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social determinants of health

Out In the Rural: Where and How Is Health Promoted?

By Diana J. Mason

June 15, 2017

Where and how is health created and promoted? If you think it’s in hospitals, you would be terribly wrong. Medical errors are the third leading cause of death in the United States; and yet, we have a health care system that spends billions of dollars every year to provide acute care. It’s costly and our health outcomes are worse than in other peer nations.

Today, there is a growing recognition that we have to move our attention and resources upstream to promote health of people where they live, work, learn and play. The Robert Wood Johnson Foundation has invested significant resources into exploring how to improve the health of communities and create a culture of health among all. The New York State Health Foundation is advancing this work in New York State and other foundations around the nation are investing in projects that build healthier communities through initiatives that will improve access to healthy, affordable foods; create safe places to exercise; bring jobs into the community; improve education; reduce pollution; and other aspects of what are called social determinants of health.

But why has it taken us so long to recognize and act on the connection between the health of a community and the health of people? In the 1960s, physician Jack Geiger had orchestrated a federal grant from the Office of Economic Opportunity as part of a major community development initiative begun by President Lyndon Johnson that represented the nation’s new “War on Poverty.” The grant went to Tufts University to build the Tufts-Delta Health Center in rural Mississippi. The Center was the nation’s first community health center that was the forerunner of the Federally Qualified Health Centers located across the nation to ensure that vulnerable populations have access to primary care. Geiger and his colleagues encountered significant resistance from both the white and black communities in Mississippi but prevailed, with the help of John Hatch, a community organizer.

What they soon discovered was that the Center would treat infected babies or malnourished and sick adults, only to have them return with the same health problems time after time. The local people in this poor community were grateful that they had access to this wonderful health center but noted that they wouldn’t need it so much if they could feed their families or had clean water, jobs, and adequate sanitation. Geiger and his colleagues worked with the community to launch major initiatives to address these concerns, empowering the community in the process and developing a generation of community and political activists.

This story has been detailed in a new book entitled Out in the Rural: A Mississippi Health Center and Its War on Poverty, by Thomas J. Ward, Jr., Chair of the History Department at Spring hill College in Mobile, Alabama. With a foreword by Jack Geiger, the book provides us with an exemplar of how to engage communities to promote healthier lives.

Today on HealthCetera, producers Kenya Beard, EdD, ANP, RN, and Diana J. Mason, PhD, RN, interview Tom Ward about this story. Tune in at 1:00 to WBAI, 99.5 FM in New York City or streaming online at Or you can listen to the program anytime by clicking here:

An overview of the story is also shared in this documentary that was made in 2010 (the story starts 30 seconds into the video) :

HealthCetera is sponsored by the Center for Health Policy and Media Engagement at the George Washington University School of Nursing.


Diana J. Mason
Diana is a founder of the Center for Health, Media & Policy, and HealthCetera Radio. She is the President of the American Academy of Nursing, the Rudin Professor of Nursing at Hunter-Bellevue School of Nursing, and a health policy expert and leader. Diana tweets @djmasonrn.

What Does It Take to Improve Societal Health?

By Kenya V Beard

May 4, 2017


Chances are you have or you know someone who has asthma, hypertension or diabetes. These are serious illnesses that raise morbidity and mortality rates. Medicine alone is not enough to manage these conditions. To start, individuals should eat healthy foods, avoid cigarette smoke, have access to jobs, health care, and safe communities.


But what if you live in a community where there is no grocery store, the air quality is poor, or the unemployment and poverty rates are so high, health is no longer a priority? These conditions are just a few of the realities that impact health for so many individuals. For example, the Morrisania section of the Bronx was once called a “food desert”; a place where grocery stores did not exist and access to fresh fruits and vegetables was inadequate. So exactly how could one eat healthier? In New York, there are some midtown districts where the air quality is at unacceptable levels. What affect does that have on individuals who have asthma and work in those areas? Lastly, there is a direct relationship between poverty and health. Individuals in poor households tend to have worse health outcomes for reasons beyond their control.


How do we improve the health of our society when we know that a prescription for medication does not translate to healthier food on the table, better air quality or employment? What are the lessons learned from our past that can be used to inform our future?


In the book, Out in the Rural: A Mississippi Health Center and Its War on Poverty, Dr. Thomas J. Ward takes us back to the early 1960’s to explore the triumphs and challenges faced by Dr. H. Jack Geiger and others who established the first rural community health center in the United States, the Tufts-Delta Health Center. The Center was established during a time when many African Americans were denied access to health care. When health care was accessible, they had to use the back door, wait in separate rooms or were expected to tell the doctor what their problem was because some doctors refused to touch them. In addition, since emergency care required immediate payment, some died on the hospital steps. Some communities in Mississippi faced astonishing health care challenges that led to the highest infant and maternal mortality rates in the country. But that was all about to change.


Tune in to HealthCetera to hear the conversation with Diana Mason, Kenya Beard, and the author of Out in the Rural: A Mississippi Health Center and Its War on Poverty, Dr. Thomas J. Ward. Find out how the Tufts-Delta Health Center addressed the social determinants of health, provided comprehensive health care, and improved the health of a community. Indeed, the lessons learned 50 years ago could still be used today. So tune in on Thursday, May 11th at 1:00 PM to WBAI, 99.5 FM in NYC or streaming at 

Kenya V Beard