Empathy Affect
On Empathy Affect, we explore the human side of government. We get to know the real people in government who serve us. We learn about their missions, the people they serve, and the true impact of their work. In each episode, we'll speak with real people about how they weave empathy into the policies and programs of government.
Empathy Affect
S3E11: What Can Pennsylvania Teach Us About Why Rural Health Is the Health of America?
Rural communities are the backbone of America—growing our food, fueling our economy, and sustaining traditions that reach far beyond county lines. But in Pennsylvania, as in much of the country, rural health is under strain. Provider shortages, rising rates of chronic disease, and shrinking access to specialty services like obstetrics (maternal health) leave families and entire towns at risk.
Pennsylvania Office of Rural Health Director Lisa Davis has spent more than 30 years working to address these challenges. In this episode, Lisa shares how rural communities and state leaders are finding creative solutions to ensure care is within reach—from deploying community health workers to expanding telehealth and more. These strategies and innovations reveal a bigger truth: rural health is inseparable from the nation’s health.
Lisa Davis has directed the Pennsylvania Office of Rural Health since 1999, providing leadership on networking, coordination, and technical assistance across the state’s rural hospitals, health clinics, training programs, and community partners. She has previously held roles at Penn State’s Department of Health Policy & Administration. Her work history spans a range of public health fields, including nutrition, mental health, substance use recovery, and correctional health.
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When you think of public health, do you picture big cities, large hospitals, a variety of doctors to choose from? What's your biggest concern? Or even cutting-edge research? For millions of Americans living outside of urban hubs, this image looks very different.
SPEAKER_00:In recent years, rural hospitals have been closing at a staggering rate, creating so-called medical deserts.
SPEAKER_04:Access to care can be hours away, maternal health services are disappearing, and small hospitals face complex problems that too often lead to closure. This is a reality in many parts of Pennsylvania. With one of the largest rural populations in the country, nearly 3.4 million people, the state mirrors the struggles of rural America as a whole.
SPEAKER_02:Pennsylvania as a whole has had some of the most severe shortages of healthcare professionals in the nation.
SPEAKER_05:You know, a lot of parts of Pennsylvania are not well serviced by physicians.
SPEAKER_02:It is interesting to note that roughly only 10% of our doctors choose to practice in rural settings, despite more than 20% of the U.S. population living in rural communities.
SPEAKER_04:For more than three decades, Lisa Davis has been at the center of these challenges. As director of the Pennsylvania Office of Rural Health, she's worked to keep hospitals open, bring providers into underserved communities, and support the people who make up the backbone of rural life. This is Empathy Affect, the Forest Marsh Media podcast that explores the human side of government. I'm Melissa Szyzinski, and Lisa joins us today to break down the real barriers rural Pennsylvanians face in healthcare, her office's role in keeping rural communities healthy, and why rural health matters. Not just for Pennsylvania, but for all of us. Thank you so much for having me. I'm delighted. Of course. So you're a lifelong Pennsylvanian and you began your professional journey working in mental health, substance use recovery, systems of care for people with disabilities, nutrition, and even with the correction system. So you've definitely seen a bunch of different aspects of public health. So when and how did you realize that amid all of this, that rural health would become your calling? How did those early experiences in such diverse areas across the state inform and ultimately lead you to direct the Pennsylvania Office of Rural Health?
SPEAKER_03:Well, thank you so much for asking. All of my career prior to going to graduate school was focused on helping individuals who were quite vulnerable and being able to access any type of the supports that they might need, whether that be mental health treatment or nutrition services or even being able to go out and find employment. And I went to graduate school focused on health policy and administration with an emphasis on public health. And at the time, the Pennsylvania Office of Rural Health was in its infancy here at Penn State. And one of the faculty in our department was one of the associate administrators. And he apparently referred me for a job to be the full first full-time staff person here. And I had sort of an idea of what the Office of Rural Health was and decided I would go on the interview anyway, even though I didn't think I wanted the position. And when I was being interviewed, I realized that this was absolutely the perfect place for me. It combined everything I wanted to do and felt was important, which was being able to address the needs of vulnerable populations writ large. So this would be all across the state, and then eventually across the nation with policy and regulation and so on. And it also combined my interest in wanting to work with external audiences all across the state, with the state agencies, associations, and clinical training programs. So I have to say that when I started in rural health, I had no idea even that there was a topic of rural health, even though I had spent much of my high school time in rural communities. I didn't realize rural health was a thing. And I can say that it has been an extraordinarily rewarding career. And what has made it so is the ability to be able to address issues in communities and also at the state and national levels and to work very closely with the rural health community advocates and educators and so on across the country, who are essentially the brightest, most educated, and most passionate people I have ever had the pleasure to know.
