Mr. Speaker:

Growing up in rural Prince Edward County, I never wondered why my mother drove my brothers and me from Farmville to Richmond to see the pediatrician or dentist for checkups. I also never asked why many of my friends rarely, if ever, had any type of checkups. And it just seemed like another trip to Richmond when I stayed with my grandparents there while my mom delivered my youngest brother at a Richmond hospital instead of the one in Farmville.

With the benefit of some years of perspective and now having lived in several other parts of Virginia, I eventually realized that my health care experience in Prince Edward County was atypical for most people living in rural areas who need access to health care services. My legislative experience through various health-related committees, boards, and commissions has also exposed me to a troubling reality: most people living in rural Virginia have a shorter life expectancy than those living in areas with better access to health care. That is an egregious disparity, and I know this is one of the reasons you took the initiative, as your first action as Speaker of the House, to create the Select Committee on Advancing Rural and Small Town Health Care.

Per your direction in creating the committee and naming me as chair, our members have traveled across the Commonwealth to hear from health care providers and citizens. From Southwest to Southside and the Eastern Shore, we visited beautiful parts of Virginia but saw areas that sorely lack the health care services that all Virginians should be able to access. As you noted in your letter creating the committee, rural hospitals have been closing at an alarming rate. We also have seen that the statewide shortage of health workers is particularly acute in rural areas. And even where rural residents have a health care provider available, many people lack transportation to doctors' appointments and dental check-ups. The latter challenge is particularly concerning because pregnant women and their babies in rural areas face higher mortality rates when mothers cannot get to prenatal and postpartum appointments.

This report outlines our committee's recommendations based on the information we collected at our meetings in rural areas. It also highlights the excellent work on these topics being done in parallel with our efforts by the Virginia Rural Health Association, State Office of Rural Health with the Virginia Department of Health, Virginia Department of Medical Assistance Services, Joint Commission on Health Care, Virginia Health and Hospital Association, and the Black Maternal Health Legislative Summit.

The report organizes our recommendations around six areas of focus: health workforce, maternal health, dental care, obesity, telehealth, and transportation. The attached appendix briefly summarizes each recommendation and indicates whether a bill and/or budget amendment would be required for each recommendation.

While many of our rural health care recommendations should benefit all areas of Virginia, the issues we are addressing are more severely impacting people in rural areas. For example, I have constituents in urban, suburban western Henrico County who suffer from obesity, but we know that obesity is much more common and life-threatening in rural areas. We have included recommendations to address the rural area obesity crisis, and those same recommendations, if adopted by the legislature, should benefit people across the Commonwealth.

There are even more rural health care issues that we have not addressed here due to time limitations or because other state entities are already focused on them. We must stress, however, that these different areas of need, including mental health, opioid addiction, pharmacy deserts, and heart disease, are critical health care issues in rural areas and also deserve the Commonwealth’s continued focus and action.

I want to thank my fellow committee members and staff who traveled the state with me and have provided invaluable input with this report. I also appreciate our meeting hosts across Virginia and the excellent set of presenters we had throughout this process.

The committee’s work is done only to the extent that we are providing the requested recommendations. We and the entire legislature have much work to do to implement the recommendations in coming legislative sessions, and we need to continue focusing on rural health care's challenges.

Please share any questions that you may have about the recommendations. I welcome the opportunity to provide a briefing or related presentations of our work.

Sincerely,

/s/ Rodney T. Willett
Chair, House Select Committee on Advancing Rural and Small Town Health Care