Book Review: Out in the Rural, A Walk Back in Time

Few may realize the remarkable history behind the Civil Rights Movement and its role in launching Community Health Centers.  The narrative of how this happened is eloquently told in a new book, Out in the Rural: A Mississippi Health Center and its War on Poverty (the title is borrowed from a short film of the same name produced in 1969).  Author and history professor Thomas J. Ward vividly deconstructs how a small group of medical students and young physicians from far-flung parts of the country organized to provide health and triage care to activists who descended onto rural Mississippi during Freedom Summer. The group, among them H. Jack Geiger, MD, called themselves the Medical Committee for Human Rights (MCHR). It was their small but fierce coalition that launched what one activist called “the medical arm of the Civil Rights Movement.”

Though initially immersed in fighting voter suppression during Freedom Summer, Ward describes MCHR’s shift from engaging in civil rights activities to improving the shocking conditions of African Americans living in Bolivar County, MS. Ward writes, “They became convinced of the inability to truly bring about racial equality without dramatic improvements in the health care of the state’s black population.” Scores of people went without medical care and struggled under poor living conditions —   living in dilapidated homes without toilet facilities or plumbing, and suffering from malnutrition. The infant mortality rate for African American children was 54.4 deaths per 1,000 live births, more than twice the rate for white children. Bob Smith, MD, a physician with MCHR, recalled:

“I understood for the first time what it truly meant to be black in Mississippi and underprivileged, and poor and without medical care, and saw people by the hundreds, and really by the thousands, go without medical care… Saw what I call a Third World Country…People had been denied benefits under Social Security… Thirty to 40 percent of children had intestinal parasites…The maternal mortality rate was out of this world.”

Image courtesy of Dan Bernstein, Southern Historical Collection, University of North Carolina at Chapel Hill.”

The story of how Geiger joined with other pioneering activists, including John W. Hatch, L.C. Dorsey, and Andrew B. James, to start a Community Health Center and address the health needs of the medically underserved in Bolivar County is well established. We know the health center in Mound Bayou, now known as the Delta Health Center, was one of the nation’s first two Community Health Centers, along with urban Tufts-Columbia Point Health Center in the Dorchester neighborhood of Boston. Lesser known are the struggles, large and small, that took place on the ground, including no small amount of skepticism from the white and African American residents as these dedicated activists attempted to launch a program that reached beyond addressing basic health needs and become, as Dr. Geiger put it, “an instrument of social change.” This was the boldest effort yet to not only treat illness but to directly intervene against the root causes of it – poverty, lack of food and jobs, and poor drinking water.

“To treat symptoms, and then to send patients back, unchanged in knowledge, attitude, or behavior, to the same physical and social environment – also unchanged—that overwhelmingly helped produce their illness and do so again, is to provide antibiotics for cholera and then send patients back to drink again from the Broad Street pump.”

Programs began to take shape in Mound Bayou to target the environmental conditions affecting the community. An agricultural co-op was established to fight food scarcity, and Dr. Geiger regularly prescribed groceries from the health center’s pharmacy for malnourished families, explaining, “The last time I looked in my textbook, the specific therapy for malnutrition is food.”

Geiger and the team at the Tufts-Delta Health Center also labored to resolve the problem of unclean drinking water and sewage disposal, the hallmarks of poverty and disenfranchisement that, until that time in history, had been the status quo.  Ward offers up a rich narrative that is instructive in demonstrating how entrenched local communities and public officials can be when it comes to resisting progress.  Bureaucracies needed to be unraveled and stubborn civic leaders needed to be coaxed. History writ large can often fool us into thinking that change is immediate when people mobilize, yet this is hardly the case.  Ward provides the context, the small skirmishes, the obstructionism, and the exhaustive effort required to empower people used to being forgotten.