SPEAKER_04:Lisa's path set the stage for her career focused on improving access to care in Pennsylvania's rural communities. The Pennsylvania Office of Rural Health was developed in 1991 to do just that. It connects rural hospitals, health clinics, and training programs with the support they need, from recruiting providers and keeping small hospitals open to partnering with state agencies and community leaders. At its core, the office serves as a bridge linking rural communities with the resources, networks, and advocacy they need to thrive.
SPEAKER_03:So the state offices of rural health were charged with being a source of coordination, networking, technical assistance, partnership development, and in the recruitment and retention of healthcare providers, especially primary care. So our office fulfills all of those missions through the partnerships that we have across the state.
SPEAKER_04:And while every state has an Office of Rural Health, Pennsylvania's is unique in that it's based at Penn State University. That means that Lisa and her team have the flexibility to act quickly and a built-in network through the university's 67 county extension offices. It's a model that connects them directly to local communities, but it also keeps them closely tied to state policymakers. That broad vantage point has given Lisa a clear view of the obstacles rural Pennsylvanians face every day.
SPEAKER_03:The problems and challenges facing rural Pennsylvanians very much mirror the issues that are nationwide. When I started in rural health 31 years ago, healthcare workforce was the number one issue. Healthcare workforce, Lowies many years later, is the number one issue. So one of the areas that all of us in rural health work toward is ensuring that we have enough primary care and specialty providers in rural communities to be able to provide comprehensive health care. And that has been a challenge for many years, whether it's physician services or specialty services or dental care, those are the most challenging. We do find that being able to provide nursing care and also care through physician assistants and advanced practice nurses, such as nurse practitioners, can often be easier to address. But the healthcare delivery system still very much is a physician-centric system. The other area that we have real challenges with, and this is especially true, unfortunately getting a lot of attention now, is access to labor and delivery and OBGYN services. In fact, in Pennsylvania, we have had several hospitals that have been forced to close their labor and delivery units simply due to finances. And we now have an area in northwestern Pennsylvania that is without any labor and delivery services, and that area is the same size as the state of Connecticut. So we have the workforce issues. We also have challenges with small rural hospitals. One reason why rural health began to get such attention was in the 80s when the reimbursement system changed to what was called at one time was a cost-based reimbursement system to something called prospective payment. There were about 400 small rural hospitals across the country that closed in a very short period of time. And that made Congress sit up and take notice and to begin to authorize and appropriate funding to try and keep small rural hospitals open. And as I said earlier, here in Pennsylvania, we have anywhere from 48 to 62 small rural hospitals. And we are very focused on trying to keep those open. And one reason, well, there are two main reasons why small rural hospitals should remain open. One is because they are very often the hub of healthcare in that community. Just as physicians are the hub of healthcare for the provider community, the rural hospital serves in that role for overall health care. And when a hospital closes, it takes a bit of life out of the community. And what we have heard from communities where a hospital has closed is basically they don't think we matter. So the other reason is that hospitals not only are the hub of healthcare, but they are also considered to be an economic anchor institution, meaning that without a hospital there, it is challenging to have a robust growing economy for several reasons. One is that every job in healthcare and in a hospital is estimated to produce 1.6 additional jobs in the community. The other is that it is very hard to attract and retain other types of workforce if you don't have a place for individuals to go for care. So those are probably the two main issues.
SPEAKER_04:Since hospital closures have been impacting rural areas nationwide, how do you see this affecting Pennsylvania as well? You were mentioning that rural hospitals tend to be anchors for many communities economically in terms of providing access. So as closures sort of happen, how is that affecting Pennsylvanians? And what strategies are being used to try to maintain access to care amid this trend?
