Waterlogged boundaries, the case for bioregionalism, and its unfortunate demise

Fording a river, Grouse mountain, British Columbia, Summer 2021

If you’ve ever been in the Pacific Northwest, you've seen the local “uniform.” Amongst the water-resistant (nothing is waterproof!) Carhartt pants, flat-billed trucker hats, and colourful spectrum of flannels, there is a waterproof jacket in the armoury. This jacket must have a hood so that you do not need an umbrella, a sin that only a tourist would make.

A bad idea, Squamish mountain, British Columbia, Spring 2022

The jacket is necessary because in the wet winter months, any person caught on the scenic trails of Squamish (known for the Chief, one of the largest granite domes in the world) would think that Noah’s flood was upon him, that the sun would never reappear, and that rain has so consumed reality that any imagination of the world can only find a cloudy mist covering a canopy of pine trees. In short, the water cycle of the PNW calls for the jacket.

In contrast, in a place like the Central Valley, deciding how to dress requires taking into account the overhead sun and the dust. Therein lies the non-ironic donning of cowboy hats and boots respectively (A recent blog post about western apparel is here). Continue further east on the Interstate 70 past the plains and the Mississippi river and you will find the habit of tucking long sleeve shirts into pants, which are then tucked into socks, a necessity in the tick laden bushes of Appalachia. (A study from Nebraska Medicine about the migration of tick populations west).

Each of these clothing outfits make sense in the place where they are adopted. Sartorial culture reflects the ecosystem hydrological and biological of the region where people live. This understanding is one key tenet of bioregionalism. Bioregionalism (defined by one non-profit here) is a philosophy which holds that political systems should reflect naturally definable, local regions rather than artificial political boundaries. (Read more about this philosophy as taught by a Bay Area theatre here). Bioregions are drawn by the natural lines drawn by watershed boundaries, topography, as well as the socio-cultural human histories of the area.

10% water capacity, Lake Hensley, California, 2025

Bioregionalists seek several core goals: including matching political boundaries with the aforementioned bioregions; prioritizing the usage of local resources and materials; and building regional sustainability and supply chains rather than global ones. This local focus benefits the making of policy that is suited to local ecological needs, rather than the difficulty of federal or state systems that cannot possibly take account of all local conditions and ecosystems. (Read more about federal funding to rural water systems here)

Current political divisions force rural and urban communities into statewide policy frameworks that, through competing interests and compromise, can poorly fit all. Agricultural water use in arid basins is legislated alongside, and often in, coastal zones where the flow of rivers can power 98% of electrical grids (read more about BC Hydro here). Or consider the current issue of the banning of or restriction of gasoline vehicles being impractical in rural regions that remain dependent on generators and gasoline vehicles (read more here).

Currently, the rural-urban divide is often framed within a structural power antagonism, where cosmopolitan elites- with vastly greater urban resources- intrude on traditional rural communities. The physical distance between these two groups sharpens these perceived differences. These urban elites live far from rural denizens, often in ecosystems that are vastly different. Consider the common epithet, “coastal elite.” (Read more about water disagreements between the rural and the urban here and here).

As the reasoning goes, how could someone in the Bay understand the water struggles of the Central Valley? A bioregionalist approach would instead link governance between metropolitan and rural communities wherever and whenever they are linked by watersheds and water cycles requiring literal downstream cooperation.

Of course, bioregionalism is not without flaws. Even from this brief inventory of bioregions, readers will see issues with assuming histories and shared interests in fluid boundaries that are anachronistic, ambiguous, and would be contentious and complex to draw. Land-based identity idealizes lives that are pre-urbanization, occasionally even pre-industrialization, and is often isolationist and exclusionary of any political change as a result.

In a globalized economy, high technology requires supply chains that cannot be localized efficiently, or at all. Anything that would require national coordination (national defense, macroeconomic policy, large scale infrastructure projects) would be difficult if not impossible under bioregional governance. Of course, there is also the potential of extreme inequality between natural resource-rich and natural resource-poor regions. Without national redistribution and the needs of national and global economy, spatial inequality would be all but guaranteed.

I finish with a point about Cascadia, the former bioregionalist movement stronghold within the PNW that spanned from Juneau, Alaska to San Francisco. Prior to the 47th American president, most money spent within Cascadia, (defined here, as in my heart, as Oregon, Washington, British Columbia), remained within Cascadia. Now with rising tensions between the United States and Canada, this seemingly unbreakable cross-border relationship is strained by the Canadians' general boycott of American goods (read more). Alas, the Cascadian identity, nascent if it ever truly existed, has yielded to national lines for now.

Superbloom, California, 2017

Rural broadband in the news as Affordable Connectivity Program comes to an end

I've been hearing a lot about rural folks in relation to broadband the last few weeks because a federal program, the Affordable Connectivity Program, is expiring.  Here are a smattering of stories that acknowledged the rural angle on this event. 

First, here is some CalMatters coverage, which explains lots of basics and also acknowledges the rural impact. 

On April 30, a popular and widely used government program began the process of shutting down due to congressional inaction. With its demise, closing the digital divide becomes considerably more difficult.

The federal government first launched a broadband subsidy program during the depths of COVID-19 pandemic lockdown, where internet connections became many peoples’ only window into the outside world. That effort, the Affordable Connectivity Program (ACP), was made permanent as part of the 2021 Infrastructure Investment and Jobs Act. It offered a $30 monthly subsidy ($75 on tribal lands) to qualifying low-income households for broadband internet or cell phone bills. The program also offers up to $100 toward a computer or tablet.

However, it came with a major caveat: The $14.2 billion Congress allocated toward the program was a one-time thing. When the money ran out at some point in the future, Congress would have to infuse the program with more money or find a more permanent funding solution.

That future has officially arrived. More than 23 million American households, about 45% of all those eligible nationwide, will no longer receive the full subsidies that previously helped them get online. Two-thirds of those households had “inconsistent or zero connectivity prior to ACP enrollment,” a recent Federal Communications Commission survey revealed.

Partial subsidies of $14 ($35 for households on Tribal lands) will be available for some ISP customers for service in May, according to an FCC notice. But that will be the program’s last disbursement.

“Many recent press reports about the impending end of this program describe how ACP households across the country are now facing hard choices about what expenses they have to cut, including food and gas, to maintain their broadband access, with some households doubtful they can afford to keep their broadband service at all,” FCC Chair Jessica Rosenworcel wrote in an April letter to congressional leaders. “These press reports echo what the Commission has been hearing from ACP households directly, with many writing the agency to express their distress and fear that ending this program could lead them to lose access to the internet at home.”

Case in point: Alfredo Camacho, who lives in Guadalupe, California, told CalMatters that because he is no longer able to afford home internet service, he’s started taking his daughters to the parking lot outside a local library so the family can use the free wifi to do homework and look for jobs.

“This takes away grocery money,” said Camacho, who is one of around three million Golden State residents losing access to the subsidy. “Being a single father, $30 goes a long way.”

