National Association of Social Workers

From the Director

Health Disparities and Rural Poor

By Elizabeth J. Clark, Ph.D., ACSW, MPH

One of the great privileges of my job as executive director is the opportunity to visit various states and to get an in-depth understanding of issues facing different populations and geographic areas. Recently, I was invited to visit eastern Kentucky to learn about the sometimes overlooked needs of citizens living in Appalachia.

My invitation was issued by the CREEK (Community-based Research Education in Eastern Kentucky) program. The program was founded by Gilbert Friedell, a physician who has championed the needs of the rural poor for decades. It is directed by Cynthia Cole, a visionary sociologist and public health specialist, and it is affiliated with the University of Kentucky (UK) School of Social Work. Deirdra Robinson, a social worker, is the UK administrative coordinator for the CREEK program, and Kay Hoffman is the dean of the College of Social Work at UK. The program has just completed its third academic year. [See story in June NASW News.]

The purpose of the CREEK program is to build community capacity to address major health concerns affecting people in rural and underserved communities. Its mission is to educate individuals to recognize behavioral health issues related to chronic illness and to provide these individuals with the skills and experience to solve health-related problems.

It is a great model for linking research, practice and policy.

During my visit, I met many remarkable individuals who work to overcome the challenges posed by severe poverty. I ate at a wonderful community soup kitchen (and tried hominy grits for the first time) and had a two-hour dialogue with community leaders including the town sheriff, the public prosecutor, the head of the community college and social workers who held a variety of positions in service agencies.

Problems specifically related to poverty in Appalachia were unemployment; lack of insurance coverage, transportation and access to care; and a lack of basic and health literacy. Significant health issues prevalent in Appalachia include cervical cancer, black lung and diabetes. Also, high levels of domestic violence were reported.

One response to these health issues is an award-winning program called Kentucky Homeplace.

It is directed by a dedicated and innovative nurse named Fran Feltner. This program might be compared to patient navigator programs. The goal is to provide access to medical, social and environmental services to enable rural Kentuckians to advocate for their own health needs. Community residents are employed and trained to assess the needs of individuals with both physical and emotional problems. Their interventions include problem identification, crisis management, health education and resource development to prevent more serious episodes from occurring.

I accompanied several Kentucky Homeplace workers to meet a family with a member receiving needed medications and for whom a day care program and transportation to that program had been arranged. Monitoring the progress and removing obstacles to needed care were the focus of the home visits. Since staff was from the community, trust and cultural competency were assured.

From my time in Appalachia, I drew several conclusions. First is the realization that few of our social work educational programs are located in rural areas. As a result, social work students generally are taught about urban poverty and how to provide services and find resources in an urban context. They also have their field placements in more populated venues. These experiences may not be easily transferred to rural communities.

Second, we need a more inclusive definition of health disparities. When we discuss issues of health disparities, we generally are referring to minority health or the health needs of people of color. The predominantly white rural population, which is also medically underserved, is frequently overlooked.

Third is recognizing the value and the necessity of incorporating individuals from the community into the planning and delivery of health care services for their community.

The linkage between poverty and health disparities exists regardless of skin color or geographic location. I recently heard an important statement relating to the poor and medically underserved. Harold Freedman, the physician who received this year's Height Award (named for NASW Social Work Pioneer® and civil rights activist Dorothy I. Height), said, "The penalty for poverty should not be death."

As social workers, we must be concerned about population health, and as we advocate for social policies that address health and mental health parity issues, the rural poor must be part of our agenda.

To comment to Elizabeth J. Clark: newscolumn@naswdc.org

From July 2006 NASW News. © 2006 National Association of Social Workers. All Rights Reserved. NASW News articles may be copied for personal use, but proper notice of copyright and credit to the NASW News must appear on all copies made. This permission does not apply to reproduction for advertising, promotion, resale, or other commercial purposes.