Health Equity in Rural America, Part 2: The Two Georgias Initiative, with Lisa Medellin, Arlene Parker Goldson, and Tara Gardner

Organizations and resources mentioned in this episode:

• Healthcare Georgia Foundation (now the Georgia Health Initiative) and its Two Georgias Initiative (TGI)
• Partnership for Southern Equity and its Just Health work, funded by The Two Georgias Initiative
• Two Georgias Initiative evaluation, Emory Prevention Research Center
• Feeding the Valley Food Bank
• Clay County Family Connection
• United Way of the Chattahoochee Valley

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 we're wrapping up our two-part series about rural health equity. This time, we'll be talking to three people who have been involved with the Two Georgias Initiative, created by Healthcare Georgia, in an effort to advance and improve rural health equity. Joining us are Lisa Medellin, Director of Programs for the Healthcare Georgia Foundation, along with Arlene Parker Goldson, who's the health consultant for the Partnership for Southern Equity, as well as Tara Gardner, project coordinator for the Two Georgias coalition that's located in Clay County, Georgia.

Alright, Lisa, to start us off today, can you talk a little bit about how the Two Georgias Initiative came about, and why there was a need for that project?

Lisa Medellin: Sure, Andrew. This goes back a few years prior to the start of the initiative, which was in 2017. And the former foundation president, Dr. Gary Nelson, had been having some conversation with different leaders around the state who were representing rural communities. And what was discovered was that there was basically a sense that the rest of the state has forgotten about rural Georgia. And resources from the state level coming into communities was very sparse. They were demonstrating lower health outcomes. Also, we were learning that the life expectancy was much lower for people in rural communities than some of the urban centers. And so there just became this awareness that essentially there are two Georgias.

There are urban centers that are very much thriving like Augusta, Savannah, Columbus. But when you get outside of the metropolitan areas and you get into the rural communities, it's a different world. And essentially the idea that two Georgias was a real thing came to light, and Healthcare Georgia Foundation, since its beginning, really leaned in on the fact that we are a statewide foundation and so we have interest in supporting and improving health for all Georgians. And that means that we have to be aware of and invest in rural communities. It was just a sense that we could do something with not only our financial resources, but our ability to convene people, our ability to put the right team together to support this work. And so we went on that journey.

Andrew Nelson: I would imagine it's very fulfilling to become aware of a need like that and then be able to come forward with meaningful change to fix some of those inequalities and disparities. What kind of support and technical assistance did the rural coalition need to get the projects going and off the ground?

Lisa Medellin: We realized early on that it was going to be significant. We're, as foundations go, a relatively small foundation. Our allocation annually is about $3.6 million a year. In the philanthropic world, that's small. And so there's the resource issue internally of the capacity of the foundation. We knew from the beginning we wanted to center this work around equity.

We really wanted communities that demonstrated they were committed to this work, they were dedicated and they had the willingness and the desire. So we weren't so concerned about their capacity because we understood we were going to help with that, but we really needed to understand that from their application, that they had the buy-in and were ready.

So in some of the communities, they had coalitions that they were going to repurpose and some didn't have any, and they were going to create new ones. Coalition work in and of itself requires a certain degree of flexibility; the ability to be nimble and to lean in on the voice of the community. We didn't have the internal capacity to have staff from the foundation in each one of the 11 communities. We would provide community coaches with an organization called Georgia Health Decisions. And we had identified four coaches that were divided up across the 11 communities, and they were the boots on the ground, if you will. They were the ones in the beginning during the planning year, helping them to understand what the coalition's work was going to be, helping them to create a Community Health Improvement Plan.

One of the things that was central to this is that the foundation did not dictate or have a mandate around what areas the communities should address. We weren't saying, “you've got to do a diabetes program.” We wanted them to go through the journey of just figuring that out for themselves and having ownership for it. Then the other central piece of the technical assistance was the equity. We expected this to be a cornerstone of the work over the five years. And so we had the fortunate opportunity to partner with the Partnership for Southern Equity. And they bought in their team of experts around equity who included Ms. Arlene Parker Goldson as a lead. And she had a team of folks working with her that actually went into the communities and did a series of onsite hands on in-person training around equity — Equity 101, if you will. And how do you elevate that narrative in a community and a coalition is leading the work.

