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What About Rural Health?™ is a rural health and global health podcast exploring how healthcare is accessed, financed, governed, and delivered in rural and underserved communities.
Hosted by Chinasa U. Imo, a global health policy strategist, researcher, and rural health advocate, the podcast brings together policymakers, healthcare professionals, researchers, community leaders, innovators, and people working directly within health systems to examine the decisions, structures, and conditions shaping rural healthcare.
Each episode combines first-hand accounts, expert insights, policy conversations, and research to explore issues such as rural healthcare access, health systems strengthening, health financing, workforce shortages, public health, health policy, technology and innovation, community health, and the institutional factors that determine who receives care, where, and when.
With perspectives from the United States, Africa, and other parts of the world, What About Rural Health?™ connects local experiences to larger questions about how health systems are designed, funded, and implemented. From deep-dive interviews to field-based storytelling, the podcast brings rural health into global/local focus and examines both the gaps and the solutions shaping care in underserved communities.
Whether you are a health professional, student, researcher, policymaker, advocate, or simply curious about how health systems work beyond major cities, What About Rural Health?™ invites you to rethink global health through a rural lens.
[00:00 - 00:07] Welcome to today's episode on rethinking rural health financing. You are listening to the\n[00:07 - 00:13] podcast that asks a question too many people forget. What about rural health? I am your\n[00:13 - 00:20] host, Chinasa Imo, and together we are uncovering the stories, challenges, and innovations that\n[00:20 - 00:27] are shaping healthcare in overlooked communities. In this series, we ask hard question about\n[00:27 - 00:34] how money moves, who gets funding, who gets served, and who gets excluded. From policy\n[00:34 - 00:42] to practice, we explore what healthcare financing should look like for everyone. Welcome back.\n[00:42 - 00:47] One thing that stood out to me when I read your book is that it challenges the way we bracket\n[00:47 - 00:54] people by chronological age, and Stuart, you've mentioned this a couple of times in our conversation.\n[00:54 - 01:04] That can also flatten the level of care that people actually need. When you say that we\n[01:04 - 01:11] should think in stages and not in ages, what do you mean by that? Can you walk us through\n[01:11 - 01:17] those stages and any of you feel free to start us off in this conversation?\n[01:17 - 01:25] In our book, we refer to seven stages of aging. Those stages range from 25 years old\n[01:25 - 01:33] up to 100 plus, point one. Point two, those stages do not need to be thought about as\n[01:33 - 01:41] a linear progression. We typically think about life and aging in a linear progression because\n[01:41 - 01:49] we go from an age year to the next year. We do that starting at age one. At age one,\n[01:49 - 01:54] everybody gets together and there's a big birthday party and everybody sings. We put one candle\n[01:54 - 02:00] on that cake. What do we do a year later? We put two candles on that cake and we keep\n[02:00 - 02:04] on going until there are too many candles. We say, oh, it's going to be one candle\n[02:04 - 02:10] for every 10 years. We're still thinking in a linear fashion and we've already talked\n[02:10 - 02:17] about how people, based on the date on their birth certificate, is not necessarily, as you\n[02:17 - 02:26] have shared, what age you actually are or what age you look like or what age you feel.\n[02:26 - 02:32] We start with ages of young adult and then we go to mid-adult. Then we have two stages\n[02:32 - 02:39] that are called pre-transition and then in-transition. Then we have a sweet spot that's called settled\n[02:39 - 02:47] in. Settled in is when you've reached a point where you have worked, you may still be working,\n[02:47 - 02:55] you have gone to school, you may still be going to school, but you have the resources. Relatively\n[02:55 - 03:01] speaking, this does not mean that you have to be not worried about money anymore, but relatively,\n[03:01 - 03:08] you have family, you have perhaps children, perhaps grandchildren, and you're in a spot\n[03:08 - 03:14] where you say, ah, this is a good place for me to be. That is where you're needing some assistance.\n[03:14 - 03:21] That assistance may be on a temporary basis because of a health condition or an incident\n[03:21 - 03:27] in your life where you need some support. Then the last stage that we use is called\n[03:27 - 03:35] elder. That could be a stage that goes all the way up to 100 years old. Within each of\n[03:35 - 03:45] those stages within the book, we have assigned a chronological age range of 10, 15, or 20 years,\n[03:45 - 03:50] again, because people could be in a stage for a period of time and each person behaves\n[03:50 - 04:01] differently within that stage. The stages of age that we identify overlap because somebody that's\n[04:01 - 04:11] in transition may be between 60 or 75 years old, but somebody who's in pre-transition,\n[04:11 - 04:22] the stage before in transition, could be 50 to 75 as well. Based on your passions, your desires,\n[04:22 - 04:32] and your potential, you can be indifferent of these stages and move back and forth between them,\n[04:32 - 04:38] and we could talk more about that, how we do that, based on your passions and your potential.