In anticipation of the shut-down, the program stopped accepting new sign-ups in early February. Participating households started receiving notifications about the program’s potential shuttering in January. After it ends, internet service providers are required to allow ACP-using households to cancel without termination fees.

The program has been an essential part of how millions of Americans get online, with nearly one-in-five U.S. households relying on the subsidy to keep their internet subscriptions active. Uptake has been especially strong in areas with high-poverty rates in both urban and rural areas.

Here is a Forbes story from May 6, 2024, with no acknowledgment of rural difference or disadvantage:

Congress first allocated $14.2 billion to the Affordable Connectivity Program in December of 2021, and that money—used to provide a $30 to $75 stipend toward internet bills per month and for a one-time discount toward the purchase of a laptop computer, desktop or tablet—is now running out.

The bill introduced to save the program would allocate $7 billion more to extend it through the end of the year and allow Congress to “work out the long-term changes that are needed for sustainable access,” according to Sen. Peter Welch (D-Vt.)

Before receiving the federal internet subsidy, almost 22% of program participants had no personal internet service and another 25% had only mobile internet, according to a 2023 survey by the Federal Communications Commission.

The same survey found that almost 77% of beneficiaries said they would need to make changes to their broadband plan if they stopped receiving the subsidy, with 30% saying they'd need to drop internet service altogether.

The New York Times reported on this pending wind-down in March.  

The program was tucked into the 2021 infrastructure law as a replacement for a pandemic-era program that provided certain households discounts on their internet bills. Although there is some bipartisan support to continue the subsidies, lawmakers have not passed an extension.

Interestingly, while it does not use the word "rural," it does include this somewhat counterintuitive quote from the Senator of South Dakota, a state popularly thought of as a rural place. 

But some Republicans have argued that the program is wasteful. In a December letter to the F.C.C., Senator John Thune of South Dakota and other Republican lawmakers raised concerns about the program subsidizing households that already had internet service. They have also pointed to findings from the F.C.C.’s Office of Inspector General, which has in recent months expressed concerns about some providers failing to comply with program rules and improperly claiming funds.

Finally, here's the Federal Communication Commission's webpage on the issue, which covers the basics, but/and also does not use the word "rural":  

The Affordable Connectivity Program stopped accepting new applications and enrollments on February 7, 2024. The last fully funded month of the program is April 2024.

All ACP households enrolled at the time of the enrollment freeze, February 7, 2024 at 11:59 PM ET, will be able to remain enrolled through the final month of ACP service if they are not required to be de-enrolled under FCC rules.

Households that are de-enrolled from the program, such as for failure to use their ACP-supported service, will not be able to re-apply or re-enroll in the ACP during the enrollment freeze.

ACP enrolled households are strongly encouraged to carefully review written notices from their internet company and from the Universal Service Administrative Company (USAC), the ACP administrator, about the ACP wind-down.

Households are also encouraged to consult their internet company to learn more about how the end of the ACP will impact their internet service and bills.

I'm glad that at least some of these sources recognize the rural angle on the digital divide.  

Less oversight means more risk to child workers

Worthington, Minnesota, population 13,947, described by a former resident as “a small, rural town in Southwestern Minnesota,” has more unaccompanied migrant children per capita than anywhere else in the country. Also in Worthington: a long-standing open secret that some of these migrant children are illegally employed to clean a slaughterhouse run by JBS, the world's largest meat processor.

In Green Forest, Arkansas, population 2,972, a cleaning company that works with meatpacking plants was fined over $90,000 for unlawfully employing six minors who were forced to work 16-hour shifts with no breaks. You can read more about Green Forest, AR, here and here.

While the number of children working in dangerous jobs is rising and media coverage of the phenomenon has raised public outrage, the recent trend among some states is to roll back child labor protections. 

Just two weeks after authorities found minors working illegally at the meatpacking plant, the Arkansas legislature passed the Youth Hiring Act, eliminating work permit requirements for children under the age of 16. Before the Youth Hiring Act was passed in March 2023, child workers under 16 years old had to get a work permit from the Arkansas Division of Labor.  Some fear that by eliminating this requirement children will be subject to less safe working conditions because the state will have no records of where underage children are employed.
 
Iowa also rolled back child labor protections in the spring of 2023. As of April 2023, children in Iowa as young as 14 can now work night shifts, and 15-year-olds can work on assembly lines.
 
Accompanying Arkansas and Iowa, Minnesota, Ohio and Georgia have all introduced bills or laws this year to allow teens to work more, and with less government oversight.
 
Who is advocating for this weakening of child labor protections? Most of the bills on this issue that were introduced in Iowa, Arkansas, and Missouri were designed by the Foundation for Government Accountability (FGA). Funded by ultra-conservative and Republican donors, the FGA “frames its child worker bills as part of a larger debate surrounding parental rights, including education and childcare.” 
 
But important and shocking facts provide a counternarrative that is grounded in parental rights: Children under 18 are twice as likely to be seriously injured at work than those over 18. In the dairy industry, injuries among all workers are double the national industry average, yet children as young as 14 regularly use dangerous equipment in that sector.
 
Most at risk for unsafe, unregulated working conditions are undocumented minors who come to the United States without a guardian. In 2022, 130,000 unaccompanied minors entered the United States, triple the number entering just five years ago. Undocumented children don’t necessarily understand the laws in the United States or even the language, which puts them at greater risk for labor trafficking.
 
While child workers are employed in all 50 states, from Maine to Hawaii,  undocumented children are likely more at risk in rural areas given the industries associated with it and the challenge of enforcing laws there. You can read about the challenges surrounding law enforcement in rural places here.
 
In addition to the obstacles regarding law enforcement, agriculture is the primary industry in many rural areas, and agriculture is a context in which child labor is commonly exploited. This is partly because federal laws are more relaxed when it comes to agricultural labor regulations.

In 1938, the standards for children performing farm work were more lenient because farming was considered a family-oriented task.  Farm consolidation, which peaked between 1950 and 1997,  shifted the size and number of farms in America substantially. From 1987 to 2012, the number of farms with more than 2,000 acres nearly doubled while farms with over 200 acres but less than 1,000 acres fell by 44%. 

Despite the shift away from family-oriented farms towards large industrial ones, the labor laws covering agricultural workers have remained largely stagnant. As a result, underage farm workers today are often paid significantly less than the minimum wage and are subject to harsh working conditions such as pesticide exposure, long working hours with no overtime, and no bathroom access or available drinking water. In fact, of all the jobs that children do, only about 7% are in the agricultural field yet agricultural jobs make up 40% of youth work-related fatalities.

Of course, child labor violations are not limited to rural places or the agricultural sector.  Tens of thousands of children are working illegally in hotels, delivery services, restaurants, and more. This is happening in all 50 states and in places stretching from rural Virginia to New York City.

