1030: Rural Health in Focus: State Strategies for Transformation

JOHN SHEEHAN: 

This is Public Health Review Morning Edition for Wednesday, November 19, 2025, with news from the Association of State and Territorial Health Officials. I'm John Sheehan.

Today, we're featuring highlights from an ASTHO deskside media briefing focused on rural health across the country. State leaders are working to close gaps in access, strengthen the workforce, and build healthier communities in areas where distance, transportation, and resources create real challenges. You'll hear from state health officials who see these needs every day and are building innovative solutions for the people they serve. We begin in Mississippi, where ASTHO member and State Health Officer for the Mississippi Department of Health, Dr. Daniel Edney, frames the importance of rural health work across his state.

DANIEL EDNEY: 

It's such a pleasure to be with you all today, especially on this Rural Health Day in Mississippi, what an appropriate topic. And we are so excited in Mississippi to have this incredibly important opportunity to invest in rural health care in Mississippi. Over half of Mississippians live in rural areas, and we know, as we invest and make a strategic, meaningful investments into rural health care in our state, we will improve rural health outcomes, which is really what is important for us. And as we improve, the outcomes of our rural Mississippians will be improving the health outcomes for our entire state, and to have this moonshot opportunity to really go after and attack some of those problems that have plagued us, and our rural areas, and our very rural state, are just incredibly exciting. These are problems, such as the need for technological investment for our rural hospitals and providers, and to get them called up, to have the real opportunity to make meaningful investment into the- the broad workforce needs that we have in our rural counties, and then, very importantly, to really attack the difficulties that we have in Mississippi, in our rural areas, with transportation inadequacies, and to be able to do this in a way that will move the needle and the right direction for us in Mississippi.

SHEEHAN: 

Mississippi is not alone. In Iowa, nearly half the population lives in rural communities, which places even more pressure on systems that must reach people across distance and terrain. Here's ASTHO member and State Medical Director for the Iowa Department of Health and Human Services, Dr Robert Kruse, on Iowa's approach to federal funding for rural health opportunities.

ROBERT KRUSE: 

You know, for Iowa, we've approached the application the same way we've approached a lot of our federal opportunities. Focusing again on the rural needs identified by Iowa communities, providers, and hospitals, relying on some of the evidence-based strategies and ensuring alignment with existing state direction processes, including the legislative process, you know, where appropriate. So, our application stays within the current Iowa law and identifies opportunities to build on some of the existing work, such as the care coordination, or digital health tools, or data modernization, and workforce initiatives, without assuming kind of future legislative outcomes. I would say, regarding support or opposition to specific federal incentives, I think our role, you know, as a state agency in health is to evaluate each policy area through the lens of what improves access, quality, and sustainability in rural Iowa and many of these policy concepts mirror work that we're already doing or exploring, and while others would require, you know, ongoing assessment and stakeholder input, it would be premature to characterize any kind of policy area, support or oppose, until that process occurs. But as for the timeline, Iowa, kind of leveraged significant existing work and some of rural health needs assessments and workforce findings, as well as maternal health strategies, and because of that foundation where we're certainly able to respond quickly while still maintaining accuracy and transparency in the data-driven type of approach. So again, ultimately, our application reflects the most priorities for Iowa and readiness, but not just a commitment to adopt any one federal policy, but positions us to bring, again, some of those meaningful resources to those rural communities.

SHEEHAN: 

Public health challenges cross state borders, and agencies have long worked collaboratively, both within their states and across regions. Here's ASTHO Member and Director of the Maine Center of Disease Control and Prevention, Dr. Puthiery Va. In Maine and elsewhere, public health partners communicate frequently, share ideas, and coordinate strategies to address barriers, seize opportunities, and better serve communities.

PUTHIERY VA: 

Public health really is systems-focused, and we recognize that a lot of these challenges doesn't matter where the borders are. So, similarly, ASTHO has been doing this for a very long time. Public health as a whole has been doing this for a very long time, where we do actually work very collaboratively within our state borders, but also across the region as well. So, similar to what Dr. Edney said, like, you know, here in Maine, we are very close, and we communicate very regularly, whether it's with rural health or something else with public health. We communicate very regularly with our other state partners, and we're always looking for opportunities to share ideas in terms of, like, how to respond and- and continue to meet that public health mission. Right? We serve people, we serve our communities, and we, you know, definitely talk and share ideas in terms of, like, how to strategize, how to deal with barriers and challenges, but we also look at opportunities as well, in terms of like, how to work and coordinate together and communicate more effectively for people.

KRUSE: 

Yeah, I'll just share, I mean, one of the most important parts of rural health transformation effort is that the rural health challenges don't follow those state borders, and patients cross county and state lines for care. Our workforce moves across regions and the issues we're addressing, whether it's, you know, chronic disease, or behavioral health needs, maternal health risks, data infrastructure, these are shared, you know, not just in the Midwest, but across the nation, and we're trying to achieve this together. So again, that's where ASTHO has been incredibly helpful. They've created that space where states can collaborate and compare approaches and understand really what's working in different rural environments.

SHEEHAN: 

And here's Dr. Edney again, with some closing thoughts.

EDNEY: 

This is the strength of ASTHO, is that the three of us know each other and have been working with each other all along. And I respect my two colleagues, and you know what they're doing in their states, and we're very close, and we have been talking from the beginning, you know. Who's doing what in their states with application, who has chief responsibility? What are you looking at? You know? How are you looking at this? How are you doing it? And what's been really important, Dr.  Vasaid is, we're all having the same challenges in rural health, and the need for rural health care is just, it's- it's ubiquitous across the country. And, you know, independently, organically, great ideas are moving forward, and it's all very similar. There might be some variations on how it's operationalized, but you hear us all saying the same thing. I get- all three of us are talking about the importance of technology investment, statewide health information exchange, connecting all providers and rural areas of the country. I mean, we all have transportation challenges. We all have workforce challenges. And what's interesting is seeing how those approaches are being attacked in Maine and Iowa, and likewise, in Mississippi.

SHEEHAN: 

Dr. Daniel Edney is the state health officer for the Mississippi Department of Health. We also heard from Dr. Robert Kruse, state medical director for the Iowa Department of Health and Human Services, and Dr. Puthiery Va, director of the Maine Center of Disease Control and Prevention. All are ASTHO members.

State health officials across the country are working to strengthen rural health systems so that care is available, accessible, and supported by strong partnerships. ASTHO is proud to work alongside them as they build the programs and policies that improve lives in every community. Check out the show notes to read the ASTHO news release, which includes a link to the recording.

Don't miss out on a webinar happening today, hosted by ASTHO and the Virginia Department of Health, spotlighting a new report on advancing brain health and caregiver support. You'll hear how the report was developed, explore innovative policy examples, and learn about a new learning community opportunity. Sign up using the link in the show notes.

ASTHO is seeking proposals from qualified organizations to design and implement a rapid response opioid and pain management ECHO aimed at strengthening provider capacity to manage patients affected by prescription-controlled substance disruptions. Learn how your organization can lead this critical initiative by heading to the show notes.

I'm John Sheehan, and this has been another Public Health Review Morning Edition from the Association of State and Territorial Health Officials.