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From the Margins: Let’s Create the Narrative Together
What About Rural Health?™ is a podcast series dedicated to bringing focused
discussions on the unique challenges, lived experiences, opportunities, and innovations
within rural healthcare—both locally and globally. Our mission is to bring rural health to
the forefront of the global health conversation, ensuring these stories are not just heard,
but impossible to ignore.
Hosted by Chinasa U Imo, a Global Health Policy Strategist, and produced by
WARH?™ Studios, this immersive series blends first-hand accounts, expert insights,
policy conversations, and cutting-edge research to elevate rural health in the global
discourse. Each episode features voices from the frontlines—community members,
healthcare professionals, researchers, and policymakers—unpacking the structural
gaps and innovative solutions shaping access to care in underserved communities.
From deep-dive interviews to field-based storytelling, we bring rural health out of the
margins and into focus—sparking dialogue, inspiring action, and influencing decisions
and policies that advance equity.
Whether you're a health professional, a student, a researcher, a policymaker, an
advocate, or a curious listener, What About Rural Health?™ invites you to rethink global
health through a rural lens—and join the movement to make rural health impossible to
ignore.
Welcome to the What About Rural Health podcast, a place where research, policy, and real life stories come together to ask the critical question. What about the communities too often left behind? I am Chinasa, a development and global health policy strategist. And for me, this work is personal. From the village health workers struggling with limited supplies to the mothers working miles for care, their stories shape the policies we need.
Speaker 1:Join me as we uncover challenges, spotlight innovations, and amplify the voices of those at the heart of rural health systems. Because every community matters, and it is time the world listens. Hello, and welcome. You are listening to the podcast that asks the question many forget. What about rural health?
Speaker 1:I'm your host, Chinasa Imo, and together, we are uncovering the stories, challenges, and innovations shaping health care in overlooked communities. We are still in our introductory series breaking down rural health issues, advocacies, policies, and systems reforms. And today's episode is titled beyond the city, what urban resistance can tell us about rural health realities. Before me here, we have doctor John Slickman. Doctor Slichman is an urban sociologist and a community owned ethnographer, a thought leader on justice centered development.
Speaker 1:He's a professor of sociology at DePaul University, and his work examines how community resist, adapt to, or shape forces like gentrification, globalization, and structural changes, and what it means to build just people centered policy. Doctor John is and I think at some point, I'll just call him John, which is what I know him and refer to him as always. He is the author of Gentrifier and Showroom City, and he has a new book coming, which we would discuss later. We'll discuss now after I'm done introducing him, and I think it's such a privilege to have him talk about his unpublished book in our episode today. So his work brings, you know, an accessible reflective lens to the question of equity, resistance, and transformation.
Speaker 1:So you may wonder, how does an urban sociologist who spends majority of his career focused on the workings of urban spaces relates to rural health? Well, you are here to find out. The topic of today says that all, but his insights are very relevant to rural health as they are also for urban planning. John's work has been featured in major outlets and journals, such as New York Times, Bloomberg, CityLab, NPR, Next City, The Economist, and Architectural Digest. John has led one of the largest virtual network of urban thinkers.
Speaker 1:It's called Urbanist on LinkedIn. You can go check that out. It has over 90,000 members of urbanists that are part of that group worldwide. And he brings a justice centered approach to development that challenges how we think about power, place, and policy, making him an important voice in today's conversation on rural health. So, John.
Speaker 1:Welcome to today's episode. Thank you. So tell me, I I know that we've discussed a lot about your work, your academic life, and sometimes I think, you know, your you know, because professionals always talk about what they do, but sometimes you like to shift away from what you do and talk about who you are. So can you tell me a little bit about why you are writing your next book and what that next book is about?
Speaker 2:That's an interesting question. So first of all, I'm a sociologist, not just by training or not even first by training, but just in the way that I look at the world, which means that, you know, you have any one given person, any one given individual with their own personal agency and ability to act. And then around that person is structures, Social structures, or sometimes we just say structures, which are the fixed patterns of the world, seen and unseen, that shape that person's action and shape that person's perception. So, you know, there is a place for holding individuals accountable. There is a place for personal agency.