More than 50 years later, original mission of MCHR and  Tufts-Delta Health Center to address the social determinants of health continues to this day in the Community Health Center Movement. There are nearly 1,400 health centers across the country in rural and urban areas providing not just excellent care, but local solutions that improve population health, create jobs, and empower communities.  “That is what we do: make a road out,” explained Dr. Geiger. “We work with people to build a road out of their circumstances, out of the inequity, out of poverty.”


Over the past three years the Health Center Advocacy Network has experienced unprecedented growth to encompass 100,000 individuals and counting. Thanks to this growing number of Advocates like you, who have not only joined the Campaign for America’s Health Centers, but have repeatedly raised your voice on behalf of Health Centers and their patients,  the power and effectiveness of our network has grown as well.

The effectiveness of our advocacy has been demonstrated time and time again with many of you helping lead the charge online to increase support for the Health Center Program. Online advocacy engagement has also expanded the ability to serve more patients and to stave off regular challenges and threats. Much the same way patients are at the heart of each Health Center, you, our advocates, are at the heart of our network.

Now, as we face even more serious threats and even greater opportunities, we have to adapt and transform our advocacy efforts to meet them. Our goal will remain unchanged; continuing to encourage even more growth while effectively supporting and accommodating the needs of all of our Advocates. To make sure that we can continue to be leaders on behalf of America’s Health Centers, we will be transforming the Campaign for America’s Health Centers into a new – and we believe more effective – identity known as the Health Center Advocacy Network.

Key Information, Dates & Actions:

  • While the Campaign for America’s Health Centers umbrella has helped us grow to more than 100,000 advocates, we have come to a point where our efforts are larger than just a single campaign.
  • To be able to meet the unprecedented challenges and opportunities in today’s environment, we need to be easily recognized and able to respond in the online world where our power matters.
  • The new Health Center Advocacy Network website provides seamless social media sharing capabilities as well as updated advocacy tools. Most importantly, our new website will make it easier than ever for Advocates to take action – from any device with the click of a button.
  • On February 20, we will formally transition to the new website. We will also hold a launch webinar on March 15 at 3PM ET. You can register for the webinar here. If you are attending the Policy & Issues Forum there will also be an opportunity to view, learn about and experience during the conference.
  • ACTION ITEM: Show your support for the new Health Center Advocacy Network by adding our web badge to your website or social media page.

We are excited to unveil this new and updated Health Center Advocacy Network – the action center and heart of our advocacy program. As part of the launch later this month we encourage advocates to visit our new state of the art website, join us in sharing and driving recognition of this updated appearance and identity across social media channels, and take advantage of enhanced opportunities to engage and ADVOCATE for America’s Health Centers and the patients they serve.

The Legacy of Dr. Martin Luther King: Small Great Things

Dr. Martin Luther King, Jr. once said, “If I cannot do great things, I can do small things in a great way.” During the Civil Rights Movement, the goal was to achieve one great ideal: equal rights. However, equality couldn’t be achieved without smaller, individual contributions from prominent leaders and lesser known advocates. Just because an act of service or outreach is small doesn’t mean it’s not quality.

Much like the Civil Rights Movement, the Health Center Movement has made grand achievements. Collectively, health centers do great things, but the less pronounced work of our advocates is what keeps up the momentum. In 2016, our grassroots advocacy network grew to over 100,000 advocates. Not to mention, several health centers received expansion grants allowing them to serve 25 million patients.

When thinking of the Civil Rights Movement, it’s easy to focus on the notable figures. Individuals who seemingly changed the American landscape with one brave action like Rosa Parks, Paul Robeson and Harry Belafonte, come to mind. The magnitude and impact of the aforementioned leaders is unquestionable, but consider the tireless efforts of student volunteers at local community offices, the young women who supplied water and food for protesters, or the journalists who went out on a limb to document black Americans living in the shadow of the Jim Crow South or struggling to get by in the urban North.