And then the third leg of the technical assistance stool, if you will, was evaluation. We really needed to be able to track and see what happened, and be able to disseminate that information at some end point. And so we engaged Emory University's research and evaluation center led by Dr. Michelle Kegler. And so she and her evaluators have also been a part of providing evaluation, coaching, training, support, but also conducting a cross-site evaluation for all 11 communities.

The first year of the initiative was a planning year. So for the first 12 months, the lead organizations and the coalitions spent about a year planning, meeting, deciding what the structure of their coalition was going to look like, what type of governance was going to be necessary. And that was another unique thing for Healthcare Georgia, that we understood in some communities, a little more formalized structure of the coalition was necessary because that's what the community members wanted and others, it might be a little bit more fluid. They created a Community Health Improvement Plan.

We gave them a template and they filled in the pieces so that they could walk through the process with the support of the technical assistance folks I just mentioned, to guide them on how to fill out those pieces to come to the conclusion of what would be the focus of the work. We were very upfront about the expectation. We were clear that we had no hidden agenda. And there was some trust building. I think what's important is each of these communities were in a very different place on a continuum of community development or community engagement based on the history of the community and maybe work they've done in their community in the past.

They each didn't start at zero, some had some history as a community. Some were new and they've never had any organized way to focus on health issues. Also there was the narrative of engagement with the funder. Some of the communities had experience receiving large grant funds, some had not. And so that dynamic was at play as well, because now you have this influx of cash and there's an obviously accounting component of it that has to be taken care of, which was why there needed to be a lead organization to accept the money and to manage it. But also there was just that year where they could figure all those little details out and who they were going to be, how were they going to work together.

They also had to work on identifying who needed to be around the table, because one of the conversations relative to equity is about who gets to make decisions for a community. And so there was some conversation during their meetings where they needed to see, “Well, who's not here? Who do we need to have that represents community that needs to be at the table?” Because oftentimes when you have things like this it's usually the people who are either self-described leaders of a community, or they're selected, maybe because of their position or title or station in a community, but they may not always be the only people who should be around the table. Often, I would submit, they shouldn't be the only people around the table. Because if you really want to level the decision making and the power structure, then you have to really invite and make a space for the average person who cares about their community.

Maybe they're the cashier at the grocery store. Maybe they're the coach on the high school football team. But if they have a desire and an interest, the door has to be made open to them that they can come and be a part of this and they can share the decision making, which is power, in a community when you have resources that are going to be deployed. That was something we really encouraged early on, and it was part of what we had the technical assistance teams from PSE to Georgia Health Decisions to Emory, elevate as well, when they would engage with the communities.

Andrew Nelson: It's really impressive to hear how that all came together. Arlene, Lisa mentioned some of the things you were involved with as part of the Partnership for Southern Equity where you had sort of a little more of a regional purview over this project. Can you tell us a little bit about the Partnership for Southern Equity and the work you do there?

Arlene Parker Goldson: Our mission is to advance policies and institutional actions that promote racial equity and share prosperity, not just in metro Atlanta, but around the state of Georgia and the American South. And it was important for us to share the mission and to advance all of the work that we do through an ecosystem, if you will. PSE'S equity focus is energy, health, opportunity growth. And let me break that down for you just a little bit. For example, we are committed to minimizing health and racial inequities identified by our community partners. We also work to minimize the impact of environmental and climate change in underserved communities. Growth is about what is the equitable development and access to housing and how are communities planned and developed.

If you think about the social determinants of health, the PSE ecosystem works is aligned with a critical review of the social determinants of health. So the PSE ecosystem includes energy, growth, and opportunity, health all SDOH issues. And, we have recently focused have included the youth focused work of, Yes! for Equity. When Lisa talked about the way in which decisions are made and who is around the table. Very often we don't include youth or the youth voice. And so our Yes! for Equity portfolio is completely driven by youth. They lead it, and part of what our value is in the work that we do is that the people most affected by inequities are the people who have the solutions. And if they are around the table, then that is a more robust way of developing policies and actions that are going to advance health equity.