\n[04:38 - 04:46] Thank you very much for that response. I learned a lot, and Marcos, I will pass this to you.\n[04:47 - 04:57] So when you guys talk about chronological age not being enough, now is one thing that we use\n[04:57 - 05:02] chronological age to understand and place people where they are in terms of age-wise.\n[05:03 - 05:09] But when we're talking about planning healthcare and other supports, you are arguing in your book,\n[05:09 - 05:14] or you're making a case in your book that that is using chronological age is not enough.\n[05:15 - 05:20] Why is that? And what are those particular things that we miss when we assume everyone\n[05:20 - 05:28] over a certain age needs the same care? For instance, when we say young adults and mid-adults,\n[05:28 - 05:37] or the one you mentioned, those in transition are settled in, when you use that term specifically,\n[05:37 - 05:41] what is it that we are missing when we plan for healthcare and support?\n[05:43 - 05:54] Chinasa, when we base our thinking, our engagement, our planning on the chronological age only, then\n[05:55 - 05:59] there's two things. One, we have a very limited view, and we base a lot of assumptions on\n[06:01 - 06:06] a person because they're at a certain age. And we see that in healthcare, where often\n[06:07 - 06:12] people are treating the age, not the person. And there's a lot of research and data which\n[06:13 - 06:19] confirms that, which is obviously a huge concern. But it leads to a whole lot of other\n[06:19 - 06:24] limited thinking, our stereotypes, indeed our ages, and which permeates across society is really\n[06:24 - 06:29] underpinned by our fixation on the chronological age. So it very much limits our thinking.\n[06:29 - 06:37] The second thing it leads to is the expectation or the presumption that aging is a period of\n[06:37 - 06:43] declination, that we simply decline more and more as we get older. Where again, there's very clear\n[06:43 - 06:49] and strong evidence and research which shows we can improve as we grow older. We can improve\n[06:49 - 06:54] our cognitive function. We can improve our physical performance with the right sort of intervention. So\n[06:55 - 06:59] one of the things we really want people to recognise through reading the book is the\n[06:59 - 07:06] fluidity of aging. And as Stuart touched on in outlining the stages, our journey is not one\n[07:06 - 07:12] linear trajectory, and nor is it a period of decline. Yes, there's going to be setbacks,\n[07:12 - 07:16] and yes, there are going to be things that are beyond our control, whether it's a sudden\n[07:16 - 07:22] health episode, whether it's a financial situation or a family circumstance, that might project us\n[07:23 - 07:29] to a particular stage. But through positive interventions, we can what we call flicker,\n[07:29 - 07:33] which is move back to our preferred stage of aging. So it's understanding that\n[07:34 - 07:41] there are positive interventions we can apply, that we can engage with, and\n[07:41 - 07:47] particularly across the four key factors that we talk about, which is physical, psychological,\n[07:47 - 07:52] social and environmental. And they're very much relevant to what we've been discussing around\n[07:52 - 07:59] the challenges and the opportunities in rural health and rural aging. So it's understanding\n[07:59 - 08:06] those factors are really important to us, recognising our ability to flicker to the stage\n[08:06 - 08:13] we want to be in, and knowing that aging is a fluid journey that isn't a particular\n[08:14 - 08:21] linear path of decline. Janosa, I just wanted to add, I'm sorry to jump in there, but\n[08:21 - 08:31] we have choices in life. We know that we have choices, and yet we don't always exercise our\n[08:32 - 08:41] right, I say right, but our ability to make those choices. But you know, do we want to continue to\n[08:41 - 08:49] live on this path? Or do we want to continue or do we want to change? And it's not 180 degree\n[08:49 - 08:57] change. It could be a five degrees change. And go down this path. We see those choices,\n[08:57 - 09:04] but oftentimes we think about them, but we can't conceive of them. We can't see the steps\n[09:04 - 09:11] that are needed. And so we also talk about planning. And when we plan, we're able to then\n[09:11 - 09:20] make decisions that allow us to select the choice of our preference. Something very important,\n[09:20 - 09:27] and that takes us through these stages or allows us to put ourselves in the stage,\n[09:27 - 09:33] the preferred stage that we have. But we need to exercise some of those choices.\n[09:34 - 09:42] Yeah, I agree. We all have choices, even including the choice to be healthy and roll back our age.\n[09:42 - 09:50] So I'm definitely up for that. And because it's so interesting that when you were talking,\n[09:50 - 09:57] you mentioned the word flicker a couple of times. And I want to come back to that later on for us to\n[09:57 - 10:01] talk a little bit of what that means, because, you know, it sounded like a throwing word, but\n[10:03 - 10:09] it caught my attention. However, I wanted to ask you guys like in applying this to\n[10:10 - 10:22] this framework to rural health, if now a rural health leader, you know, somewhere in a district office\n[10:22 - 10:30] or somewhere in the community is listening to this podcast and wonder how would this framework\n[10:30 - 10:37] change the way I look at my community or the communities that I serve? How should\n[10:38 - 10:45] rural communities use this stage-based model to understand what the residents would really\n[10:45 - 10:52] need early on? What would be your response? To me, Chinasa, there's two things which really\n[10:53 - 11:00] come to mind, and that is engagement and integration. So by engagement, I mean really\n[11:01 - 11:06] connecting with people, understanding where people are at in their aging journey. What are their\n[11:07 - 11:13] passions? What are their priorities? How do they want to participate? How do they want to contribute\n[11:13 - 11:20] and be a part of their community, as well as their own individual planning for their health and aging.