By Sarah Baird, Kaiser Health News

SOMERSET, Ky. — It’s a sweltering Wednesday morning in Somerset, Kentucky, but at 9 a.m., the Pulaski County Public Library is already bustling.

From the community room, the hum of sewing machines echoes into the entryway, as the “pedal pushers” club stitch up their latest creations. An elderly man in sneakers examines a sign advertising a free nutrition workshop for October, which features a registered dietitian promising to help answer any and all questions about the “L.E.A.N.” lifestyle: Living Energized and Nourished. And waiting to greet the day’s walking group is its leader, volunteer Brenda Jo Hood. 

The group usually walks about a mile, taking a different route each day. In another week, Hood said she’ll introduce another library activity: chair yoga. “People have been really interested in it,” she said.

When most people visualize the day-to-day happenings at a public library, diabetes prevention courses, lectures on wound care and Zumba classes aren’t necessarily the first things that spring to mind. But for small town and rural librarians across Eastern Kentucky, health-centered activities are becoming every bit as common as checking out a book. 

“We partner a lot with our health department, because they’ve found people are more willing to come to the library to a program than to their facility or the hospital,” said Gwen Stivers, adult programs supervisor for the Laurel County Public Library in London, Kentucky. “People are hesitant to go into hospitals. They have a phobia, I think, about it. So, they come to us, and we’re more than happy to help them.” 

Working in conjunction with a local hospital, Stivers’ library each month offers learning lunches, an event that pairs a free box lunch with an hourlong lesson on a relevant health topic, from migraines to sepsis. The lunches, launched in 2014, see attendance as high as 40 people. Topics planned for 2020 run from urology to shingles. 

Just like everything else in public libraries, the health offerings are free.

Public health has taken a drastic hit in rural areas across America over the past decade, as local hospitals continue to shutter at a record rate, chronic health conditions skyrocket and drug addiction runs rampant.

In Eastern Kentucky, the number of primary care physicians is 26% lower than the national average and 21% lower than the rest of the state, according to a 2017 report from the Appalachia Regional Commission and Foundation for a Healthy Kentucky. Specialty physicians are even harder to find, with 59% fewer specialists in the region than in the nation as a whole.

What’s more, Eastern Kentucky’s dearth of health care professionals is compounded by a number of pressing community health issues, such as widespread hunger (a fifth of people in the region are food insecure, meaning they have limited or uncertain access to adequate food) and homelessness (a fourth of the students in Harlan County alone experience housing insecurity). Many towns are trying new approaches to public health education that are both trustworthy and accessible. That’s where public libraries come in.

“I really think libraries are going to be the institutions that people who work in a public health setting are going to naturally turn to and see as the perfect spot to do an activity that’s off-site or community-based,” said Noah Lenstra, assistant professor of library and information studies at the University of North Carolina – Greensboro and the director of Let’s Move in Libraries. “Librarians are going to be seen more and more as integral cogs in any [public health] effort that goes forward.”

But funding can be a concern. Librarians are constantly looking for ways to stretch their dollars to provide public health information, from asking experts to volunteer to getting creative with materials, said Lisa Lewis, president of the Association for Rural and Small Libraries, via email.

“The National Network of Libraries of Medicine have opened up grant opportunities for public libraries so that they can create public health hubs for their patrons,” she added. “But again, in rural and small libraries, often there is only one staff person who runs the entire library. Taking the time to write a grant is not always realistic.”

Some 200 people showed up to a health fair at Pulaski County Public Library last spring, said Ruth Thomas, the county’s reference librarian. Half a dozen health agencies attended to dispense information to the community.

Especially in small towns, public libraries serve as a neutral ground, allowing patrons to seek out information or attend classes that they might feel uncomfortable pursuing in a more traditional setting.

“I think libraries also take away some of the preconceptions that people might have,” said Ruthie Maslin, executive director of the Madison County Public Library. “It’s like the Zumba classes we do at the library, which are very popular.”

“But for a person who doesn’t think that they could do Zumba, or doesn’t feel comfortable going to say, a gym,” she said, “the library is still a neutral place where they don’t feel that pressure.” 

Libraries’ role as a public health resource in Eastern Kentucky is especially important for aging residents. According to the Cornell University 2013 Disability Status Report, a third of older Kentuckians (ages 65 to 74) have some form of disability, with rural areas being particularly affected by a lack of access to proper doctors, therapies and treatment options.

