When we talk about transforming health in rural America, the conversation usually starts in the United States. But maybe it shouldn’t.
For decades, the Johns Hopkins Center for Communication Programs has partnered with communities around the world to address similar challenges, often in places that at first glance, look very different from the United States. Rural communities in Nigeria. Indigenous regions in Guatemala. Remote mining areas in Guyana.
On the surface, the settings could not be more distant. But the challenges often rhyme: limited access to care, workforce shortages, low trust in institutions, and social and cultural norms that shape whether people seek care at all. These are the kinds of challenges addressed through social and behavior change approaches – efforts that focus not only on services, but on the social, cultural, and behavioral factors that shape health decisions.
In parts of northern Nigeria, for example, family planning services were available but unused. Social norms and gender roles made it hard for women to seek care outside the home. Rather than building more clinics, CCP-supported programs partnered with community members to bring services closer to women and to deliver care in ways that fit daily life.
In Guatemala, CCP nutrition work centered mothers and grandmothers as the people who shape childcare. Peer groups, radio stories, and neighborhood partnerships helped shift everyday habits around feeding. A grandmother in one village described learning a simple feeding practice that helped her grandchild gain weight and stay healthier, showing how small, community-rooted changes can have real effects.
In mining towns in Guyana, many workers did not see malaria as preventable and relied on informal remedies. As a result, preventable illness remained common. Written pamphlets had limited impact where literacy was low.
So, CCP teams and partners worked with trusted community members, such as shopkeepers and barbers, to share information using visual tools and practical, peer-to-peer communication that reached people more effectively.
These approaches have delivered measurable results in many settings: contraceptive use rose in selected programs, child nutrition indicators improved, and malaria cases fell where community-centered messaging and services were scaled. The key is adaptation.
Programs start by listening to local people, testing small changes with trusted partners, and scaling what works rather than imposing a one-size-fits-all model. These efforts also are supported by knowledge management practices that capture lessons, adapt them across contexts, and ensure they inform future programs.
While the contexts differ, the underlying principles – trust, access, and relevance – are directly applicable to rural communities in the United States. Those same ideas already show up in the United States, including in communities facing barriers to care.
The opportunity now is not to invent new tools. It is to use the ones that have been tested by CCP and others: listening to people first, designing programs around how they actually live, working with local leaders and peers, and using simple, trusted ways to share information. These models also build local systems, skills, and networks, so improvements can be sustained and adapted after initial funding ends.
The new federal Rural Health Transformation Program in the U.S. is directing roughly $50 billion toward rural health system redesign over the next several years. That funding could support community health workers, mobile and pop-up clinics, local health communication campaigns, and grants that require community co-design and evidence-informed approaches. A practical next step for funders and policymakers is to set aside money for pilot projects that partner with local leaders and to require community co-design in grant criteria.
Rural America is not Nigeria, Guatemala, or Guyana. Contexts differ, and approaches must be adapted, not copied. But the barriers are familiar: distance, distrust, limited resources, and social norms that shape behavior in ways formal systems often miss. And so are many of the solutions.
The path forward has already been mapped by CCP and others in places around the globe through approaches that prioritize listening, trust, and connection between communities and health systems. Those proven techniques can and should be adapted for rural America.
The tools are already here. The challenge is deciding how to use them.
Debora B. Freitas López, MS, is the executive director of the Johns Hopkins Center for Communication Programs.