\n[11:21 - 11:27] And I think integration in terms of harnessing what is there in the community that can be\n[11:27 - 11:33] made more of. So be that health services, be that community activities, be that families in\n[11:33 - 11:38] the community. How can we bring things together to make more of what we have and create better\n[11:38 - 11:45] opportunities for people to engage, to be planning, to be making choices, and to be participating as\n[11:45 - 11:52] well. So to me, those two things come to the fore. And I think if in a rural community, if we are\n[11:54 - 11:59] applying those sorts of initiatives, we can better support people in terms of their\n[12:00 - 12:07] aging journey and moving to their preferred stages to understanding what they have available to them\n[12:07 - 12:14] and to support their choices so that they are engaging with the right things to align with\n[12:14 - 12:23] their passions, to align with their preferences. Okay, Stuart, you want to add something to the\n[12:23 - 12:29] conversation? I think Marcus's answer for this one hit it right on the head, Chanosa.\n[12:29 - 12:34] I would agree with you. I'm good at that. I would agree with you. But then I have a\n[12:34 - 12:42] right to that question. Because we looked at this very narrowly from our community\n[12:42 - 12:49] and rural health perspective, right? But what about when we zoom out to a global perspective\n[12:49 - 12:58] on this, right? And what would proactive planning look like from that global stage\n[12:59 - 13:07] to support rural communities around the world? What would you say? The things that are involved,\n[13:07 - 13:15] the way we're supposed to be thinking, the biggest risks of making those plans so that\n[13:15 - 13:20] people already know, okay, these are the risk factors that we should look out for\n[13:20 - 13:30] when we are designing care for rural communities. I think straight away, Chanosa is the need for a\n[13:30 - 13:35] whole of aging view from that policy perspective. And I think that's been a great\n[13:35 - 13:41] bailing across global and national authorities that we have a very fragmented view when it\n[13:41 - 13:48] comes to aging and people growing older. We might look at housing in isolation, we might look at\n[13:48 - 13:54] healthcare, but we look at it in isolation. We might look at things like pensions and social\n[13:54 - 13:58] security, but we look at that in an isolated way. We don't have a whole of aging approach where we\n[13:58 - 14:06] could build much more effective strategies about our aging populations and our communities. We would\n[14:06 - 14:12] have a much more effective approach to policy settings and creating better frameworks for\n[14:13 - 14:20] all manner of things when it comes to aging. And so that certainly would be the first\n[14:21 - 14:27] order of the day in terms of making change at that global and international level. But\n[14:27 - 14:32] similarly, the things we've been talking about in regards to the rural community certainly apply at\n[14:32 - 14:41] the global and national levels as well with things that are important. Moving away from\n[14:41 - 14:47] the limited view of aging, casting aside the assumptions that we make in terms of\n[14:48 - 14:54] aging is a period of decline and opening up our thinking to what's more appropriate for\n[14:55 - 15:00] people as they grow older and how do we better create opportunities for people where they are.\n[15:00 - 15:05] And I think as we touched on earlier in the conversation, understanding that different\n[15:05 - 15:11] cultures, different communities have things to offer that we can learn from. And then coming back to\n[15:11 - 15:18] what Stuart shared about how we can do aging in rural environments around family care models,\n[15:18 - 15:23] co-opted care models, there's different ideas, different examples that we can be sharing and\n[15:23 - 15:31] learning from and not necessarily duplicating but being inspired by and that can be leading to\n[15:31 - 15:38] new thinking and new solutions. And building on what Marcus has just shared, one of the major\n[15:38 - 15:48] supports that we have access to and it just takes us all to put it together is technology.