The Stories We Tell About Rural Health

Across this series, we’ve explored the stories told about rural communities. This episode examines how rural health is framed — and what those narratives reveal about who belongs, who gets overlooked, and who gets blamed. Sociolinguist Julie Sweetland of the FrameWorks Institute explains how language shapes public understanding of health, responsibility, and community, and why changing the story can change what solutions people believe are possible.

Learn more: Read FrameWorks Institute’s work on rural health framing, including Reframing Health Disparities in Rural America, Talking about Health Disparities in Rural Contexts, and Julie Sweetland’s writing and presentations on public health, language, and narrative change.

Rural Narratives is a project of Narrative Arts, a nonprofit media and storytelling organization working alongside communities to share stories that deepen connection, expand understanding, and strengthen public life in rural America. Learn more at www.narrativearts.org.

Transcript

SPEAKER_03 0:00

Is that you somehow transcend that place of I'm tired of being picked on to a place where you can demonstrate a reason to go forward, a reason that it matters, a reason that your community should have a chip in the game and should have their stories elevated. You know, it's it can't be just fighting against these ghosts. You gotta you gotta go somewhere else.

SPEAKER_01 0:35

Across this series, we've been talking about the stories that get told about rural communities, the stories that tell us who belongs, who gets overlooked, and who gets blamed. These stories don't just shape our perceptions, they shape policy, public health, and the kinds of solutions people believe are possible. Sometimes they even shape how communities see themselves. I'm Lena Hong. Welcome to Rural Narratives. Today's episode is about framing, not political spin, not messaging strategy, but the deeper stories that shape how we understand health, responsibility, and each other. I spoke with Julie Sweetland, a sociolinguist and senior advisor at Frameworks Institute. It's a nonprofit made up of social scientists who work with various people and groups to change how we talk about social issues like climate change and public health. They study the stories and assumptions people already carry with them. And what Julie researches helps explain something we've heard again and again throughout this series. Many of the biggest problems facing rural communities are often talked about as personal failures instead of shared conditions. When Julie studies how Americans think and talk about health, she says one pattern comes up again and again. In other words, health is often understood as individual responsibility. Drinking water every day, going to the gym, eating your fruits and vegetables. These are all decisions that we make. And we assume that everyone else has the same opportunities to make the quote unquote right choices.

SPEAKER_00 2:30

It's kind of a narrow picture on health, that health means the absence of illness. If you're not actively sick or injured, you're healthy, which, you know, is not completely wrong, but isn't as full of a picture of health. And then finally, health equals health care, right? That health care, that health is something that happens at the doctor.

SPEAKER_01 2:48

But health is shaped by so much more.

SPEAKER_00 2:51

Our bodies are in communities, our bodies are in wider contexts, and all of those places where our bodies go affect our bodies' health.

SPEAKER_01 3:00

Now we're getting to the things that you might not consider when you first think about what health means. Secure housing, access to transportation, a good paying job, whether you feel safe in your neighborhood, green spaces.

SPEAKER_00 3:14

People won't naturally go there on their own typically, but if you put that image in front of them, they're like, yeah, of course, right? Of course it makes sense that people who live in neighborhoods with sidewalks walk a little bit more than people without them. And then you need to connect all the way to, and that's a design choice we make in our communities, and it has effects.

SPEAKER_01 3:35

And our tendency to think narrowly goes beyond health. We also see it in how rural communities are understood. In research that frameworks conducted on how people see rural communities, Julie says they found two main ways of thinking.

SPEAKER_00 3:49

One mental model was rural dystopia. Backwards area, you know, no good jobs, poor housing stock, lack of opportunity, poverty, that sort of thing. And the other mental model was rural utopia. Clean, fresh air, beautiful vistas, people who just love each other, you know, close to God and country, um, simple people that have each other's backs and you know love the land and love their neighbors.

SPEAKER_01 4:22

She says both stories contain pieces of the truth, but neither tell the whole story.

SPEAKER_00 4:27

Both uh capture something about the reality of rural America, just like a model car captures something about a real car, but it's not the full thing, right?

SPEAKER_01 4:38

And those stories are pervasive, they're constantly being enforced in what we experience and consume in our everyday lives.

SPEAKER_00 4:45

People can hold them because they live there or because they've heard about it and gotten that model from entertainment and TV and culture and all the things. And she says part of the work is pushing back against these narratives. I think that the understanding that those models exist and that part of our work as advocates is to complicate them, navigate them, and help people understand that complexity of any situation, in this case rural America, is really important.

SPEAKER_01 5:15

Julie says framing matters because it shapes our inherent understanding of the issue. Take the issue of digital connectivity. In the United States, rural communities are among those who are less likely to be connected to the internet.

SPEAKER_00 5:28

So imagine advocates had framed the need for greater digital connectivity in rural America as only an individual benefit, right? That people need to be able to watch Netflix and surf the internet and get on social media.

SPEAKER_01 5:45

And if that's the story, broadband sounds optional. It's something that would be nice to have, but not necessarily a need. But Julie says advocates frame the issue differently.

SPEAKER_00 5:56

But as advocates really talked about digital connectivity as a form of participation in every, you know, in modern life, as an essential resource for education, for employment opportunities, for health and health care.

SPEAKER_01 6:12

And once advocates pointed out all the things that we need the internet for to participate in public life, it became easier to argue that entire communities were being left behind.

SPEAKER_00 6:22

And that most of us in America can take it for granted, or many of us in America can take it for granted, but there are whole swaths, right, of the nation that are left out. The issue itself didn't change, but the story around it did. That's really it's talking about the collective benefits, it's talking about fairness across places, and it's it's really making the point that things are uneven and unfair and showing what we can do about it.

SPEAKER_01 6:47

And Julie says sometimes the biggest shifts can come from very small changes in language. Like sometimes it comes down to who we imagine a problem belongs to.

SPEAKER_00 6:57

You know, if we can structure our sentences so we can say we and us rather than they and them. It's a small thing, but it has a big difference.

SPEAKER_01 7:08

Julie says the way that we talk about people can quietly shape who listeners believe belong inside a problem and who is imagined outside of it.

SPEAKER_00 7:16

You can say, you know, elderly people face social isolation. We need to have programs to serve them. You've set up this idea that older people are a separate category. But there's another way to tell that same story. You can also say we all need to be connected to communities as we age. We need to set up our communities for that for that ongoing participation. Well, now we're all aging, we all have this need, and we all need this system.

SPEAKER_01 7:44

And maybe that's the deeper point Julie has been making all along. Framing isn't only about persuasion, it's about whether we see each other as connected. Earlier this season, we spoke to Dee Davis, who runs the Center for Rural Strategies out of Kentucky. He told us that rural communities have to work to build new narratives.

SPEAKER_03 8:04

Is that you somehow transcend that place of I'm tired of being picked on to a place where you can demonstrate a reason to go forward, a reason that it matters, a reason that your community should have a chip in the game and should have their stories elevated. You know, it's it can't be just fighting against these ghosts. You gotta you gotta go somewhere else.

SPEAKER_01 8:40

And Julie says part of that work starts with the stories we tell about one another.

SPEAKER_00 8:45

There's a lot of work that we can do as advocates to to reinforce the fact that we're all in this together, that none of us, you know, are on on our own, none of us do anything alone, and and to to remind people of that as well.

SPEAKER_01 8:58

I'm Lena Hong. Thanks for listening to Rural Narratives.