Susan Grafstrom’s Award-Winning Essay

05 Feb

Our first winning essay comes from Susan Grafstrom from the University of Minnesota:

My current pursuit of a Masters of Public Health degree at the University of Minnesota and future career plans include reducing rural health disparities and improving the health of rural Americans.   I’ve given a lot of thought to this topic so from my perspective, to eradicate health disparities, two things need to change.

First, the inclusion of representatives on local, state, and national policy and work groups who live and work in rural areas or other areas of disparities needs to be a requirement of any policy setting or program development group.  Too often important decisions are made by legislative, academic or career professionals who may study rural health or other health disparities but have never personally experienced, lived or worked within these areas.  While they may be knowledgeable about their field of study, gathering information, drawing conclusions and making decisions are made in the context of their frame of reference which is mostly urban-centric.  Recently on the radio show Rural Health Leadership Radio, Roger Knak the CEO of a hospital in rural Oklahoma remarked, “You’re not going to change the health of a community at an academic center.”

Second, we will never be able to eradicate health disparities until we have a very clear understanding of the health of those experiencing disparities without the availability of strong statistical information.  Lack of data is problematic for most rural areas and I would surmise this is the same for other areas experiencing health disparities as well.

Specifically for rural America, The County Health Rankings are promoted as a snapshot of how healthy a county is and is referenced frequently as a way to measure population health.  Counties are ranked against one another in each state partly to create a competitive environment to increase health and ultimately scores, but also as a measurement for leaders to utilize in program planning and decision-making. While I do not disagree that this tool is valuable, data for rural counties is not as statistically sound as data for urban counties.  According to the article, “The County Health Rankings: rationale and methods” 1The County Health Ranking does not promise accuracy in the reliability of estimates, particularly for counties with smaller populations; we recognize that the reliability of our measures does vary.

Second, when good data sources are available they are measured too infrequently to be utilized for responsive population health.  In Minnesota, The Minnesota Student Risk Survey is given to all school districts in the state.  While it has very detailed community, county and state level data it is only done every 3 years and only on the same three grade levels.

Therefore, to eradicate health disparities include the leadership and membership of individuals part of the disparity and eliminate data deserts which will provide city, county and regional decision makers with accurate information from which to measure health or to set health programming and policy.


  1. Remington PL, Catlin BB, Gennuso KP. The County Health Rankings: rationale and methods. Population Health Metr. 2015;13:11. doi:10.1186/s12963-015-0044-2.
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Posted by on February 5, 2018 in Uncategorized


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