“The combined effect of outmigration of the young, aging in place, and high poverty rates is resulting in an aging population that is isolated and living on limited resources,” notes the 2015 Kentucky Institute for Aging’s “State of Aging” report about Eastern Kentucky.

As a result, when seniors or their caregivers are looking for a dependable, nearby source for health information, they turn to the local public library. The 2018 Laurel County Public Library senior fair featured presenters ranging from home health workers, to the Kentucky Office for the Blind, to veterans’ services.

“Public libraries, in a lot of places, are really becoming de facto senior centers, where they’re offering older adults a wide variety of services that go well beyond books or information or technology support,” said Lestra of the University of North Carolina – Greensboro, who notes that the range of classes runs from “memory cafes” for people experiencing dementia through pre-diabetes classes and beyond.

And in Pulaski County, librarians work daily to help seniors, who often lack both internet access and computer skills, retrieve their Medicare records online.

“They didn’t grow up in that digital era, and everything now is computerized,” Thomas said. “If they want a copy of their Medicare benefits and they call the Social Security office, the [Social Security office] is like, ‘You can get that off the computer.’ Well, they don’t even have a computer or internet, so a lot of times they then will say, ‘Well, you can go to the library.’”

And then there’s the opioid epidemic. Rural libraries have become outsized players in the fight for health information about addiction services across the country, including the region that has become an epicenter for the rise in opioid abuse: the “coal fields” (defined as Eastern Kentucky, Southern West Virginia and a handful of counties in Virginia, Tennessee and Ohio) of Central Appalachia.

In October 2018, biopharmaceutical company Emergent BioSolutions offered two free doses of the anti-overdose drug Narcan (the nasal spray version) to all 16,568 public library locations in the United States. The effort came on the heels of the Public Library Association announcing a new initiative to “collect and share knowledge and resources to support public libraries and their community partners in addressing the opioid crisis.”

At the Association for Rural and Small Libraries’ 2019 annual conference, Amy Grasmick of the Kimball Public Library in Central Vermont — another rural region hit hard by the opioid crisis — spoke on a panel devoted to how rural public libraries are addressing the opioid issue. At a recent library screening of the documentary “Heroin,” Grasmick partnered with the behavioral health program at a local hospital to help begin a conversation about addiction in her community.

“People showed up who might never have been seen before at the library to talk about their own family members with addiction,” said Grasmick, who keeps naloxone (the generic form of Narcan) on hand at the Randolph, Vermont, library.

“It feels to me like there’s still definitely a stigma for family members and individuals with addiction,” she said. “Where do you go to find support? Where do you go to find other people who are in a similar situation and not feel like you’re going to be judged? If there’s a place that people should be able to do that, I think that’s at a public library.” 

Walking around Somerset, Hood noted that the barriers to participation in health activities at the library often stem from self-consciousness.

“Whether it’s the walking group or starting chair yoga next week, I tell them, ‘Just come and try it!’ You don’t have to like it, but at least you tried. Just walking or doing the simple stretches that are part of the chair yoga class can help everything from fibromyalgia on down.”

There are, of course, limits to the range of health services that smaller libraries can offer. In poorer areas where the need for health care is most acute, there often isn’t enough money to provide all the services that people want.

“I think there’s a danger that the library cannot pick up all the slack for everything,” said Maslin of the Madison County Public Library, who is exploring the option of having a health department outpost in the library as well as the feasibility of a social worker on hand. “We can’t do that. We don’t have the resources.” 

And not every librarian is thrilled about their spaces taking on an ever-expanding role as community hubs. In a recent article in The Conversation, a nonprofit news site, Paulette Rothbauer, associate professor of library and information science at Western University in Ontario, Canada, took a hard look at what could be lost if libraries lose their focus on books, reading and literacy.

“One such consequence might be the disavowal of public librarians’ unique, professional knowledge base related to books and reading. Another might be the abdication of a mandate related to the promotion of reading as a social good,” Rothbauer wrote last month. “It is critical that libraries continue to be about books and reading.”

But as the community fiber of rural areas continues to shift, librarians and health officials expect the library will continue to grow as a nexus for reliable and nonjudgmental access to public health programs and information. 

“A lot of [urban librarians] will say, ‘Well, we don’t do that at our libraries,’” Stivers said. “And I say, ‘You don’t need to. You have all that stuff available in your community. We don’t.’”

Kaiser Health News, a nonprofit health newsroom whose stories appear in news outlets nationwide, is an editorially independent part of the Kaiser Family Foundation.