The four teams we are working with from north central Nebraska are all rural. Very rural. In fact they would tell you that they don't have enough population to count as rural: most of their counties are "frontier," a few with densities of less than one person per square mile. The health districts themselves have only been around for ten years. The state used tobacco settlement money to establish public health infrastructure.
The teams are working on great public health prevention issues: restaurant inspections (a role not in the public health portfolio in some areas), dental sealants for kids, healthy workplace products, sustainable plans for distributing vaccinations (flu and whatever comes next).
In all four cases they are working hard to find the sustainable revenue stream to support their work over the long haul.
One more thing they all share: great partnerships. Before there were health districts, many of these rural areas had health coalitions of health-conscious partners. As a result, the health leaders in these areas all think very deeply about how to engage and empower their partners. And the partners respond.
To me, the trip it felt like a glimpse at the origins of public health agencies: energy and green shoots and wide-open spaces for the community service mission to express itself.
--Stephen Orton