So for the big picture for Partnership Southern Equity, we do want to be clear about PSE's work and why it's so important. We lead with race and we focus on the way in which race and inequities have bubbled up in, um, particular in underserved communities. For example, rural communities in the state of Georgia. The Two Georgias Initiative was an organic and natural way for PSE to have the conversation with a group of people that we had not intentionally focused on in the past until Lisa's point in rural communities. TGI was a great natural, timely partnership with Healthcare Georgia Foundation. While the Healthcare Georgia Foundation may be a small foundation in the big picture, the impact that the Healthcare Georgia Foundation through the Two Georgias Initiative has had a huge impact.

So if you think of land mass in the state of Georgia, going and visiting the counties was like a three or four hour drive from Atlanta. It was important for us early on to have boots on the ground for Partnership for Southern Equity. And what we did was intentional. We had recruited someone from each of those communities to be part of the Two Georgias Initiative in the counties where they lived to serve as community ambassadors. Their primary focus was to work with project managers and the coalitions to increase community engagement so that those folks who would not normally be around the table of the coalition making decisions and creating the community improvement plan. They would increase their agency and understanding, have access to information, but they would also have a voice around the decision making table. The other thing that was important for us during the planning process before the Partnership for Southern Equity engaged in the health equity conversations with coalitions was to meet people where they were. And so, I had an opportunity to visit a few of the communities and sit in on the coalition meetings during their planning process where they were identifying what was important to them, what's the priority for this project, and/or will this be a project going forward that we can sustain? Partnership for Southern Equity began to meet people before the Atlanta people came in with the prescription. Here is what we want you to know, and here is what we can offer as resources. You just need to know who people are and what they care about and their priorities for community change before you come in with what I call the quote unquote prescription for fixing whatever ails you. That helped frame the PSE health and racial equity conversation we developed because it was designed for the people based on who they are, who they were, and what they cared about, and the things that they identified as health and or racial equity inequities. So we developed Why Health Equity Matters®, a training module, to ensure coalitions and communities were able to grapple with, “What is equity, why are we doing this, why does it matter, and how will it impact the work that we plan to do?”

And to come to a shared consensus about the definition of equity, and what that meant for the communities that were part of the Two Georgias Initiative. So that meeting folks during the planning process, hearing what they cared about, coming back to the drawing board and designing a training, the conversation which would make it more palatable and comfortable for people who very often had not even used the word “equity” in their work in community. And so that was an important piece.

Andrew Nelson: You already kind of explained how you how you worked with coalitions from the Two Georgias Initiative to help them advance and expand health equity. Would you say there were any insights you got from that experience that other rural communities could benefit from?

Arlene Parker Goldson: Lisa talked about how there are two Georgias. There's metropolitan Atlanta, which is a number of counties depending on who you're talking to. It could be 22 or 18, but there's metropolitan Atlanta, and then there's everybody else. It's the everybody else, that different world, rural nuance that was important to understand, especially as a person who lived and worked primarily in metro Atlanta and in larger urban centers. While we all focus on community improvement and the way in which we develop communities and make life better for the people we love and we care about in our particular communities, there's also that small-town rural nuance that is important for everyone to understand. In other words, you can have a conversation in metro Atlanta, but you cannot have the same conversation in South Georgia or other rural communities, because people have different lived experiences.

It's important to know that you can't go in with a prescription. There is not a one-size-fits-all. Even in the rural communities, the 11 coalitions that were part of the Two Georgias Initiative, while they were rural communities, they all had a different focus, a different way of doing things, a different lived experience, if you will. Each community has their own history and power dynamics.

And then how do you work with that history, power dynamics, and the people around the table to move the needle just a little bit to minimize the inequities? People have identified, more often than not, everybody is on a, is in a different place. Everybody doesn't come to the table with the same understanding and the same level of interest. And that's the way in which community building, community engagement works wherever you are. It's important to know who the people are, what the history is that has shaped and developed wherever they are in their community work and advancing equity. And then let them drive a conversation because we are here as helpers and not the doctor with the prescription to fix whatever ails you that is determined by the folks around the table. It's how we get to most people getting off the elevator on the same floor.

We write reports, share the narrative, and have conversations. And then there is the lived experience of the people who are most affected by health inequities. They have a story to tell as well. It's our role to work with folks around the table so that when they walk away, most people have the same understanding and the same focus around the work that they're going to do.

