FORT LUPTON, Colo. -- Colorado's community health centers have had to shift gears during the coronavirus pandemic to ensure migrant workers, who harvest the food for dinner tables across the nation, have access to health care.

In addition to increased on-site checkups and distributing Personal Protective Equipment, Deborah Salazar, migrant health director with Salud Family Health Centers, said telehealth services have been critical for workers out in the fields from sunrise to sunset on the state's eastern plains.

"And so for them to actually have to take off time to go somewhere to wait for the doctor, to get into the visit, and then go back somewhere - and especially if transportation is an issue - this is perfect for them," Salazar said.

Many migrant workers were slow to seek care, even when they had COVID-related symptoms, because they couldn't afford not to work. When workers became eligible for paid sick leave after the state issued a guidance that would compensate employers with tax credits, health center staff played a big role helping employers implement the policy.

Dante Gonzales, director of program operations at Valley-Wide Health Systems, said relationships built over the years with community leaders trusted by workers in the San Luis Valley was key for connecting workers with care during the health crisis. He said from March through August, health center staff were able to bump up their outreach efforts by nearly 50% over the same time period in the previous year.

"While people were running away, locking themselves up, this team has just stepped up, went out there, partnered with the community, and made sure that we were doing our best to still give access and touch base with all these individuals that need to be assessed," Gonzales said.

Salazar said the integrated health care model pioneered by Federally Qualified Health Centers, which puts medical, mental and dental care under the same roof, continues to put providers in a good position to meet shifting needs.

"Access to behavioral health right now is as important as the medical side of things, because people are scared," Salazar said. "Having access to that behavioral health piece, for the general population as well as the agricultural workers, is really important."

Additional information and guidance from the state for agricultural workers navigating the pandemic is available at COVID19.colorado.gov.


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When newly elected candidates take office next month, they will hear from a range of constituents and special interest groups about a wide range of issues.

In states such as Nebraska, the health effects from factory farms could be among them. Nebraska is among the states with the most concentrated animal feeding operations.

Jonathan Leo, an environmental and land use attorney, worries the election results will not do anything to shake up the status quo in regulating such sites. Even with growing research about harmful nitrates from animal waste polluting drinking water, Leo said there is too much of a "baked-in" resistance at the local, state and federal level to push for meaningful change.

"There is a long-standing political culture that is antiregulatory," Leo pointed out.

Under the Biden administration, the U.S. Department of Agriculture has made moves aimed at helping smaller, less-polluting farms thrive. But Leo pointed out it also pushed for carbon-sequestration projects, which benefit factory farms. He also wonders what might happen under President-elect Donald Trump's pick for agriculture secretary. Observers said she does not have much history related to ag policy but is backed by groups aligned with industrial farming.

Eleanor Rogan, professor and associate dean of the College of Public Health at the University of Nebraska, has helped lead research on health issues linked to agriculture runoff, including higher cancer rates among children. She said it is not just cases of extreme drinking water pollution to worry about.

"Chronic illnesses are beginning to be associated with lower levels of nitrates," Rogan emphasized.

Rogan argued protecting public health is vital but acknowledged unintended consequences, such as tighter regulations forcing smaller communities to spend money they might not have on water system improvements.

Leo acknowledged there are promising signs in conservative states such as Nebraska, where some GOP legislators have introduced bills to address the effects of pollution from concentrated animal feeding operations. But he stressed there needs to be more urgency and those concerned need to keep educating policymakers about what is at stake.

"To indicate that it's a genuine, nonpartisan concern that has solutions, if only people can embrace them," Leo added.


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Pennsylvania health care advocates are in Washington, D.C. today and Wednesday to urge Congress to extend federal funding for Community Health Centers before a deadline at the end of the year.

Community Health Centers serve as primary care providers for more than 32 million Americans.

Joe Dunn, chief policy officer for the National Association of Community Health Centers, said more than 300 advocates are rallying for a solution and to ensure patients can continue to get health access and be seen by their clinicians.

"Health centers serve one in 10 Americans across the country," Dunn pointed out. "About 40% of the health centers are in rural areas, and then about 90% are under 200% of the federal poverty level, and oftentimes in rural areas, they are the only primary care options in the community."

