Healthcare in Rural Areas: A Philanthropic Prescription

In 1901, Standard Oil Company Founder John D. Rockefeller started the Rockefeller Institute for Medical Research, which is now Rockefeller University. Located in New York City, it remains the oldest operational biomedical research facility in America.Home Depot Founder Ken Langone and his wife, Elaine, donated $200 million in 2008 to NYU’s medical center, and in 2018 Langone donated $100 million as well as helped raise another $350 million to enable the school to become tuition-free. NYU Langone Health bears his name.In December 2019, DreamWorks co-founder David Geffen donated $46 million to UCLA’s medical school, which is named after him. Geffen had previously provided a $100 million contribution to start the David Geffen Medical Scholarship Fund at UCLA in 2012.Although medical schools and research facilities such as these can yield advances that benefit patients across the globe, they are located in urban areas that attract highly skilled jobseekers, including those in the medical profession. Conversely, studies show that very few new doctors prefer working in small towns.RURAL NEEDBut in recent years, philanthropic focus has begun to turn to the healthcare needs of rural Americans. Data from the University of Michigan Poverty Solutions initiative finds that residents of the poorest U.S. communities, many of which are rural, on average have life spans a decade shorter than residents of the wealthiest communities. A study by the Pew Charitable Trusts shows that rural residents tend to have worse health than city dwellers, who often benefit from living near many top-tier hospitals.People living far away from urban and suburban areas have seen their communities dwindle in population, concurrent  with a tougher environment for jobs and business. That scarcity of resources has in turn contributed to the closure of more than 160 rural hospitals since 2005, with about 2,200 surviving on tight operating margins, according to the Sheps Center for Health Services Research at UNC Chapel Hill. The National Center for Rural Health Works found that between 2012 and 2018, nearly 400 rural clinics shut down, leaving about 4,200 open. These trends seem set to continue into 2020, according to the Center.For example, the planned closing of Our Lady of Bellefonte Hospital in Ashland, Kentucky, is expected to eliminate 214 hospital beds from the community, along with at least $650,000 in payroll-tax income for the nearby town of Russell. The Bon Secours Health System is struggling to reallocate the 1,000 employees currently working at the hospital. And, according to Clemson University, although more than 25% of South Carolina’s population is rural, as recently as 2016 only 14% of the state’s nurses served rural areas.PHILANTHROPIC POTENTIALThese conditions inspired Allen Smart, a longtime grantmaker and project leader for philanthropic and healthcare initiatives, to found PhilanthropywoRx. His current organization aims to improve connections between philanthropic foundations and rural communities. It does this by advising foundation and nonprofit executives on how to work with local institutions such as universities, hospital systems, and government agencies.“Philanthropy can serve the health needs of rural communities in various ways,” says Smart. “It can help hospitals and clinics explore options such as mergers, sales, and collaborations with other healthcare facilities, years before a closure becomes imminent. Philanthropies can analyze data and conduct studies on behalf of facilities, that lead to timely funding reimbursements from state and federal government. And they can support innovations at facilities that result in healthier communities.”Private organizations are stepping in with ideas, funding, and manpower to enact positive healthcare change for rural areas. Hyperlocal projects may have a beneficiary that is a single hospital or clinic. Regional projects may focus on several facilities in a single state. Then there are national-level nonprofits and philanthropies that are directing their resources to many communities across the country.On the hyperlocal level, midsize firms across America are chipping in to support medical facilities in their communities. Last year, for example, McKenzie County Hospital in Watford City, North Dakota, received $250,000 in donations from Denver-based Whiting Petroleum Corporation, which operates in Colorado, Montana, and North Dakota. On the regional level, there are entities such as the Kate B. Reynolds Charitable Trust (started by a member of the family that founded the R.J. Reynolds Tobacco Company), which funds healthcare systems in low-income areas of rural North Carolina.Americares, a global disaster-relief nonprofit, has a program called Safety Net Center, an online resource that provides free medicines and supplies to healthcare organizations serving low-income areas in the U.S., with a strong focus on rural clinics. In addition to individual donations, Americares relies on corporate partnerships with major firms including Northrop Grumman, Chevron, Southwest, Voya Financial, Anthem, and Medtronic.The Robert Wood Johnson Foundation, known as the largest philanthropy in the U.S. dedicated purely to health, was started by Robert Wood Johnson II, son of the co-founder of the Johnson & Johnson corporation. The Foundation funds grants and conducts research for a wide range of health initiatives as well as supports several other entities that focus on rural healthcare needs, such as Project ECHO, Well Connected Communities, and Partners for Rural Transformation.LIFE SCIENCES & BIOTECHTechnology may offer the greatest source of untapped potential healthcare benefit for rural areas. While breakthroughs in the fields of life sciences and biotech still have a ways to go before they yield large-scale gains outside of the urban areas where they are being developed., recent developments suggest that the crucial shift could occur within the next few years, according to the PwC Health Research Institute.Project ECHO, at the University of New Mexico School of Medicine, uses interactive videos and telemonitoring to help primary care practitioners deliver specialized care. Well Connected Communities brings together young people and healthcare volunteers to improve local education about topics such as mental illness, substance abuse, nutrition, and fitness. Partners for Rural Transformation seeks to increase access to healthcare and economic development in areas with persistent poverty.PwC HRI points to corporate ventures from 2019 that might generate much-needed advances. These include Vertex Pharmaceuticals spending $950 million to purchase a biotech firm pursuing Type 1 diabetes stem cell therapy, and biopharma firm Genentech working with newly launched Clover Therapeutics to better treat eye diseases.Data gathering and analysis will play a big role, according to PwC HRI, as the health industry becomes better at processing a host of information about patients: genetics and family diseases, eating and exercise habits, fertility and mortality, even buying patterns and financial track records. All of this can create a holistic picture that leads to faster diagnoses for individual patients, more accurate preventative guidance, more effective treatments, and ultimately improved medical outcomes.Computer-enabled virtual doctor visits are already connecting skilled physicians with patients in low-income areas far away, and patients are already using smartphone apps to measure vitals such as  heart rate. Thanks to virtual technology, doctors have begun to perform remote surgery on patients miles away. In the near future, data analysis, mobile apps, virtual visits, and remote surgery may allow medical specialists in cities to routinely provide significant care for patients in rural areas.Reports from organizations such as the Philanthropy Roundtable and the Fred Hutchinson Cancer Research Center, as well as publications including Rejuvenation Research and Inside Philanthropy, advocate for charitable donations in cutting-edge experimentation that produces life science and biomedical solutions. If history is any indication, corporate philanthropy will contribute to this progress.“Innovation can be slow in healthcare, due to the regulatory environment and the nature of testing,” says PhilanthropywoRx’s Smart. “For philanthropists interested in health innovation, there is no better place to pilot projects than in a rural community, because the project can adapt in real time as residents rally behind the initiative.”