Rural-Proofing: A Conversation with North Dakota’s Mylynn Tufte on National Rural Health Day

November 14, 2018 | ASTHO Staff

What population health challenges do rural communities in your state face, and how are you mobilizing partners to address these issues?

The population health challenges rural communities face in North Dakota are very similar to those in many other states. It comes down to the social determinants of health: housing, education, employment, food security, and access to healthcare. There are some differences for rural communities in terms of scalability, cost, and sustainability. Many programs are created for larger metropolitan areas, which can be difficult to scale for a rural setting. It requires us to think differently.

How do your past roles as a health management executive and critical care nurse inform your work as a state health official? In these previous jobs, were you exposed to rural health issues?

My past roles as a health management executive and critical care nurse have allowed me to experience healthcare through a different lens. I’ve been able to live, learn, and add value from both the payer and provider side. I think that’s why I get so energized about being the state health official in North Dakota. Adding public health and policy components offers me the ability to look across the continuum of care and understand that to improve the health and well-being of populations we must work together—strategically, proactively, and collaboratively.

What types of innovations, interventions, or programs are you using to improve health outcomes in rural areas?

Through North Dakota Gov. Burgum’s Main Street Initiative, North Dakota communities have access to a community dashboard that highlights information they can use to help prioritize and strategize how to create healthy, vibrant, financially solvent communities. The Main Street Initiative is built on three pillars: (1) healthy, vibrant communities, (2) a 21st century workforce, and (3) smart, efficient infrastructure. Under the healthy, vibrant communities pillar, a health and wellness steering committee was reconstituted from North Dakota’s state health improvement plan advisory group and other key statewide private partners. We’ve made it our goal to help communities promote health and well-being through a behavioral health toolkit and targeted campaign messaging. In addition, the North Dakota Department of Human Services’ Behavioral Health Division created a calendar with media releases, videos, events, and other evidence-based strategies for communities.

What does “rural-proofing” mean to you? How do you “rural-proof” your policies in North Dakota to ensure that the effects of your policies do not disadvantage rural communities?

With a population just over 755,000 in 2017, we have to think about “rural” and “frontier” in most everything we do. In fact, we celebrate rural! We appreciate that being rural allows us to address needs and act quickly. We know how to collaborate and often joke about being connected by two degrees of separation—as opposed to six degrees. We understand there are still disparities and we are working within our communities to actively address these.

Many rural communities are facing hospital closures, provider shortages, and other challenges around access to healthcare services. How are you addressing these issues through state health policy?

The workforce shortage is a key concern across all sectors of business, including government and healthcare. Gov. Burgum is committed to growing the workforce in North Dakota and has given new life and purpose to a workforce development council. The council recently conducted a statewide workforce survey and released results that address several areas for improvement.

How often and in what capacity do you work with your state office of rural health or other rural health organizations? What benefits are there to your collaborations?

The North Dakota Department of Health works quite often and in close collaboration with the Center for Rural Health at the University of North Dakota School of Medicine and Health Sciences. Some examples of the work that we do together include:

• Contracting on primary care office activities for improved workforce development, as well as provider recruitment and retention.
• Planning the annual Dakota Conference, a regional symposium on rural and public health.
• Improving population health based on findings from the community health needs assessments that the Center for Rural Health conducts for many of the critical access hospitals and local public health units.

What strengths and resiliencies do you see most often in rural communities? How does ASTHO’s 2019 President’s Challenge align with your work in rural communities?

As mentioned, we have strong partnerships in rural communities. Because North Dakota is so small, it is easier to make needed connections and achieve desired outcomes, pilot strategies, develop new models, and be innovative. Our rural communities are made up of creative thinkers who know their community needs and are passionate about getting the job done. The 2019 ASTHO President’s Challenge aligns well with the work we are doing with the Main Street Initiative. Public-private partnerships that allow for business leaders and policymakers to come together to improve the health and well-being of communities are fundamental to the president’s challenge and the Main Street Initiative. Our purpose is to empower people, improve lives, and inspire success that benefits all communities!