Dean Barbara Rimer from UNC’s public health school brought researchers to present to members of the House Health Committee Tuesday.

By Rose Hoban

Health care has been one of the most contentious political issues in the past few election cycles, from debates over parts of the Affordable Care Act, such as Medicaid expansion and the individual insurance mandate, to arguments over how best to combat obesity and opioid deaths.

But Barbara Rimer, dean of the UNC-Chapel Hill Gillings School of Global Public Health said she thinks there are ways to find common ground to think about public health. Rimer came to the legislature this week to make the case for the work done by her institution, which has been named as the top publicly-funded public health school in the country.

“We are, really, a significant resource for the state of North Carolina,” Rimer told members of the House Health Committee on Tuesday morning. “We see ourselves as the people’s school of public health, we’re not the Democratic school of public health or the Republican school of public health.”

Rimer and several researchers gave short presentations to lawmakers about their research and the value of the school, which Rimer said has provided North Carolina with thousands of jobs, hundreds of thousands of dollars of free student labor, and has been the driver behind companies large and small.

She pointed to large, multibillion dollar contract research organizations such as Quintiles, started by former faculty member Dennis Gillings as well as small, social innovation companies such as Aquagenx, which manufactures a low-cost water treatment system.

“[Aquagenx] was started by students,” Rimer said.

Rural hospital emphasis

“You can see there’s a real and persistent gap in mortality [between urban and rural communities] across the last 15 years” of between 6 and 10 percent, said health economist Mark Holmes, who has been looking at what’s driving the mortality increases in rural communities.

“The many reasons behind this is that rural communities tend to be older, poorer, isolated and generally have lower health care infrastructure in terms of physicians, hospitals,” he said. Holmes noted that across the country, about 12 rural hospitals have closed per year since 2005.

“You can see that most of those [closures] are in the South, even though there are fair number of rural hospitals in the Midwest that are not seeing nearly the closure rates that we see in our neck of the woods,” Holmes said. He told legislators that North Carolina sits squarely in the “distress belt” of rural hospital survival.

Graph shows higher age-adjusted mortality for rural areas than urban.
Data show that rural areas experience poorer health on almost every measure, and have less healthcare infrastructure to support residents. Data, chart courtesy: Mark Holmes

He pointed to research and technical assistance provided by the school to help those hospitals find ways of keeping their doors open.

“We all understand that when a community loses a hospital what that would be in terms of access to health care and the physicians and from a health care structure,” he said. “But there are real economic effects there, the hospital is often the largest or second largest employer in the community.”

He said his research has found when a county loses its hospital, per capita income in the area drops by about $1,300.

“That’s a real effect that the whole community feels when that hospital closes,” he said.

In a series of questions, Rep. Darren Jackson (D-Raleigh) tried to pin down Holmes on the relationship between Medicaid expansion and rural hospitals being able to avoid closure.

“Rep. Jackson, you’re convinced I’m putting myself in a box, aren’t you,” Holmes said, to laughter in the gallery. But when pressed, Holmes said evidence suggests there’s a “slight to modest improvement in rural hospitals’ finances in the Medicaid expansion states.”

Disparities discussion dominates

Faculty member Wizdom Powell told the mostly male lawmakers about how men, despite having “more economic standing, privilege and power, these privileges rarely translate into better health or better health outcomes.”

Powell outlined how women live longer than men, and how, of men, minority men have the worst health outcomes of any group in the U.S. She cited many reasons for these disparities.

“Men tend to delay health screenings, and they wait longer to seek acute and chronic medical attention,” she said. “Males are also reluctant to disclose physical and health problems. Many of you have probably heard the term, ‘Boys don’t cry…’ those kinds of messages boys receive across their lifecourse have a significant impact on how they utilize health care services.”

Injury prevention researcher Chris Ringwalt got many questions from lawmakers in response to a presentation on the controlled substances reporting system. The system is a tool for physicians to track how many painkiller prescriptions patients are receiving from all of their doctors.

“We have identified metrics that would enable the [North Carolina] Medical Board to screen for providers who may be potentially abusing the system,” he said. He told the committee the Board is using his research to work on policies to investigate and discipline these “high-flying” physicians who write lots of narcotics prescriptions.


Rimer told of how the chancellor from UNC Asheville had contacted her about creating a new collaborative public health program to focus on addressing public health issues in the western part of the state.

The UNC School of Medicine has created similar such collaborations with UNC Asheville and with UNC Charlotte, Rimer said. The first students are slated to start in fall 2018.

After the meeting she elaborated that the program could be an important model.

“There are states that now have multiple schools of public health,” Rimer said. “We’re all competing for the same students and faculty and grants and if we expand infinitely it’s not going to be good.”

“There are other ways besides investing in infrastructure,” she said of the program, which would be jointly offered by her institution and UNCA.

Rimer said she had brought her people to Raleigh simply to educate, not to ask for anything.

Rep. Greg Murphy (R-Greenville) said Rimer had invited legislators to Chapel Hill last week, but some weren’t able to attend. So the lawmakers invited Rimer to come downtown.

“It’s good for other members of the panel,” he said. “Everybody comes from a different background and here we are making health policy decisions and if people are not educated on what’s actually going on with health policy, then it’s all moot.”

Creative Commons License

Republish our articles for free, online or in print, under a Creative Commons license.

Rose Hoban is the founder and editor of NC Health News, as well as being the state government reporter. Hoban has been a registered nurse since 1992, but transitioned to journalism after earning degrees...