Rural Public Health: “Less Messaging, More Listening”

Share

Instead of focusing on Robert F. Kennedy Jr., many public health experts based in rural communities are focusing on the social and economic landscape that gave rise to the popularity of extreme figures like RFK Jr. In particular, they are concerned about the loss of healthcare infrastructure and the risk of H5N1, or bird flu, in rural areas. 

ANNE SOSIN; anne.n.sosin@dartmouth.edu

    Sosin is a public health researcher and practitioner based at Dartmouth College. 

Sosin told the Institute for Public Accuracy: “I’m more interested in the forces that give rise to figures like RFK Jr. than I am in RFK as a nominee. He represents an enormous threat to public health, and his record needs to be scrutinized closely, but we also have to pay attention to the political economy that has fueled the rise of RFK and other extreme figures. There is a tendency to [try to find] ideas of his that we might want to latch onto. I’m hesitant about that impulse. Some leaders in the public health community say that some of RFK Jr.’s critiques are fair and reasonable, and therefore maybe we need to compromise. I think that’s the wrong takeaway. We have to find common ground with communities, not with extreme figures seeking to exploit those communities.

“As someone who lives and works in a rural place, I understand why RFK Jr. holds appeal. But the answer isn’t to collaborate with RFK––it’s to listen deeply to communities and groups that find some of his ideas attractive, and offer some kind of alternative. Public health communities focus on ‘finding the right message.’ We need less messaging, more listening.

“People in rural places are concerned about basic health infrastructure. They’re worried about losing their hospitals, primary care providers and pharmacies. I have seen the loss of healthcare infrastructure in the last few years and the impact it has on the communities. In the Northeast Kingdom region in Vermont, we had flooding in 2023 and 2024; one community lost a pharmacy, another had a pharmacy shut down. That loss was felt deeply. Once the infrastructure is lost, it’s not easy for it to come back. These pharmacies serve a large geographic area in a region that tends to be much older than the rest of the state.” Sosin noted that although the growth of telehealth and online pharmacies represents creative solutions for these issues, “at the end of the day, you need basic healthcare infrastructure.”

Sosin also emphasized that right now, “H5N1 is concentrated in rural places with limited healthcare infrastructure and increased immigration. The dairy industry relies on migrant workers who exist at the legal, economic, and social margins of society. I worry what will happen if the Trump administration starts deporting workers en masse. Even the threat of legal consequences would hamper public health efforts that have been makeshift at best.

“So far, the U.S. has bungled the H5N1 response. There has been a ‘Covid-ization’ around the thinking about H5N1: a focus on preparing vaccines without looking at the testing and surveillance infrastructure that we need to put in place or the social protections for at-risk populations. Infectious diseases settle into the margins in our society. If we see the dismantling of our threadbare infrastructure [that Trump is threatening], we could see explosive conditions for an epidemic to take root. We can’t control what viruses will do or how they will mutate, but we have created the social conditions for devastating consequences” if the virus eventually does make the leap to human-to-human transmission.