It Takes a (Rural) Community
Garrett County, Maryland, wins a 2017 Robert Wood Johnson Foundation Culture of Health Prize for its multidisciplinary approach to a healthier community.
Part of a series.
Garrett County is the state of Maryland’s westernmost county. It’s in Appalachia, abutting both the West Virginia and Pennsylvania borders. The population is just under 30,000. The driving forces of the economy have traditionally been mining, quarrying, oil and gas extraction and agriculture, but in the summers tourists flock to Deep Creek Lake, and along its 69 miles of shoreline stand million-dollar-plus second homes and condos.
Then there are those at the other end of the spectrum – those who work seasonal and/or low-wage jobs, living on the margin.
“We have million-dollar homes here and lots of homes that are really very substandard,” says Bob Stephens. As Garrett County’s health officer, he’s concerned about health equity in his community. And he’s addressing that concern.
Stephens is part of a multidisciplinary cadre of county residents who are taking action to improve the health of everyone in their community. It’s an effort that earned Garrett County a 2017 Robert Wood Johnson Foundation Culture of Health Prize.
An ‘Asset-based Collaborative Approach’
In a February report, researchers at the University of Chicago’s NORC Walsh Center write that engaging “change agents” across multiple sectors in improving a community’s health is even more critical in rural areas than in urban ones.
The fact is, in rural communities “interdisciplinary” is the way things generally get done. People tend to wear more than one hat. “There’s also often just that tight-knit community feel,” says Aliana Havrilla, “a strong asset-based collaborative approach that they’re bringing to this work addressing complex issues.”
Havrilla is a community coach with the County Health Rankings & Roadmaps program, a collaboration of the Robert Wood Johnson Foundation and the University of Wisconsin Population Health Institute. Each year, the program publishes its County Health Rankings. Those rankings substantiate what Garrett County’s change agents already knew – that they have some significant health issues to tackle.
Garrett County ranks 15th among Maryland’s 24 jurisdictions (23 counties and Baltimore City) in health outcomes and 19th in quality-of-life measures, which include the percentage of days people report poor or fair health and the percentage who report physically and mentally unhealthy days within the past 30 days.
As Havrilla can attest, having worked with Garrett County in her role as a community coach, Garrett County is going about tackling its issues in the most effective way it can – as a community, leveraging it most valuable resources.
‘Grown up Together’
“There’s a long history here of collaboration, of working together,” says Shelley Argabrite, the Garrett County Health Department’s strategic health planner. “We’re families that have grown up together and raised their kids together.”
Garrett County’s community leaders recognize that health care involves much more than what happens in doctors’ offices, clinics and hospitals. They recognize, as the Walsh Center points out, that it involves a number of factors, including access to information to better inform health choices, quality education to expand opportunities, access to transportation and improving social connectedness.
Among the county’s most significant initiatives was building an online planning tool, MyGarrettCounty.com, designed to foster community participation.
The Garrett County Health Department developed the tool to help its community create a shared vision based on data related to current needs.
“The tool has helped us take collaboration to a new level,” Argabrite says, “to collect some hyperlocal data on some specific programs to look at their collective impact and be more responsive to the community and better engage the community.
“It’s about being transparent, bringing more people to the table and trying to improve equity.”
Priorities were set based on the county’s health needs assessment, and data was collected for six months, “engaging with the community about what really mattered to them,” Argabrite says.
The planning tool has a feature called Action Groups that helps community members mobilize. It allows them to focus on a specific issue, “to choose one strategy and begin measuring their work together on that strategy,” Argabrite explains. “We’re collecting hyperlocal data and seeing some real differences.”
MyGarrettCounty.com has been up 18 months. It’s logged 125,000 page views and hosted 35,000 sessions, with 20,000-plus users and 1,800 planners – planners being those actively engaged.
The tool’s software was created in house. “This was developed by Shelley and another person in the community, both of whom were born here,” Stephens says. “They could have gone elsewhere but want to stay and help improve the community.
“We’re really using our local human capital in order to do this.”
Approximately $175,000 of competitive grant funding has been awarded to the health department by the Public Health National Center for Innovations, a division of the Public Health Accreditation Board, to replicate the tool and offer it to other communities along with technical assistance.
Across this rural community, people are mobilizing.
Under the administration of the Garrett County Community Action Committee, and with support from the Annie E. Casey Foundation, the community has a 2-Generation initiative, taking a holistic approach to families’ needs. Among the services offered are early-childhood education, health insurance assistance, adult-education classes and career coaching – “helping them with whatever is preventing them from getting ahead,” Stephens says.
The county also has a tax-funded scholarship program that allows all residents to attend Garrett College, a community college in McHenry, tuition-free.
Then there’s the Learning Beyond the Classroom Bus, which visits the county’s more impoverished communities offering a library and learning games for kids and Wi-Fi and computers for adults.
Opting for Rec
The Garrett Regional Medical Center has played a central role in this community-wide effort. Its Well Patient Program assigns a team of health care providers to make certain their patients have the resources needed to care for themselves at home – an initiative that’s reduced readmissions.
Last year, the community raised $4.9 million to open a cancer wing at the medical center. Cancer patients previously had to travel to West Virginia or Pennsylvania for care. “It was an issue our community felt very strongly about,” Argabrite says.
And when a debate arose over whether to fund a jail expansion or a recreation center, the rec center won out. Membership in the Garrett College Community Aquatic and Recreation Complex is available to everyone for a sliding-scale fee. It offers a free “I Can Swim!” program to every Garrett County kindergartner.
“There again,” Stephens says, “it was a lot of groups coming together and collaborating, which again speaks to the nature of the community.”
Though, like most rural communities, Garrett County has traditionally found it hard to keep its talented youth from moving away in pursuit of more and better opportunities, that trend may be turning. “People want to stay part of this community,” Stephens asserts, “and they know they need to work together for the betterment of the community.”
‘Always Been Doing’
The authors of the Walsh Center report write that while rural culture is often characterized as an asset that can be leveraged to improve rural communities, sometimes the opposite is true.
Sometimes, they write, “negative stereotypes and narratives of rural communities have made it difficult for some places to recover from economic downturns because those perceptions are internalized into feelings of hopelessness and worthlessness at the community level.”
Not so in Garrett County.
“Honestly, we look at one another and say, ‘Hey, this is what we’ve always been doing,’” Shelley Argabrite says. “I think there’s so much to the notion of belonging to a community, and all the positive health impacts that brings.”
Bob Stephens says that when he looks at his county’s health rankings data – at rates of obesity and physical inactivity, for example – he recognizes there’s much work yet to do.
“We look at the data and what resources we have, and the opinions of the folks in the community, and we try to rally around that. We want to systematically approach some of these things that have been so tough to deal with.”
Key recommendations from the Walsh Center “Supporting Change Agents across Sectors to Improve Health and Equity in Rural Communities” report:
- Engagement of local conveners, organizations and networks.
- Forums for learning across rural communities to facilitate new ideas, dissemination of promising practices and networking.
- Development of cross-sector advisory panels to inform rural implementation efforts.
- Support for economic-development efforts to have upstream impacts on health and well-being.
- Further study of formal and informal cross-sector networks and partnerships to understand how they can be mobilized for change.