are great assets in rural. And so how do we lift those up? How do we tell the story about the amazing work that we're all doing together as the collective; how do I replicate Dianne and get her story and then encourage other librarians to jump on as well? So I think part of it is sharing your story with us. You know, perhaps it's not anyone on this call that has worked with you, but if you've worked with the AHA, what's been that success and or if it's like Jessica said, an opportunity, tell us that story.

Tell us about that innovation, because we're always looking for what's working. And then how we can scale that, how we can make that big and robust and use our network to share that innovation, to share those stories. I might have something working in Wyoming that I want to share with Idaho or vice versa. And so we are a very large organization and how do we spread that innovation? How do we spread what's working to other parts of the country that, and make sure that no matter where you are in rural America that you have access to this information and being that information hub and sharing that latest resuscitation science, or what we did in a food pantry. And I think we have the gamut of knowledge, and how do we just get that out there to our rural community. So share your story with us so that we can share other innovations and ideas as well.

Andrew Nelson: You've been listening to Exploring Rural Health, a podcast from RHIhub. In this episode, we spoke with Dr. Jennifer Conner and Jessica Black from the American Heart Association and Dianne Connery, Director of the Pottsboro, TX Area Public Library. Look in our show notes for more information about their work and visit ruralhealthinfo.org for all things pertaining to rural health.