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Rural Health Information Hub

May 15, 2014

An Interview with Lisa Davis

by Beth Blevins

Lisa DavisLisa Davis joined the Pennsylvania Office of Rural Health (PORH) in 1994 as its first full-time staff person. After a two-year hiatus, she came back to PORH in 1999 to serve as its director, a position she still holds. Prior to PORH, Davis worked with schizophrenics in community-based mental health programs and in federally-funded programs to help vulnerable populations find employment.  She volunteered for almost two decades as an advocate for the prison population and worked at the county prison as a volunteer and as a paid intern during graduate school.  Before going to graduate school, she was a coordinator of international research in the Department of Meteorology at Penn State.

Davis serves on a number of national and state boards of directors, commissions, advisory councils and committees that address rural health policy, rural development and special populations. Among her national activities, she is the co-chair of the National Organization of State Offices of Rural Health (NOSORH) Policy Committee and sits on NOSORH's Board of Directors. She is the Pennsylvania representative to the Appalachian Regional Commission's Health Policy Advisory Committee and the Mid-Atlantic Telehealth Resource Center.  In the state, she is the chair of the Legislative Committee for the Pennsylvania Rural Health Association and serves on numerous boards for state agencies and organizations such as the Pennsylvania Department of Health.  Her past awards include the NOSORH Distinguished Service Award, the state rural health association's Outstanding Leadership Award, and the Award for Individual Contributions to Public Health from the Pennsylvania Public Health Association.  Her office also received the NOSORH Award of Merit.

Davis earned a bachelor's degree in sociology/psychology from Clarion University and a master's degree in health administration from Penn State.  A lifelong resident of Pennsylvania, she lives in Boalsburg with her husband and daughter.  In her spare time, she entertains, attends her daughter's sporting activities, and tries to get a few minutes of sleep in between. (For more on Davis, see her Penn State Biography page).

What are some of the big rural issues in your state right now?

There are more than a few issues in the state that affect rural communities:  access to healthcare providers, access to payment mechanisms and access to transportation.  About 10 percent of our population is uninsured and although that has been addressed somewhat by the Affordable Care Act, a good number of the newly insured are in the metropolitan areas.  As a state that has not expanded Medicaid through the Affordable Care Act, it's estimated that Pennsylvania will continue to have about 700,000 who will remain uninsured.  That's a challenge for all of our healthcare delivery systems and for safety net providers, just as it is in many states.

Hydraulic fracturing or “fracking” in the Marcellus Shale is an issue that has affected a large part of the state and, for a time, there was no conversation I had that didn't end up about fracking. The Marcellus Shale lies under about 95,000 square miles in Pennsylvania and is the largest source of natural gas in the United States.  Although gas companies knew for years that the gas deposit was there, it wasn't until Penn State developed the technology to get at the gas that drilling began in earnest.  In communities where fracking occurs, it affects every part of society.

Fracking requires a tremendous amount of water to cool the drills and most of the water is trucked in…and then the contaminated water is trucked out.  The huge increase in truck traffic on rural roads has been an issue—the noise, public safety issues around increased truck traffic, and the conditions of the roads, which deteriorate under the weight of all those trucks.  A friend of mine who lives in a rural county that has experienced tremendous drilling activity counted 125 water trucks in one hour while she was out jogging.

There's the issue of land leases.  Penn State Extension got out in front of all of this—when drilling companies were negotiating leases with landowners—and helped to educate landowners about drilling rights, expiration dates, and drafting wills and transferring wealth.

Drilling also has had an impact on affordable housing.  Many of these counties are economically stressed with families struggling to find decent homes.  The gas companies can afford to sign long-term leases at high prices, leaving few options for permanent residents with low incomes. Some companies have built hotels and mini apartment complexes for workers.

We've been hearing from some of the primary care clinics that they were seeing higher numbers of the uninsured. But it's hard to tell if that is directly related to Marcellus Shale drilling since it is hard to connect patients directly or indirectly with drilling activity.  That's especially challenging with those who work for contractors and sub-contractors.

There also are anecdotal reports about higher rates of STDs, pregnancy, prostitution, and drug abuse.  One very rural county reported that their murder rate had doubled—suggesting it was related to fracking.  I was part of a research group at Penn State that looked into the effects of drilling in four counties in the state that had high drilling activity; we tried to assess the impacts on demographics, housing, crime, education, economic development, agriculture and health care.  We found that, in some cases, it is easy to correlate changes to drilling activity but for other topics, it is very challenging to do so—and to demonstrate a cause-and-effect relationship.

And in many communities, the gas companies have tried to be good neighbors and have put a lot of money into road repair and community infrastructure.  One company gave very generously toward the building of a new Critical Access Hospital this last year.  So, for every topic related to drilling, there is an argument and a counter-argument.

Your SORH employs a farmworker protection specialist—perhaps the only one of its kind in the country. What needs does this program address?

