Publications
Recent PublicationsThe Health of US Primary Care: The Cost of NeglectThis report outlines how chronic underinvestment in primary care contributes to declining performance and widening gaps in care delivery. It describes how financial pressures undermine efforts to provide continuous, whole person care and intensify workforce strain across the system. The publication underscores the need for more sustainable financial and policy support to strengthen primary care and improve community health outcomes.
Iowa Hospitals Provided $1.4 Billion in Community Benefits in 2025The report underscores the vital role Iowa hospitals play beyond delivering healthcare, highlighting their far-reaching impact on local communities and the state’s economy. From charity care and community health programs to workforce development and economic investment, Iowa hospitals remain essential partners in improving the health and well-being of Iowans.
Advancing Strategies to Bridge the Gap in Rural Public Health and Rural Health CareThe ASTHO blog highlights persistent barriers in rural areas, such as workforce shortages, limited access to care, constrained public health capacity, and insufficient investments that hinder health and quality of life. To address these challenges, ASTHO convened the Rural Health Academy, which facilitated peer learning among state health officials and strengthened connections between public health, healthcare, and community partners. The blog emphasizes the growing role of Rural Development Hubs, which are community-rooted, multi-sector organizations that coordinate resources, build local capacity, and address systemic issues across regions to bridge the gap between public health and healthcare delivery. By integrating clinical care with social services, economic development, and education, these collaborative models aim to improve health outcomes and resilience in rural communities.
How Medicaid can strengthen children’s health through CHWsA recent study examines the impact of CHW home visits for Medicaid-enrolled children with asthma, concluding that kids in the program had more symptom-free days and less need for urgent health services. Additionally, the National Pediatric Readiness Project’s nationwide assessment is now open, providing each participating ED with an individualized score, benchmarking with national data, and a customized gap report.
New Study Highlights Rural Cancer Disparities and Opportunities Across IowaA newly published study by researchers affiliated with the University of Iowa Holden Comprehensive Cancer Center examined rural cancer disparities across Iowa using a mixed-methods approach that combined cancer registry and public health data with interviews with rural cancer leaders. The study found that rural Iowans experience higher incidence rates for colorectal cancer, bladder cancer, and leukemia, along with lower participation in cancer screening and HPV vaccination. Researchers also identified ongoing challenges related to transportation, access to care, education, and workforce shortages in rural communities.
Student Loan Debt Burden in the Public Health WorkforceGovernmental public health has been saddled with underinvestment and stagnant wages, making recruitment into the sector challenging. Although governmental public health pays reasonably well overall, it is also generally viewed as uncompetitive with the healthcare and tech sectors, which often capture recent graduates and recent hires. The growing concern of student loan debt, coupled with compensation challenges, presents a significant barrier to service in governmental public health.
This article characterizes the national landscape of student loan debt for state and local public health workers and considers the potential roles of loan forgiveness and repayment in workforce development. Closing the Distance in Rural Primary CareThe 2025 Evidence Report, Closing the Distance in Rural Primary Care, highlights the growing challenges facing rural health care, including workforce shortages, declining primary care spending, and hospital closures. The authors urge policymakers to measure and boost primary care investment, maintain reimbursement rates, and ensure the $50 billion Rural Health Transformation Program centers whole-person care and rural-appropriate value-based models.
Rural Health Care Workforce Retention Measures: A Rapid Scoping ReviewA recent Journal of Rural Health study examines the growing challenges facing rural labor and delivery services and the risks communities face when local maternity units close. The authors highlight how declining birth volumes, staffing shortages, and financial pressures are driving service reductions, while also outlining strategies that help hospitals sustain safe perinatal care. The research shows that strong community partnerships, flexible staffing models, and targeted support can make a measurable difference in keeping maternity care local. The findings offer timely insights for policymakers and healthcare leaders working to improve maternal health access in rural areas.
Sustaining Rural Labor & Delivery ProgramsA new report from the Flex Monitoring Team examines why rural labor and delivery units continue to close nationwide and identifies strategies that can help sustain essential maternity care in rural communities. The analysis highlights financial pressures, workforce shortages, and declining birth volumes as major contributors, while also outlining innovative models that Critical Access Hospitals are using to maintain safe, local access to perinatal services. The report emphasizes the importance of community partnerships, targeted funding, and flexible staffing approaches to support rural families. These findings offer practical guidance for states and health systems working to strengthen maternal care in underserved areas.