As consumers of Nature Valley granola bars, Lucky Charms, Ford cars, Tyson chicken nuggets, and Ben & Jerry's ice cream (all of which, along with many more companies, have used child labor in their factories per the New York Times) we all have a responsibility to demand tighter labor laws for children in this country. Moreover, addressing this problem should not be limited to rural or urban places. Instead, this is a topic that should be tackled by coalition building along the rural-urban divide. 

On the closure of a rural(ish) hospital in California's Central Valley

I've been thinking about the hospital closure in Madera County, California, since it happened earlier this year, leaving this entire county without a hospital.  Now, two Los Angeles Times reporters and a photographer have done a deep dive into the consequences of the January closure of the Madera Community Hospital.  (Here are all of the posts that have mentioned Madera County over the years).  Here's an excerpt highlighting the gist of what has happened in Madera County--and what is threatening other rural hospitals: 

During its half-century run, Madera Community Hospital provided a crucial link to healthcare for the 160,000 people who call Madera County home. Spanning from the heavily farmed floor of the eastern San Joaquin Valley to the forested central Sierra, Madera is majority Latino, and 20% of the population live in poverty.

For most residents, the hospital was more than a place to go when disaster struck. Madera Community helped them sign up for Medi-Cal, the state’s version of Medicaid insurance for low-income adults and children. It was readily accessible by bus, and it coordinated services with community clinics where residents could receive routine care and prescriptions. Sometimes the hospital was the only place people saw a doctor. Unlike the many private providers that exclude certain types of health insurance — including Medi-Cal, with its notoriously low reimbursement rates — Madera Community served everyone.

“It’s the worst thing that could have happened to us,” Tony Camarena said of the closure. Camarena runs a business that enables sending money abroad, and many of his customers made use of the hospital’s services, he said.

Healthcare experts say Madera’s closure — and the untenable financial realities that brought on the collapse — offer a case study on the challenges facing rural hospitals across the country. Nearly 30% of all rural hospitals in the U.S. — more than 600 of them — are at risk of closing, according to the Center for Healthcare Quality and Payment Reform.

In California, nine rural hospitals have been shuttered since 2005, and 17 are at risk of closing. Kaweah Health Medical Center in Visalia, about an hour’s drive from Madera and the largest hospital in rural Tulare County, is among those bowing under serious financial problems.

Experts in healthcare economics say rural counties generally have fewer patients than suburban and urban communities — and a high share of those patients are low-income and enrolled in Medi-Cal. That means there are fewer patients with private insurance whose payments can offset Medi-Cal’s low reimbursement rates. Small hospitals also have less muscle than bigger ones to negotiate rates from private insurance companies.

Don't miss the rest of this engaging and deeply reported story.  

More on Democrats' neglect of rural voters, this time in the Missouri Senate race

This is from the Missouri Times, an opinion editorial by Wes Shoemyer, a former Missouri state senator, writing about Democratic Senate Candidate Trudy Busch Valentine's failure to commit to campaigning for the rural vote: 

“Valentine, who owns farmland in Montgomery County, said she will spend much of the primary election focusing on Democratic voters in the state’s major population areas. But, she pledged to make more forays into the rural, red part of the state if she wins.” –St. Louis Post Dispatch

Reading Trudy Busch Valentine’s plan to abandon people like me made my blood boil. There’s a reason rural America thinks elitist Democrats like her are entitled — it’s because they are.

When I was in the state Senate, I represented my rural community in northeast Missouri. I know what it takes for Democrats to win in tough parts. Believe me, it’s not easy. But you have to have the guts to try. At the very least, you have to be brave enough to show up and meet with us.

It’s been well documented how our party last lost touch with rural voters. I attribute a big part of that to an unwillingness to show up and listen to us. Heck, how could you ever fight for us if you don’t know a thing about us?

And nowadays, despite Democrats regularly losing by double digits statewide, in no small part due to this rural collapse, we’ve got Democratic candidates like Trudy Busch Valentine who don’t even think we’re worth their time. She’s even cut out the middle man — instead of getting ignored by politicians who are bought off by out-of-touch megadonors, we’ve moved on to just throwing the megadonor on the ballot instead.

I live on a farm with my family here in northeast Missouri. Let me tell you something about Missouri farm families — we don’t trust someone who shows up on our doorstep a week before an election with a lame message after ignoring us for months. Why should we?

(emphasis mine). 

It's a powerful column about an issue I've spent a lot of time and energy thinking about in recent years:  what does it take to cultivate the rural vote?  

By the way, Montgomery County, where Busch Valentine owns farmland, is exurban St. Louis, but has a population of just 11,322.  It includes Hermann, Missouri, which I visited in the fall of 2019, between a talk at the University of Missouri and a flight out of STL.  

I wrote this yesterday about Democrats' similar neglect of rural Texas.  It is based on an article in Texas Monthly Magazine.    

Aging and disability services unequally distributed along rural-urban axis

Here's the policy brief from Syracuse University's Lerner Center for Public Health, authored by Claire Pendergrast (Syracuse) and Danielle Rhubart (Penn State):  

As the U.S. population ages, demand for aging and disability services will increase, but 15% of U.S. counties have no aging and disability services organizations. This brief shows that rural counties and counties with the highest rates of poverty, highest shares of older adults, and highest shares of non-Hispanic Blacks are most likely to be aging and disability services deserts. To support healthy aging across the country, policymakers should invest in aging services infrastructure and should prioritize resources for places that are aging and disability services deserts.

And here is a related paper, also about aging and rurality, just published in the Journal of Rural Social Sciences, "Support from Adult Children and Parental Health in Rural America," by Shelley Clark, Elizabeth M. Lawrence, and Shannon M. Monnat.  The abstract follows:  

Adult children are a primary source of care for their aging parents. Parents in rural areas, however, live further from their adult children than parents in urban areas, potentially limiting the support they receive and compromising their health and ability to age in place. We use two waves of the Panel Study of Income Dynamics (2013 and 2017) to investigate the relationships among geographic proximity, adult children’s instrumental and financial support, and parental health. Rural parents live further from their adult children and receive less financial support, but they are more likely to receive instrumental assistance. In addition, rural parents have worse health and more functional limitations than urban parents, and these differences persist after controlling for proximity to and support from adult children. Our findings indicate that factors beyond proximity influence the complex relationships between spatial and social boundaries and their consequences for older adults’ health and well-being.

Coronavirus in rural America (Part CLXXV): COVID aid spending trends from urban to rural

Bella DiMarco and Phyllis W. Jordan share this report on K-12 COVID federal aid spending trends with FutureEd:  

The Covid pandemic can look different in a small rural school district than in a big city or suburb. Transportation challenges are often magnified with fewer students spread across wide areas. Internet access is frequently harder to find, and so are mental-health professionals to support students and staff. Such challenges —and shared priorities—are reflected in a new FutureEd analysis of how local education agencies are planning to spend the latest round of federal Covid-relief spending aid.

