Key Frameworks

High-Performing Rural Healthcare Systems

The RUPRI Health Panel envisions affordable, accessible healthcare for rural residents through a sustainable health system that delivers high-quality, high-value services. A high-performing rural healthcare system informed by the needs of each unique rural community will lead to greater community health and well-being.

The RUPRI Health Panel recommends a range of alternative approaches to achieve a high-performing rural healthcare system, categorized in the following way:

    1. Community-appropriate healthcare system development and workforce design.
    2. Governance and integration approaches.
    3. Flexibility in facility or program designation to care for patients in new ways.
    4. Financing models that promote investment in delivery system reform.

Comprehensive Rural Wealth Framework

The most well-known measures of wealth (per capita income, median household income, and GDP), are limited in their ability to comprehensively measure holistic well-being. As a result, the Comprehensive Rural Wealth Framework has emerged as a powerful, comprehensive, and dynamic approach to more fully understand not only the assets and opportunities rural communities and regions hold, but also the challenges they must confront in achieving development and sustainability. In short, this framework seeks to measure what is valued, rather than to value what is measured.

The framework was built upon the earlier work of other scholars and was pioneered by RUPRI. The approach centers around two premises:

Central Premise #1: Comprehensive wealth must be the focus of well-being, whether considering individuals, households, neighborhoods, communities, regions, countries, or the global community.

Central Premise #2: Comprehensive wealth is the stock, or value, of all assets minus liabilities; our well-being depends on the benefits that flow from these various assets. Understanding the distinction between stocks (assets) and flows (benefits received from assets) is essential in understanding the power and importance of the framework.

Learn more about the principles of this framework and the eight capitals or types of wealth.

Eight Capitals

8 Capitals or Types of Wealth
The eight capitals or types of wealth include financial, intellectual, human, social, cultural, political, physical, and natural capital. A description of each type is found below.

The Comprehensive Rural Wealth Framework incorporates eight distinct types of assets. When taken together, these capitals represent a robust and comprehensive measure of both tangible and intangible wealth, and they create the basis for assessing current well-being, as well as improving the future.

  • Financial capital—The stock of money and other liquid financial assets (e.g. stocks, bonds, and letters of credit) that can be readily converted to money.
  • Intellectual capital—The stock of human knowledge, innovation, and ideas embedded throughout a society. Includes intellectual property (e.g. patents and copyrights) as well as common knowledge.
  • Human capital—The stock of productive capabilities of the individuals in a population, embodied in the education, skills, talents, and health status of the people.
  • Social capital—The stock of trust, relationships, and networks found in civil society. Social capital can be held by individuals as well as groups and organizations.
  • Cultural capital—The stock of practices, values, and sense of identity embedded in a society. Cultural capital is held by individuals and groups. Tangible examples include works of art, architecture, monuments, and places of significance. Intangible examples include beliefs, traditions, and practices that distinguish and identify groups of people and their values and identity.
  • Political capital—The stock of influence, power, and goodwill held by individuals, groups, and organizations that can be held, spend, or shared to achieve specific goals.
  • Physical capital—The stock of built assets, including equipment, buildings, roads, bridges, telecommunications networks, and other types of physical infrastructure.
  • Natural capital—The stock of resources provided by nature, including clean water, clean air, climate, land, flora (forests and vegetation), and fauna (wildlife).

The Comprehensive Rural Wealth Framework is based on the following eleven principles:

  1. The flow of benefits from wealth can either be consumed or invested. Only the latter increases future stocks of wealth.
  2. The framework recognizes both economic (e.g. financial capital) and non-economic assets (e.g. political capital).
  3. The framework recognizes assets for which traditional markets exist (e.g. physical capital) and assets for which that is not the case (e.g. social capital).
  4. The eight capitals can be thought of individually, but they are often inter-related, sometimes complementing and sometimes substituting one another. Furthermore, the greatest impacts typically occur when the potential synergy across these capitals is recognized and catalyzed.
  5. Some assets are mobile (e.g. human capital) and others are not (e.g. most types of natural capital).
  6. Certain place-based or non-mobile assets may be owned by local residents, or by those outside the locality, and that property rights determine the distribution of the benefits that flow from these assets. Absentee ownership of natural capital, for example, may impact the wealth of a community very differently than would local ownership.
  7. The framework includes both public and private assets, and recognizes that some assets may be primarily owned and controlled by individuals (e.g., private land), while others may be primarily publicly controlled (e.g. highways or airports).
  8. The framework recognizes that certain non-mobile assets (e.g. recreational areas or national parks) have value to both those who live nearby and those who live far away.
  9. The framework recognizes and makes explicit that collective action and governance play a major role in wealth creation and retention. For example, the public sector is a major generator of human capital through its investments in public education. Likewise, the public sector generates intellectual capital by creating and enforcing patent and copyright laws.
  10. The framework recognizes that the distribution of assets is very important. For example, the distribution of assets across households can have an enormous impact on inter-generational social and economic mobility. Or, as another example, political capital that is not widely shared, but is concentrated in the hands of a few, may not benefit the entire community, state, or region.
  11. The framework recognizes that individuals’ wealth depends not only on their own assets, and how they use them, but also on how the assets of their neighbors are used. For example, when individuals invest in cultural diversity, the wealth of other residents is enhanced.