Notice of Criteria for Determining Maternity Care Health Professional Target AreasHealth Resources and Services Administration (HRSA) finalized updates to the criteria for determining Maternity Care Target Areas (MCTAs), geographic areas within Health Professional Shortage Areas (HPSAs) that have a shortage of maternity care health professionals. HRSA finalized its proposal to remove the Social Vulnerability Index (SVI) from MCTA scoring criteria and reallocate the SVI points to the nearest source of accessible care and population-to-full-time-equivalent maternity care health professional ratio criteria. Updates to Maternity Care Health Professional Target Areas will be implemented beginning August 15, 2026.
Rural Populations are Aging – What it Means for IowaNew data from the USDA Economic Research Service shows a major demographic shift in rural America. While the overall rural population has grown by more than two million, the number of working-age residents (15–64) has declined by over two million. This trend reflects longer life expectancy, lower birth rates, and younger individuals moving away—while more older adults choose to retire in rural communities.
Obstetric Care Access Declined in Rural and Urban Hospitals Across US States, 2010-22.
With support from the Federal Office of Rural Health Policy, a team of researchers from the University of Minnesota, Harvard University, and the University of Pennsylvania found widespread loss of obstetric services across states, especially among rural hospitals, during the 12-year period studied. By 2022, eight states had more than two-thirds of rural hospitals without obstetric services.
Access and Quality of Mental Health Services in Rural and Urban America
Among the key findings in this brief from the University of South Carolina Rural Health Research Center:
Current Approaches to Rural Health Workforce Challenges Need Improvement
Rural health and access to care have been a concern to health care providers and policymakers for many years. The daunting combination of a scarcity of health care resources; enduring poverty; and challenges related to education, technology, transportation, and infrastructure have resulted in widespread and growing health disparities for people living in rural areas, relative to their urban neighbors. While the data show New York’s efforts to be highly successful in recruiting providers into rural areas, the lesson learned is that additional measures are needed.
New Report Describes Rural Health Challenges and Action Steps
The Dartmouth Institute for Health Policy and Clinical Practice at the Geisel School of Medicine, together with partners at Dartmouth Health, have issued a new report that details the key insights and primary recommendations that emerged from the inaugural Rural Health Symposium.
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Topic Areas
Community Health
Dental/Oral Health
Direct Care
General Rural Health
Maternal Health
Mental & Behavioral Health
Primary Care
Public Health
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The Iowa Healthcare Workforce
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A Review of Recruitment and Retention Strategies in US Local Health Departments: Insights and Practical Solutions
This study highlights the staffing barriers facing LHDs and offers practical solutions they can implement to support successful recruitment and retention. More work is needed to identify specific ways to improve workplace culture, quantify the disparity between pay offered by health departments and their competitors, and better understand barriers and opportunities related to supporting a diverse workforce.
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Who Is Leaving the Emergency Medical Services Workforce?Emergency medical services (EMS) are a critical part of the US healthcare, public health, and public safety systems, providing both emergency and non-emergency care across diverse pre-hospital settings. EMS clinicians hold tiered credentials based on education, certification, and licensure, yet workforce shortages persist due to the absence of a comprehensive national database.
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Obstetric Care Access Declined in Rural and Urban Hospitals Across US States, 2010–22.
A new Health Affairs study reveals a nationwide decline in hospital-based obstetric services between 2010 and 2022, affecting both rural and urban hospitals. The study emphasizes that these closures are linked to policy and resource decisions and warns that reduced access to obstetric care may worsen maternal and infant health outcomes, especially in highly rural and underserved communities.
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New Study Finds Key Factors to Expanding Dental Care in the Safety Net
Our recent study examined critical factors influencing the delivery of oral health services at federally qualified health centers (FQHCs), and findings were recently published in the June issue of the Journal of Public Health Dentistry. Researchers analyzed FQHC utilization data from 2012 to 2021 to evaluate trends in oral health services at over 1,000 FQHCs nationwide.
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Training a rural oral health workforce: Effects of rural background on dentist practice choice
This study compares access to, and services offered by, Certified Community Behavioral Health Clinics (CCBHCs) in rural and urban communities. The increasing numbers of CCBHCs in rural communities combined with their range of offered services holds promise towards increasing the availability of care for rural communities within an integrated model.
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