I shared with you that one of the ways in which we engaged the coalitions was designing the Why Health Equity Matters® training, which really was the conversation, the initial conversation about “What is equity, what are some of the inequities that you have identified in the community, and what are some of the ways in which you plan to implement your community health improvement plan with health equity being the core value of the work that you do.” So that was Why Health Equity Matters 101®, which was “what is equity”?

Fast forward four and a half years later, we circled back to the coalitions and communities and conducted Why Health Equity Matters 102®, which was the “How do we do this?” What are some of the ways in which now that we understand health equity, how racial equity impacts the work that we do can minimize inequities?

Why Health Equity Matters 101® was the “what”, Why Health Equity Matters 102® was the “how,” the tools and the resources to continue the health equity conversation. So that was the training. And then we conducted monthly Health Equity Office Hours (HEOH) T-shirts and Tea, very relaxed one-hour conversations for program managers and coalition members and other members of the community just to be around the table to talk about whatever they wanted to talk about that focused on health equity, and not just the challenges, but the things they had to celebrate. And it was a great way for them to hear lessons learned in collaboration.

So, to summarize, I think that those were the important ways in which we engaged coalitions and the communities and provided technical assistance and training. After five years, one of the most important outcomes of the Two Georgias Initiative is the relationships we now have with a whole host of health equity champions around the state. And Tara is one of those. So I just wanted to lift that up.

Andrew Nelson: Yeah. Tara, you worked as a coalition member with Two Georgias Initiative in Clay County specifically.

Tara Gardner: That's correct.

Andrew Nelson: Can you talk a little bit about how you and other community members from Clay County came to be part of the Two Georgias Initiative?

Tara Gardner: When I heard about the Two Georgias Initiative grant that was awarded to Clay County, I did my research on the Healthcare Georgia Foundation, and I learned more in depth about what Two Georgias Initiative stood for. And so I put in my application and I went through an interviewing process and was hired as the Project Director and the Clay County Community Health Center was our lead organization, and we created the Clay County Health Partnership. My other community residents, neighbors, they had the same concerns I did. We did rank 159 in the health rankings, and we wanted to make a difference to improve the health and the quality of life for our neighbors in Clay County.

So through that, Dr. Karen Kinsell and a team of partners wrote at the grant and submitted it to the Healthcare Georgia Foundation, and they were awarded the grant. I was the community keeper. I was the voice for the community for the people that lived in this county. We have 50 partners within our coalition. We did not stop just at county lines. We crossed regional lines, we crossed state lines. Without the voice of the whole community, we would not be as successful as we have been the last five years.

With proper planning, educating, building relationships with trust, we had been able to make it happen in an area that has no manufacturing, an area that does not have a chain grocery store, an area that does not have a chain restaurant, but we knew that we could do it. We knew that through the Healthcare Georgia and the TA support that they give us that we could get back to the basics and bring our quality of life up.

How we established a common vision for the coalition is through the support of the Healthcare Georgia Foundation, supplying us with technical support through PSE, through Emory, and through Georgia Health Decisions that we collectively were able during the very first quarter of our planning year, to have an opportunity to bring 52 partners into one room. And we spent the whole day listing our health disparities, prioritizing our needs. We were one of the ones that were a blank slate. I think that we had people with great experience in nonprofit work, but we had a laundry list of health disparities in our community, and it was very overwhelming.

And when you're a rural community, you don't even have the opportunity for data for some things because we are so small.

Andrew Nelson: Can you go into a little bit more detail about some of the ways in which you and the other coalition members worked to advance health equity, in Clay County and beyond?

Tara Gardner: In the year of 2018, I wanted to educate the partners about what health equity was. And so Arlene's team presented a workshop that really brought everybody up to speed about what is health equity. Our Georgia Health Decisions coach, Beverly Tyler, actually came into the community and we facilitated town hall meetings. We facilitated focus groups. So that was a really good way to, to get the word out in the community and also receive conversation from just people with lived experiences that we were serving. We did commissioners meetings, city council meetings, other organizational meetings, parent engagement meetings with our school system.