\n[15:49 - 15:56] Technology can be a great support to all that Marcus just shared and that is globally\n[15:57 - 16:05] because we can reach across the world with technology and it can support. Now do we have\n[16:05 - 16:13] broadband access in all rural communities? The answer is no, but that's our decision as a society\n[16:13 - 16:21] as to whether or not we can expand it to areas that aren't yet touched. We have satellites\n[16:22 - 16:30] in the sky that can pinpoint a house on the ground if it need be. So why can't we\n[16:32 - 16:41] expand broadband to take in all rural communities? And once we do that as a simple example,\n[16:41 - 16:50] we can connect people of like minds or like interests and so we can all get together just\n[16:50 - 16:57] as we are doing right now in three different geographic locations. We are spanning tens and\n[16:57 - 17:05] hundreds of thousands of miles here and all sharing, talking about a common theme,\n[17:05 - 17:10] rural communities. Well we could do that based on current events, we could do that on history,\n[17:10 - 17:17] we could do that based on cooking and recipes or anything else which brings people together\n[17:17 - 17:25] and brings life going back to the significance of not being socially isolated and the impact\n[17:25 - 17:33] on health care. And so when Marcus refers to the whole of aging, it's not only about\n[17:34 - 17:39] the medical components of that and access to medicine, talking about sharing recipes\n[17:40 - 17:47] so that you could have food that's nutritious or if you choose to be vegetarian or vegan\n[17:47 - 17:53] or anything, you can talk with other people who are experts on it and then you can do the same.\n[17:54 - 18:01] And what impact will that have on your health going back to the prevention mode? So there is\n[18:01 - 18:12] so much that we can do that is possible. This isn't thinking beyond what we have the ability\n[18:12 - 18:19] to do these days, we just have to have a mindset as a society to take the whole of aging approach\n[18:19 - 18:25] and use the tools that we have such as technology to bring us all together.\n[18:25 - 18:33] I like how you drill down the conversation about technology to a very visible practical\n[18:33 - 18:39] things because sometimes and oftentimes when we mention technology, it seems like this one\n[18:39 - 18:48] big gigantic thing and our mind moves to what do we do with AI, what do we do with integrated\n[18:48 - 18:54] you know, machine learning and the rest of them. Those things are quite useful and productive\n[18:54 - 19:02] in the thinking and learning process that the whole globe is now working on. But they are\n[19:02 - 19:11] simple technology that has been in existence and I always love that, you know, to kind of like\n[19:12 - 19:17] bring the devil out of the detail when we talk about technology, like simple things like recipe\n[19:18 - 19:28] you can learn how to live healthier just by having the ability to share out recipes across spectrum,\n[19:28 - 19:34] across continents, you know, across people who appreciate certain level of community,\n[19:34 - 19:41] you know, where our systems of eating that makes it easy for one person or the other to find out,\n[19:41 - 19:46] you know, simple techniques or simple tool even if it's not just about, you know,\n[19:46 - 19:52] sharing recipe but tips about aging knowledge that, you know, could be far removed from someone\n[19:52 - 19:59] because they don't have access to such information. So thank you for taking the time to really\n[19:59 - 20:05] explain this in more detail, especially with the use of technology part of it.\n[20:06 - 20:12] And Marcos, I'm going to come back to you in that concept that you mentioned because\n[20:13 - 20:21] I feel like that idea, I mean, I also saw it in your book and I appreciate the way you explained it\n[20:21 - 20:28] but, you know, and I think that that is something that rural community needs to understand as people\n[20:28 - 20:34] move back and forth, you know, between these stages of age depending on their health, purpose,\n[20:34 - 20:40] connection, loss, recovery, or even the way they receive treatment within their environment.\n[20:40 - 20:47] But can you in a more simpler term, like everyday language that people use,\n[20:47 - 20:51] explain what this Flickr concept means for my audience?\n[20:53 - 21:01] Sure. Though firstly it recognises the fluidity of aging and really it's about our ability,\n[21:01 - 21:09] for everyone's ability to overcome setbacks and to move to their preferred stage of aging. So\n[21:11 - 21:19] we might have a sudden health episode, we might have a sudden change in our working life or our\n[21:19 - 21:26] family situation, financial scenario, whatever it might be, things are going to happen through\n[21:26 - 21:30] our aging journey, that's a reality. And often they're going to be beyond our control,\n[21:30 - 21:36] they're going to be unforeseen. But what we do have is the ability to apply and engage with\n[21:36 - 21:43] positive interventions, both in response to those sudden setbacks, but also from a proactive\n[21:43 - 21:51] ongoing perspective. And they fuel our ability to Flickr to our preferred stage. So for example,\n[21:51 - 21:57] we might have a sudden hospitalisation and we have a health condition that\n[21:59 - 22:05] propels us to the supportive living stage of aging. But with positive interventions we can\n[22:05 - 22:11] restore our physical capacity, we can recover from that particular health episode\n[22:11 - 22:18] and Flickr back to our settled in stage of aging. And sometimes those periods of\n[22:19 - 22:25] to Flickr will be sustained over a period of time, sometimes that might be a shorter duration,\n[22:25 - 22:30] it'll depend on our circumstances and what's happening. But really it's recognising our\n[22:31 - 22:39] ability and our potential to overcome our setbacks, overcome challenges and move to\n[22:39 - 22:46] our preferred stage of aging. And it's recognising those key factors that are at play at any time\n[22:46 - 22:53] through our aging journey, our physical factors, our psychological factors, our social and\n[22:53 - 22:58] environmental and understanding what sits underneath each of those factors and recognising\n[22:58 - 23:02] the things that we want to be engaging with both from a proactive point of view,\n[23:02 - 23:09] but also from a restorative perspective. And I come back to the research which points to that\n[23:09 - 23:14] ability to improve both our cognitive function, our physical performance as we grow older. And\n[23:14 - 23:22] that really affirms this concept of Flickr and our ability to move to our preferred stage of aging\n[23:23 - 23:30] as we grow older. Okay, so let me try and paint a picture of what I think I understand.