On Friday, October 18, Less Cancer hosted a public roundtable at the Laurel Ridge  Community College located in the rural agricultural community of Fauquier  County, Virginia. The event was moderated by founder and cancer prevention visionary Bill Couzens, with participants discussing challenges and solutions related to providing healthcare in less privileged rural communities. Continuing medical education credits were provided by UVA Health Continuing Education’s School of Medicine and School of Nursing.  

Why conduct this roundtable on rural health and cancer risk and prevention?  The importance of building community engagement and increased awareness around cancer prevention and equity in our health services cannot be overstated. Rural communities across the nation are needlessly suffering as hospitals continue to shut their doors for good. With the loss of these larger institutions and other medical professionals in their neighborhoods, people are left to survive in what the European Journal of Medical Health refers to as a ‘medical desert’. Those living in these medically underserved regions not only experience higher mortality rates from cancer than urban areas, but a disproportionate percentage of these deaths can be attributed to cancers that are easiest to prevent, yet the deadliest when undetected for too long. 

In recognition of this disparity and the need to correct it, Less Cancer assembled a panel of dedicated healthcare professionals committed to improving equitable health outcomes for rural communities.  

The Roundtable 

Grounded in her work as a family practitioner and professor of culinary medicine at the University of Utah, Tricia Petzold, MD highlighted the importance of incorporating nutrition into medical school curriculums. Thanks to Dr. Petzold, and a handful of other dedicated health workers, culinary medicine is now integrated into the curriculum of 80 medical schools around the country. Dr. Petzold also emphasized the importance of educating policymakers on the ways in which human health directly impacts social productivity and how funding for programs such as community gardens, community cooking classes, and free public transportation can drastically reduce preventable deaths in underserved rural and otherwise impoverished regions.  

John Sykes, RN, PhD, complimented Dr. Petzold’s food-as-medicine ethos with a conversation about obesity and increased risk for cancer as well as how positive food modeling can reduce the risk for cancer. This modeling can be understood through Bandura’s Bobo doll experiment in which children watched adults interact with a doll and then consistently mirrored the adult behavior they witnessed, even when the behavior was violent. Just as this experiment shows the power of learned behavior in the parent-child dyadic relationship, so too can children learn to make positive food choices from the adults in their life. Dr. Sykes also noted that while the CDC recommends beginning health education in pre-kindergarten most are not introduced to health literacy until the seventh grade. As children in lower socioeconomic and rural communities are more likely to be obese than their urban peers, early interventions and education are essential to improve quality of life and health over the course of a lifetime.  

Tammy Le Graffe RN continued the panel discussion by sharing the struggles she has experienced with medical compliance while serving as the beloved director of the free clinic in Culpepper, Virginia. In working closely with a local pharmacist  Eugene Triplett who has volunteered his services to free clinic for over twenty years, she noted that while clients were not able to take medications regularly whether due to transportation, economic, or cultural barriers, the fresh produce  Eugene brought to the clinic from his farm was always met with obvious excitement. Their clinic now hosts a food ‘farmacy’ which includes a free food garden and a partnership with several local farmers who collectively served clients over 300 pounds of vegetables in 2023.  

Another champion of the rural free clinic, Rob Marino MSW has tirelessly worked to expand healthcare access in Fauquier County, Virginia for the last twenty-five years. Having started with the clinic open on Thursday evenings only, the clinic is now open 5 days a week and offers many services in-house to reduce care access issues related to transportation and other economic adjacent factors. While the clinic has yet to see a significant increase in medical compliance in their community, the numbers still point to hundreds of lives being saved by annual physicals and other preventative measures.  

Though data and research and statistics help illustrate the need to promote health  literacy and reduce medical deserts in our rural communities, anecdotal stories also  play an important role. One such story shared by a panelist during the roundtable  described the plight of a cancer survivor in the rural Midwest who was forced to  drive 500 miles one way to receive chemotherapy.  

In this modern day and age, no one should have to drive 1000 miles for life-saving healthcare; we can and must do better.

References 

Ausenhus, C., Gold, J.M., Perry, C.K. et al. Factors impacting implementation of nutrition and physical activity policies in rural schools. BMC Public Health 23,  308 (2023). https://doi.org/10.1186/s12889-023-15176-y 

Brînzac MG, Kuhlmann E, Dussault G, Ungureanu MI, Cherecheș RM, Baba CO.  Defining medical deserts-an international consensus-building exercise. Eur J  Public Health. 2023 Oct 10;33(5):785-788. doi: 10.1093/eurpub/ckad107. PMID:  37421651; PMCID: PMC10567127. 

CDC Healthy School. Standards for Health Education. 

https://www.cdc.gov/healthyschools/sher/standards/index.htm#:~:text=Standards% 2Dbased%20health%20education%20helps,%2C%20designing%2C%20or%20rev ising%20curricula. 

Graham, P., & Arshad-Ayaz, A. (2016). Learned unsustainability: Bandura’s bobo  doll revisited. Journal of Education for Sustainable Development, 10(2), 262–273.  https://doi.org/10.1177/0973408216650954

Henley S.J., Anderson R.N., Thomas C.C., Massetti G.M., Peaker B., Richardson  L.C. Invasive Cancer Incidence, 2004–2013, and Deaths, 2006–2015, in  Nonmetropolitan and Metropolitan Counties — United States. MMWR Surveill  Summ 2017;66(No. SS-14):1–13. 

DOI: http://dx.doi.org/10.15585/mmwr.ss6614a1. 

Hess, A., Passaretti, M., & Coolbaugh, S. (2019). Fresh Food Farmacy. American  Journal of Health Promotion, 33(5), 830–832.  

https://doi.org/10.1177/0890117119845711d 

Rural Hospitals at Risk of Closing. (2024). Center for Healthcare Quality and  Payment Control.  

https://ruralhospitals.chqpr.org/downloads/Rural_Hospitals_at_Risk_of_Closing.p df 

Pati, S., Irfan, W., Jameel, A., Ahmed, S., & Shahid, R. K. (2023). Obesity and  Cancer: A Current Overview of Epidemiology, Pathogenesis, Outcomes, and  Management. Cancers, 15(2), 485-. https://doi.org/10.3390/cancers15020485