We used the National Center for Education Statistics’ four classifications of school district settings—city, suburban, towns, and rural—to analyze the spending plans of nearly 2,500 school districts and charter organizations educating some 53 percent of the nation’s public-school students. The information company Burbio collected the local agencies’ plans, which represent about $60 billion of the $122 billion in the third round of federal Elementary and Secondary School Emergency Relief funding (ESSER III).

We found that staffing has emerged as a pandemic priority for local leaders nationally. Regardless of classification, more than half of all school districts and charter entities in the sample intend to spend relief funds on hiring and paying teachers and academic staff, and about 40 percent in each category expect to invest in teacher training. Similarly, at least half the local education agencies in every category plan to invest ESSER III funds in summer learning and upgrading ventilation systems.

Mental Health:

* * * 

By contrast, Powhatan County Public Schools, a rural district in Virginia with 4,300 students, plans to set aside less than 1 percent of Covid-relief funds for mental-health first-aid training. Most rural districts have designated less than 10 percent of their funds for social-emotional learning and mental-health-related items. A notable exception is Bartow County, Georgia, which plans to spend $13.3 million, nearly 60 percent of its allotment, on mental-health services and supports, in some cases through full-service community schools.

Similarly, rural districts are the least likely to prioritize hiring or paying mental-health staff. About 42 percent of city districts and charter organizations plan to spend on mental-health professionals or psychologists, compared to 29 percent in towns and 25 percent in rural areas.

The pandemic has certainly affected students’ mental health in small, rural communities and intensified opioid addiction and other rural problems. But as Allen Pratt, executive director of the National Rural Education Association, points out, there’s a dearth of mental health counselors in many rural areas, leaving districts unable to hire as many of the specialists as they might like.

Transportation:

A greater share of rural districts remained open during the 2020-21 school year than in other settings, and there's less support for going back to remote schooling in these communities, RAND Corporation researchers found. But getting students to school every day can be complicated by the long distances to school in some sparsely populated areas. Our analysis showed that rural districts are more likely to propose spending on transportation than education agencies elsewhere. About 38 percent of rural districts in the sample are earmarking ESSER III funds for transportation, compared to 21 percent in the suburbs, 28 percent in cities, and 32 percent in towns. The shortage of school bus drivers affecting schools across the country may lead to more spending in this category in the months ahead than is reflected in agencies’ current plans.

In one instance, Marietta Public Schools in Oklahoma, a remote rural district serving about 1,100 students, is planning to spend roughly 21 percent of its allotment on transportation-related items. This includes $540,000 to purchase additional buses and $25,000 to purchase a van to transport food to a new building for middle and high school students. The district also plans to spend an additional $140,000 on new camera systems for its buses.

Academic Spending:

Rural educators appear less inclined than educators in other settings to spend ESSER III dollars on extended-day programs and more likely to spend the money on instructional materials and student assessments, the FutureEd analysis found.

Pratt from the National Rural Education Association says that transportation challenges can sometimes limit the ability of rural school districts to offer afterschool programs, because it’s harder to arrange bus transportation after hours. He wasn’t surprised to see the proposed investments in instructional materials and software, and observes that with earlier rounds of federal funding putting mobile devices in the hands of more students and broadening internet access, rural educators now have more ways to reach their students.

For example, Hennessey Public Schools in Oklahoma, a remote rural district serving 833 students, is planning to spend almost $400,000 on classroom curriculum materials and textbooks, or about 13 percent of its ESSER III funds. In the town of Russellville, Arkansas, the 5,400-student school district intends to invest $1.4 million, also about 13 percent of its allocation in instructional materials.

Having grown up about 60 miles from Russellville, I will go on the record as saying i certainly do not consider it rural. By contrast, the 450-student district where I was educated is dwarfed by comparison.

* * *

HVAC:

At least half of the local education agencies in each category are planning to spend ESSER funds on updating and upgrading heating, ventilation and air conditioning (HVAC) systems. RSU 25, a small rural school district in Maine, plans to spend half its ESSER III allotment, about $1.3 million, to install a mechanical HVAC system in one of its four schools that previously did not have a system throughout the building.

In the town of Ukiah, California, the school district intends to devote about half its ESSER funding, $6 million, to upgrade and replace aging systems. Similarly, the Newport News Public Schools in Virginia plans to spend $40 million, or nearly half its allotment, to replace HVAC systems in several the city’s schools and add air purifiers and filters. Suburban Montgomery County, Maryland, by contrast, has earmarked $6.6 million of its $262 million in ESSER funds for improving and upgrading ventilation systems.

Rural school districts and charter organizations plan to spend $559 per pupil on HVAC systems, compared to $495 for towns, $378 for cities, and $340 for suburbs. The cost differences could reflect the economies of scale for education agencies in less-populous communities

Coronavirus in rural America (Part CLXII): U.S. Health and Human Services responds to rural strain

A New York Times story by Mark Walker from a few days ago suggests that the U.S. Dept. of Health and Human Services is responding to the particular stresses the rural health care system has faced during the pandemic.  Here's an excerpt that uses the word "rural" perhaps a record number of times compared to NY Times norms.  (In what follows, emphasis is mine).

Xavier Becerra, the health and human services secretary, said that Covid-19 made clear the importance of having timely access to quality medical care, especially in rural America.

“When it comes to a rural provider there are a number of costs that are incurred, that sometimes are different from what you see with urban providers or suburban providers,” Mr. Becerra said in an interview. “And oftentimes, they’re unique only to rural providers.”

Wow. Now there is a rare concession of rural difference--even uniqueness.  The story continues:  

Rural physicians serve a disproportionate number of patients covered by Medicaid, Medicare or the Children’s Health Insurance Program, who often have more complex medical needs. Many rural hospitals were already struggling before the pandemic, and 21 have closed since the beginning of 2020, according to data from the Cecil G. Sheps Center for Health Services Research at the University of North Carolina.

Under the program, every eligible provider that serves at least one Medicare, Medicaid or CHIP beneficiary in a rural part of the country will receive at least $500. Payments will range up to $43 million, with an average payment of $170,700. They are based on how many claims a provider submitted for rural patients covered by these programs from January 2019 through September 2020.

Rural America is home to some of the country’s oldest and sickest patients, many of whom were affected by the pandemic.

The new funding is supposed to help rural hospitals stay open in the long run and improve the care they provide, building on efforts the Biden administration has already made to help improve access to health care in rural communities, which it considers crucial to its goal of addressing inequities in access to care.

What's in the infrastructure bill for rural America

The Rural Blog reports in some detail here, so it's a good place to start.

And here's a story from Ski-Hi News in Grand County, Colorado (Grand Junction) indicating that the infrastructure bill renewed the Secure Rural Schools Act, a significant boon to rural communities.    

I'm seeing lots of stories mentioning rural broadband.  Here's one from August, speculating about what might happen under the infrastructure bill.  I'll be on the lookout for more recent coverage post-bill passage.  