\n[23:30 - 23:38] Typically, I have a grandparent who is severely ill and have reduced mobility. And I moved this\n[23:38 - 23:44] person to urban area to receive specialised medical care because that is not available in\n[23:44 - 23:50] the rural community, right? They could live with me for like six months or a year and then they\n[23:50 - 23:57] start getting better. And because of all of these other factors that they want to go back to,\n[23:57 - 24:04] they want to go back to their community. And there's really no reason for why I should keep\n[24:04 - 24:08] them with me, even though I love them to the bone and I want them to stay with me, but they\n[24:08 - 24:14] have their life, right? And they go back to their rural community. So I'm understanding this\n[24:14 - 24:22] from the Flickr point of view. Is there, having this understanding now, is there a way to now\n[24:22 - 24:28] kind of like design a support system that will meet her at that present need where she's gone\n[24:28 - 24:34] past the emergency phase, go back to a normal stage, go back to the community, but then there's\n[24:34 - 24:41] this medical or health history that she suffered some, something severe within this period of\n[24:41 - 24:51] time. And that needs to come into conversation when we talk about how much she should be able\n[24:51 - 24:59] to function. So yeah. Yes. And Chinasta, in the book, we provide very practical tools and resources\n[24:59 - 25:06] for people to apply to their own personal circumstance. And part of that is assessing\n[25:06 - 25:12] where you're at and understanding what stage of aging you're in. And then for things to think\n[25:12 - 25:18] about in different scenarios, like you just outlined. So there might be health circumstances\n[25:18 - 25:22] at play. So what are the things I should be thinking about to either help me restore\n[25:23 - 25:29] different capacities or to prevent things from happening? It might be social factors that are\n[25:29 - 25:33] at play. And it's thinking about, well, what are the relationships that are important to me\n[25:33 - 25:40] that I want to either reconnect with or to maintain or to further tap into? And that might\n[25:40 - 25:45] be for particular reasons at different times, or it could be from that ongoing perspective,\n[25:45 - 25:51] to maintain our social connection and fuel our sense of purpose. It could be environmental\n[25:51 - 25:57] and understanding our living environment, our surrounds in the wider community.\n[25:58 - 26:04] What are the things that I can be utilising, engaging with that are going to support my\n[26:05 - 26:10] ability to flick it back to my preferred stage of aging? Obviously physical and particularly in\n[26:10 - 26:17] regards to our health. What are the things I should be doing from a preventative sense,\n[26:17 - 26:22] from a restorative sense? And then our psychological obviously is hugely important\n[26:22 - 26:26] in terms of our emotional wellbeing, our cognitive function. So again, what are the\n[26:26 - 26:32] things that I should be and can be tapping into to support that? So in that example you gave,\n[26:33 - 26:38] somebody coming back to their community, well, from a social perspective, what are those\n[26:38 - 26:42] relationships that are available to me that are important to me, that are going to be positive?\n[26:43 - 26:48] The environmental factors are the things that I should be looking to modify at home or the\n[26:48 - 26:52] things I need to bring into the home to make that environment more conducive to my\n[26:52 - 26:58] ability to flick it back to my preferred stage of aging. Thank you very much. We'll go for a quick\n[26:58 - 27:05] break and when we come back we actually will dive into talking about the financing opportunities\n[27:05 - 27:10] to doing all of these things that we have been discussing here. Do you have a rural story that\n[27:10 - 27:16] needs to be heard? Whether you are a health worker or patient or policymaker or an advocate,\n[27:16 - 27:21] we want to hear from you. So share your story on our website at whataboutruralhealth.com\n[27:22 - 27:27] stories and help us amplify the realities behind the data. Someone from our team\n[27:27 - 27:32] will contact you with details on how to get your story published on our website\n[27:32 - 27:41] and other media platforms. Welcome back. So this podcast is really interested in\n[27:41 - 27:47] investment for a rural community. We don't just talk about the broken systems or where\n[27:47 - 27:55] the challenges lies but also in the opportunities that we can draw out of those problems like doing\n[27:55 - 28:01] a root cause analysis to get to the solution part of the tree. So I want to ask both of you\n[28:01 - 28:09] and Stuart please jump in here and start us off in this conversation. If you are thinking\n[28:10 - 28:16] as a system designer or rather let me put you in a place where you are now thinking\n[28:17 - 28:25] from a system design perspective and you are designing a better investment model for rural\n[28:25 - 28:32] aging, where should that money go first? What should we fund before someone ends up in a\n[28:32 - 28:38] situation like the one I narrated where I need to move them out of their community to a facility\n[28:38 - 28:47] based care? If I had a magic wand, we would not have to concern ourselves with\n[28:47 - 28:54] how this is being paid for. But since in the real world we do have to think about how this\n[28:54 - 29:00] is being paid for, let me first start with how we might come up with the money for this model.