More Than Just Snow: Challenges to Rural Health Care in Northern Michigan

The Education to Practice team took off this winter to northern Michigan to better understand the unique health care challenges faced by rural Upper Peninsula communities.

The team met with the Luce, Mackinac, Alger, Schoolcraft District Health Department (LMAS) to discuss their unique health care workforce needs and explore ways of expanding access to care through a team-based approach.

There are not only wide health disparities between regions of Michigan, but also wide disparities within this rural four-county region in Michigan. The LMAS region includes Luce county, which is ranked the 66th healthiest county in Michigan (out of 83) as well as Munising, part of sixth-ranked Alger County.

This part of the state is home to the Pictured Rock National Lakeshore’s sweeping vistas, but is not home to a large number of people. Alger County’s 9,000 residents represent the third-least dense population in the state, and Luce County is second, home to only 3.0 people per square mile.

The fact is the health department, as LMAS Health Officer/Environmental Health Director Nick Derusha puts it, is “people poor.” According to Derusha, LMAS has identified several public health issues they would like to address. However, LMAS does not have enough staff to address those issues because staff are so busy handling their required daily duties.

It is a challenge to provide the essential services needed to run a health department in this area. Nevertheless, LMAS is doing some very innovative things. One example is a home visitation partnership across the entire upper peninsula (the Governor’s Prosperity Region 1) that is entering an intentional planning phase.

This lack of people, property tax revenue, and state cutbacks have required staff cut backs of almost 75% at LMAS since 2009. LMAS, an agency that once employed almost 400 people is down to about only 40 remaining staff members. This downsizing has really strained the ability of LMAS to provide basic public health services.

Derusha noted that the agency’s recent search for a nurse practitioner lasted for more than a year.

The geography isn’t the only challenge. The area is home to many seasonal tourist destinations, which bring several hundred thousand tourists and a lot of seasonal workers who often have special health care needs.

How can these rural communities continue to remain viable with such severe health care shortages? One option is a team-based approach to health care leveraging tele-health and collaboration among health care providers.

In order to ensure that all Michigan’s families have access to high quality health care professionals, we must continue to invest in new and innovative models of health care delivery.