On November 7, 2022, Dartmouth Health, in collaboration with community partners, inaugurated the Center for Advancing Rural Health Equity (CARHE), a unique initiative focused on identifying and addressing persistent health disparities through collaboration, partnership and action. To mark its launch, the Center convened its first-ever event, “Working Together to Improve Health for Rural New England Communities,” bringing people together from across community services, healthcare delivery, research, and education to explore how to catalyze the transformational change needed to eliminate the unfair conditions that create barriers for people in rural New England communities to be as healthy as possible.
“Rural health inequity is one of the most significant, yet largely overlooked, challenges facing our healthcare system today,” said Joanne M. Conroy, MD, Dartmouth Health CEO and president. “We have major challenges delivering—and receiving—healthcare in our rural communities. And we know that amongst our rural populations, there are those who have even greater challenges due to racism, historical marginalization, poverty, and sexual orientation. Through the work of the Center for Advancing Rural Health Equity, we strive to learn with the community what are the causes of unequal health in rural northern New England and to test solutions. The launch of the Center for Advancing Rural Health Equity is a significant step in advancing our mission to tackle these stubborn disparities head-on and ensure that our patients are fully connected to the care they deserve.”
The Center for Advancing Rural Health Equity—believed to be among the first centers of its kind in the nation—will be grounded in four pillars of work focused on making sure everyone has a fair chance to live a healthy life, no matter who they are or where they live:
- Healthcare redesign: Translating knowledge into practice to meet the needs of our populations
- Research: Community-engaged research, creating evidence to inform practice
- Community action: Community and health system partnerships responsive to local needs
- Education: Training, learning, and the sharing of knowledge
The launch event, held at Lake Morey Resort in Fairlee, Vermont, featured a series of conversations about the work necessary to advance health equity in the region, including examples of best practices for collaboration. In keynote remarks, Trinidad Tellez, MD, Principal, [Health] Equity Strategies, LLC and adjunct instructor at the Dartmouth Institute for Health Policy and Clinical Practice, discussed how to work equitably to ensure an equal opportunity for everyone to thrive. That was followed by a series of facilitated conversations and networking opportunities for participants to begin to establish connections, with the goal of understanding and addressing the challenges to being as healthy as possible in our rural area.
“People living in rural communities have worse health outcomes compared to those who live in urban areas. These disparities have existed for a long time but have worsened in recent years. We need a new approach and new solutions. The health system alone will not solve these complex problems,” said Sally A. Kraft, MD, MPH, vice president of population health at Dartmouth Health. “The Center for Advancing Rural Health Equity is focused on building strong, collaborative community partnerships, rooted in local knowledge and insights. Together, we will work to develop solutions that allow every individual to be as healthy as possible, regardless of their zip code.”
Rural populations skew older and sicker than those in urban areas and have higher rates of poverty. People living in rural areas face unique barriers to accessing healthcare and social services. Ensuring fair access to health and healthcare for people disproportionately impacted by barriers to care—including Black, Indigenous, and other People of Color, LBGTQ, veterans, immigrants, people living in low-income areas, and others—can be particularly challenging in a rural area, where population numbers are small and widely dispersed throughout a region. Rural geography makes it hard for health systems and social services to reach everyone who needs care.
Rural health equity means that all people living in rural areas are able to live their healthiest life possible. This includes living a life free from discrimination and unfair treatment, as well as having access to healthcare and social services, safe neighborhoods and places to live, reliable transportation, healthy foods, working wages that support basic needs, and community policies that are fair to all people.
A six-month co-design process between January and June 2022 brought together diverse team members to shape the Center. Planning team members were chosen for their expertise, knowledge and willingness to tackle big ideas in pursuit of health for rural populations. Representation on the planning team included individuals from academia, community-based organizations, the Vermont Department of Health, and residents of rural communities in Vermont and New Hampshire.
“We are excited to work together with so many partners to establish the Center for Advancing Rural Health Equity and advance this shared vision for improving the health of our communities in meaningful ways,” said Rudolph (Rudy) Fedrizzi, White River Junction Public Health Services District Director and Chair of the Center’s Leadership Council. “This collaborative approach, which draws on both expertise and lived experience, is a powerful strategy for improving the lives of all of our friends, family and neighbors across rural New England.”
The Leadership Council, the primary governing body of CARHE, first convened in August 2022, provides strategic direction and ensures that Center activities remain consistent with its mission, vision, and values. Members include clinicians, community leaders, researchers, and educators. In addition, a Community Advisory Council comprised of people representing the diverse populations of rural northern New England advises on strategy and activities, ensuring that the voice of the community is always at the fore of the Center’s work..
About Dartmouth Health
Dartmouth Health, New Hampshire's only academic health system and the state's largest private employer, serves patients across northern New England. Dartmouth Health provides access to more than 2,000 providers in almost every area of medicine, delivering care at its flagship hospital, Dartmouth Hitchcock Medical Center (DHMC) in Lebanon, NH, as well as across its wide network of hospitals, clinics and care facilities. DHMC is consistently named the #1 hospital in New Hampshire by U.S. News & World Report, and recognized for high performance in numerous clinical specialties and procedures. Dartmouth Health includes Dartmouth Cancer Center, one of only 56 National Cancer Institute-designated Comprehensive Cancer Centers in the nation, and the only such center in northern New England; Dartmouth Health Children’s, which includes Children’s Hospital at Dartmouth Hitchcock Medical Center, the state’s only children’s hospital, and multiple clinic locations around the region; member hospitals in Lebanon, Keene and New London, NH, and Bennington and Windsor, VT; Visiting Nurse and Hospice for Vermont and New Hampshire; and more than 24 clinics that provide ambulatory services across New Hampshire and Vermont. Through its historical partnership with Dartmouth and the Geisel School of Medicine, Dartmouth Health trains nearly 400 medical residents and fellows annually, and performs cutting-edge research and clinical trials recognized across the globe with Geisel and the White River Junction VA Medical Center in White River Junction, VT. Dartmouth Health and its more than 13,000 employees are deeply committed to serving the healthcare needs of everyone in our communities, and to providing each of our patients with exceptional, personal care.