Speaker 2:In our friendships, you know, we hold our friends accountable. We never say we never talk to our friends in terms of the structures that they're located within. We we we help to motivate them, but at the same time, we recognize what they're going through. So that's my approach towards communities. Right?
Speaker 2:And so my new book, was motivated out of my previous two books, looking at the arguments that people have over what just development looks like. And all of the vague statements that are made, all of the errors that are made, the way that people talk past each other. And so throughout my career, I have worked on equipping people to have better arguments, better debates. And so my goal is to reach broader audiences than just academia with each book to help people understand, and this is getting to the current book, where people where communities have come from and where communities are going. So communities that have been devalued, symbolically but also economically, there are plans in place to revalue those communities.
Speaker 2:And everyone has a different motive in the revaluation, and every community has a different story in the devaluation. So my third book is a handbook, basically, of what I call the threads of community history, which is what are the all of the things, and I've identified 11 things that a community can go through that would cause it to be devalued, and what are the 11 things that a community can go through that would cause it to be revalued. And so this brings a lot of clarity because the minute we talk about a community being devalued, the conversation's not over, it's just beginning. Because you have all of these various threads that create a fabric of how this particular community got to this particular place. Now when you come with a plan to revalue it, now you those those threads of revaluation, they're fitting into an old fabric of devaluation.
Speaker 2:And so my my main breakthrough in this book, my main epiphany in this book is that every community is completely distinct, But the threads that make it distinct, those 22 threads of 11 devaluation, 11 revaluation, are very common throughout the world. So if you examine those threads, you begin to compare places that people wouldn't think of comparing, and you get clarity that people don't normally get in these conversations when they just say, well, you know, this area was devalued because it was redlined, and then that's the end of And So then what does what does that mean? You know? What's the answer? And and so my book helps to push those conversations forward.
Speaker 2:It doesn't provide the answers. It provides clarity in the discussion.
Speaker 1:I yeah. Thank you for that explanation. And I'm I'm curious, and I just need to do a full disclosure that I've seen those frameworks. So and I'm going to ask you questions that bug my mind. Like, when you talk about eleven and eleven of the re devaluation and revaluation frameworks, and what usually struck me when I'm when, you know, when I think about this in relation to places and efforts in the way they are, whether from government or, you know, individuals themselves within the community making meaning of how their environment is becoming devalued and what they think would make an improvement if, you know, certain changes are done.
Speaker 1:And sometimes I try myself to pair these things together between, okay, if there is, if a devalued factor is here, should we apply an alternate force? And sometimes that's not the way because there are underlying things that is that could be making what we are seeing look the way they are, but, you know, the frauds that need to repay it are not directly matched. Would you, you know, say a little bit about that?
Speaker 2:Yes. So I think this is the number one way that communities are exploited, is in the marketing and the promotion of what seems to be common sense plans, that if this community was defunded, then we need to refund it. Conversation over. If this community was detached, we need to reconnect it. Conversation over.
Speaker 2:If this community, was deteriorated in its housing stock, then we need to renovate it. And when you look at communities from a fabric approach, you can't undo the fabric that's already created. You can't go back in history. So, you know, there is a craze around the world right now in wealthier nations of removing roads that were unjustly placed. But, you know, I think this is the kind of the most obvious example.
Speaker 2:Like, removing a road sixty years after the community didn't want it there might not be the number one way to address that, that issue. So another analogy that I use, and I have there's two analogies in the books. One is a fabric, and one is the making of a loaf of bread. You know, you put in all these ingredients to the loaf of bread, and it becomes something new. You can't go back three days later and take out the eggs.
Speaker 2:You can't go back later and add the chocolate chips that you wish you added. You know? And with the fabric, you know, you can't go back later and take the red threads out that you don't like. So I think it's it it provides a framework like this, shows us the messiness and the nuance of community building, which I think are the two things that are most lost in conversation because everyone wants an easy side to be on and an easy side to articulate, And everyone wants to have an obvious quick answer that you can put in a one page document.
