Rising disability as a rural phenomenon

Chana Joffe-Walt reported this week as part of NPR's week-long series on disability in America.  Her piece was called "Unfit for Work," and in it she explored the concept of disability that garners for the designee a monthly payment from the federal government.  As Joffe-Walt explains, 14 million people now get a disability check from the federal government, adding up to more than the federal government spends annually on food stamps and welfare combined.  Joffe-Walt notes that people "on disability"--as the status is often expressed--"are often overlooked in discussions of the social safety net." But, she asserts, even though those on disability are not counted among the unemployed, the who, what and why of those "on disability" is very much a story about the economy.  What Joffe-Walt makes less clear is that it is a story about local economies as much as it is a story about the national economy.  Joffe-Walt sites her story in Hale County, Alabama, population 15,388, and her investigation takes her to consideration of that county's limited labor market and how those very limitations contribute to adjudications of disability because of the candidates' inability to find the sort of job that will accommodate their physical limitations.  Yet Joffe-Walt never talks about the ways that rural economies differ from more robust and diverse metropolitan labor markets, which may feature more jobs that are less physically taxing.  Thus Joffe-Walt never expressly discusses disability as a rural phenomenon.

Here's more from Joffe-Walt's "Unfit for Work" report:

There's no diagnosis called disability. You don't go to the doctor and the doctor says, "We've run the tests and it looks like you have disability." It's squishy enough that you can end up with one person with high blood pressure who is labeled disabled and another who is not.

I talked to lots of people in Hale County who were on disability. Sometimes, the disability seemed unambiguous.

* * * 

Other stories seemed less clear. I sat with lots of women in Hale County who told me how their backs kept them up at night and made it hard for them to stand on the job. "I used to cry to try to work," one woman told me. "It was so painful." 

People don't seem to be faking this pain, but it gets confusing. I have back pain. My editor has a herniated disc, and he works harder than anyone I know. There must be millions of people with asthma and diabetes who go to work every day.

* * * 

As far as the federal government is concerned, you're disabled if you have a medical condition that makes it impossible to work. In practice, it's a judgment call made in doctors' offices and courtrooms around the country.

Joffe-Walt goes on to interview a Hale County physician, Perry Timberlake, who is associated with many of the determinations of disability there.  She puzzles about the fact that, when making a disability determination, Dr. Timberlake always asks his patient, "what grade [in school] did you finish?"

Joffe-Walt continues:

What grade did you finish, of course, is not really a medical question. But Dr. Timberlake believes he needs this information in disability cases because people who have only a high school education aren't going to be able to get a sit-down job. 

Dr. Timberlake is making a judgment call that if you have a particular back problem and a college degree, you're not disabled. Without the degree, you are.  

Over and over again, I'd listen to someone's story of how back pain meant they could no longer work, or how a shoulder injury had put them out of a job. Then I would ask: What about a job where you don't have to lift things, or a job where you don't have to use your shoulder, or a job where you can sit down? They would look at me as if I were asking, "How come you didn't consider becoming an astronaut?"

Later in the story, Joffe-Walt illustrates the point by referencing job openings in Hale County:

Occupational Therapist, McDonald's, McDonald's, Truck Driver (heavy lifting), KFC, Registered Nurse, McDonald's.

In other words, there aren't many desk jobs in this corner of Alabama, especially for those who are poorly educated. Joffe-Walt discusses the impact of education level and the changing labor economics landscape on this disability phenomenon, but she fails to grasp--or at least does not articulate--the difference that geographic context makes. (I note this oversight, even as she references one of her earlier stories about rural restructuring, featuring the closure of a lumber mill in Aberdeen, Washington, in micropolitan Grays Harbor County). 

In any event, this entire story is worth a listen, not only for what it (and the rest of the week-long series) reveals about the disability phenomenon, but for what it reveals about various aspects of rural disadvantage, most specifically education levels and job markets.

I have noted elsewhere that courts considering applications for benefits such as unemployment sometimes expect claimants to move from rural to urban areas because they are more likely to be employable in the latter.  Some cases adjudicating this and related issues include Parsons v. Employment Sec. Comm’n, 379 P.2d 57, 59, 61 (N.M. 1963) (finding that if no “labor market” exists for petitioner’s job skills in rural area, she may collect unemployment and is not required to move to an area with more work opportunities) and Mohler v. Department of Labor et al., 97 N.E.2d 762 (Ill. 1951) (holding that several elderly women in rural Illinois were not "available for employment" as required by the state's unemployment benefits scheme; court found women "detached from the labor market ... because there are no labor opportunities where they reside, but in addition there are no transportation facilities to a place of employment where opportunities exist"; the women had previously worked at a cannery in their town, but only seasonally because the cannery operated only seasonally).

I wonder if judges adjudicating claims for federal disability ever go down the path of holding the limited nature of an applicant's labor market against the applicant, implying that s/he should move to where jobs are available.  I have not seen that in a case yet ... but then I haven't gone looking for it either.