Health centers receive federal funding from two sources, annual discretionary funding and multiyear base funding. In March, Congress extended the base funding through this month at a rate of more than $4 billion per year. This bipartisan legislation would need to continue to increase funding for health centers.

Kristie Lenze, CEO of the Keystone Rural Health Consortia, said they serve everyone, regardless of their ability to pay. She added her center is a one-stop shop offering a wide range of affordable, comprehensive primary care services, from lab work to radiology and more.

"We have dental services, behavioral health services, substance-use disorder treatment," Lenze outlined. "We also have a chiropractor on staff and a pediatrician. So, Community Health Centers do way more than just provide your typical primary care. We, as a safety net, are often operating as specialists in some of these rural areas."

The National Association of Community Health Centers is seeking an increase in funding, aiming for up to $5.8 billion, the highest level passed in a bipartisan manner by a congressional committee in the past year and a half. They stressed extension is crucial and additional resources will significantly affect communities nationwide.

By Liz Carey for The Daily Yonder.
Broadcast version by Mark Richardson for Michigan News Connection for the Daily Yonder-Public News Service Collaboration

In September, the Centers for Disease Control and Prevention (CDC) unveiled its Rural Public Health Strategic Plan, which outlines the priorities, objectives and outcomes the agency hopes to see over the next five years as it collaborates with other federal agencies and various stakeholders on how to improve the health of rural residents.

The plan was developed with the help of more than 50 experts within the CDC who reviewed more than 200 rural initiatives, programs and efforts to identify opportunities. Then the agency enlisted the feedback from more than 230 federal and external partners through listening sessions, lunch meetings and town hall events, Dr. Diane Hall, the director of the CDC’s Office of Rural Health (ORH), said in an interview with the Daily Yonder.

The strategic plan is a guide for ORH and the CDC at large, as it moves forward with programs and research into rural health needs. Developed with stakeholders such as the National Rural Health Association (NRHA) and state offices of rural health, the plan seeks to combat issues that are seen at higher levels in rural communities, like obesity, chronic illnesses and substance abuse.

Opened last year, the ORH came as a result of the Covid-19 pandemic. Disparities between urban and rural access to care shined a spotlight on the need for more attention on rural public health, she said. The strategic plan is the office’s first major publication.

“We really wanted the strategic plan to actually be strategic, but also be actionable,” Dr. Diane Hall, the director of the CDC’s Office of Rural Health, said in an interview with the Daily Yonder. “But more than that, we wanted it to be relevant to the lives of people that live in rural communities.”

Stakeholders, like Alan Morgan, CEO of the NRHA, said the plan is an indication of what is coming in rural health. 

“Realistically, this is a blueprint for the future,” Morgan said in an interview with the Daily Yonder. “They have highlighted long-standing issues and now they have a direction and a plan to get to where they need to be.”

The plan focuses on four main priorities – engaging with community health partners, strengthening rural public health infrastructure, advancing rural public health science and improving rural public health preparedness and response.

“CDC is committed to advancing rural public health across America by identifying and addressing gaps in the evidence base, data analytic capabilities, and the workforce in rural communities,” the plan said.

Hall said her office will work alongside stakeholders and other subject matter experts to develop a more specific action plan and to determine how best to serve rural areas.

“A lot of times, rural communities haven’t really been served well by government policies or decisions,” she said. “All of that needs to be addressed when we’re talking about health decisions.”

The plan isn’t regionally or state-specific, but it is a step toward an action plan, Hall said.

“Rural health is an issue that garners bipartisan support in Congress,” Hall said. “And Congress has been very clear that they wanted the CDC to create this office. These are the first steps in a very long process to address the rural urban disparities in healthcare.”

Hall said that before the end of the year, the National Center for Health Statistics (NCHS), part of the CDC, will release an updated method for urban-rural classification.

That will make researching rural health issues easier, Katy Backes Kozhimannil, the co-director of the University of Minnesota Rural Health Research Center, said in an interview with the Daily Yonder. One of the issues facing researchers is determining the rurality of subjects.

Although the strategic plan doesn’t provide direct actionable items, it is a step in the right direction, Kozhimannil said.

“This is a long process,” she said. “Working with local hospitals and rural public health agencies, as well as research centers like ours, is the beginning of the process. I think we’re all looking forward to the next steps and seeing what action items come out of this strategic plan.”


Liz Carey wrote this article for The Daily Yonder.


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