Speaker 1:Wow. I know some of our listeners will be wondering, why am I asking an urban sociologist to talk about, you know, spaces and stuff when we are asking the questions around, you know, rural health care? And that brings me to a follow-up question. I looked at the frameworks, and I teased us specifically four of those devalued frames that you put together. And I want us to talk a little bit about it because they jump to me as very relatable when I'm thinking about place based policies and how they affect, you know, health care accessibility.
Speaker 1:And these four frameworks are defunding, and you've mentioned you mentioned it when you were speaking the other time. The second one is detaching. And by your definition, like, when you detach people or by my understanding, when you detach things from the services that they used to receive before. And then the third one is destabilization, and then the last one is deterioration. I bring these four questions specifically because when we look at rural communities, there's always that inherent challenge of health facilities, you know, being left to deteriorate because of other things that I could still tie back to defunding and other kind of things.
Speaker 1:And, you know, that struck me as, yes, this is something that I want us to spend a little bit of time to talk about. And I know you might disagree. Oh, I don't see the direct relations between rural health care accessibility and all of these frameworks.
Speaker 2:Well, you know that that's my perspective. So you you know you know I was asking you why why why you want me here. So yes.
Speaker 1:So and, I mean, I know you can disagree, but, you know, when I look at it from that place based issues Sure. I want you to just, like, tell me about these four frameworks, you know, how you see them play out in communities. And looking at the examples that I have given to you, what was running through your mind when you structured them?
Speaker 2:Well, I mean, these are very these are very, very common threads that communities face. So you said defunding, deterioration.
Speaker 1:Detaching.
Speaker 2:Detaching and Destabilization. Destabilization. And you did say deterioration.
Speaker 1:Yes, I So
Speaker 2:deterioration is so in in my definitions, deterioration is the physical decline of the place, which becomes very, very costly, you know, when a place is when a when a place is built environment, and built environment is just all of the things that were made by people. Mhmm. So when a place's built environment or all the things that have been made by people begin to deteriorate because of a lack of, maintenance, then the whole conversation changes. I mean, so, you know, well known example in The United States is Congress allowed US public housing to deteriorate by by not funding regular maintenance. And so the conversation's able to change into something like, well, we need to demolish it, which is another thread.
Speaker 2:But deterioration is also important because deterioration helps to create health hazards in terms of lead, other things that asbestos, other things that decaying buildings might have. Community destabilization relates to the social weakening of of the community. So if you have a community that's weakening in its social fabric and also weakening weakening in its physical buildings, you have a momentum that's very hard to overcome. And so these are just two reasons why a neighborhood would become detached. And when I say that a neighborhood is detached, I mean something very specific.
Speaker 2:It's a real or perceived reduction in a neighborhood's resources, its functions, its purposes, its assets, its safety in the minds of outsiders. So people from outside that neighborhood. And so what this means in urban planning talk is that this neighborhood disappears from the cognitive or mental map that people have of the city. So they have a map of the city in their minds, and there there are are murky places, blurry places, what one leader famously and and horribly called holes on the map. And so that begins to have its own momentum.
Speaker 2:Once a place begins to disappear, that that becomes its own driver for housing to become devalued because people aren't looking at that housing or wanting to live in those apartments. It retail becomes devalued because the only clientele is a local clientele. So that would detaching. And then defunding is a decrease in government support for buildings, for infrastructure, for businesses, for spaces, for programs. And, you know, governments oftentimes try to especially in a in a conservative leaning, right leaning government, where community is looked at through a business lens.
Speaker 1:Mhmm.
Speaker 2:The idea is this community is a bad investment, so we're going to take away our funding from it and put our funding in some place where that deserves it. And this results in what is known and what I call in the book a containment strategy, where it's like, okay, this this area is going to have problems because of all of these issues. We're going to have to, the government says, create a boundary around this neighborhood and make sure that all of those issues are contained within this area so it doesn't blight, pollute the rest of the city. And that becomes an entire strategy around urban planning and policing, etcetera. Wow.
Speaker 2:And so in many countries, the decanting or relocation of people from prime urban areas to the rural periphery is a strategy to remove many of these issues out of sight.