We looked at health access for care. It was very bleak. Dr. Karen Kinsell was the only doctor in our community for 20 years that served the uninsured and the community residents that live below the poverty level that could not afford go to the doctor. We looked at how can we build on that? Because she never brought her head above water. She gave her own time and personal fundings to be able to serve the people with access to care to the best of what she had available to her. So we looked at that. We had no behavioral health in this county, and we needed to advance care.

So we started in conversation with Mercer University, and we now have a choice of access to care for the Clay County Medical Center and the Clay County Mercer Clinic. Then we actually brought in behavioral health services to this county. And now that we have that in-person, we've advanced it with telehealth as well for behavioral health, and not just for adults, but for our youth and adolescents as well. We did not have any type of nutrition. And so I teamed up with the Department of Public Health and was able to provide SNAP education and community gardens for four years straight. And that involved exercise, cooking, planting of community gardens, distributing fresh produce, because we had no way to have access to fresh produce with other partners through Feeding the Valley, in the Clay County Family Connections, we have opened a food pantry that serves about 400 people a month.

And we are still ongoing and going strong with that. We wrote a grant a few years back, the Shape Up grant for the school system. And we introduced exercise and nutrition to the youth that attend school here in Clay County. We wrote a grant for a PhotoVoice, and I had 30 youth that were a part of a PhotoVoice program, and they wanted to showcase abandoned houses in their community. I tried to get them to do access for exercise, but they didn't want to do basketball courts. They were saddened by all the rural, dilapidated houses in our community. So they went out and they took pictures, and we were able to secure a professional photographer. The photos are wonderful, and we were able to take those photos and go to our local infrastructure and regional and government and show them what our children were concerned about.

We have a very large youth empowerment group, and we listened to them. They're part of this community and their voices matter as well. When we were looking at developing the Clay County Health Partnership, we wrote a grant for a school-based health center, and we are in the construction phases of that. And we will open our doors in the spring of 2023. It will also provide dental services that we have been trying to address on our long laundry list of disparities. We will have a dental clinic here twice a week that will not only serve youth, but will serve adults. As we advance the next five years, that will be a health equity, not a health disparity, that we will be able to have dental services full-time in our community.

You cannot do it through all volunteer. There has to be somebody that can help hold all of these moving parts up as you're volunteering partners. It might be a part-time, might be a full-time, but I can honestly tell you that it's a life-changing experience for the person that is the voice of the community. You have to have someone that is dedicated. It has to be a person that can maneuver around barriers. We say it takes a village to raise a child. It takes a community to uplift a community.

In rural Georgia, you can't rely on just data. You have to rely on everything else around you. Five years ago, we were 159. Today we're 154. So we have moved the needle a point up each year, and I can honestly say at the end of the next five years in 2028, that we will even see a larger impact. Within five years, we've got a drug store, we've got behavioral health, we have green spaces for exercise, we have walking trails, we have a food pantry. We have several opportunities now for access to care. We have a new bank. We're looking at transportation. We're looking a housing. Clay County was never a part of a United Way, and it was hurting us. It took me three years to advocate, but we finally were accepted. National opened it up, and the Chattahoochee Valley United Way out of Columbus, Ben Moser worked with me and we were finally able, his board accepted us. That opened a door for us to add *223, which is a list of services for people that do not have transportation. All they have to do is call a number and they can get a service that they're in need of.

The impact that has been given through technical support, through the Healthcare Georgia Foundation, through our partners, our quality of life is better. And the Healthcare Georgia Foundation, even though the grant is ended, they still put us at the forefront and they're still sending us access for resources or for conversation to see if there's potential collaboration with other organizations. I am very proud, and our community and our partners are very proud, to have been a part of this because they have set the foundation.

And it's very emotional for me, because I've seen the desperation on the people's faces, and there's not as much desperation anymore. I see light in people's eyes. I see people of all backgrounds relating together for the greater good. And Healthcare Georgia Foundation gave us the opportunity to be unique, to be able to develop what we needed. It wasn't just a template that everybody had to go by. There has never been another grant opportunity like this opportunity.

Andrew Nelson: Yeah. Absolutely. Lisa, getting back to Healthcare Georgia and kind of looking over The Two Georgias project in general, how do you think the Two Georgias Initiative has helped to advance healthcare health equity in Georgia?

Lisa Medellin: We realized that all of the communities were very different and had very different experiences.

