Training the Next Generation of Rural Health Leaders.
Training the Next Generation of Rural Health Leaders
The New England Public Health Training Center at BUSPH is partnering with the New England Rural Health Association to recruit a new class of healthcare providers and public health practitioners to a Rural Health Leadership Institute launching September 2026.
A “grey wave” is sweeping the United States, and rural New England is experiencing the most acute aging crisis in the country.
Maine, New Hampshire, and Vermont have median ages well above the 39.1-year national average—44.8, 43.6, and 43.6, respectively—a trend expected to intensify as the 65-and-older population is projected to surge nationwide. Rural communities will likely experience widening of existing gaps in access to transportation, limiting employment, education, and social participation and delaying healthcare.
To bridge the transportation gap and tackle other challenges facing the rural public health landscape, Patricia Janulewicz Lloyd, adjunct associate professor of environmental health, and Kathleen MacVarish, former associate professor of practice—both leaders of the New England Public Health Training Center (NEPHTC) housed within the Department of Environmental Health at the School of Public Health—partnered with New England Rural Health Association (NERHA) to establish the Rural Health Leadership Institute (RHLI).
Through an emphasis on mentorship, networking, and collaborative learning, the 8-week hybrid program aims to impart systems-thinking skills and leverage transdisciplinary teamwork to empower participants to address the unique health problems facing their rural New England communities.
“Our vision was to develop a flexible, practice-based rural public health leadership institute that integrated expertise in leadership, management, rural health, and adult learning,” says Janulewicz Lloyd. She and Madeleine Scammell, professor of environmental health, serve as co-principal investigators for NEPHTC, one of 10 regional training centers located at top universities throughout the U.S. focused on public health workforce development.
The 2025 RHLI cohort comprised 30 participants from all six New England states, representing diverse professional backgrounds including nursing, medicine, public health, social work, emergency medical services, and law enforcement. Divided into groups of six, the participants collaborated to address five categories of public health problems: the transportation gap, food insecurity, community mental health and substance use service needs, declining trust in public health, and the integration of public health to strengthen local emergency response systems.
“We felt that using real-world problem-solving over traditional didactic instruction would foster innovative and sustainable approaches to improving rural health outcomes,” Janulewicz Lloyd says.
Now, NEPHTC is recruiting its third annual cohort of rural healthcare providers and public health practitioners to the program. Participants will gather in person for RHLI’s launch at NERHA’s 2026 Rural Health Student Summit at Dartmouth Hitchcock Medical Center on September 12, and meet virtually on a biweekly basis through November 16, when they will reconvene at NERHA’s 2026 Rural Health Conference in Concord, NH for a grand showcase.
Daniel Merrigan, an associate professor of community health sciences and the founding director of NEPHTC, has spearheaded practice-based learning initiatives at SPH in one capacity or another for more than 40 years. He has served as the lead faculty member and a subject matter expert to RHLI since its inception and will return to help lead the 2026 cohort with Candice Bangham, senior project manager for NEPHTC.
“We want people to be able to undertake data-informed decision-making and action,” says Merrigan. To that end, RHLI aims to answer the fundamental question: What does our workforce need to know or be able to do to change the conditions that hold our community challenges in place?
Over the course of the program’s six virtual sessions, participants work in groups to draft problem and vision statements, identify stakeholders and resources, create communications strategies and data visualizations, and plan for roadblocks—culminating in proposals for sustainable, community-driven solutions. The exercise is theoretical in nature, but the goal is real: build the leadership capacity of New England’s rural health workforce.
Andy Lowe, the executive director of NERHA, recalls a time during the COVID-19 pandemic when it was possible that someone could be working as a staff nurse on the floor of a small hospital one day, and the next day, be chief nursing officer with little or no preparation.
“The benches are not deep in small rural providers,” says Lowe. “Hence, there’s a real need to strengthen the emerging leaders before they get thrust into positions of leadership.”
The timing of the 2025 cohort proved fortuitous. Shortly after the program concluded, the Centers for Medicare & Medicaid Services announced the Rural Health Transformation Program, a $50 billion initiative to help state governments modernize the healthcare delivery ecosystem in rural communities.
“I want our learners, our participants—I’d like to see these people being part of what’s resourced by some of that money,” says Merrigan. He hopes that as the RHLI network grows, alumni can serve as an ongoing resource to one another as they strive to apply what they have learned in their respective roles and communities.
Dr. Anais Ovalle, an infectious disease and international health physician at Dartmouth Hitchcock Medical Center, participated in RHLI in 2025 with the explicit intent to make professional connections as she works to establish a rural health equity track within the Leadership Preventive Medicine Residency Program at Dartmouth Hitchcock.
“I was trying to figure out who is in the rural health space, and what is the best way to get myself in the headspace to think about the problems uniquely affecting this community,” says Ovalle.
Her group investigated how sparse settlement patterns, aging populations, underfunded transit networks, and degraded infrastructure complicate access to healthcare for rural New England residents. After briefly considering an intervention involving self-driving cars—unpaved roads posed too many problems—Ovalle and her teammates developed an idea for a transportation collaborative that would coordinate regional transportation associations, councils on aging, local private transportation companies, community health centers, volunteer organizations, and healthcare providers to organize ride shares.
“Everyone had a different perspective—I think that’s one of the strengths of this program. We all brought our various life experiences and our technical expertise to try to figure out the problem and see what the most realistic solution would be. We realized that the most impactful thing you could do is something very small, and then connect the small things together,” says Ovalle. “I feel happy that I was a part of [RHLI], and I got to meet a lot of folks reimagining rural health.”
For more information on applying to participate in the 2026 cohort of the Rural Health Leadership Institute, please visit the New England Public Health Training Center webpage. Applications are due July 24, 2026.
