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Building Community Trust: A Rural Health Department's Journey Toward Health Equity.

Lisa A Campbell1, Mary K Canales2, Keely Spiser3

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|March 9, 2026
PubMed
Summary

Rural health departments can advance health equity by addressing political barriers and systemic inequities. This community health assessment (CHA) highlights strategies for building trust and elevating marginalized voices in public health.

Keywords:
community health assessmenthealth equitylessons learnednurse‐ledpoliticsrural health departmentsystemic racism

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Area of Science:

  • Public Health
  • Health Equity
  • Rural Health

Background:

  • Rural health departments face unique challenges in advancing health equity, exacerbated by political polarization and the COVID-19 pandemic.
  • The pandemic underscored the complex relationship between public health, political dynamics, and community trust.

Purpose of the Study:

  • To document how a rural local county health department (LCHD) navigated political barriers and systemic inequities.
  • To assess the process of conducting a community health assessment (CHA) during and after the COVID-19 pandemic.

Main Methods:

  • Mixed methods data collection (2021-2023): bilingual community survey, listening sessions (English/Spanish), informal interviews.
  • Health equity lens applied to analyze power dynamics, systemic barriers, and community health perspectives.

Main Results:

  • Survey data indicated disparities in health concerns and perceived barriers between Hispanic and non-Hispanic respondents.
  • Healthcare access emerged as a significant barrier exclusively for Hispanic respondents.
  • Lessons learned from the CHA process are detailed.

Conclusions:

  • Strategies used in the CHA demonstrate how rural health departments can promote health equity amidst political challenges.
  • Key success factors include linguistic considerations, strategic coalition-building, and amplifying marginalized voices.
  • The LCHD successfully built community trust despite political resistance by adapting language and forming strategic coalitions.