The Last Big Barrier To A Rural Renaissance: Healthcare

I’ve written before about the ways that small towns and rural areas
can take advantage of broadband Internet connections to gain access to
global economic opportunities, educational and cultural resources, even
the virtual equivalents of coffee shops that used to be only available
in big cities.

Perhaps the biggest remaining barrier to a 21st century rural renaissance is access to world class health care.    

that in mind, President Obama’s Rural Council brought together about
three dozen experts to the White House complex last week to identify
innovative ways of bringing health care to the countryside and to
establish a “community of practice” that will help the Obama
administration and hopefully its successor to address the problem. 

group included:

  • Federal officials from various agencies, including Secretary of Agriculture Vilsack
  • Leading broadband providers and the Rural Broadband Association’s CEO, Shirley Bloomfield, and Joshua Seidemann, Vice President of Policy (who helped organize this meeting)
  • Exemplary providers of tele-health, and
  • A
    couple of other experts, including myself (in my role as Senior Fellow
    of the Intelligent Community Forum and director of its New Connected
    Countryside initiative)

This “convening” was led by Doug O’Brien, Senior White House Advisor for Rural Affairs.

was noted, although not news to those around the table, that the nearly
60 million Americans who live in rural areas were hit especially hard
by the Great Recession.  Their local economies have taken longer to
recover, still not back to pre-recession employment levels.

But the comparisons of rural versus urban health care were most striking.  Here are just some highlights:

  • Rural areas have higher rates of disease and higher mortality rates than urban areas. In 1980, the rural mortality rate was 2% worse than the urban rate and now it’s 13% worse.
  • While
    approximately one in six Americans live in rural areas, only one in ten
    physicians practice there. There are even fewer medical specialists per
  • Suicide rates are higher and getting worse in rural
    areas. Along with a growing drug abuse problem, this is a reflection of a
    growing need for mental health services.

None of these
medical problems are helped by the fact that rural residents are poorer
and less likely to have health insurance.  Of course, given the lack of
sufficient nearby medical resources, rural residents need to travel
further – often hours further – than their urban counterparts.

the Internet age, that last problem should be able to be mostly overcome
with health care delivered remotely.  So most of the meeting was
devoted learning about the use and deployment of tele-health care.  In
this post, I won’t be able to describe all of them or any one of them in
detail, but here are some that stood out to me:

  • Using cost-effective solutions, like iPads, Vanderbilt University Medical Center
    has established a network of rural tele-health services. This even
    includes virtual group sessions for people with drug addictions.
  • The
    US Department of Veterans Affairs has pioneered the use of virtual ICUs
    in its rural clinics and facilities. With a fully developed set of
    tele-health tools, to the patients and local staff, it’s like having the
    expert ICU doctor at the bedside.  As a byproduct of these virtual
    ICUs, the medical staff at these facilities are also getting an
    education in newer and better medical techniques.
  • Through East Carolina University School of Medicine, there is now a tele-psychiatry network in North Carolina. The relatively low cost of making tele-psychiatry available is helpful, given the increasing need for mental health services.

many rural areas do not yet have the broadband which is necessary to
deliver these services.  But there are clearly broadband providers,
especially telecommunications coops, which are up to the task.  We heard
about just two of those who had completed gigabit deployments to every
household in their rural areas in Kentucky and North Carolina.  One of
those, Peoples Rural Telephone Coop was reported on in a Daily Yonder article last month, “One of the Nation’s Fastest Networks Serves Two of Its Poorest Counties”.

before the recent recession, there were long term trends in rural
America that called out for a different and new economic strategy.  In
his closing remarks, Secretary Vilsack noted that, since 1950,
agricultural productivity has increased a hundred fold on 27% less land
and with 22 million fewer farmers.  So the challenge today is what
opportunities and quality of life can the remaining families have.  

people around that table last week and ICF believe that a revived rural
community can be built upon the intelligent and creative use of
technology – and improving access to quality healthcare is just one very
important example.

© 2016 Norman Jacknis, All Rights Reserved


Engineering Human Biology


Although information technology companies get most of the attention in discussions of future trends, it’s worth remembering that biotechnology and medical developments will perhaps have a greater impact on our lives going forward.

The engineering of human biology is already moving rapidly, sometimes in ways that are even scarier than the dystopian visions you can read about future computer technology.

In its August issue, WIRED magazine had a story about scientists creating new enhanced capabilities to reorder genes.  The article was titled “Easy DNA Editing Will Remake the World. Buckle Up.” with this teaser:

“We now have the power to quickly and easily alter DNA.  It could eliminate disease.  It could solve world hunger.  It could provide unlimited clean energy.  It could really get out of hand.”


“The end of life as we know it”.


More recently, in another example, researchers at the University of California San Francisco announced that they have created a way to “print” human tissue on demand.  Their goals in the short run are not as dramatic as WIRED portrayed, but the possibilities are also large.

In another form of biological engineering, the Wyss Institute for Biologically Inspired Engineering at Harvard University was given an award several months ago by the Defense Department’s DARPA.  While there have been exoskeletons to help soldiers with limb injuries (or just to take a load off their bodies), these have been clunky metallic models.  The scientists at Harvard are to develop a more comfortable, less noticeable, exoskeleton – a Soft Exosuit as described in this video.

A few miles away, however, other scientists are doing away with the need for such external supports in something from science fiction stories – the Massachusetts General Hospital announced in June that its staff had developed a “transplantable bioengineered forelimb”.  The chief researcher at MGH noted:

“Limbs contain muscles, bone, cartilage, blood vessels, tendons, ligaments and nerves – each of which has to be rebuilt and requires a specific supporting structure called the matrix.  We have shown that we can maintain the matrix of all of these tissues in their natural relationships to each other, that we can culture the entire construct over prolonged periods of time, and that we can repopulate the vascular system and musculature.”  

Of course, before we get to these biological futures, there is already computer technology to help our bodies.   The mental health profession has been one of the early adopters of information technology, so let’s start with that.

Thriveport promises its MoodNotes app:

“helps you to: Track your mood and identify what influences it; Develop healthier thinking habits; Learn about “traps” in your thinking style and how to avoid them; Bring new, helpful perspectives to situations; Increase your self-awareness; [and] Reduce your distress and enhance your sense of well-being”


Along the same lines, the research staff of the University of Rochester “have developed an innovative approach to turn any computer or smartphone with a camera into a personal mental health monitoring device.”  It analyzes “selfie” videos when you use social media.

The number of physical health apps and inexpensive devices available now is too numerous to be called news anymore.  

But a couple of months ago, Australia’s Centre for Nanoscale BioPhotonics announced that they had “created a simple, portable and economic biosensing device that allows for immediate diagnostic testing of arthritis, cystic fibrosis, acute pancreatitis and other clinical diseases.”  They built it because

“the device has enormous potential for use in point of care medical diagnostics, particularly in remote or developing areas where professional and expensive research laboratory equipment is unavailable”.

They’ve also made their software available so you can convert your smartphone into a “portable bioanalytical devices”.  

Finally, to keep healthy, you apparently not only need to monitor your body, but also to monitor the environment where you live and work.  So along comes the network-connected CubeSensors, which claims that it will “help you discover how small changes in your environment also affect your wellbeing” by observing factors like air quality, air pressure, temperature, humidity, noise and light.


© 2015 Norman Jacknis, All Rights Reserved