Rural Health in North Carolina

Blog | November 6, 2018


By Kaitlin Ugolik Phillips


Though North Carolina’s cities are growing, much of the state is still very rural. As the Office of Rural Health celebrates its 45th anniversary, the North Carolina Medical Journal asked authors from across the state to address the health opportunities and challenges facing rural residents.


Thomas G. Irons, associate vice chancellor for health sciences and professor of pediatrics at ECU, and Margaret L. Sauer, director of the Office of Rural Health of the NC Department of Health and Human Services, served as guest editors for this journal and contributed an issue brief about the history and future of rural health in North Carolina.


“Together we must engage in conversation and constructive dialogue across our self-imposed silos in support of, and along with, our rural neighbors and friends,” they write. “It must be deliberate, meaningful, and intentional.”


Rural Workforce Recruitment & Retention


When stakeholders discuss rural health care, the issue of rural workforce recruitment often comes up – how do we get the best and brightest health professional students to live and practice in our rural communities? Several articles in this issue of the NCMJ highlight the further complexities of this issue, arguing that distribution and retention deserve more focus.


“We don’t have a national physician shortage; we have a national physician distribution problem,” writes Mark Holmes, director of the North Carolina Rural Health Research Program at the Cecil G. Sheps Center for Health Services Research, University of North Carolina at Chapel Hill. Herbert G. Garrison, associate dean for graduate medical education at ECU, and coauthors from MAHEC and AHEC point to research showing that where retention – along with recruitment – is addressed, efforts to support the rural health workforce are more effective. Dana M. Weston, president and CEO of UNC Rockingham Health Care, writes about the bankruptcy process and rebirth of her small hospital in rural Eden, North Carolina, and Rep. David Lewis and former state Senator David Curtis provide a legislative view of the challenges facing rural health in our state.


Healthy Rural Communities


Opening with a poignant story about her own son, Robin Tutor Marcom of the North Carolina Agromedicine Institute, ECU, and coauthors write about behavioral health issues faced by farmers. In a piece about the importance of collaboration to early childhood success in rural communities, Sarah Langer Hall of the Institute for Emerging Issues at NC State and Kimberly L. McCombs-Thornton of the North Carolina Partnership for Children write: “Data and collaboration are essential pieces of the rural early childhood success equation.” Kim A. Schwartz and Catherine M. Parker, respectively the CEO of Roanoke Chowan Community Health Center and director of the Hertford County Student Wellness Center, bring it all back to love in a piece addressing healthy eating and active living in rural areas.


Patrick Woodie, president of the North Carolina Rural Center, writes about the impact of economic development on the health of rural communities, and Amy Huffman of the Broadband Infrastructure Office at the North Carolina Department of Information Technology writes about the importance of broadband infrastructure for access to care in rural areas.


And in our Running the Numbers column, Randy Randolph of the Sheps Center provides some context for the rural-urban uninsured gap in North Carolina.


Taking Action


NCIOM CEO Adam J. Zolotor and associate director Berkeley Yorkery provide an update to our Rural Health Action Plan with concrete recommendations for improving rural health in North Carolina.


Jeff Spade, the most recent vice president of the North Carolina Healthcare Association, is our latest Tar Heel Footprints and Health Care subject for his contributions to the financial health of rural hospitals across the state.


Finally, Adam Linker, program officer at the Kate B. Reynolds Charitable Trust, explains in our latest Philanthropy Profile how his organization works to empower rural communities throughout North Carolina. He writes: “We can alleviate and even eliminate the growing gap between urban and rural health outcomes by listening to marginalized voices, focusing on systems change, building greater capacity in underserved areas, and tracking progress to keep ourselves accountable.”


To see the whole issue, visit