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MY VISION FOR RURAL HEALTH IN THE 1990S
BY

C. EVERETT KOOP, M.D., Sc.D.
PRESENTED TO
THE NATIONAL RURAL HEALTH ASSOCIATION

13TH NATIONAL ANNUAL CONFERENCE

MAY 17, 1990

NEW ORLEANS, LOUISIANA
| AM PLEASED TO HAVE THE OPPORTUNITY TO BE A PART OF THE

NATIONAL RURAL HEALTH ASSOCIATION’S ANNUAL CONFERENCE.

| AM SORRY |! WAS NOT ABLE TO ACCEPT YOUR INVITATION TO
SPEAK TO THE CONFERENCE IN WASHINGTON TWO YEARS AGO.

ACTUALLY I WOULD PREFER TO BE IN NEW ORLEANS.
WHEN | ACCEPTED YOUR INVITATION LAST FALL I FELT AN
INTELLECTUAL BOND TO YOUR CAUSE, BUT DID NOT KNOW A LOT

ABOUT IT.

SINCE THAT TIME | HAVE WALKED THE LONELY ROADS OF
APPALACHIA, | HAVE VISITED SICK CHILDREN, VISITED WITH RURAL
ADULTS, AND TALKED TO WORRIED AND OVERWHELMED HEALTH

CARE PROVIDERS.
| HAVE SEEN THE FACE OF RURAL POVERTY, | HAVE SEEN THE
S
GROWING LOSE OF THE CAPACITY AND LOSS OF PUBLIC

CONFIDENCE IN LOCAL HEALTH CARE ¥%@ DELIVERY.

MY INTELLECTUAL BOND WITH YOU AND YOUR RURAL

CONSTITUENCY IS NOW AN EMOTIONAL BOND, AS WELL.
| NOW FEEL AN EMOTIONAL BOND WITH YOU AND YOUR RURAL
CONSTITUENCY. WHILE | AM APPALLED AT THE LEVEL OF NEED FOR
ALL HUMAN SERVICES IN OUR RURAL AREAS, MY HEART IS WARMED

AT THE STRENGTH, COURAGE, AND HOPE OF OUR RURAL CITIZENS.

| HAVE KNOWN WHAT NRHA DOES FOR SOME TIME. NOW I KNOW

WHY IN A VERY PERSONAL WAY.
IN THE LAST YEAR NRHA HAS BLOOMED INTO MATURITY.

YOU HAVE BECOME A FORCE TO BE RECKONED WITH AS AN
INTEREST GROUP PROMOTING THE HEALTH AND WELL BEING OF

RURAL PEOPLE.
YOU HAVE COME A LONG WAY FROM THE LITTLE BAND OF

FEDERALLY ASSISTED RURAL PROJECTS OF THE MID-1970’S.

YOU HAVE ALL THE ELEMENTS OF A MATURE ORGANIZATION. YoU
Have FOUNDING FATHERS: DAVID FENTON, MIKE SAMUELS, JOHN CLARK,

JOHN LACASE.
YOU EVEN HAVE YOUR MARTYRS: LOU GORIN, FOR WHOM YOUR
HIGHEST AWARD IS NAMED, TERRY REILLY, FOR WHOM THE

MEMORIAL LECTURE IS NAMED.

A VERY RICH HISTORY INDEED WITH A CLEAR TREND OF

DIVERSIFICATION TO INCLUDE ALL CONCERNED GROUPS.
YOU MERGED WITH THE AMERICAN RURAL HEALTH ASSOCIATION TO
ADD AN ACADEMIC AND RESEARCH COMPONENT AND THE JOURNAL

OF RURAL HEALTH, TO SHARE KNOWLEDGE.

| COULD CONTINUE,
BUT THE POINT IS THAT YOU HAVE ACHIEVED A DIVERSITY THAT

MIRRORS THE RURAL AMERICA FOR WHICH YOU ARE ADVOCATES.

THE COALITION YOU HAVE BUILT CUTS ACROSS MORE NARROWLY

FOCUSED INSTITUTIONAL AND PROFESSIONAL INTERESTS.
MUCH OF THE CREDIT FOR YOUR SUCCESS MUST GO TO YOUR

EXECUTIVE DIRECTOR BOB VAN HOOK.

WHEN HE ASSUMED HIS POSITION AS EXECUTIVE DIRECTOR THIS
ORGANIZATION WAS ON THE CRITICAL LIST. HE BROUGHT YOU OUT
OF THE ICU, YOU HAVE RECOVERED AND ARE POST

REHABILITATION.

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ON YOUR BEHALF HE HAS BUILT NRHA INTO A STABLE
BROAD-BASED ORGANIZATION OF NEARLY 2000 INDIVIDUAL AND
INSTITUTIONAL MEMBERS AND A WELL DIVERSIFIED BUDGET OF

OVER $1.5 MILLION .

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THIS STRONG COALITION OF PRIMARY CARE CENTERS, HOSPITALS,
CLINICIANS, ACADEMICS, RESEARCHERS, AND COMMUNITY PEOPLE

HAS SUCCESSFULLY ENGAGED THE POLITICAL PROCESS.

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YOUR FRIENDS INCLUDE, AMONG OTHERS, SENATORS HARKEN,
AiD> = Abwitc As
BYRD, HOLLINGS, DURENBEGER, DOLE, PRESIDENT CARTER, AND

VICE PRESIDENT MONDALE.