\n[29:01 - 29:11] And that is through a private public partnership through the business community and the\n[29:11 - 29:20] government as well as perhaps private investors in addition to the business community.\n[29:23 - 29:28] Now the business community is interested in earning money so you have to come up with\n[29:28 - 29:35] some sort of a financing mechanism that will pay them back a bit but that mechanism exists.\n[29:35 - 29:40] It is called social impact bonds. It is a concept that has been used where\n[29:40 - 29:44] government and business come together or there is an investment and there is risk\n[29:44 - 29:48] associated with that investment which the business community recognizes.\n[29:49 - 29:55] So I will not go into the whole social impact bond model but a model like that\n[29:56 - 30:03] brings funding with incentives to both government and the business community.\n[30:04 - 30:13] Then in order to fund, we have talked a lot about technology already but there are\n[30:13 - 30:18] certainly we have all heard of and we see it on television all the time, models where somebody is\n[30:18 - 30:27] at some distant location and helping somebody at a distance away to provide solutions for healthcare.\n[30:28 - 30:34] But coming back to the whole of aging concept, very important in responding I believe to the\n[30:34 - 30:43] question you are asking and that is prevention is part of the whole of aging. So if I was to be\n[30:43 - 30:50] waving that wand and somebody had the dollars, I would put my money in the preventive mode\n[30:51 - 30:59] going not when somebody is 70 years old because prevention has to occur in the much earlier stage\n[30:59 - 31:06] of life. So I would say in the earliest stages, in the young adult or mid-adult stages,\n[31:07 - 31:15] we should be focused on prevention and giving people again the right foods, the right\n[31:15 - 31:24] vaccinations, all the preventative tools that we know will help somebody to stay healthy at\n[31:24 - 31:31] longer times. And part of that is the psychology. We talk about psychology as an important factor here.\n[31:32 - 31:40] Think with the glass half full not with the glass half empty and can we do that in a way\n[31:40 - 31:47] that teaches people to think like that so that you're not thinking that you are going up this\n[31:47 - 31:51] hill that's going to get to the top and all of a sudden you're going to have this tremendous\n[31:51 - 32:01] downslide. That's where I would place my bet. I like the PPP model. I think in places where\n[32:01 - 32:11] I've seen that successfully implemented, it shows more results than having just a private investor\n[32:11 - 32:19] or a government going because then there's a much of business model that helps us to look at impacts,\n[32:19 - 32:27] but also a businessman wants a return on investment. They are interested in that. Government is\n[32:27 - 32:32] interested in providing services so they're looking towards impact, but when they merge\n[32:32 - 32:39] together and bring this model together and tracking both indicators and other kinds of\n[32:39 - 32:48] indicators of interest to these two people, it makes it easier to get results. I absolutely\n[32:48 - 32:55] agree with you. If I might, Janessa, because you just triggered something in me, when I talk\n[32:55 - 33:02] about prevention, I'm not just talking about it from the vaccination standpoint. I'm referring\n[33:02 - 33:10] to it from the social care and healthcare integration. If you provide somebody with the\n[33:10 - 33:16] proper housing and if you give them transportation so that they can access when they are younger,\n[33:16 - 33:25] whatever it is, whether it's social connections or access to a clinic, if you give them the\n[33:25 - 33:33] transportation, if you give them the food and you invest in those areas, social care has a tremendous\n[33:33 - 33:41] impact on healthcare. I agree. That's where it all goes. I agree, and Marcos, when\n[33:42 - 33:51] Stouts was talking about all of these investment portfolios, yes, we can signpost technology and\n[33:53 - 33:57] every other thing, but there are people who provide these services and those are also investment\n[33:57 - 34:07] portfolio opportunity area like social workers, social service providers, community-based organizations,\n[34:07 - 34:16] ETC, ETC. However, in rural communities, those are very limited. I sometimes go and barely see\n[34:16 - 34:23] these things in existence, so how would you make a case for an investment in this area to make sure\n[34:23 - 34:30] that this functional arm of government is visible in rural communities in the ways that they\n[34:30 - 34:36] think around all of these comprehensive things that make aging sustainable?