SPEAKER_03:Well, Pennsylvania has been really fortunate. We have had far fewer hospitals closed than have other states. So we've had five closures in the last five to six years. Just recently, we've had two closures, but those have been in urban areas and were as a result of hospitals not being able to survive financially. What ends up happening, especially in rural communities, when a hospital closes, the surrounding community comes together to try and provide healthcare services there. For instance, in one community where the hospital closed, the federally qualified health system in a neighboring county has come in to fill that care. They've been providing mobile clinics and rotating physicians and other providers in that community and are planning on establishing a site there. So that's one way in which they are trying to address issues. In other communities, what we see is, for instance, in one community where the hospital closed, one of the local businesses that has been there for generations invested significantly in the facility where the hospital was located. And they have opened up a primary care and behavioral health and soon-to-be dental health clinic in that hospital. So while these closures have occurred, we work very hard to make sure that the facilities that are there are receiving the support that they need, that are being considered in terms of when federal or state legislation and regulation is being passed. In Pennsylvania, we mirror other states also in that we have a number of very large healthcare systems. And so we've seen significant consolidation over the years, and that has helped small rural hospitals be able to stay open. So there are a number of ways in which we are focused on that.
SPEAKER_04:But even when the hospital doors stay open, the health conditions that Pennsylvanians face still loom. One of the biggest public health challenges for Pennsylvania overall is the burden of chronic disease. Conditions like diabetes, obesity, and heart disease affect rural Pennsylvanians at higher rates than their urban counterparts. And the barriers to manage those conditions can be steep.
SPEAKER_03:I would say that chronic disease prevention and treatment is one of the highest priorities of every healthcare delivery system in Pennsylvania. Rural, urban, hospital, clinic, it is one of the highest priorities, especially because a third of Pennsylvanians are overweight, and we have a higher percentage of young kids who are also overweight. So I think facilities and communities are very much focused on addressing these kinds of issues. Also looking at chronic disease in terms of diabetes and trying to manage diabetes in communities, and also looking at cardiovascular disease and so on. So I can say that just as workforce has been an issue for the last 31 years, so has chronic disease management. And that has really, really come forward in the last 15 years or so as something we need to focus on. So one model of care that we have here in Pennsylvania that I think other states do as well, we have a very robust community health worker system. And we have a whole training and certification program here in this state for training community health workers and getting them certified. And what we find is that community health workers, because they come from the community and they understand the community so well that they are able to provide the connections in communities to the healthcare delivery system and to overcome barriers to care. For example, if a person is getting access at the emergency department very frequently, the community health worker could come in and find out what the issues are. Is it because that individual is not able to get to the pharmacy to get their medications or is not able to have nutritious food delivered? They can overcome those barriers. So there's lots of ways in which we are looking at addressing chronic disease prevention and treatment.
SPEAKER_04:Going back to just like the overcoming certain um challenges to what are some innovative approaches or success stories that you've seen developing in rural health? You were mentioning community-based programs and having those partners down at the community level. But also, I know telehealth is a big innovation. What other things do you see out there to sort of lead the way forward in providing access in rural health?
SPEAKER_03:So telehealth is a great example of this. And certainly telehealth became enormously important during COVID because so many individuals, you know, almost no one was going to the physician, but almost everybody needed to access healthcare services. So what we see are within hospitals, they have very innovative programs where, for instance, they they will have a tele ICU or a teleemergency department so that they can overcome the challenges with having ED, their ED staffed by ED docs 24-7, or their ICU staffed 24-7 by physicians because there are challenges with that. So they will connect up. They have an automatic connection to a tertiary care facility that can provide that level of care if needed. We have telestroke programs that are in rural communities that are hooked up to the tertiary care facilities and other kinds of ways in which telehealth has played a role. We also are using telehealth to do a home assessment once an individual has been discharged, or to do remote patient monitoring, which certainly saves the time and expense of sending home health nurses out to patients' offices. So there are lots of ways in which we are looking at that. But also, again, I want to say that communities are really good at being able to develop their own solutions. So, as an example, I talked about the rural community where the hospital had closed. That facility was able to open because the local well-established business purchased the building and started to develop all of the programs that are there. We also work really closely with the community and economic development groups in rural communities because they have ways of bringing in funds for those communities and being able to make sure that there are services available. And we also look to external organizations such as USDA Rural Development, which has been terrific at being able to find funds to bring in special services or special equipment to organizations. And right now we are working with the Penn State College of Medicine. They are focused on wanting to establish a rural-based medic program that would be a training ground for individuals coming out of high school, for veterans coming back who might have been in, you know, a medic in the military, or for older persons who are retired but want to give back. So there's lots of ways that we're looking at creative solutions. And they're not all coming from us, but we're fortunate to be involved in many of them.
