A series of four parts to treat other America

Foreword: Why rural health requires a national conversation

This essay is the first in a series of four parts that I call rural health resistance-a look at the state of agricultural health in America through the eyes of a surgeon, politics and businessman. During my life, I have taken care of patients reported by agricultural hospitals and doctors as surgical Intern. I have treated them in VA hospitals and academic medical centers as a specialist of heart and lungs and represented their interests in Washington as a Tennessee Senator. I have helped design companies – such as Aspire Health, Main Street Health and Monogram Health – now serving hundreds of thousands of rural Americans in their homes and communities. And I have personally served as a surgeon in remote clinics throughout Sub -Saharan Africa, where geography often determines survival. I am not an expert in agricultural care, but I try to become an intense observer.

What I have learned is that rural America is often overlooked. But her health is inextricably linked to the health of the nation. We can no longer expect economics, organizational and traditions designed for urban areas to work in rural communities. They don’t. We need to respond to the needs of rural populations with a new, more adapted approach. I will share some ideas as possible solutions during this series.

This series will explore four pillars of the rural health landscape:

1. The Crisis of Rural Health: How We Reached Here – and why it affects us all (this first essay)

2. Closing distance: resolve access to care in agricultural America

3. What counts: How technology can transform agricultural health

4. A healthy performance: How the investment in agricultural care is good for America

The Crisis of Rural Health: How We Reached Here – and Why It Affects We All

A crisis in a simple look

At first I began to think seriously about the vulnerabilities of agricultural health not from a policy paper, but by a patient. He was a 52-year-old farmer from Western Tennessee-Stoic, Salt-of-The-Earth, the kind of man who came to the doctor only when he could no longer walk to the stairs of his tractor. By the time he did, a specialist of the heart was in advanced heart failure. His local hospital had been closed. The nearest cardiologist was two counties away. And the many obstacles to achieving special care cost valuable time.

The story of this man is not unique. In fact, it is painfully public.

Rural America today faces a slow health crisis that affects almost 60 million people-while one in five Americans. The definition of “rural” varies slightly by the government agency, but it generally includes non-transitional counties characterized by a lower population density, distance from urban centers and limited access to movement. These communities cover the country, from Appalachia to the Mississippi Delta to the high plains of Montana – and together they are the backbone of our country’s food, energy and cultural identity. And, yes, they include even more populous coastal states such as California, New York and Florida, which contain important rural areas – spaces where access, infrastructure and results reflect those that are most traditionally considered as rural states.

These same communities face disproportionately high rates of chronic disease, mental illness, maternal mortality and premature death. The phrase “penalty of rural mortality” is real. According to Dr. Shannon Monnat, a farm demographer at the University of Syracuse, “the rural US are sick, poor and losing a population.

With numbers: Geography as destiny

The data is intense:

• Rural Americans are 20-30% more likely to die of heart disease, cancer, unintentional injury, stroke and chronic lower respiratory disease.
• They are 50% more likely to die prematurely than their urban peers.
• Mother mortality rates are 60% higher in rural areas – and more than doubled for black and indigenous women living in rural counties.
• Over 65% of rural counties do not have a psychiatrist and 80% does not have an internal patient detox facility.
• Since 2010, more than 130 agricultural hospitals have been closed – and over 600 more are at risk.

These are more than numbers. They are cuts cut. The families left behind. Communities are exhausted.

Health gaps we don’t see

Inequalities in agricultural health are not just about the availability of clinics or emergencies. They are deeply linked to social decisive health factors, such as housing, transportation, education, access to food, income inequality and broadband connectivity.

As Dr. Carrie Henning-Smith of the University of Minnesota, “the biggest guides of agricultural health inequalities are not medical. These social dangers make up clinics. Continuous solutions should include attention to each of them.

Simply put: many rural Americans do not die because they cannot reach a doctor. They die because of what happens long before they need one.

Aging, isolation and distribution of infrastructure

Rural America is quickly getting older. Almost one in five rural Americans is over 65. Many are getting older in place, even when younger generations are moving away. This means that more and often older people with complex needs and fewer providers or carers to meet them.

These elderly often manage multiple chronic diseases without access to home care, nearby pharmacies or geriatric specialists. As Dr. Tim Slack of the State University of Louisiana puts it: “What we see is a slow erosion of systems that support health -economic, medicine and politics.” “” “” “” “” “” “” “

In the meantime, in a post-world world, we have warned Telehealth as a powerful solution. And it may be if patients have a broadband. But millions still do not. Whether because of the cost, geography or digital alphabetism, virtual care remains inaccessible to many of the people who need it most.

Real stories, real bet

I have seen this reality firsthand. At Monogram Health, we take care of patients with advanced kidney disease who cannot safely reach the dialysis centers. At Aspire Health, which focuses on palliative care, we have faced rural elderly with a complex, restrictive illness of life, often homebound, often only, disconnected from coordinated care. And through Main Street Health, we have created a primary care model that develops reliable, local “health navigators” in agricultural communities in 22 states to encounter patients where they are geographical and clinical.

These are not pilot projects. Everyone started as innovative ideas, every carefully organized with agricultural needs. Now they prove and operate on a scale. They show that agricultural care can work. But only if we plan it deliberately and viable, listening to the local needs of the communities and aggressively involved in solutions.

Not a monolith, but a common challenge

Rural America is different – racial, economic and cultural. The needs of an Appalachian coal city differ from those of a South Dakota Center or an Agricultural Community in the central valley of California. But the basic vulnerabilities are shared.

As Monnat reminds us, “we often treat agricultural as a category of inadequacy, but the truth is that rural communities have huge assets-court networks, cultural durability and deep-based knowledge.

A call to see – and then to act

The crisis of agricultural health is more than just a side line in the national debate. It’s the national debate. If we ignore the progressive decline in agricultural health, we run the risk of losing entire communities. Economically, we lose work. Socially, we lose confidence. Politically, we deepen divisions.

But I believe that agricultural health is also one of the greatest opportunities to make significant progress in American health care. This is this order. The data is in. There are models. And the maps are clear. Smart rural health solutions can accelerate care for all of America. We will explore this more on essay three where we focus on technology.

What will follow

In the next essay, we will look at the specific obstacles that keep rural Americans having access to the care and innovations that help bridge the gap. From the lack of workforce and the challenges of transport to mobile health units and broadband expansion, we will look at what is broken – and what works.

And a final thought: If we can’t get the right to health care for 60 million Americans who feed us, they feed us and form the fabric of this country – for whom do we do it right?

Footnotes

1. Dr. Shannon Monnat, president of Lerner for the promotion of Public Health, University of Syracuse, “Population Health in Rural America”, White Papers Group Health Group Aspen (AHSG), 2025.
2. Dr. Carrie Henning-Smith, Deputy Director of the University of Minnesota Center for Rural Health, “Rural Health in the United States”, AHSG White Papers, 2025.
3. Dr Tim Slack, Professor of Sociology, University of Louisiana, “Population Health in Rural America”, AHSG White Papers, 2025.
4. Dr. Shannon Monnat, ibid.