\n[34:38 - 34:44] Chanasa, what I think is a really good way, and I've seen work in different rural areas, is\n[34:45 - 34:52] a model where there's shared infrastructure. Services are delivered on the ground or resources\n[34:52 - 34:57] are available on the ground, but behind the scenes, the system which underpins that and\n[34:57 - 35:03] the infrastructure that supports that is shared across a number of communities, a number of\n[35:03 - 35:11] regions, so from a viability point of view, you can find those efficiencies which make it more\n[35:11 - 35:20] practical to deliver those services on the ground. And obviously, technology and different\n[35:21 - 35:28] initiatives can be really valuable in setting up what's needed behind the scenes so that\n[35:28 - 35:33] infrastructure is in place. Importantly, though, with those sort of models, it's ensuring that\n[35:33 - 35:37] the local identity is still prevalent on the ground in those communities. So\n[35:39 - 35:44] having people, whether it's disciplines like social work or other allied health or whatever the\n[35:44 - 35:51] particular services and delivery might be, that that is seen as being local, it's connected to\n[35:51 - 35:55] people on the ground in those communities. Behind the scenes, the infrastructure can be\n[35:56 - 36:03] centralized and managed in an effective way, so it's then shared across those different\n[36:04 - 36:08] delivery points in the communities. So I think it's getting that balance right of where there's\n[36:09 - 36:14] that centralized shared infrastructure behind the scenes, but on the ground,\n[36:14 - 36:23] there's this local identity, local connection. Yeah, that's a good response. And this is me\n[36:24 - 36:35] thinking aloud in terms of how do we convince investors? Because oftentimes, it's like you go\n[36:35 - 36:40] to government and you do advocacy. You know what this looks like. They talk about overwhelming\n[36:40 - 36:46] priorities and not knowing where to put their money to just because the priorities are enormous.\n[36:47 - 36:53] At least that's what my government, and I'm Nigerian, that's what my government always say,\n[36:53 - 37:00] there's so much to do with little resources. However, there are creative ways that resources\n[37:00 - 37:09] have begun to be made available through either private investors or angel investors. But\n[37:10 - 37:14] these people are always looking for a case portfolio where they would invest in\n[37:15 - 37:21] and get their money back. I like the money language because money move things and move\n[37:21 - 37:28] the world around. But then we also want to move money in ways that privileges the care and dignity\n[37:28 - 37:34] of those people receiving this care. So this is me thinking aloud, feel free to ignore this,\n[37:34 - 37:40] or feel free to chime in. But I'm just thinking to say that opportunities exist in the way that\n[37:40 - 37:48] we can tweak a model to make rural investment case profitable for investors in ways that\n[37:48 - 37:53] government can also use their infrastructure to support this and provide the backbone.\n[37:53 - 37:57] So just in case you want to add one or two things, feel free to do that.\n[37:58 - 38:06] Well, I think in that spirit and consistent with the model I was referring to before is\n[38:06 - 38:12] allowing or demonstrating the ability for scale for those investors. And as Stuart rightly pointed\n[38:12 - 38:20] out before, obviously, businesses need a return on their investment. They want to be profitable.\n[38:20 - 38:28] So I think the secret to achieving that in supporting rural communities is to foster\n[38:28 - 38:33] that ability to scale out. And again, the caveat for me in relation to that is,\n[38:34 - 38:40] there's a retention of that local identity community connection. So that's got to be the\n[38:40 - 38:46] condition, I think, in terms of allowing that at scale investment and that at scale\n[38:48 - 38:53] involvement or ownership. The other side of the coin for me too is, and I've seen it in places\n[38:53 - 39:01] like Australia and elsewhere, that the government has invested money or allocated money for rural\n[39:01 - 39:07] initiatives, but it's being quite closed or quite limited in terms of who can receive that\n[39:07 - 39:13] money and what they can do. And I think we need to see a greater flexibility or an openness\n[39:13 - 39:17] to the right sort of initiatives from government when they're going to contribute money so that\n[39:19 - 39:26] a private partner can see the opportunity to scale and to impact with the right\n[39:27 - 39:30] caveats and conditions, obviously. But I think we need that combination of\n[39:31 - 39:35] some more open thinking from government in terms of how they're supporting\n[39:36 - 39:44] rural initiatives and then the opportunity for the scale from an investor perspective.\n[39:45 - 39:50] Thank you for that response. I still want to stay on you because this is literally the last\n[39:50 - 39:57] question that I have. Now, if you have to make a case, and this question is to you, Marcos,\n[39:57 - 40:02] if you want to, if you have to make a case to an investor, so I'm being very practical here\n[40:02 - 40:09] because I like to close on the note that even if someone is unable to grasp everything that we\n[40:09 - 40:13] discuss, pick this one thing and go home and that will be very useful for you in listening\n[40:13 - 40:19] to that conversation. So if you are going to make a case to an investor, whether he's a\n[40:19 - 40:24] policymaker or private investor or hospital leader, what would be that one thing that you\n[40:24 - 40:30] would ask them specifically to invest as a place of opportunity in rural aging?