Here's a story that suggests several states with significant rural populations, e.g., Montana, Wyoming, Alaska, Vermont, the Dakotas, and West Virginia are getting more money per capita from the infrastructure bill.  (Interestingly, uber urban Washington, DC, is also in the highest per capita range).  This may look like old-fashioned pork, but it probably more accurately reflects the fact that when a road or bridge needs repairing, it needs repairing regardless of how dense or how sparse the population.  

And this story calls out how much Texas, with vast rural reaches, specially in the west, will get from the infrastructure bill, $30 billion.  

Coronavirus in rural America (Part XCVII): Distributing a vaccine to remote locales

Pro Publica reported a few days ago on the challenge of distributing the coronavirus vaccine to remote locales, like those in Indian Country. The headline is "Most States Aren’t Ready to Distribute the Leading COVID-19 Vaccine," and Isaac Arnsdorf, Ryan Gabrielson and Caroline Chen report:  

As the first coronavirus vaccine takes a major stride toward approval, state governments’ distribution plans show many are not ready to deliver the shots.

The challenge is especially steep in rural areas, many of which are contending with a surge of infections, meaning that access to the first batch of COVID-19 vaccines may be limited by geography.

* * * 

The Pfizer vaccine is unusually difficult to ship and store: It is administered in two doses given 21 days apart, has to be stored at temperatures of about minus 100 degrees Fahrenheit and will be delivered in dry ice-packed boxes holding 1,000 to 5,000 doses. These cartons can stay cold enough to keep the doses viable for up to 10 days, according to details provided by the company. The ice can be replenished up to three times. Once opened, the packages can keep the vaccine for five days but can’t be opened more than twice a day. The vaccine can also survive in a refrigerator for five days but can’t be refrozen if unused.

Health officials haven’t figured out how to get the ultracold doses to critical populations living far from cities, according to a ProPublica review of distribution plans obtained through open records laws in every state. Needing to use 1,000 doses within a few days may be fine for large hospital systems or mass vaccination centers. But it could rule out sending the vaccine to providers who don’t treat that many people, even doctors’ offices in cities. It’s especially challenging in smaller towns, rural areas and Native communities on reservations that are likely to struggle to administer that many doses quickly or to maintain them at ultracold temperatures. 

Coronavirus in rural America (Part LVIII): Rural Mississippi hospital at capacity

The Wall Street Journal's William Mauldin reported Saturday from Wayne County, Mississippi, "Coronavirus Outbreak Pushes Rural Mississippi Hospital to Brink."  Here's the lede:

The coronavirus pandemic is challenging Mississippi’s rural health-care system as outbreaks worsen in far-flung areas at the same time state officials allow all businesses to reopen. 

Deep in the state’s southeastern Pine Belt, the latest pressure point is Wayne County, population 20,000, which is served by a single hospital that is more than an hour by ambulance from a larger one in Hattiesburg and two hours from the university medical center in Jackson.

The struggle to serve rural Wisconsin's higher education needs

John Hart reported on February 28, 2020, for The Chippewa Herald in northern Wisconsin, on what's happening to the state's multi-campus higher education system outside the flagship Madison campus, with particular focus on the state's rural reaches.  Here's an excerpt that paints a pretty dire picture, focused on Richland Center, population 5,184, the county seat of Richland County, in southwestern Wisconsin.  The enrollment at that campus has hit an all-time low of 155.  The last time the UW system closed a campus, Medford, in 1980, the Richland campus had an enrollment of 264. Here's more background on the system's declining enrollment:

Seven of the System’s branch campuses this fall, including Richland Center, tallied their lowest enrollment in nearly half a century, according to preliminary data. Total enrollment at the branch campuses, about 7,300 students, marked a 46-year low.

The demographic trend shows little sign of reversing during the next decade. Projections based on the state’s birth rate show the number of students graduating from Wisconsin high schools this spring will be the lowest since 2000, according to a UW-Madison report.

Nationally, the contraction in college enrollment will worsen as an even smaller pool of students born during the Great Recession enters college between 2025 and 2030.

The share of students enrolled at the System’s branch campuses is small — less than 10% of students attending Wisconsin’s public universities. But the campuses play an outsize role in the lives of the students they serve.

Four in 10 students at the Richland campus in 2018, for example, were the first in their families to go to college. Nearly half were eligible for a Pell grant, federal aid that mostly goes to students whose families earn less than $40,000 a year. About 40% of students came from communities with fewer than 5,000 people.

For students like Faith Morga, 19, the prospect of attending a four-year campus was daunting, both personally and financially.

Richland Center’s small classroom setting and lower tuition rate appealed to Morga. She decided to save even more money by commuting from nearby Soldiers Grove, the 500-person village where she grew up. She started classes this fall and plans to eventually complete her degree in elementary education at Platteville [the UW 4-year campus associated with Richland Center].

“I’m not sure why more students aren’t going here,” she said. “It’s a great campus to start out small.”

Sudden U.S. Dept. of Education "bookkeeping" change will hurt remote schools

Erica L. Green reports today in the New York Times under the headline, "Education Department to Cut Off Federal Funding for Some Rural Schools."  Here's the lede:

A bookkeeping change at the Education Department will kick hundreds of rural school districts out of a federal program that for nearly two decades has funneled funding to some of the most geographically isolated and cash-strapped schools in the United States.

The story explains the bookkeeping shift in relation to the Rural and Low-Income School Program, a funding stream that requires districts to report how many of their students live in poverty.  In the past, the percentage of students receiving a free- or reduced-price lunch has been a proxy for high poverty (20% or more) among school-age children because "census data can miss residents in rural areas."  Now, however, the Department of Education has suggested that it must strictly follow the Small Area Income and Poverty Estimates (SAIPE) rather than rely on lunch program data, though it has been relying on the latter for 17 years.

On bi-partisan pushback against the new interpretation, Green writes:

The department’s decision to enforce the tougher criteria drew swift, bipartisan condemnation, and alarmed lawmakers and advocates who questioned why an administration whose political base includes large sections of rural America would initiate such a change — especially in an election year. Rural school districts, which serve nearly one in seven public-school students, have long been considered the most underfunded and ignored in the country. 

Congressional leaders indicated that they were prepared to take swift action. A spokesman for the Senate committee that oversees education said its chairman, Senator Lamar Alexander of Tennessee, was “very concerned” about the change and working with Senator Susan Collins, Republican of Maine, to “solve this problem for hundreds of rural schools around the country.”

Will be interesting to see the outcome of this tussle.   Will rural schools once again be a sacrificial lamb? 

