The Power of Rural: Kim Malsam-Rysdon Discusses South Dakota Efforts to Improve Rural Health

November 13, 2017|5:39 p.m.| ASTHO Staff

Kim Malsam-RysdonOn the third Thursday of November each year, the National Organization of State Offices of Rural Health celebrates National Rural Health Day to highlight public health and healthcare successes in rural communities across the country and provide an opportunity to discuss the challenges these communities face.

With this in mind, ASTHO spoke with Kim Malsam-Rysdon, secretary of health for the South Dakota State Department of Health, to discuss South Dakota’s efforts to improve rural health statewide.

What are the most pressing rural health issues in South Dakota?

There are several rural health issues in South Dakota. The rate of health disparities is higher in rural and frontier areas of South Dakota. We see increased rates of accidents and suicides in rural South Dakota in particular. Access to healthcare services is also limited in many rural areas of the state. Like other states, we have significant workforce shortages across the healthcare service delivery system that are very pronounced in rural areas. 

What programs and activities are underway in your state to address rural health issues?

We are engaged in multiple activities statewide to address rural health concerns. The department of health does targeted work in injury and suicide prevention at the community and state levels through programs such as Helpline Center, which offers extensive suicide prevention, intervention, and postvention programs. We have piloted crisis texting programs for high school and college students, increased opportunities for Mental Health First Aid training and supported services through prevention resource centers throughout the state. We are also helping communities better understand data to develop injury prevention plans and integrating behavioral healthcare screening into primary care settings. In addition, we are working with providers to implement Zero Suicide, a global movement that encourages public health and healthcare leaders to support individuals who may have suicidal thoughts, provide key resources and tools, and aim for a zero tolerance approach to suicide. All of these efforts encourage injury and suicide prevention not only in rural areas, but statewide.

Furthermore, South Dakota utilizes healthcare provider recruitment and retention to address and improve rural health. In 2012, Gov. Dennis Daugaard convened a Primary Care Task Force to train more primary healthcare providers for rural areas. Since then, the state has expanded its medical school, started rural training programs for physicians, nurses, social workers, pharmacists and other healthcare professionals, as well as invested in healthcare exposure programs for middle and high school students. Most recently, the University of South Dakota Sanford School of Medicine developed a rural family practice residency track, which will begin in spring 2018.

In addition, the department of health analyzed the scope of practice and provider requirements to balance the need for quality service provision, protection of the public, and the needs of people living in rural South Dakota. We reorganized emergency medical services a few years ago to support their integration into the healthcare delivery system. Providers in our state are leaders in using telehealth approaches and creating partnerships between providers to deliver care in rural and underserved areas. 

What are the most notable successes or outcomes you’ve had regarding rural health issues?

In South Dakota, exposure to rural practice has resulted in a large increase in rural health providers. More than 90 percent of physician assistants and nurse practitioners, as well as more than 70 percent of physicians who participate in recruitment assistance programs continue to practice in their rural communities. Rethinking service provision in rural areas has also been a key strategy. An emergency services provider significantly reduces unnecessary emergency room visits by expanding use of targeted responders to people with behavioral health needs.

What tools and resources can help states and territories to improve rural health?

There is an ongoing need for analytical data to help rural communities improve public health. Sometimes, this can be standard public health data. However, often rural health issues require a unique approach to effectively communicate the issue so communities can take action. Community health assessments are an underutilized tool that can be very helpful in improving rural health.

Given your experience in South Dakota, what are key actions or best practices that other state or territorial health officials can take to improve rural health?

Understanding and appreciating rural culture is key to making lasting change. We find that rural communities often have champions for rural health issues who may not be the usual suspects. The link between population health, healthcare access, and economic development can also be compelling for communities seeking to stay relevant. Respecting and leveraging the grit of rural communities can lead to innovative, sustainable solutions.