I think about the takeaways that came to me in how people grew together, how their humanity expanded to be comfortable and feel safe to talk to each other. Maybe they hadn't been doing that in the past about what could their community look like if they reimagined it together, how to have difficult conversations about maybe some of the history in the community or just the layers that were there that none of us could anticipate. A pandemic, the racial and social unrest we saw relative to years of injustices and people deciding they needed to speak up about it, and that we as a community and a culture or a society needed to address it. And you had all those things going on at the same time this initiative was in play.

And so those nuances had an impact on changing the trajectory of equity. I've always maintained that the equity journey is just that, it's a journey. There is no finite end. That you don't get to a place where you say, “Oh, well, we've reached this, we've done it. We can check that box and keep moving.” It's a continuing process. It's a thing that always needs to be managed and nurtured and cultivated, and that we hope these communities will continue to do. We feel confident that they will. And so their lessons and what they've learned are very individual, like I said, learning to have shared power, learning to talk to one another, learning that we're all in it together.

The other layer of the equity piece to this work, I think, was very individual, because what I've learned is that you cannot do equity work in an authentic and genuine way if you don't address your own biases, yourself personally. You cannot disconnect and say, “Oh, well this is my job, or this is what I do.” Whether you're doing it on the coalition or you're the project manager, or you're the technical assistance provider, or you're even a staff person at the foundation, you cannot disconnect from that. And so, I think that piece of the journey really was evolving for all of us. I can speak for myself personally as a staff member at the foundation, and how I think about this work is very different than when we first started this. I didn't know a whole lot about rural community. I grew up in an urban area and I didn't know what to expect, but I learned a lot about myself.

I learned a lot about the people in these communities, and so I think the equity journey and what's happened here has been pivotal. And by no means do we feel like, “Okay, we've solved the equity challenges in any of these communities.” That was never the point. It was hopefully to get people in a place where they felt like if we understood the basic construct of what equity is, and that it's a way of thinking and a way of being and doing, then you can start to really address all the myriad of issues and challenges. One of the lessons I think that we've learned is that rural communities have a lot of resources and even if it's just the people, even if they don't have a lot of financial or material things, but if you have the people there who are committed, care, and are dedicated to their community, then you have a gold mine at your hand and at your disposal. This foundation very much put in motion and planted the seeds that hopefully in 5, 10, 20 years from now, each of these communities will benefit from the growth of those seeds that were planted in 2017.

Andrew Nelson: Do any of you have any advice for rural coalitions that might be trying to get started? And what are some important things for them to know?

Tara Gardner: I think that when you're talking about rural coalitions, they just need to look at the low-hanging fruit first. And it's okay to have trial and error and don't stop at local for resources. Go as far as you can go to get what you need to make the changes in advanced health equity in your community and rely on the people in the community.

Arlene Parker Goldson: The people most affected by inequities have to be part of the conversation. They're closest to the problem. And they very often, to Lisa's point and to Tara's point as well, people are assets. And very often people think, “Oh, we don't have the resources. We don't have A, B and C.” But this work is about people. And the people closest to the problem have the solutions. And I also think that this work requires intention. That it takes intention and time and the resources both human capital and, and other kind of capital and that relationship building and building trust will determine the success of whatever it is we decide to do.

Again, I want to echo what Tara has said about the way in which the Healthcare Georgia Foundation created a model for other funders to follow. I have been around since before dirt working with nonprofits and communities and the Healthcare Georgia Foundation, the Two Georgias Initiative, was the first funder that I have ever worked with that provided not just a list of, “Here are the people you can contact if you need A, B, and C.” But they provided as part of the infrastructure for the Two Georgias Initiative — the technical advisors that were around the table, the subject matter experts, the coaching, the health equity technical assistance, the evaluation — all of that was part of the Two Georgias Initiative universe. And that is something that I have never seen. So I say that to say that this is cutting edge, but for those who are looking to do this work and to work with people, I think the other thing is we are not working for people, we are working with people. And those include the people that are most impacted by inequities. Sometimes having the equity and the racial equity conversation in particular is a challenge for people. It is a challenge for us, who have perhaps these conversations all the time. I wanna remind us that two and a half years of the Two Georgias Initiative was in the COVID pandemic and the racial unrest universe.