The Health Center Movement was in fact inspired by the Civil Rights Movement. Dr. Jack Geiger and Dr. Count Gibson carried out a vision to make health care accessible and equitable. In addition to providing primary care, health centers were created to address the social determinants of health like unemployment, poverty, and environmental health issues. Health centers grew from 2 to nearly 9,800 in 52 years. That type of expansion only occurs when multiple people from all sides of the aisle do small things in a great way.

2017 represents a new set of challenges for health centers and health center patients. As advocates, we must engage in small yet powerful actions to ensure high quality care is available for the patients we serve. As we honor the legacy of Dr. King, remember that a singular action of sharing health center stories, recruiting an advocate or sending a letter to your elected official is essential to the advancement of the Health Center Movement.

New Studies On Quality of Care at Health Centers

New research published today in Health Affairs underscores the value of Community Health Centers and their longstanding partnership with Medicaid. Two studies focused on states that opted to expand the public insurance program under the Affordable Care Act and  provide clear links between the Affordable Care Act’s expansion of Medicaid and improved care quality at health centers.

“The first year of Medicaid expansion was associated with increases in insurance coverage and improvements in asthma treatment, BMI screening, pap testing and blood pressure control,” wrote the authors of the study from Brown University [see Becker’s Health Care article].

The study looked at comparative data between states that expanded Medicaid and those which did not and found higher rates of insurance among patients in expansion states by just over 11 percent.  The impact on quality care for patients was also affected.  More patients came to health centers for care in expansion states and were substantially more likely to contribute to their health centers’ revenue (due to having insurance) and more likely able to purchase medications and access specialty care.

Another study in Health Affairs by the Center for Health Policy Research at George Washington University [See Kaiser Health News article] also uses data to examine Medicaid. In this case, researchers looked at data from 2012 to 2015 to track visits to Community Health Centers.  Again, in states that opted for expansion, health centers experienced more patient visits, lower rates of uninsured patients, and an increase in patients seeking mental health care.

With so much uncertainty about what the future holds for health care, these studies provide solid data showing the value of having both access to health care and coverage.

Both studies are available to Health Affairs subscribers here.

Innovation and Partnerships Bloom in Rural America

What happens when two adversaries meet in health care? In Hazen and Beulah, North Dakota, where a Community Health Center and Critical Access hospital were vying for market share and staff, something extraordinary took place.  They decided to work together.   The two organizations, Sakakawea Medical Center and Coal County Community Health Center, realized that cooperation was better for the bottom line than competition.  So the two started talking.  That was six years ago.  Today, the two entities are a success story as one of the few hospital health center combinations in the country that share leadership and have integrated governance and staff — and they are gaining notice.  They won the 2015 Outstanding Rural Health Organization award from the National Rural Health Association (watch video about the award).

“When individuals or organizations work together towards a common goal there are no disadvantages,” says Darrold Bertsch, who serves as Chief Executive Officer of both Coal County Community Health Center and Sakakawea Medical Center.  “We are seeing improved patient care, improved patient outcomes, and in a rural area like ours people should not have to settle for less.”

How this unusual model came about is a story about vision.  Competing for the same market share, services and staff produced a lot of duplication, as well as an adversarial relationship.  When the prior CEO of the health center and the health center governing board chose to end their employment relationship, with the encouragement of the health center Medical Director, the boards of both organizations saw an opportunity for shared CEO relationship, and indeed a shared vision.  Now, the hospital and health center boards are working together, sharing resources and training, and even providers back and forth as needed.

“The collaboration between the two organizations has provided a host of benefits for health care delivery in our area,” explains Bertsch.  “There is now a community framework in place to conduct a collaborative community health needs assessment for the services areas so we can develop a strategic plan and a community health improvement plan  around the health needs of the entire community — the local nursing home, ambulance service and public health agency.   Steadily, we are reducing the fragmentation and waste of resources that all too often drive up costs and reduce the quality of patient outcomes in health care delivery.  So much good can come of working together and forming a shared mission.  That is how health care is supposed to work.”