Agricultural Worker Health Day- #NHCW18

Rural Health Information: Access to Health for Agricultural Workers

The theme of National Health Center Week 2018 – Celebrating Health Centers: Home of America’s Health Care Heroes- is meant to recognize individuals who exceed the call of duty to support health centers in providing accessible, cost-effective, and high quality health care for patients in all 50 states and territories. Today we celebrate Agricultural Worker Health Day, as health centers provide care to nearly 1 million agricultural workers across the nation. Kristine Sande and Nicole Ingalls-Caley of the Rural Health Information Hub (RHIhub), a national clearinghouse on rural health issues, discuss the role their organization plays in supporting agricultural worker health. 

What role does the Rural Health Information Hub play in supporting community/primary healthcare?

We’re an information center for all things related to rural health. We’re funded by the Federal Office of Rural Health Policy to be a resource for people in rural communities working to improve health and healthcare access. So everything we do is built around that goal of making their work easier and more efficient and to help them find all of the opportunities and resources that are available to them.

Another piece of this, too, is that often times the conversation about rural health is really negative. It’s true that there are a lot of challenges and barriers, but there are also endless stories of resilience and innovation and success, but those don’t get talked about as much. So part of what we try to do is shed light on all of the amazing things that are happening in rural health, in addition to those challenges.

Check out our website at to access thousands of opportunities, resources, and model programs related to rural health.

What do you think is the biggest dilemma facing rural health?

Most of the challenges in rural health are somehow related to healthcare access, social determinants of health, or both. Healthcare access issues might be on the side of the provider, like with recruitment and retention, or the consumer—lack of health insurance, that kind of thing. All of which is complicated by social determinants, which are things outside of healthcare that impact a person’s health like poverty, access to transportation, access to safe and affordable housing, infrastructure, and environmental factors. There’s been a real push to incorporate social determinants of health into healthcare because they can have such a significant impact on a person’s health outcomes.

What are some RHIhub resources that can help rural health centers be successful?

We have an Online Library where we index freely available resources along with things like news, events, organizations, and funding, which of course is everyone’s favorite. You can search among our thousands of items by topics like ‘Federally Qualified Health Centers’ or ‘farmers and farmworkers’.

Our Topic Guide on Federally Qualified Health Centers is consistently one of our top guides in terms of traffic. This guide provides an overview of FQHCs, includes Frequently Asked Questions, and links to related resources in our Online Library.

Also, we have our Evidence-Based Toolkits, which are designed to help rural communities build evidence-based health programs so they can make the most of limited resources and funding. We partner with the NORC Walsh Center for Rural Health Analysis and the University of Minnesota Rural Health Research Center to create these. They’re generally specific to a health need or intervention, but we do have a general toolkit to help with the creation of any rural health program. They include modules on planning, implementation, sustainability, evaluation, and dissemination, so they are really built to be a resource through the entire life of a program.

How does RHIhub’s work play into access to care for agricultural workers?

Of course, all of our services and resources are available to folks working on providing care and interventions to agricultural workers.  We also have resources that are aimed at addressing the specific needs of this population, including a couple of topic guides that can help health centers and other rural health organizations provide quality, accessible care to farmers and farmworkers.

Our Agricultural Health and Safety guide covers everything from common health risks that are associated with this type of work to resources, agencies, and funding that can support an organization in developing or sustaining an ag-specific health program.

The other guide that might be relevant here is on Rural Migrant Health, which discusses health challenges and concerns that are common for migrant and seasonal farmworkers and their families. It includes information on how rural healthcare and community organizations can help this population access healthcare and get health insurance, among other things.

And both of these guides, like our FQHC guide, link to related items in our Online Library, so that the people doing this important work can easily find new and important items related to their work.

We also held a Twitter Chat on Agricultural Health and Safety last August, with some really great representation from experts in the field who answered questions and shared resources.

How would you define a rural or agricultural health hero?

You know, we are just constantly blown away by what people are doing in rural areas. There are some really amazing programs out there. So we’re very lucky in that sense—we get to see rural health heroes every day. For us, that means those people who are doing the hard work, building health programs from the ground up and coming up with these inventive solutions to really complex problems, despite often having pretty limited resources.

In terms of agricultural and migrant health, health centers have really been a phenomenal force for good. In 2016, they served something like 950,000 migrant and seasonal farmworkers and their families, which is really incredible when you think about it.

We have a section of our website, Models and Innovations, where we highlight rural programs that are doing this work, on the ground, and these programs could really just answer this question for me. And we share their stories because not everything that works in urban areas works in rural areas, and we want to provide some rural-specific options and ideas. They can be searched by topic, state, or evidence-level, and include results, barriers faced, replication principles, and a program contact, so that rural people don’t have to constantly reinvent the wheel.  

So, for example, there’s Promotores at Family Health Centers. This is a program started by Family Health Centers in a rural county in Washington state to improve healthcare access for their migrant farmworker population. They used Promotores—Community Health Workers who are bilingual in English and Spanish—to reach members of their community who had been difficult to reach. They helped migrant workers and their families access culturally competent care and other community resources.

Another example would be Bridges to Health in Vermont and New Hampshire. This program is a consortium between the Bi-State Primary Care Association, the University of Vermont Extension, and a local clinic. It uses care coordination and health promoters, including Community Health Workers, to increase healthcare access for migrant farmworkers.

How can health centers support the great work the RHIhub is doing?

You know, I think the biggest support would just be to share with us. Share their success stories, resources they use and appreciate, challenges they’ve faced, so that what we offer is more dynamic and robust. And likewise, if there’s something they’re looking for and we don’t have it, let us know. We have a Resource and Referral Service where anyone can call or email with rural health questions, and oftentimes, even if we don’t have the answer on the website, we can connect our callers with an expert who does have the answer. And these calls help us identify needs and expand our resources, so we really appreciate them.

And of course, just sharing information about us to others, helping us expand our reach. We can’t help anyone who doesn’t know we exist.

What has been the most rewarding part of your work?

It’s definitely knowing that we’re making a difference. We’ll get feedback on the website, sometimes, or people will come up to us at conferences and tell us about how they used information on our site to successfully get a grant or develop a program or, you know, any number of things. People say things like, they ‘don’t know how they’d live without us,’ that kind of thing—and you know that it’s a little over the top—but, yeah, it’s incredibly rewarding to hear that. To know that you’re providing something valuable to people and making an impact.   

What’s been the most challenging?

You know, I think what we found early on is that there just isn’t the same kind of focus on rural areas and rural health as their urban counterparts. That applies to research, to funding and foundations, all kinds of things. And so one of our early challenges was how to go about building a rural evidence-base, because one of the things about people in rural health is, they’re often doing a lot of work without a lot of people to do it—they’re too busy to take the time to really share what they’re doing in any kind of depth. So we took that upon ourselves, to some extent, to help rural programs share what they were doing and build up that evidence-base. We didn’t do it alone, not by any means, but—that’s been a significant challenge to try to overcome, trying to level that playing field a bit, so that no matter where you live, you have the means and the resources to try to address your community’s needs.  

What inspires you and your staff to work in rural health?

A lot of our staff are rural people. They have rural roots, or they still live in rural communities today. They have family members in rural areas, and they witness the impact that some of these barriers to health have on people who are near and dear to them. So, there’s a pretty deep personal connection.          

But the other thing is that rural health is a topic that’s really easy to get passionate about, once you start to understand some of the disparities and the challenges. You don’t need a rural connection, necessarily, to be really inspired to want to help and make a difference. 

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