The University of Iowa has been selected by the National Endowment for the Arts (NEA) to receive one of the first projects funded through a new program, NEA Research Labs. The cross-sector projects supported through the program investigate how the arts contribute to positive outcomes for individuals and communities. The NEA will fund four inaugural projects totaling $598,600 that will yield insights for the arts sector and for non-arts sectors such as healthcare, education, business, and management.
The Rural Policy Research Institute (RUPRI) at the University of Iowa College of Public Health, in partnership with the organization Art of the Rural, will look at the intersection of the arts, entrepreneurship, and innovation in rural contexts. RUPRI also will work with its Rural Intracultural Policy Council to develop pilot studies of rural “cultural ecologies.” The pilot studies may use social network analysis, structured interviews, and respondent-driven survey sampling to test hypotheses about cultural and social capital as preconditions to innovation.
Other labs recommended for funding are: Drexel University, Philadelphia, PA; University of Arkansas, Fayetteville, AR; and Vanderbilt University, Nashville, TN.
Each of the labs will design and implement a research agenda and prepare reports in one of three areas:
- The Arts, Health, and Social/Emotional Well-Being
- The Arts, Creativity, Cognition, and Learning
- The Arts, Entrepreneurship, and Innovation
The NEA Research Labs initiative is intended to fulfill milestones of the agency’s new five-year research agenda.
A new research report by the Rural Policy Research Institute’s Health Panel, which includes University of Iowa faculty and is supported by research staff in the UI Department of Health Management and Policy, outlines the challenges and opportunities confronting rural providers, policymakers, and health systems as they work to implement reforms in rapidly expanding state Medicaid programs.
The report notes that efforts to reform the health care delivery system are gaining momentum among all payers and within Medicaid programs in particular, given their significance to a growing population as well as to state budgets. The report calls on policymakers to “recognize both the desirability and shortcomings of new delivery system models for rural patients and providers.”
“While both national and state policymakers shape Medicaid reform, state-level policies have the potential to encourage a broader statewide focus on population health by connecting Medicaid to other important and impactful state-level resources, like human and social support services and public health,” the report states. “In implementing policies that promote delivery system reform, it is important to consider how certain models may be capable of either promoting access for rural populations or diminishing it.”
According to the report, broadened eligibility under the federal Affordable Care Act (ACA) nearly doubled the percentage of people covered by Medicaid programs — from 10.4 percent of the U.S. population in 2000 to 19.5 percent in 2014. As of January 2016, more than 72 million people nationwide were enrolled in Medicaid.
The significance of state Medicaid programs is even greater in rural areas where, as of 2014, 22 percent of residents were enrolled. Medicaid has surpassed Medicare as the largest source of public health coverage in rural areas, and is second in coverage only to employer-sponsored insurance plans. The program is also a crucial source of provider payments in rural communities.
The report identifies six recommendations for rural policymakers, providers, and communities. The recommendations are:
- Promote integrated and comprehensive primary care delivery.
- Promote integrated and comprehensive care across the health care continuum.
- Promote accountability for the health of the Medicaid population in rural communities.
- Promote measures, reporting standards, and payment approaches relevant to rural providers.
- Promote payment designs that recognize the nature and circumstances of rural providers and systems.
- Provide technical assistance to rural providers during the Medicaid transition to value-based payment.
The report was authored by the RUPRI Health Panel, which is chaired by Dr. Keith Mueller, professor and head of health management and policy at the University of Iowa College of Public Health. The work was supported by the Leona M. and Harry B. Helmsley Charitable Trust. The full report is available at the RUPRI website.
Charles Fluharty, clinical professor of health management and policy, and founder, president, and CEO of the Rural Policy Research Institute (RUPRI), was recently honored by Iowa Wesleyan University as the inaugural recipient of the Presidential Medal for Outstanding Merit.
The award, conferred during the Iowa Wesleyan University commencement ceremony on May 7, recognizes Fluharty for “lifelong and exemplary leadership and commitment to advancing the development of rural life and communities.” The award also acknowledges the extensive work of RUPRI over the past 26 years to address “the full range of policy and program dynamics affecting rural people and places.”
Fluharty’s career has focused on service to rural people, primarily within the public policy arena. A seasoned policy analyst and practitioner, he has authored numerous policy studies, journal articles and policy briefs addressing the rural differential in public policy decision making. He is also a frequent speaker before national and international audiences, having delivered major public policy speeches in over a dozen nations, and has provided senior policy consultation to most federal departments, state and local governments, associations of government, planning and development organizations, and many foundations.
He was a German Marshall Fund Transatlantic Fellow from 2007 to 2011, and recently coordinated a collaboration between former Kentucky Gov. Steve Beshear and U.S. House Appropriations Chairman Hal Rogers to address the severe economic dislocation resulting from the decline in the eastern Kentucky coal industry. His two-year engagement resulted in the establishment of Shaping Our Appalachian Region (SOAR), a public/private/philanthropic intermediary collaborating across 60 counties in the Appalachian mountains.