\n[40:33 - 40:41] I would come back to integration and engagement. I think there's so much impact to be had by\n[40:41 - 40:48] enhanced engagement in our rural communities and by better integrating services and resources that\n[40:48 - 40:53] are available in those communities. If we bring those two things together, then we're going to\n[40:53 - 41:00] empower people, educate people and enhance their ability to prosper as they grow older.\n[41:00 - 41:06] Thank you very much for that response. And Stuart, I will turn to you now and ask you,\n[41:08 - 41:17] for someone listening from a rural community, but this person is not a stakeholder,\n[41:17 - 41:27] is just a caregiver or a family member and is taking care of an aging parent. Just like I gave\n[41:27 - 41:34] him my analogy with my aging parent, what would be the thing that you would advise that we put\n[41:34 - 41:46] in place in terms of planning, but in terms of also making sure that we are ready to provide\n[41:46 - 41:54] support when, whether us or a family member needs it, what are those safety plans that you want us\n[41:54 - 42:00] to put in? And while you're answering that, I wanted to also be specific in letting the\n[42:00 - 42:04] audience know what they would hope to get out of reading your book.\n[42:07 - 42:15] I would go back to, in a less formal way, I would say to those families, those people,\n[42:15 - 42:24] that population. I talked about cooperative care models before, and that can be a very formalized\n[42:24 - 42:34] model, but it can be an informal model as well. And it goes back to human nature, it goes back to\n[42:35 - 42:41] who we are as people respecting other people, and they just help each other.\n[42:41 - 42:50] But do that with a little forethought. You can't wait until the crisis to all of a sudden say,\n[42:50 - 42:55] hey, why don't we all come together, and what can you offer? Do you have a car? Do you have\n[42:56 - 43:03] a way to a phone? Do you have technology? Do you have an app? So a little bit of forethought,\n[43:03 - 43:08] and do it in an informal way, where you talk with your neighbors, where you talk if you're\n[43:08 - 43:15] going to a place of worship on some regular basis, and the place of worship, again, does not have to\n[43:15 - 43:21] be a building. You might come together in a field regularly with your friends. You may come together\n[43:21 - 43:29] on Sunday morning. At that time, think a little bit about how we could help each other relative\n[43:29 - 43:39] to the care of our older adult population. And then, if the need arises, you ring the bell,\n[43:39 - 43:44] figuratively speaking, and people will come to help. You could then take the step\n[43:46 - 43:53] to formalize that a bit, and you come together, you plan, you make decisions, you do it on Tuesdays\n[43:53 - 43:59] and Wednesdays, I do it on Thursdays, and you come up with a plan. That's a very practical way\n[43:59 - 44:07] in rural areas that we could help each other in an informal way, and then incrementally move\n[44:07 - 44:13] toward formalizing it as we have some experience with it and get a little bit better at it.\n[44:14 - 44:18] In terms of the book, I'm sorry, are you going to say something? No, go ahead.\n[44:20 - 44:29] In terms of the book, it's about how you want to live life. You can live it\n[44:30 - 44:40] by following what society has told us, that at age 65, you're supposed to finish, you're supposed\n[44:40 - 44:48] to sit down on a chair and look out and reflect on all that you've done. But you still have,\n[44:48 - 44:58] based on average ages these days, and the length of aging, at 65, another 20 years\n[44:59 - 45:05] just on average that most people will be living. We are now talking about many people living into\n[45:05 - 45:14] their 90s, let alone over 100. How do you want to live life? This book helps you to think about that\n[45:15 - 45:22] from early stages, from young adulthood, from mid adulthood, how you want to live life.\n[45:22 - 45:30] Think about it, and then make those choices to live the life the way you want it. That's\n[45:30 - 45:38] something that we refer to in the book as aging on pace. How do you want to live life? At your pace,\n[45:39 - 45:46] it should be the answer. That's a perfect way to wrap up this conversation. I would say that\n[45:46 - 45:54] listening to both of you, what I have picked out of this conversation is that we shouldn't treat\n[45:55 - 46:01] rural aging as a late state crisis. We have to think about them early, more personally,\n[46:01 - 46:08] and more creatively. So, Marcos and Stuart, thank you so much for giving us the language\n[46:09 - 46:15] for that, and for sharing your insights with us at what about rural health. I would\n[46:16 - 46:25] remind our listeners that the book title is Your Aging Advantage, the seven new stages of aging.\n[46:25 - 46:32] We would include the link in our show notes. Feel free to click on that and go purchase the\n[46:32 - 46:37] book and read more. We encourage you, because it's important for us to learn more about\n[46:37 - 46:48] what it means for us to age elderly. Thank you. To everyone listening, thank you for joining us\n[46:48 - 46:54] on today's episode of What About Rural Health? If today's episode moved you or challenged you\n[46:54 - 47:01] or made you think a little bit differently about rural health conversation, please follow us, subscribe,\n[47:01 - 47:07] and leave us a review on your favorite podcast platform. As always, we'll keep asking the same\n[47:07 - 47:14] question. What about rural health? Until next time, I am your host, Chinasa Imo. Bye for now.\n