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YOUR ALLIES INCLUDE THE ACADEMY OF FAMILY PHYSICIANS, THE
AMERICAN ACADEMY OF NURSE PRACTITIONERS, AND THE

AMERICAN HOSPITAL ASSOCIATION, AND NOW ME.

14
YOUR CONFERENCE THEME ”EMPOWERED TO MAKE A DIFFERENCE
” REFLECTS THE CAPACITY YOU AS THE NATIONAL RURAL HEALTH

ASSOCIATION HAVE BUILT OVER THE LAST THIRTEEN YEARS.

YOU ARE EMPOWERED IWDEED §

15
LAST YEARS SENATE APPROPRIATION LABOR, HEALTH AND HUMAN
SERVICES SUB-COMMITTEE REPORT WAS CALLED ” THE RURAL

CHRISTMAS TREE ”.

AND YOU HAVE CONSISTENTLY SCORED WELL FOR RURAL HEALTH

INTERESTS IN THE PAST THREE BUDGET RECONCILIATION BILLS.

16
YOU HAVE INFLUENCED THE ESTABLISHMENT OF A FEDERAL OFFICE
OF RURAL HEALTH POLICY AND ARE FORTUNATE TO NOW HAVE
JEFF HUMAN AS A STRONG VOICE FOR RURAL HEALTH INSIDE THE

BUREAUCRACY.

WITH EMPOWERMENT COMES THE STEWARDSHIP AND ALL THE

RESPONSIBILITIES THAT GO WITH IT.

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HOW CAN YOU BEST SERVE RURAL AMERICA ?
SO OFTEN MATURE MOVEMENTS PERPETUATE SELF SERVING
POLICIES AND FORGET THAT IT IS NOT THEMSELVES BUT A

CONSTITUENCY THAT MUST BE SERVED.

CLEARLY YOU HAVE DONE A GREAT DEAL TO FOCUS ATTENTION ON

THE HEALTH NEEDS OF THE RURAL POPULATION.

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YOUR CONTINUING LEADERSHIP TASK IS TO FORMULATE AND
REFORMULATE A COLLECTIVE VISION FOR THE HEALTH OF RURAL

AMERICA.

MY ASSIGNMENT FOR TODAY IS TO THINK ALOUD WHAT THAT

VISION LOOKS LIKE FOR THE 1990'S.

prpofies)
IN THINKING ABOUT THIS G®&=6R | WONDERED, WHAT CAN |

CONTRIBUTE ?

19
BouxLyvV
| WAS BORN AND GREW UP IN NEW-CYSRE-CEFY AND LIVED MOST OF

MY ADULT LIFE IN URBAN PHILADELPHIA.
AS YOU KNOW, HOWEVER, RURAL IS A STATE OF MIND AND BESIDES

MY HEART WAS ALWAYS IN RURAL #&@@5He NEW HAMPSHIRE.

AMERICAS’ SOUL HAS DEEP RURAL ROOTS.

20
LIKE JEFFERSONS’ DREAM OF A NATION OF SMALL FARMERS, AND
THE LURE OF THE 1/4 SECTION OF LAND (160 ACRES) THAT

BROUGHT OUR LANDLESS PEASANT ANCESTORS FROM EUROPE

OR THE DREAM OF ”40 ACRES AND A MULE ” THAT ENTICED SLAVES

RECENTLY FREED TO HOMESTEAD AFTER THE CIVIL wary

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RURAL AMERICA PROVIDES THE BREAD FOR OUR TABLES, THE FUEL
FOR OUR CARS, AND THE WOOD FOR OUR HOMES, AND
INCREASINGLY, THE SMALL MANUFACTURED PARTS THAT MAKE

MOST THINGS GO.

PERHAPS THE MOST IMPORTANT CONTRIBUTION OF RURAL
Fel
AMERICA, HOWEVER, IS ITS VALUES OF RESPECT @F OUR PRECIOUS

FARMLAND, AND AN UNQUESTIONED BELIEF IN THE FUTURE.

22
THE AMERICAN DREAM AND THESE HEADY, SOMEWHAT ROMANTIC
THOUGHTS DON’T SQUARE WITH MUCH OF WHAT | SEE AS THE

REALITY OF MODERN RURAL AMERICA.

BUT THERE IS NO DOUBT THAT THESE THOUGHTS DO BIND

TOGETHER THOSE WHO COULD HELP CHANGE IT FOR THE BETTER.

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| WILL FIRST PREACH TO THE CHOIR AND OUTLINE WHAT | BELIEVE

ARE SOME MAJOR RURAL ISSUES, SOME IMMEDIATE ACTION STEPS

THAT COULD BE TAKEN.

AND THEN CONCLUDE WITH SOME BROADER VISIONS OF DESIRABLE

CHANGE.

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A MAJOR ISSUE AND THE DRIVING FORCE BEHIND THE CURRENT
SUPPORT FOR RURAL HEALTH IS THE THREAT TO THE CONTINUED

EXISTENCE OF SMALL RURAL HOSPITALS.

THE CLOSURE OF A RURAL HOSPITAL MARKS MORE THAN A LOSS

OF HEALTH CARE CAPACITY FOR THE COMMUNITY.

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