On suicide in the Sierra foothills of California

Sammy Caiola reported on Capitol Public Radio's Insight program today, with a follow up on a story she did last year out of Amador County, population 38,091, just southeast of Sacramento County.  You can listen to the segment here, but I want to highlight just a few things Caiola pointed out about Amador County that make its residents vulnerable to suicide.  First is a lack of mental health services, meaning folks must often travel to Sacramento or another major city in the region for care, sometimes due to a shortage of providers at the county's sole hospital, in Jackson.  Aggravating this problem is dearth of public transportation.  Second and related to the lack of transportation infrastructure is the physical geography and built environment--lots of small-ish towns/cities, with people spread across the countryside amongst those small population clusters.  And third, Caiola suggests that a greater stigma attaches to mental health treatment in rural places than in urban ones.  These are all issues I have discussed in my scholarship, theorizing the legal relevance of aspects of rurality, e.g., lack of anonymity, material spatiality. 

The segment is well worth a listen in its entirety, as is Caiola's earlier reporting on what is happening health-wise in Amador County. 

Who fights wildfires out west?

Wildfires in the west get a lot of media coverage, especially now that fire season is upon us.  One angle of some of this news coverage is who's doing the firefighting, and I'm going to summarize some of that coverage in this post.

I first started collecting stories on this topic a few months ago when the Trump administration laid off more than 1000 workers in the Rural Job Corps program.  Lisa Rein reported in the Washington Post that this Forest Service program, which "trains disadvantaged young people for wildland fire fighting and other jobs in rural communities."

The Job Corps Civilian Conservation Centers enroll more than 3,000 students a year in rural America. The soon-to-close centers — in Montana, Wisconsin, Arkansas, Virginia, Washington state, Kentucky, North Carolina and Oregon — include hundreds of jobs in some of President Trump’s political strongholds. In Congress, members of both parties objected to the plan. 

The drawdown of the program, starting in September, will result in the largest layoffs of civil servants since the military’s base realignment and closures of 2010 and 2011, federal personnel experts said. Nine of the centers will close and another 16 will be taken over by private companies and possibly states.

The thousands of young people aged 16 to 24 who participate in the program are from low-income communities.
Politico reported this same story under the headline, "USDA ends long-standing Forest Service job training program for at-risk youth."  Catherine Broudreau, writing for Politico, quotes Forest Service Chief Vicki Christiansen who told staff,

[Secretary of Agriculture Sonny] Perdue has a goal of efficient and effective government.... This was a high-level policy discussion and decision. It in no way reflects on your excellent work and dedication.  

Noting that the Department of Labor will take on oversight of the remaining program, such as it is, the Washington Post story paraphrased the efficiency point this way:

Officials said many of the Forest Service operations are low-performing, with inefficiencies and high costs, and that a reboot was necessary.

This echoes a common theme of my writing about rurality:  doing most anything in rural areas is inefficient because it is hard to achieve economies of scale in sparsely populated places.  I wish the stories had more to say on the privatization angle, which is barely mentioned.   

In California news, the Sacramento Bee reported on July 31 that Gov. Gavin Newsom has hired hundreds of additional fire fighters with fire season looming.  Wes Venteicher and Sophia Bollag write:

California will hire 393 more firefighters in anticipation of an upcoming wildfire season that has the potential to be even worse than last year’s, Gov. Gavin Newsom announced Wednesday. 

The long rainy season promoted heavy growth of grass and other underbrush in which fires can start and spread once the vegetation dries out. Cal Fire and the state firefighter union have said the state needs more firefighters to face the escalating threat.

Newsom signed an executive order Wednesday authorizing more seasonal firefighters to boost staffing on a third of Cal Fire’s 340 engines.

* * *  

The newly announced hires will add to the state’s force of about 6,000 firefighters, a number the Cal Fire Local 2881 union has pointed out is lower than the department’s peak staffing in 1975, when fire seasons were shorter and the state was responsible for less territory. 

Newsom is quoted:

I think that’s going to help morale, it’s going to help with rotation, it’s certainly going to help with women and man power as it relates to suppression efforts and mitigation efforts.

High Country News just published this piece on the use of prison labor to fight wildfires in Arizona.

[Prison] wildfire crews are a rare spark of hope in a dark system. Arizona’s prisons are notoriously callous: According to Corene Kendrick, a staff attorney with the nonprofit Prison Law Office, as other states move toward restorative justice, Arizona is locking up ever more people — even first-time offenders — under mandatory sentencing laws for nonviolent offenses, such as drug use, shoplifting or drunk driving, with little possibility of time off for good behavior. Kendrick said that’s despite plenty of research showing that “extremely tough and long sentences, especially for low-level offenses, don’t reduce crime.” 

Arizona’s draconian policies mean that its state prisoners and county jail inmates have faced unusual mental and physical hardships — fewer than three meals a day, for example, or lack of access to menstrual products. 

* * * 

But even amid these chaotic and oppressive conditions, participants in Arizona’s Inmate Wildfire Program come to believe that they, and their future lives, can be different. It’s the rare program supported by prisoners and correctional officers alike, notwithstanding the exploitative system of which it’s a part.

Be sure to read the entire story for a full account of what is cast as an empowering prison program--apparently a win-win. 

Meanwhile, two magazines just ran big features on California's fire season and the Camp Fire of November, 2018, which destroyed the small city of Paradise.  Read Los Angeles Magazine's story here and the New York Times Magazine story here.  The former is by Mark Arax, who has just published a book on the history of California's quest to control nature, The Dreamt Land.  On the post-wildfire gentrification of Paradise, don't miss this.

And on the subject of wildfires and their aftermath, let me mention again this policy brief recently released by the California Commission on Access to Justice which discusses legal needs and challenges in the wake of disasters.

P.S.  Here's another High Country News piece on fighting wildfires, this on the three months of training wildland firefighting recruits gets.  This is dated August 5, 2019 and precedes the date of this post, but I'd missed it when I wrote this post last month.

When rural and urban compete for resources

That's the scenario at stake in the proposal of the Centers for Medicare and Medicaid Services  to shift some reimbursement funds to rural hospitals.  Because the pot of money is (apparently) fixed, this is a zero sum game, meaning that urban hospitals will lose what/if rural ones gain.  Bloomberg Law reports this morning under the headline, "Rural Hospitals See $200 Million Medicare Win at Cities' Expense."  Here's the lede from Tony Pugh's story:

Low-wage rural hospitals would see more than $200 million a year in additional Medicare payments under a Trump administration plan to shift money from urban hospitals in areas with higher wages, a leading health-care law firm found. 

The proposal by the Centers for Medicare & Medicaid Services is designed to cut payment disparities between urban hospitals and rural facilities. Rural clinics and hospitals are struggling in many states that haven’t expanded eligibility for Medicaid under the Affordable Care Act. 

Since the proposed rule was published earlier this month, "hospital associations in states with higher concentrations of urban facilities" have been protesting.  Pugh cites the analysis of the Hall Render law firm, which shows, for example, that California's Medicare payments would be reduced by $108 million annually.  Other big losers would be New York ($41 million); Massachusetts ($19 million) and New Jersey ($18 million).  Southern states stand to gain most, presumably because the South is the most rural region in the nation.  The reductions would be phased in, taking full effect in 2021.