About 10 years ago, the Pennsylvania Department of Agriculture (PDA) asked if my office could develop a technical and compliance assistance program on the Environmental Protection Agency's Worker Protection Standard (WPS) for agricultural producers.  These standards regulate how pesticides for agricultural production are used and stored so as to reduce the likelihood of pesticide exposure.

Jim, our rural farmworker protection specialist, travels about 25,000 miles a year around the state visiting agricultural production sites that fall under WPS.  He provides compliance assistance to growers on issues such as signage, the use of personal protective equipment, record-keeping, pesticide storage, etc.  He also distributes videos that have been developed for specific sectors of the Ag industry (like orchards, Christmas tree growers, and mushroom growers).  His purpose is to help the growers do the right thing so that when they are inspected by PDA, they can pass with flying colors.  Jim also has become a one-stop shop of information for the producers on agricultural safety programs, other resources in the state that are Ag-related, and he has become very familiar with the ACA and the Health Insurance Marketplace so that he can be a source of information to farmers needing health insurance. They also ask him questions about other laws and regulations related to their specific production site.

Are there any other SORH programs you would like to brag about?

I'd like to brag about everything that we do, but that would take up too much space!  We deliver great continuing education programs, including the only migrant and immigrant farmworker health conference in the state; we have terrific partnerships across Pennsylvania, in the northeast region, and nationally that help us do great work; and, through our Flex program, we have initiated a data-driven population health initiative in central Pennsylvania.  We also have been able to engage in a wide range of research efforts that have added to the knowledge base in our office and in the state.

Before you worked for the Pennsylvania SORH, you worked in a prison. How did you end up there—and what did you do?

My first job out of college was working in a community-based residential treatment program for schizophrenics.  And then, through an agency funded by federal job training partnership funds, I worked in local economic development.  It's how I got interested in prison populations. I was invited by the Pennsylvania Prison Society to go to the county jail and talk with guys about options for employment after release.  It was the first time I'd ever been to prison and I became very, very involved in the local chapter of the society.  It was a population that I thought was in need of support and advocacy and I knew a lot of guys in our county prison because many of them had been clients of mine when I worked in the community-based residential program.

Every Tuesday night for 12 years, I went into prison as a volunteer.  I went to graduate school because I wanted to work in prison health administration.  My graduate program required a summer internship so I did mine at the county prison.  I very quickly discovered that being there from 9:00 am-5:00 pm Monday through Friday was really different than being a weekly volunteer. Even though I had known some of the inmates for more than a decade, they tried every trick in the book.  It was like I didn't know them—or anything at all about working in a prison.  The final straw came later that summer when a local woman, who was a pillar in the community, was brutally murdered in broad daylight on the side of the road by a local guy who wanted to impress a girl.  The next morning when I came to work, he was sleeping like a baby in solitary confinement.  I thought—that's it; I'm done.  I believe that everyone has the right to dignity and respect but that was too much.

However, I think that my time working in prison helped foster a desire in me to advocate for those without a voice and for vulnerable populations.  And it made me absolutely grateful to have been offered a job in rural health.

Why is advocacy important to you?

I'm not sure that there was any specific trigger growing up, but I always felt that I was very fortunate and had been given, just through the luck of the draw, a life that was full of opportunities.  I am the only child of a single parent who, when I was growing up, worked full-time and went to school full-time.  At a really early age, I was responsible for running the household since she was pretty busy.  I always felt that I was a really valued part of keeping our lives going and that was a very good feeling.  I also saw first-hand that hard work paid off and learned that if I worked hard enough, almost anything I wanted to achieve was within my reach.  Not everyone has those choices.

How do you apply that interest in your present work?

I am part of a group in my county that started, in 1995, a volunteer coalition that supports mammograms for the un- and underinsured.  Whenever I start to whine about my life, I listen to the stories of the (mostly) women who call for a mammogram.  Unemployment.  Illness. Homelessness.  You name it.  And many of them are facing a potential cancer diagnosis.  That makes me shut up in an instant and remember to be grateful for what I have.

What about working in rural health most appeals to you?

There are several things.  First, I think that access to quality, affordable health care is a right, not a privilege, so it is gratifying to be able to have a voice in that issue.  Second, I have the chance to work with some of the smartest and most talented people in my state and across the nation who are passionate about advancing rural health and who always teach me something.

You are a lifelong resident of Pennsylvania.  What do you like about living there?

I was born and raised in Pittsburgh. I think that having lived in the state my entire life helps me be an effective advocate.  We are the Keystone State and we played so many important roles in shaping this country.  I love all of the wild and crazy nuances that every corner of this state has—I can't imagine living anywhere else.

Opinions expressed are those of the interviewee and do not necessarily reflect the views of the Rural Health Information Hub.

Back to: Spring 2014 Issue