Speaker 1:Wow. That's very insightful. And when you were talking, I my mind just go went through a time that I was doing a documentary on hospital functionality, specifically primary health care. And most of the about 75% of the hospitals that I went to were so deteriorated that you would think you are coming there to pick diseases. And not getting, you know
Speaker 2:Not not
Speaker 1:not not getting care. So and when I look around, like, when you were mentioning about the duration of building and I think you called them, you know, Biowest, like, in relation to the hospital setting, that will be medical waste. Now imagine when because of deterioration, the pipes, the sewages are not working, and the hospital, the doctors still need to work. They need to function. Women still come there to give birth, And all those wastes are not properly managed because, you know, they have a whole lot of structural problems within the health facility to grapple with.
Speaker 1:And, you know, that becomes a good pro a huge problem. Well, you are still listening to what about rural health. We are going for a short break. When we come back, our guests would dive into the deeper conversations that, you know, coming out from his other book, showroom city. Welcome back.
Speaker 1:You are still listening to what about rural health with Chennacer. So, John, let's dive into showroom city.
Speaker 2:You If you insist.
Speaker 1:I do insist because see, the thing is when I read that book, and I took away because I'm not a new one, an urban sociologist. I am not. I'm an administrator. I look at things from public perspective and how does that inform public policy? How does community action inform change?
Speaker 1:That is what I'm looking out for. And that is a whole lot of things that the book was telling me when I read them and I when I read it. So I still want to bring it in, and we'll talk about it, and then we'll come back to these frameworks. So your work in showroom city, it ties directly it ties real estate to urban changes that shows broader social impact. And you've discussed a whole lot about this from the re the framework.
Speaker 1:But when you think about these spaces, how how do you think it shapes people's health and well-being?
Speaker 2:So the question is how do spaces shape health and well-being? Yes. I mean, I think, you know, one of the one of the benefits of this moment is is that we are thinking about, health in regards to the social determinants of health. Yes. You know, so if you think about that individual and you think about all of the things that surround that individual, You know, you think around about the air, around the individual.
Speaker 2:How polluted is that air? What is polluting that air? How noisy is that place? Can the person sleep? How stressful is is the noise?
Speaker 2:Is the noise itself threatening? Is it bombing? You know? So you think about the air around someone, you think about the soil, that's available, the lead in the soil, the the pollutants in the soil, and the weather around that individual, you know? Places that are heavily paved and the heat island that envelops those places because there's not the natural ecosystem to be able to handle heat.
Speaker 2:You think about how easy it is for that person to walk around and get to other places, not just walk around within the neighborhood, that's one piece, but to get around to other places. The food that's available to that person. The housing that that person's living in. Is there mold in the housing? Is there lead in the housing?
Speaker 2:The health care that's in the area. And then you begin to look at the social cohesion, the social capital, the what what we would call the glue between people. And so, I think that's one of the things that, devalued, marginalized neighborhoods have, oftentimes in abundance, is social cohesion. And I think that is where, plans that are successful in addressing all of these other things about the environment, air, soil, noise, pedestrian access, housing, food, health. Oftentimes, successful plans will leverage the cohesion, the social glue, the social capital that's already in place.
Speaker 2:And I think, you know, major institutions, you know, you're you're from more familiar than I, but major institutions like the United Nations and and others are are leaning on this type of perspective now as a default, even if it's only in rhetoric, in a way that's never occurred before. So it's almost the new common sense that the local has expertise. The you know, that that that community cohesion, that those community relationships, that there's expertise and know how in it. Now whether that actually is acted upon, whether that know how is actually respected, whether community input is just a symbolic stage, that's a whole another thing. But I think, you know, these are the social determinants of health, which I've basically overviewed here.
Speaker 2:Like, this is a great way to understand where a community sits and then how it can can move forward. So I think, you know, in the in the High Point case, this was the case of a city that lost it. This is the the subject of So Room City is High Point, North Carolina, which is a city that, lost its downtown because its downtown became the setting for a global exposition of furniture fashion that occurred twice a year so that the whole world, every continent would come, 85,000 visitors from a 110 countries would come to this downtown, and the place lost their community center and therefore lost a lot of the mechanisms they had for cohesion Wow. And glue and social capital. And so this book is largely about that.
