The Legacy of James D. Bernstein: Part 1

“Don’t tell the community what they need.” 

The Foundation for Health Leadership and Innovation’s (FHLI) founding director, James (Jim) D. Bernstein, was a rural health pioneer. Throughout his 35-year career, he led efforts to support community-driven care for low- and moderate-income, isolated, and underserved populations.  

As the founder of the first state office of rural health in the United States, Jim’s work has impacted communities across the country. He believed:  

  • Everyone has a right to health care.    
  • Care should be respectful, effective, and efficient.    
  • Each health care system belongs to the communities where people live and providers practice.  

Today, FHLI continues to work to ensure Jim’s legacy of innovation and approach to community-centered work endures. You can learn about his experience and approach, the history of the North Carolina Office of Rural Health, and the evolution of FHLI in this three-part blog series. 

Peace Corps, U.S. Public Health Service, & Global Community Health Fellowship  

Jim earned his BA in Political Economy and Sociology from Johns Hopkins University. Then, he served a two-year term with the third class of Peace Corps volunteers as a high school English and gym teacher in Morocco, where he also met and married his wife, Sue. When he returned, he earned his MA in Hospital Administration from the School of Public Health at the University of Michigan.  

Upon completing graduate school, he entered the U.S. Public Health Service and was awarded a Global Community Health Fellowship in 1969. His studies and experiences in the Peace Corps sparked a keen interest in and passion for working with rural communities.   

Community-Based Rural Health Care in North Carolina 

After serving as Administrator for the Sante Fe Indian Hospital and Service Unit Director for health facilities, a series of events led Jim to meet with Dr. Cecil Sheps, Director of the University of North Carolina at Chapel Hill Health Services Research Center (for whom the UNC Sheps Center is now named). Jim began his first community-based health project in the state through this connection.  

The first community he built a relationship with was Walstonburg in Greene County. The rural, predominantly Black community had no doctor, and there was still KKK activity there at the time. Yet, Jim earned the community’s trust and collaborated with the biracial community board to drive solutions and decision-making. The model subsequently followed by the Office of Rural Health began with this work in Walstonburg.  

The model they implemented involved a physician assistant, family nurse practitioner, or another trained provider supervised by a nearby physician who supplied clinical support and backup when needed. The community-based providers were trained to do the same essential functions as physicians and returned to deliver health care to rural communities with none.   

Dr. Edgar Beddingfield, a past president of the North Carolina Medical Society, became the first physician to implement this approach. He supervised Donna Shafer, the first nurse practitioner to serve the Walstonburg community and a close friend of Jim and his wife Sue. You can learn more in this dedication to Jim by Donald L. Madison, MD published in the North Carolina Medicine Journal [PDF]. 

Entrance to Walstonburg, NC, the first community Jim built a relationship with

The First Office of Rural Health  

UNC leaders pitched North Carolina’s governor the idea of a statewide government program to help develop rural health clinics. In 1973, Jim established the North Carolina Office of Rural Health (NCORH)–the first in the country. 

Jim faced many obstacles while getting the program off the ground. It required policy change to enable providers to practice within the full scope of their training and enough acceptance from physicians and medical examiners who pushed back on the whole idea. Even in those early days, Jim understood that community buy-in and investment were essential. 

In addition to his knack for building trust with community members, Jim had a keen ability to hire good people from a wide range of backgrounds dedicated to the cause. By collaborating closely with a hand-picked team dedicated to supporting and addressing the needs of rural and underserved communities across the state, he laid the foundation for creating local county health centers throughout North Carolina. 

One of his many gifts was his ability to connect with people across lines of difference. He developed strong, trusting relationships wherever he went—from the heart of rural communities to the halls of Congress.     

Working alongside rural community and health leaders, he helped establish a roadmap for designing and implementing innovative solutions to address even the most complex health challenges. According to those close to Jim, he saw challenges as opportunities for change. 

Under his leadership, NCORH supported groups of local citizens in establishing nearly 85 rural-community-operated health centers in North Carolina. To do this, Jim and his team traveled to each community to listen and learn. They operated on a few fundamental principles: 

  1. Act only upon request 
  2. Never tell the community what they need 
  3. Be present and listen 

If people wanted a health care center, they assembled the necessary resources, uplifted local leaders, and ensured community ownership during the design process and ongoing operations. 

Jim Describes NCORH’s Philosophy & Approach 

We weren’t going to run anything… They, the community, would be primarily responsible, and we would provide the pieces that they couldn’t put together themselves, as well as the know-how to make it work. 

Nor were we going to push ourselves or come out from Raleigh saying, ‘We’ve got this new idea for your community, and this is what you should do: You should have a health center; you should have a nurse practitioner; it should be run by the community…’ We acted only where we had a request.  

We might get a call saying, ‘We haven’t had a doctor in a long time, and we’re interested in just talking to you.’ Then we’d send a staff person out. So that was another principle: Don’t tell the community what they need. If they don’t want what we have, that’s fine. The next thing was to be able to put together all the pieces that were needed to do the job.  

So, if a community wanted to do it, we had the ability to make it happen. And the most important part of that was our field staff… the people who interfaced with community folks. Our philosophy was, we go to them.”  

Today, NCORH provides funding, training, and technical assistance to improve the quality, accessibility, and cost-effectiveness of health care in rural and underserved communities. 

In part two of this series, we will dive into the personal impact of NCORH on rural health providers and how Jim acted as a mentor for rural health leaders across the country.

Related content