Making Investments In Rural Health: What Are The New And Old Challenges?

Fairly early in the day of November 9, 2016, the frenzy began. It was the day after Election Day 2016.

Enormous swaths of rural Americans had helped to deliver a presidential candidate over the finish line who promoted ideas and plans that were antithetical to the sensibilities of a majority of health foundation boards and staff. So what were those funders going to do now? Who were these rural voters, and what were they saying?

More immediately, what were foundations supposed to do to get past the election surprise and to start thinking about being useful to a rural America that can seem very “out-of-sight and out-of-mind” to the philanthropic world?

First off, let me say straight out that there are lots of funders already doing great work in health and other areas in rural communities across the country.

In June, the fifth annual convening of the Public-Private Collaborations in Rural Health meeting was held in Washington, D.C. More than forty staffers from private funders met with federal officials from several federal agencies responsible for rural programs to better align interests and learn from each other. A joint venture of Grantmakers In Health, the National Rural Health Association, and the Federal Office of Rural Health Policy, the meeting promotes the idea that many funders are, in fact, already rural funders, and that funders already funding in rural health can be more effective in rural communities by approaching the work with renewed commitment and intentionality.

Being an effective rural funder requires a suspension of belief in what foundations may hold to be true. Instead, foundation staffers: turn around and really try and understand what you see.

Key Tenets Of Being A Better Rural Health Funder

Here are some points to consider.

• It is absolutely necessary to work with people who may have widely divergent political and social views from your own.
• Leadership can often come in unexpected styles and is best identified by members of the community themselves.
• Financial resources may look very different than they do in an urban community. (For example, the owner of the local metal recycling yard might be the wealthiest and most quietly philanthropic person in town.)
• Don’t get caught up in whether a particular place is definitionally rural. If the local people think of themselves as rural, treat them as such.
• Rural culture in the United States comes in many varieties. Don’t assume that you can easily adapt work from the rural Midwest to the rural Deep South, for example, and get the same results.
• Keep reminding yourself that the rural United States is not a homogeneous group of white people of European ancestry. There are people of all colors and backgrounds in rural America—some who had a presence well before there was a United States and some who are newly arrived.
• Your logic models, evaluative frames, and impact theories may not be meaningful to people in rural areas. Do your best to remember that what you think is important may have little value to local people trying to solve a real, long-term problem.
• Be cautious about making assumptions about the role and influence of the church community. Just because people are devoted to their church family, that doesn’t necessarily translate into following a particular pastoral message. Watch and listen.
• Understand that just because there is no entity fitting your definition of a strong nonprofit doesn’t mean there is “no one to fund.” Think creatively about solutions to the administrative leadership issue rather than using it as an excuse to either not fund in a rural locality or to fund agencies outside of a rural community.
• You don’t have to learn all of this by yourself. Other funders, such as community foundations and the United Way, can be great resources. The creation of hundreds of health care conversion foundations in rural communities has helped to greatly accelerate the level of philanthropic wisdom out there.

Lastly, let me state the obvious. It is impossible to be an effective rural funder without staff and partners who have rural experience and can bring a rural “lens” to the table. No one assumes that foundation staff from a small rural funder can easily grasp all the moving pieces in a major urban area. Similarly, we shouldn’t assume that urban-centered funders and their urban-focused staff can easily interpret what they see in a rural context.

It takes time and a willingness to stop, look, and listen to what is around you in smaller localities. I am greatly encouraged by many foundations’ sincerity and their renewed commitment to their rural constituencies. I am very confident that there are major opportunities for foundations to help rural America become healthier, economically viable, and integrated into the way that philanthropy goes about its business.