Speaker 2:It's a very, very unique and strange, one reviews called it weird case that helps to highlight very common threads. And again, this is one of the things that led me to this thread approach that as strange as High Point is, the threads that make it into what its strangeness are very common.
Speaker 1:Yeah. Yeah. And thank you for that response, thank you for drawing social determinants of health to this conversation because, you know, when we talk about health care and I think I I usually make this point so much that we are remove we are not just focusing on the medicalization of the health care system where you become sick and you go get help, but the constitution of everything that makes you a healthy being, and spaces are part of that. And I when you mention social cohesion, I just smile. I'm like, it is only an ethnographer who would, you know, take time to study humans, people, and how they function within society, how they build this social cohesion.
Speaker 1:And and I would add that in some cases, even how they disintegrate, It is still within, like, human to, you know, move from being discomfort to taking action. And you being an ethnographer.
Speaker 2:If I could just say, like Yes. We're we're at a moment in history Mhmm. Where doctors and sociologists are discovering each other. Mhmm. And public health has not bridged that gap.
Speaker 2:Like, public health has not bridged the gap between the people who look at individuals and structures, which are sociologists, and the people who who provide medicine, which are doctors. And we are in a moment right now where, like, this is everyone's learning from each other. So I'm hoping that twenty years from now, you'd never have someone like me on this podcast Mhmm. Because we would have moved past a place where I would have something useful to say even though I don't do rural health.
Speaker 1:Right? I agree with you. I I agree with you. I went to a global health conference in DC two years ago, and that is that became the frame of the conversation. Like, we're talking about public health, and things were still being typified around, you know, health communication and promotion, one bucket.
Speaker 1:Right? Surveillance in one bucket. Right? And laboratory services in one bucket.
Speaker 2:Mhmm.
Speaker 1:And then medical practice in one bucket. Everything, even when we talk about public health, things are still bucketed. For instance, when we talk about rural health, people think, oh, okay. It's just it's rural spaces. Yet, we have seen the migration of diseases from, you know, water, contaminated water, to the global space where everybody grapple with both in the urban and rural spaces.
Speaker 1:So all these things are interconnected. And sociologists do this by studying why are these things happening within social spaces. Right? Doctors do what they do, but if they open up spaces to think that what is presenting before them in the hospital are a combination of all of these other things put together. And if we just open up that space to understand this, you know, and begin to see that the decisions that you make, you know, begin does not just begin and end with you.
Speaker 1:There is someone else making conscious decision that may facilitate or destabilize your work. And if we look at it from that interconnected spaces, the world will be better. I think so.
Speaker 2:Yes. And so, you know, I think that people are specialists. Yes. And they want to bring the thing that they specialize into the group that they think needs it. And I think that's where a lot of damage is done.
Speaker 2:You know, a famous insight or a well known insight from policy, and I can't remember, you know, who was the first to state it, but that the the policies of today fix the problems caused by the policies of yesterday. You know, the the things that we consider social problems today were are caused by are the answers from yesterday. That's true. And so and so to have the humility of saying that there's so much more going on than this one area that I specialize in. So, like, to give an example, like, the person who wants to bring transit cannot understand why someone would not want a transit stop.
Speaker 2:Mhmm. They think that they must they think that they must be naive. Mhmm. When in fact, it could be the transit stop proponent who's naive because they're not looking at all the all the various factors.
Speaker 1:Yeah.
Speaker 2:Someone who says, you know, I wanna bring a bike lane. That's my life's work. And someone says, no. I don't want a bike lane. And the response is, that's naive.
Speaker 2:No. The person bringing the bike lane is probably the one who is naive. You know, solving a food desert with a Whole Foods, you know, that seems like an obvious thing for the person who wants to bring the best, you know. Well, we don't just want any grocery store. We want a Whole Foods.
Speaker 2:But that's not looking at at the whole picture. And so I think this holistic approach is very complicated. It's also very difficult to politicize. You know, you see mayors in Chicago and and now in New York, in in that election trying to talk about a totality of issues that result in individual well-being. And it's very difficult to pursue that today.