Sarah Jane Tribble, covering the same issue for NPR, provides an illustration of the "wage index," which has been around since the 1980s. 

[It] means under the current index a rural community hospital could receive a Medicare payment of about $4,000 to treat someone with pneumonia while an urban hospital received nearly $6,000 for the same case, according to CMS.

They "why" for the shift is hinted at in the article's opening line:  the wages paid by rural hospitals are lower than those at their urban counterparts, and Medicare reimbursements have typically been pegged to an "area wage index."  This has meant rural hospitals with low local labor costs have typically received lower Medicare payments than urban ones, albeit for rendering the same services.  A related story on NPR, by Sarah Jane Tribble, is here.

I'm very sympathetic to the needs of rural hospitals, and I'll be fascinated to see if this proposal goes into effect because I've never seen a proposal that takes from the urban (rich?) and gives to the rural (poor?) implemented--at least I cannot recall such a circumstance.  For example, since it was published in 2010, I have been pondering the careful word choice of the California Commission on Access to Justice Report, "Improving Access to Civil Justice in Rural California," framed to avoid a rural-urban contest for funding streams.  Here's a quote of one of the key recommendations from that report:

2.  Expand Funding for Rural Legal Services The significant lack of funding for California’s rural legal aid programs must be addressed. All legal aid programs face the challenge of inadequate resources, including programs in urban as well as in rural areas; therefore any initiative to address the severe lack of resources in rural areas should not be developed in a way that unnecessarily undermines urban programs. The goal is to increase the total resources available for all legal services programs across the state, not merely to reallocate existing resources. 

In fact, what has happened in the years since that report was published is that per "poor person" funding for legal aid organizations serving rural populations has fallen relative to that for organizations serving urban populations.  This just emphasizes again how hard it is for rural institutions to get their "fair share" of funding in all sorts of contexts.

Maybe this Robin Hood-like move at CMR will go forward, however, at least if the Trump administration sees it as currying favor with the president's rural "base." 

On rural healthcare in Iowa

Two recent stories in the Des Moines Register have touched on rural health care issues in Iowa.

This story in today's paper is dateline Greenfield, Iowa, population 1,982, where an innovative and quickly brokered solution is keeping the local pharmacy open.  That solution involves Greenfield's older pharmacist, a newer pharmacist, and NuCara, a small chain of pharmacies, working with both of them.  Kevin Hardy writes for the Register about Greenfield, a town that "seems to punch above its weight," but which "almost became a town without a pharmacy":

Greenfield, about 50 miles southwest of Des Moines, is no stranger to the long-term trends that continue to redraw the rural American landscape. After all, the southwest Iowa community's population peaked nearly four decades ago.

Greenfield is the county seat of Adair County and it's also home to a hospital, a factory, and schools, as well as shops and a single-screen theatre on the courthouse square.  But what saved the pharmacy, it seems, was the commitment of the two local pharmacists, the flexibility of NuCara, and even the expedited review of the federal Drug Enforcement Agency.  The new pharmacy opened in a building that previously housed the Adair County Memorial Hospital's business office. The younger pharmacist, Rachel Hall, owns a 20% stake in the new business.  She is from a neighboring town.  Interestingly, when the prior chain pharmacy, Shopko (based in Wisconsin) closed, it sold its patient/client records to Walgreens, whose nearest location is 50 miles away.

Hardy puts what has happened in Greenfield in context:

The loss of Greenfield's only pharmacy would have tracked with decades of changes in Iowa's pharmacy industry. While the number of Iowa pharmacists has grown in recent decades — from 2,344 in 1996 to 2,991 in 2017 — they have increasingly consolidated in larger communities, according to the Iowa Pharmacist Tracking System. 

Over those 21 years, the number of Iowa communities with at least one pharmacist dropped from 251 to 223 — a decrease of 11 percent.

In 2017, every Iowa city with a population of at least 5,000 was home to at least one pharmacist. But of 867 communities with populations below 5,000, only 143 had a pharmacist.

Reading this rural pharmacy story today reminded me of this Des Moines Register story from January, on mental health services in Carroll, Iowa, population 10,103.  The lead for Tony Leys story is:

St. Anthony Regional Hospital's leaders couldn't bring themselves to do what eight other rural Iowa hospitals have done in recent years: Shutter their psychiatric unit. 

The Carroll hospital's board nearly pulled the plug several years ago. The inpatient mental-health program was losing money, and it struggled to keep psychiatrists and other professionals on staff. 

But St. Anthony's is the only hospital in Carroll County or the seven surrounding counties that offers inpatient care to people having mental health crises.

Ed Smith, the hospital's chief executive officer comments:   

If we don’t do it, who’s going to?

Here's more context on what's at stake in Iowa, particularly in the counties that have closed their inpatient psychiatric units.  Note the criminal justice interface.

Nearly 100,000 Iowans live in those eight counties, which cover 4,600 square miles. Without the Carroll program, psychiatric patients would have to be shuttled to faraway hospitals. Many would face the humiliation of being driven an hour or more in the back of a sheriff's squad car. 

St. Anthony's scrambled to find a full-time psychiatrist. It is spending tens of thousands of dollars on training for local nurses to become psychiatric nurse practitioners.  

One St Anthony's patient commented on the importance of being seen by medical professionals who know them, as opposed to traveling an hour or more to get treatment: 

It means the world. These people here care about us so much.

Rural Criminal Justice Summit at SMU's Deason Criminal Justice Reform Center

Visual notetaking at Summit by Michael Lagocki (White Board No. 1)

We're winding down Day 2 of this pathbreaking summit at Southern Methodist University's Dedman School of Law.  This event, organized by SMU's Deason Criminal Justice Reform Center, is turning a rural lens on criminal justice reform.  I going to take this opportunity to bullet point some of the issues we've discussed:

• defining rurality and rurality as a continuum, from exurbia (e.g., Williamson County, Texas) to remote (where you can walk all day and not see another person, e.g., parts of California, Idaho, Montana)
• county size--typically larger in the west, which can present additional challenges when the county is responsible for service provision; 
• ditto state size, e.g., Montana is the fourth largest state in land area; Arizona is the sixth largest
• pretrial detention and appearances, including whether represented by counsel 
• Texas has three counties that provide representation at first appearance; soon they will have five 
• Montana is interested in "tele-representation" of clients at first appearance, in part to deal with conflicts of interest 
• lack of services, including social services, mental health services, drug treatment and many others.  (And, as I sat at the summit, a student emailed me this story about mental health services being provided at a Walmart in Carrollton, Texas, through a contract between Walmart and Boston-based Beacon Health Options, a behavioral health services company.  With a population of 131,000, Carrollton is hardly rural, and it is part of the Dallas-Forth Worth Metro area).
• lack of justice system resources, including adequately resourced and staffed public defender offices and contract defenders.  (The study Beth Colgan and I did of Arizona's delivery of indigent defense is here).  
• the challenge of material distance and lack of public transportation, a recurring theme
• conflicts of interest, including lawyers "wearing multiple hats," e.g., part-time/contract public defenders who may be prosecutors in neighboring counties and judges in still others.  
• multiplex relationships within the legal community and within the wider social community/environment, e..g, the prosecutor as basketball coach of the team on which the judge's daughter plays; the parent of the teen who has just been arrested for minor in possession as the high school classmate of the prosecuting attorney.   
• rural homelessness and the rural housing shortage as just one barrier to successful re-entry.
• the rural jail expansion boom (documented so well by the Vera Institute; see links below)  
• the pros and cons of lack of anonymity and multi-plex relationships in rural communities, including the "usual suspects" phenomenon.  