SPEAKER_04:Yeah. I I feel really drawn to a lot of the community-based solutions out there since rural areas so often rely on those strong community ties. How else do you see community partnerships shaping solutions to health disparities in rural areas? I know that faith-based community intervention is a big boon, but how else are you seeing it manifest?
SPEAKER_03:One of the ways, I'm glad you mentioned faith-based, one of the ways that we found out about the importance of faith-based messaging to overall health is a project that we had done a number of years ago looking at agricultural fatalities and the impact on the communities. And what we heard when we interviewed families who had lost, it was all husbands and grandfathers, unfortunately, to a farm incident, they all said, you know, it it was their time, it was their destiny. We started reaching out to faith-based groups because we realized that in rural communities, activities revolve around the school and the church and the service organizations. And if we can have messaging come from the pulpit about strong, healthy behaviors, we feel that that is a way that we can get the message out. So those have become an important part of the community. We also find that working through the school districts and either having school-based health centers, which are extremely important, or being able to work with students who take information home to their parents, that that is another way to spread the messaging. You know, parents might not listen to the messaging that comes out over the radio or in the newspaper or whatever, what their doctor tells them. But if their kid comes home and says, We read that we had this paper today on healthy eating habits and on, you know, reducing tobacco use, the parents might that that might be a form of messaging that that makes a difference. We also see that in communities where there are uh strong service groups that they come together to raise funds. I was just reading an article about volunteer fire departments. They rely 90% of their funding comes from fundraisers and bake sales and other kinds of community events, you know, where it will cost$750,000 to buy a fire truck. Well, that's pretty expensive. And so the communities come around and build that. We also see Pennsylvania is a state that has a very large Amish and Mennonite population, otherwise known as Anabaptists. They are enormously supportive of their communities and they will donate land, they will build facilities and clinics. We actually have several clinics here in Pennsylvania that focus exclusively on the Amish population and on kids who may have some genetic issues that are specific to Amish and Mennonite groups.
SPEAKER_04:Yeah, um I love those different stories. And speaking of which, you've been serving as director for quite a long time and have seen the landscape evolve. So how do the stories of rural residents you've met over your career shape the way you approach policy and leadership in this space?
SPEAKER_03:Well, the important thing is to understand what that messaging is. And as an example, the Pennsylvania Rural Health Association just published the first standalone rural health plan in the state since the year 2000. So we have the 2025-2030 Rural Health Plan. The next steps for that are to develop town hall meetings where we can go out and actually hear from residents. We love to hear from the healthcare delivery systems and we love to hear from the advocates because you know those are the folks who we normally intersect with. But the importance of hearing from someone who lives in a rural community is absolutely the most important piece because they are the ones who access the healthcare system. They are the ones who are having the challenges or the successes. So they shape just about everything that we do. And what we encourage both the healthcare providers to do and those who live in the communities is to talk to their policymakers, talk to your county supervisors, talk to your county commissioners, talk to your elected uh representatives and senators, both at the state level and at the national level. We tend to come to those meetings with data and information and graphs and charts, and all of that is important. What really makes the difference is when a policymaker hears from an individual about their specific experience. So we we hope and we encourage everyone to tell their story.
SPEAKER_04:Absolutely. I'm wondering, I and I get the sense it's the people who you know are driven behind this or and the patients you feel like you're a steward of in your position. But what gives you hope about the future of rural health in Pennsylvania?