Speaker 2:You know? That's the question. Yeah. You know, other nations have had a more holistic view of of the individual.
Speaker 1:That's right.
Speaker 2:A more societal view of the individual. The US in particular has been individualistic to a fault, had so much to learn from other nations. Many of those nations, its communities, you know, The US has ruined with this individualism. But I think it's very difficult to say, well, how do you help this individual who's sick? Well, you do it through transportation.
Speaker 2:You do it through grocery stores. You do it through sidewalks. You do it through green space. You do I mean, that's a very difficult thing to run for, you know, to to to to have a platform as as a mayor.
Speaker 1:That's true. Thank you for for that response. And we we are still on on showroom city and, you know, having conversation around that. But I I want to ask you a question. In by your profile, yourself, you always describe yourself as both a teacher and a student, and that's now, like, you know, puts you in a place of both teaching and learning of community sociology and how you use that to approach your work.
Speaker 1:I you know, while putting together this, I'm like, what do I hit him with? What question do I hit him with that would allow him to talk about his academic work? Right? It was the comeback to showroom city. And I got fascinated in your use of asset based community led development And, you know, in within this context, how can we use that to understand health equity generally?
Speaker 2:I think asset based community development is used quite often for health outcomes. I could because I think health outcomes are kind of the most social of our outcomes. You know, we could also put maybe education in that, you know, that it takes all of these determinants to create an educated child. But really, health is is something when you think about mental, physical, spiritual health, it's really something that brings together all aspects of of society. And so asset based community development is very, very straightforward.
Speaker 2:It looks at places from the lens of their strengths rather than their their deficiencies. And it says, what are the strengths of individual talents in a place? Mhmm. What do these residents do better than anyone? Or what what what can they do that others can't do?
Speaker 2:What are the physical assets of this place? Like, what are the what are the buildings? What are the plazas? What are the trees? Because, you know, some communities a 200 year old tree might be one of the most important meeting spaces in that community.
Speaker 2:You know? So what are the physical assets of that community? And then institutions, you know, what are the organizations that maybe some of them inhabit those important buildings. What are the organizations that that, are the strengths of that community? And the association.
Speaker 2:So things that are less formal, you know, residents that get together, around savings clubs or things like that, which may actually become more formalized in the future. And then culturally, what are the things that this community wants to retain and develop? So looking at a community through the lens of its strengths and moving forward from from there. That's the only type of development that can possibly be sustainable.
Speaker 1:That's true.
Speaker 2:Because that's the only type of development that respects what the current fabric is and weaves into that current fabric. Most other plans are to create a new fabric, and that's how development has operated around the world from the removal of informal settlements to the demolishing of public housing is the the declaration of we need a new fabric and you know, by elected officials and and appointed officials. And while that can seem like a very neat and clean answer and even a very profitable answer, if you are turning that land into something that makes more money and has higher rent, The societal costs of that, and I don't just mean the social costs of that, I mean the economic costs of that. Okay. So the costs of people who had social cohesion now no longer having social cohesion.
Speaker 1:Mhmm.
Speaker 2:The the cost of places that had networks of kids that knew each other and were growing up together, now not no longer having those relationships for kids. The those the businesses that catered to local people that allowed them to get discounts until they got paid or maybe not pay for something until payday, that being lost. Like, all of those things being lost increases issues like health problems, increases issues like crime that all have economic not to mention the lost productivity. The lost productivity of that local business being gone, of, people who were living close to potential livelihood, their their proximity to jobs being gone. So it's it's really comes down to the issue of short term economic costs and profits and long term economic costs and benefits.
Speaker 2:All of these things that we are doing for short term profits have long term economic costs.
Speaker 1:That's true. Thank you, doctor John, for coming to our show today. And for our listeners, I would invite you to stay with us, listen to the podcast. And if there's something that you learn out of it, please share to your audience as well and leave us a review. You are still listening to what about rural health because health isn't just about systems, it's about the people those systems are made to serve, how they make meaning of the places they call home, which sometimes are left behind.
Speaker 1:That is why we continue to ask this question, what about rural health? Let's create this together. Until next time, I'm still your host Chinasa Imo. Thank you. Bye.