The Rural Policy Research Institute is forging innovative collaborations at the rural-urban intersection.
The prevailing narrative about the rural-urban dynamic is well-known: Rural America is on the decline, while urban America is moving ahead. Residents of rural areas are older, poorer, less healthy, and have lower levels of education than those living in urban regions. Population across rural America is decreasing and the rural economy is struggling. On balance, not an especially optimistic outlook for rural regions.
While structural, demographic, economic, and geographic challenges have seemingly stacked the odds against rural regions, leaders of the University of Iowa-based Rural Policy Research Institute (RUPRI) aren’t buying the stereotypes of “urban growth vs. rural decline.”
Instead, they articulate an alternative view of rural and urban regions as vital, complementary sectors, intrinsically bound together, each essential components of a healthy social, cultural, economic, and environmental whole.
Confronting Common Challenges
Chuck Fluharty, RUPRI president and CEO and clinical professor of health management and policy in the UI College of Public Health, is a passionate proponent of this view of rural-urban interdependence. It is a view, he says, that encompasses the enormous potential for beneficial synergies built on models of regional collaboration.
“Throughout the United States and the world today, people are confronting common challenges, such as the need to develop affordable and appropriate energy systems, including renewables, create functional local and regional food systems, mitigate and adapt to climate change, foster vibrant arts and culture, nurture private civic and social entrepreneurship, and do all this with less, but for wiser public investments,” says Fluharty.
“The rural-urban intersection and regional innovation systems are some of our most important opportunities. Many of the challenges facing modern urban centers depend on rural areas for solutions. Rural citizens steward these resources that urban America needs. So, rural-urban interdependency is our common future.”
Iowa is a microcosm of how America is going to have to address this intersection to craft locally appropriate solutions, notes Fluharty.
“The Des Moines Water Works lawsuit is emblematic of these challenges,” he says, referring to the high-profile legal battle pitting the public water utility of Iowa’s capital city against three rural Iowa counties upstream. At issue is the question of who bears the mounting financial cost to produce clean public drinking water when rivers are heavily polluted by agricultural chemicals and other farm run-off. “These types of challenges require effective regional policy responses, and there are jurisdictional, sectoral, and political dynamics which make all this even more difficult. But these must be overcome.”
Building the Evidence Base for Rural America
The pursuit of effective public policy has been the impetus for RUPRI since it was founded 25 years ago. It was the absence of objective, non-governmental information about rural policy impacts that prompted United States Senate Agriculture Committee members Kit Bond of Missouri, Dale Bumpers of Arkansas, Bob Kerrey of Nebraska, and Tom Harkin of Iowa to establish RUPRI in 1990.
Over the past quarter century, RUPRI has yielded a trove of research, analysis and consultation, engagement, dissemination and outreach, and decision support tools for policymakers. Initiatives cover the full gamut of the rural experience – from health and human services policy to arts and culture, regional innovation and governance, entrepreneurship, poverty, transportation, telecommunications, and wealth creation. (See rupri.org for more on RUPRI’s areas of work.)
RUPRI has led innovative economic development initiatives seeking to diversify the economy of hard-hit rural areas, such as the coalfields of eastern Kentucky. Its health policy experts are helping rural providers adapt to changes in health care finance and delivery, including telehealth programs. Arts partnerships strengthen rural culture and community. A RUPRI panel is working to improve health and human services delivery models. And by focusing on comparative policy assessments, through collaborations with entities such as the Organisation for Economic Co-operation and Development, RUPRI brings its rural research and policy innovation expertise to the international arena.
The work taking place within this remarkably diverse portfolio is carried out by a core team based in Iowa and Washington D.C., and a number of joint initiatives and panels comprised of colleagues from universities, policy institutes, and organizations across the United States. Funding is primarily through federal grants from agencies such as the U.S. Department of Health and Human Services, the U.S. Department of Agriculture, and the National Endowment for the Arts, among others.
“The breadth of the RUPRI portfolio across multiple sectors, coupled with its extraordinary analytic and research expertise, makes it an invaluable resource for understanding the experiences of rural populations and the complexity of rural issues,” says Sue Curry, dean of the UI College of Public Health. “This is why so many policymakers rely on RUPRI and it’s why it adds such tremendous value to the University of Iowa and the College of Public Health.”
Valuing Rural Culture
Beyond simply building the evidence base to inform sound public policy, however, Fluharty and RUPRI have staked a commitment to the unique value of rural places and the contribution that rural life and culture makes to America’s national identity. Whether through testimony before Congressional committees, advocating for greater private philanthropic investments in rural America, or presenting research findings and recommendations, the RUPRI leadership team is focused on changing the rural-urban narrative to one that appreciates the intrinsic value of rural America.
“Since our nation’s founding, rural areas and rural people have provided the food, fuel, and fiber for all our citizens,” Fluharty says. “Today, as never before, the health, welfare, and future viability of urban America are directly linked to the wellbeing of rural America.”
This article originally appeared in the Fall 2015 issue of InSight.