Creativity a must for rural health care

There are two New Jerseys, particularly when it comes to public health. There are the urban hubs, older cities in the north and central Jersey with their mix of poverty and prosperity, often sitting side by side with affluent suburbs. And there are the vast rural stretches, including much of the state's south, with its farming communities and former waterfront factory towns.

They both face many of the same public health issues: childhood obesity, undiagnosed and untreated diseases such as diabetes and cancer, smoking, and opioid addiction.

But the manner in which they approach these problems can be very different, as can be seen in the way one tiny urban pocket in South Jersey, Salem City, tackled its public-health problems. What they discovered, as they moved ahead, is that it takes a village to keep young folks healthy.

"A lot of grant opportunities that are available have a bias or focus on urban communities, because that's where we tend to think of the need. And there certainly is a need there," said Janan Dave, director of community health with the New Jersey Healthcare Quality Institute.

"But rural communities have needs, too. And you have a very different set of challenges with rural communities," she added, including the distances that people need to travel for care and a lack of public transportation.

Dave runs the Mayors Wellness Campaign, a program the institute started with the New Jersey League of Municipalities to help mayors pull together resources from local and county organizations and the business community to address public health challenges. A town without a gym nearby started yoga classes in the park, she said, and another mayor worked with local farmers to start a weekly market at town hall.

"We're really trying to galvanize from the grassroots," Dave added. "It's about being more innovative and reaching people where they are because, in rural areas, they're just so much more spread out."

This approach also has strong support from Trenton, where acting State Health Commissioner Cathleen Bennett has made it a priority to encourage providers of all kinds to collaborate around public health since she assumed the role in August. She quickly launched the department's Office of Population Health, which she said is designed to "knit together" the many programs DOH runs to address public-health issues throughout its vast network of offices and divisions.

To help keep its rural residents healthy, Bennett said, the state has become creative in how it connects them with care. Mobile vans travel to small towns to provide cancer screenings and blood-pressure checks in a parking lot; public health workers visit summer camps to counsel teens on healthy, planned pregnancies.

She said the DOH has organized several programs in conjunction with the Southern New Jersey Perinatal Cooperative, one of three regional maternal and child health centers licensed by the state.

Bennett said the department's Rural Health Office has an advisory committee that is working with Rutgers' Institute for Families to develop additional strategies to tackle some of the public health problems that are more prevalent in rural areas. Research has shown that some of New Jersey's rural areas have higher levels of opioid addiction, smoking, obesity and teen pregnancy than the statewide averages for these health concerns.

All of these issues have come together in Salem City, which saw the launch last week of the Salem City Wellness Collaborative, an effort to bring together teens, parents, teachers, clergy, police officers, and others to find effective ways to help young people have safer sex; healthy, planned pregnancies; and better health in general.

The collaborative is led by the Southern New Jersey Perinatal Cooperative and is fueled in part by $50,000 in federal funds - and expertise - from a national safe-sex group, Advocates for Youth. It builds on a successful peer-mentoring program at Salem City High School created by the Perinatal Cooperative and a countywide philanthropic organization, the Salem Health and Wellness Foundation, which helped fund a 2014 study that focused attention on the public health issue.

Salem was no stranger to community outreach regarding public-health concerns. Founded in 2002, the Salem Wellness Foundation has granted more than $11 million to dozens of local organizations for projects designed to keep county residents healthy. Last year, in grants from $832 to just under $2,000, the foundation helped expand meals-on-wheels and flu shot programs, funded mental-health counselors and fitness classes, and paid for needy county residents to stay two extra weeks at inpatient drug rehabilitation facilities.

Brenda Goins, the Foundation's executive director, said conversations with local health-care providers, law enforcement, teachers and others confirmed that teen pregnancy was a widespread concern, along with childhood obesity. Data compiled by Robert Wood Johnson Foundation's County Health Rankings organization shows that, from 2006-2012, Salem County had the second-highest rate of teen births, with 37 out of 1,000 women age 15-19 having babies.

"These are big problems, but there's been no resources to tackle these issues," Goins said.

That's where Advocates for Youth came in. The national organization, which partners with local groups to encourage sexual health among teens, helped the Salem City team identify effective programs and train outreach workers. This led to the Salem City High School program, in which teens in the older grades were taught how to mentor younger students and help them make good decisions when it came to sex. Evening workshops allowed parents to get involved too.

"It can't just be about the kids. It has to be the kids, the parents, and the community," Goins said. "And it's not just about pregnancy and sex. It's about self esteem and good decision making in general."

The new Wellness Collaborative seeks to tap into the larger community and use its input and strengths to develop long-term strategies to address teen pregnancy and teen health. Goins said they will develop action teams to examine individual behavior, the availability of health services, and what messages are most effective with teens.

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