SPEAKER_03:Well, first of all, I think that very excitedly, in the last two years, rural health has received a lot of attention here in our state, and I would also say nationally. And there are so many who are committed to working together to overcome barriers. One project that we are going to be involved in that I think most states will be involved in is the$50 billion in funding that is coming out from HR1, which is the one big, beautiful bill that was signed into law on July 4th. So every state is asked to submit a rural health transformation plan. And we've already had rural health transformation here in the state, funded through CMS about 15 years ago, but those programs are sort of winding down now. So now we are able to look at rural health transformation essentially 2.0. And this will be bringing together all of the stakeholders in the state, from communities up through the state agencies, to develop pathways to ensuring that we have the workforce needed, that we have the facilities needed, and we also have the creative opportunities to look at different models of care in the state that we hope will actually transform health care in rural Pennsylvania.
SPEAKER_04:Yeah. Is there anything that you hope will come out of this movement with the bill and the funding it may provide or the strategies that you may be able to implement?
SPEAKER_03:Well, I think we're going to be looking at new models of care. So whether or not that's mobile care or that is different types of clinical training programs or new ways in which hospitals can partner even across health systems. I think those will be really exciting. I think being able to look at the funding that is available for increasing telehealth services will certainly be very helpful. I know that AI is getting a great deal of attention, and I'm a novice with AI, but there are many who are out there who are quite savvy with it. So I'm hopeful that AI will be able to provide exceptional training opportunities for providers and hospitals and also in communities. And, you know, we need to be looking at health care across the continuum, from cradle to grave, as far as patients are concerned and consumers are concerned, but also across the continuum from prevention to emergency care to acute care services to chronic disease management and then to long-term care. So we need to make sure that all of those systems are integrated so that it should be seamless for the patient to intersect into the healthcare delivery system. We've had something called patient-centered medical homes for a very long time, and they have been quite successful where they have been implemented. And I think we need to take that idea and put the patient and ensure that the patient is always at the center of the care and that the care then wraps around that patient so that they are getting the right care at the right time for the right price.
SPEAKER_04:One last question on my end. If you could share one message with policymakers or the public about the importance of supporting rural health, what would it be?
SPEAKER_03:I am so glad you asked that. So as I say to folks, if you had breakfast this morning, you have rural to thank. If you woke up in a building, you have rural to thank. If you have clothing on, you have rural to thank. And so many of our traditions are rooted in rural culture and rural activity. So it is absolutely essential that rural health is sustainable because without rural health, we have very challenged rural communities, and without rural communities, we will have challenges in Being able to feed, clothe, and house America.
SPEAKER_04:Couldn't have said it better myself. Lisa, is there anything else you wanted to add before we wrap up today's conversation?
SPEAKER_03:No, just to say thank you so much for this opportunity. And thank you to everyone out there who is listening and who is supporting their rural community and their rural healthcare delivery system.
SPEAKER_04:Well, thank you so much. It was such a pleasure to have you here and bring light to the landscape of rural health in Pennsylvania and elsewhere and helping us think about how we should be serving the well-being of our rural communities. It was a pleasure to have you. One thing I'm taking away from this conversation is that rural health is more than just a policy issue. It's a lifeline. As Lisa reminded us, rural communities grow our food and power our economy. But they also face unique barriers that can't be ignored, from hospital closures to provider shortages to the growing burden of chronic disease. Lisa and her team have worked to ensure that these communities aren't left behind. And, as we heard today, the lessons from Pennsylvania resonate far beyond the state's borders. Rural health matters, not just for the people who live there, but for all of us. Thank you for tuning in to Empathy Affect. If you enjoyed today's episode, go ahead and share it with a friend, and make sure to follow and give us a review wherever you get podcasts. I hope you'll join me next time. Thanks, y'all.
SPEAKER_01:Empathy Effect is a product of Forrest Marsh. You can reach us at Forest Marsh Media at Forzmarsh.com with any feedback, questions, or inquiries. If you want to know more about today's guest, are interested in participating with Forrest Marsh, or becoming part of our community, check out our show notes for more information.