I think I've talked about all of these issues at one time or another (typically multiple times) on this blog.  

Some startling data points that I've heard at this summit, not all related to rurality:

• one in four jail admissions is a woman 
• Oklahoma is the state with the highest rate of female incarceration, per capita
• By sheer number, more women are incarcerated in Texas than in any other state, and 81% of the women in Texas prisons are mothers.  
• USDA rural development grants are being used to build rural jails 
• "tying the jail to community values" is in the playbook of architects who specialize in building jails; these architectural firms advise counties on how to secure funding for jail expansion or construction; such "values" can include community safety.  
• building jails is pitched as creating "good, clean jobs"--to contrast them with extraction industry jobs that have disappeared in recent years, often devastating rural economies.  

Don't miss the Vera Institute's work on rural jails and other rural criminal justice issues.  A smattering of those are here.  

Rural patients in southeast Minnesota hurt by inclusion in Mayo Clinic network

Don't miss this story by Dan Diamond for Politico.   The headline is "Tax-exempt Mayo Clinic Grows, but Rural Patients Pay a Price."  The subhead is equally provocative:

The famed medical center builds a grand main campus while consolidating services elsewhere.

Here's a short excerpt:

Patients from nearly 150 countries travel to Mayo Clinic sites in Minnesota, Arizona, Florida and beyond. Famed filmmaker Ken Burns is making a documentary about Mayo and the story of its founders — Will and Charlie Mayo, a pair of brothers and doctors who have assumed near-mythic status in the health care field. It's the system that lawmakers around the nation cite when pushing health reforms, and that clinical researchers praise as a model for other caregivers.

But in Albert Lea, Minnesota, a small city set among cornfields and lakes about 64 miles from Rochester, Mayo Clinic is something else: the enemy. 

Mayo took over the hospital that serves the 18,000-person city in 1996, and residents have seen services and supports slowly bleed away ever since. In 2012, Mayo merged Albert Lea’s hospital with another Mayo-owned facility 23 miles away, and locals say their control of the hospital's fate went with it.

The story quotes Paul Overgaard, an octogenarian and former state law maker who is a long-time resident of Albert Lea:

The noose tightened imperceptibly at first.  Mayo made all these overtures about, oh, it's going to be so good. I wouldn't say we were stupid, but we believed people when they told us.

Turns out, Mayo has expanded its campus and its reputation at the cost of places like Albert Lea, whose residents now have to travel farther to have babies delivered and for intensive care.

The service area for Albert Lea's hospital includes more than 50,000 people, and the description of Albert Lea makes it sound like a thriving place as small metropolitan areas go.  If things go as Mayo is planning, Albert Lea may soon be "the biggest community in the state and one of the largest in the nation to not have a full-service hospital."  Still, in the hospital biz as in so many others, bigger is seen as better, efficiency--and, economies of scale, it would seem--above all else.

Minnesota Attorney General Lori Swanson and Lt. Gov. Tina Smith have asked Mayo to pause its consolidation to allow time for more review.

"Mega farms" and their impacts on rural livelihoods

According to the United States Department of Agriculture (USDA), 40 percent of people in rural areas lived on farms in 1950. In 2010, USDA statistics revealed that less than 10 percent of the rural population lives on farms and that only 14 percent of the rural workforce is employed in agriculture. The shift from rural to urban is attributable to many factors, including, industrialization, social preferences, demand, and costs. Whatever the cause of the shift, the traditional farms showcased in 20th century literature, art and film are being pushed to the wayside by large-scale farming activities, corporations and “industrial agriculture.”

Over the summer, National Public Radio (NPR), reported on this subject in a piece called “In the Making of Megafarms, A Mixture of Pride and Pain,” by Dan Charles. For me,The most surprising portion of the show was the statistic that: “According to the latest census of American agriculture, there are two million farms in America. But just four percent of those farms account for two-thirds of all agricultural production.” This shift is viewed with mixed feelings. There are both benefits and drawbacks to this form of production.

The benefits of large-scale farming are production efficiency, arguably food-safety, profitability, and lower costs to the consumer. For every proponent of large-scale farming, there an equal number of opponents. John Ikerd falls into the latter category. In his paper, Reclaiming Rural America from Corporate Agriculture, Prof. Ikerd writes:

Rural communities are being systematically polluted and plundered by an industrial agriculture that is increasingly under the control of large agribusiness corporations. . . . Many rural communities, desperate for jobs, are encouraged to compete for new prisons. If they can’t get a prison, they may be encouraged to settle for a landfill. . . . If they can’t get a landfill, they can probably get a toxic waste incinerator or a nuclear waste site . . . . [or] large-scale confinement animal feeding operations. The corporate world sees rural areas as empty spaces occupied by desperate people . . . . The profits go to wealthy corporate investors, while rural people are paid but a few dollars . . . .

Prof. Ikerd’s position is not atypical. Other rationales some rural residents give for being opposed to “mega farming” include foul smelling odors and other negative secondary environmental effects. The unemployment that Prof. Ikerd’s paper mentions is one of the largest concerns. In 2001, a Congressional Research Service (CRS) report found that declines in farming and opposition to industrializing trends in agriculture are compelling rural areas to seek new job sources, abandoning farming, and sometimes leaving their hometown, altogether. Rural farmers, like Donn Teske, have observed a type of rural-flight: "there's nothing left but huge modern farms and boarded-up main streets of county seats. And that's really sad to see."

“Mega farming” may be necessary to facilitate a relatively cheap and plentiful source of food for America. However, this form of farming comes at a cost to the farmers and their rural way of life. Donn Teske’s home county of Jewell, has fallen victim to a large, 25 square mile farm. Since the “mega farm” took root in the 1980s, the population of Jewell County has fallen by nearly half. Daily accommodations and necessities have given way. The town of Jewell no longer has its own schools, nor are there shops where one could by a suit and shoes. This lack cannot help but impact the local rural community.

As the negative consequences of larger farms on rural livelihood continues to accumulate, one cannot help but to reflect on this trend historically. The move from rural farms to “mega farms” can be said to be somewhat analogous to Rockefeller and the oil industry: although the production is arguably more efficient and the product itself is more consistent and arguably safer, many families livelihoods are compromised in the process.