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One Doctor’s Cause in Rural America

March 16, 2017

Dr. Tim McKnight giving a presentation about rural health trends.
Pole-vaulting enthusiast and alumnus of HRSA's National Health Service Corps, Dr. Tim McKnight has brought hope to the densely forested hills of east-central Ohio -- at a time when rural America is facing a health crisis on multiple fronts. The Corps places clinicians where they are needed most in exchange for tuition payments.

When Dr. Tim McKnight first landed in Dennison, Ohio, it didn't take him long to see that a major public health threat was bedeviling his adopted community.

In a five-county area at the northern tip of Appalachia, long plagued by health care shortages, about one of every three patients McKnight saw at the 13-bed Trinity Hospital Twin City was obese – and it was stoking dangerous cases of diabetes, pre-diabetes, strokes, cancers and heart disease.

"We have more problems in rural America," McKnight said. "We have higher rates of high blood pressure, high cholesterol…" Add a higher prevalence of smoking and opioid misuse, and a predictable result would be "devastating consequences," including widespread early deaths.

McKnight also knew there was little hope of addressing such a pervasive problem by counseling "one patient at a time" in 20-minute primary care visits, he said in a March 1 webcast with experts from HRSA's Federal Office of Rural Health Policy and the Centers for Disease Control and Prevention.

Some 46 million people live outside U.S. Metropolitan areas – 15 percent of the U.S. population — and the CDC estimates that tens of thousands are at markedly higher risk than city or suburban dwellers of dying younger than they should, reported the disease control agency's Macarena Garcia and Dr. Ernest Moy of the National Center for Health Statistics.

While preventable deaths from heart disease, stroke and cancer declined nationally from 2010-2014, for example, a yawning gap between rural and urban mortality widened further over the same period, Moy said.

Two Charts comparing the trends of five health conditions for rural and urban dwellers - heart disease, cancer, stroke, chronic lower respiratory disease, and unintentional injury. Declines have been slower in rural counties and some have risen.
Troubling trend: "As we see these rates decline for heart disease and cancer over time," Moy said, "they are declining more slowly in rural areas." The "worst pattern" of rural-urban disparity is evident in deaths from lower respiratory disease -- which have increased dramatically among rural residents. Moy called the gap "terrible."

But the crisis in rural health -- most recently brought to national attention by the opioid epidemic -- was visible in rural Ohio a long time ago.

McKnight was a recent graduate of The Ohio State University College of Medicine, a nutritionist and avid fitness buff – in fact, a one-time high school track standout and pole-vaulter. He knew that obesity was the main driver of a whole range of chronic health conditions in his "medically underserved" NHSC service area.

Almost 15 years and 2,200 patients later, the charismatic rural doctor is still practicing at Trinity, the area's only "critical access" hospital. He's regularly featured in local newspaper and TV news testimonials as the man who "saved my life" by local residents who were well down the road to grim futures before he came to town.

McKnight set up a grassroots program – Fit For Life -- that linked residents to trainers at the local YMCA, to diabetes and smokers' support groups, to dietary counselors, healthy cooking seminars, talking sessions with local and visiting doctors. Little by little, he filled the local calendar with nightly public events.

At the heart of the program is a kind of ad hoc community surveillance system that "changes people's relationships" by fusing them together in a common cause to stop obesity and diabetes through regular attendance.

In the process, McKnight enlisted hospitals, private practices, behavioral health providers, grocery stores and pharmacies in East-Central Ohio in the fight.

A picture of three human hearts, one healthy and two unhealthy.
Seeing is believing: Fit For Life gatherings regularly feature exhibits of ruined hearts, clogged arteries and wrecked aortas so local residents can actually see the end results of deep-fried onion rings, sugary sodas and binge-drinking on a normal heart (left). "It becomes very real to them," McKnight said of his patients. "We allow them to put on gloves so they can feel this and look at it very closely. It really makes an emotional impact."    

Tom Morris, who heads HRSA's rural policy office, now points to McKnight's campaign as "an ideal example of making a difference at the community level" – on as little as $79 per person, which mostly covers blood screening to track patients' progress.

The HRSA-supported program, said McKnight, is "absolutely scalable and replicable" elsewhere in rural America.

Watch the webcast for a detailed breakdown of recent CDC data and Tim McKnight's Fit For Life campaign.

Hosted by the Rural Health Information Hub at the University of North Dakota, the webcast is one in a 17-part series of web events and journal articles on rural health planned by the CDC for this year.

Recent mortality studies in the series have highlighted lower adherence to "healthy behaviors" among rural dwellers; stark gaps in the availability of care across a range of conditions, including HIV; and tens of thousands of potentially preventable deaths.

Date Last Reviewed:  July 2017