And that had great impact. To your last question, how did it affect health equity in the communities? Well, I think that we lived in that universe for two and a half years. We are still in it. And to Tara's credit, she came to PSE to say, “How do we have the racial equity conversation during this very challenging time?” And so that was a way for PSE to step back and say, “What are some of the resources or technical assistance?” And we created a racial equity conversation guide. And that was because Tara asked the question. I think it takes intention and time and commitment. And certainly, the passion that Tara exhibits and everyone that we have worked with around the table of Two Georgias Initiative are there because they want to be there and they want to improve the quality of life for the people in their communities and their families.

Transparency is key to building relationships based on trust and mutual benefit. Because one of the things we've learned is it's not just about what the foundation wants, or PSE, or the Georgia Health Decisions, or the evaluation team. It's “what do people want that we can provide that can help improve the quality of their life?” And then what we get is to feel good about what we have accomplished working with people at the community level.

Tara Gardner: You have to look at your disparities, you have to prioritize, you have to create your CHIP. Every community needs a Community Health Improvement Plan. And part of that journey is also looking at creating your community profiles of assets. Health equity's only a word until the people in those communities are educated about what health equity really is. During COVID, we were already in to our fourth year of our Comprehensive Health Improvement Plan, our CHIP, because we just kept going. We never stopped. So when pandemic hit, we were ahead of the game and were able to look at some other areas.

Some of the disparities that people really didn't want to acknowledge, one of them was food security. It really came to the forefront when we had 250 families standing in line to get food boxes during COVID.

And two and a half years is a long time, and I think it may have set us back a little, but now that we can be face to face, we were able to fast track those relationships and get back on track to where we were before COVID.

Arlene Parker Goldson: And I think that changed the way we had conversations with people who experienced food insecurity, who understood what it felt like not to have access to healthcare. One of the indirect benefits of the pandemic was that people began to see those inequities. They were pretty much right up in our face. And while we experience inconvenience and perhaps some challenges, we then understood what people who experienced those challenges, those inequities every day felt. And we began to perhaps look at and have these conversations differently.

Lisa Medellin: From a philanthropic standpoint, we were quite stressed out in terms of our grant making for that particular year in 2020. But it is through the partnerships and the relationships that we had with Partnership with Southern Equity that helped us with that. They helped us pivot on how could we get funds quickly to places that needed it relative to COVID testing and so forth.

I believe that because these coalitions existed, they became a central point for these communities to address what was needed in the community because they had established relationships. They were already coordinated, they had people who already knew what to do and they had trust in their community. So if their community need to organize getting a COVID test, they were at the center of helping getting that off and running. And even some of them using the locations of their coalition lead organization existed as the place to do that. Many of them were involved in the food distribution and then vaccines once those showed up.

I'm just very proud of them and what they were able to do during the pandemic and do their very best to at least stay connected to people virtually which was difficult for everyone. In the beginning it was a novelty, but after a while it was exhausting. And I was also very proud that once things started to open up and people were gathering again, they were patient and they led by what the community felt comfortable with. And the foundation respected that and provided additional support to help them do that so that they had the resources. Because one of the things that's a challenge in many rural communities, and not just in Georgia, is the access to stable and reliable Wi-Fi is nonexistent in many areas. And so having to pivot to technology like this via Zoom, ideally for us in the urban center, that makes perfect sense. But if you're in an area where you don't have Wi-Fi at all and you have no connectivity or very spotty, you become isolated.

You really can become isolated because the normal methods of connecting people and sharing information, which often were face to face, no longer could happen. I think there were just so many lessons about that for all of us in rural communities or not. I think it was one of those situations you could have never predicted, and I was just very pleased that we have had a hand in these communities having that support available to them during the pandemic.

Andrew Nelson: You've been listening to Exploring Rural Health, a podcast from RHIhub. Today we spoke with Lisa Medellin, Director of Programs for the Healthcare Georgia Foundation, and Arlene Parker Goldson, who's the health consultant for the Partnership for Southern Equity, as well as Tara Gardner, project coordinator for the Two Georgias coalition located in Clay County, Georgia.

Look in our show notes for more information about their work, and visit ruralhealthinfo.org for all things pertaining to rural health.