Recent reports identify rural public health interventions, some with potential to mitigate Medicaid cuts

U.S. Department of Public Health Building.
Image courtesy of Boston Public Library. 

Healthcare in rural America finds itself a topic of much discussion lately, with mainstream media coverage of the crisis unfolding after Medicaid cuts by the Trump administration's 2025 budget reconciliation bill, which was signed into law July 2025. By some estimates, the new law will increase the number of uninsured people by 10 million in 2034. Other coverage concerns the fate of a $50 billion rural health slush fund that is yet to pay out in the communities who need it most and the recent slew of hospital closures in rural communities.

While the new restrictions on Medicaid eligibility and reduced federal spending will be felt across the nation, rural communities will be hit especially hard, due to the higher rates of people on Medicaid in nonmetropolitan areas. Sarah Jane Tribble, reporting for KFF Health News, writes: "[p]eople who live in the nation’s rural expanses have more chronic diseases, die younger, and make less money. Those compounding factors have financially pummeled rural health infrastructure, triggering hospital closures and widespread discontinuation of critical health services." 

Hospital closures (online tool showing a map of recent closures) exacerbate the present struggle to meet rural healthcare needs, where people are generally more vulnerable and less likely to utilize primary care services due to structural barriers like cost and provider shortages. "Rural adults are less likely to be insured, less likely to use healthcare, and more likely to delay seeking care than urban residents," Caldwell et al., 2016. To put it plainly, access to acute care is bleak in much of rural America right now, and reductions in Medicaid spending and eligibility are poised to make things worse. 

Rural hospital closures, 2005-2010 (in blue) and 2010-present (in yellow).
Graphic courtesy of Sheps Center for Health Services Research, UNC. 

There is, however, another dimension of the rural health conversation that is gaining traction in public discourse – rural public health. Where the trends in healthcare are alarming, improvement in public health feels tractable. This post focuses on insights from two recent reports – this one from the Aspen Institute (Feb. 2026) and this one from California's Department of Public Health (Feb. 2026) – to highlight opportunities for high-impact rural public health intervention amid the ongoing healthcare crisis. 

Public Health: Rurality in Focus

In general, the healthcare industry aims to treat people who are sick or injured, whereas public health seeks to keep people from getting sick or injured in the first place. Healthcare focuses on individualized care; public health focuses on entire populations. Because a key responsibility of public health is to collect, analyze, and interpret health data to inform timely public health interventions, policies, and resource planning, it is more likely to analyze and include the axes of identity and experience that inform vulnerability. In fact, rurality has been an axis of analysis in public health research for decades. "Place," meaning where people live, work, and play, is widely understood by experts in the field as a fundamental social determinant of health.

In February 2026, the Aspen Institute and the California Department of Public Health each published reports that examine, in significant detail, the state of rural public health. The Aspen Institute Report is titled "Meeting the Health Needs of Rural America," and represents the tenth installment in the Aspen Health Strategy Group's mission to tackle a single health issue annually through year-long, in-depth study. The California Department of Public Health Report, the State's second-ever "California State of Public Health Report," ("Cal. DPH Report") carves out tens of pages devoted to risks, trends, and interventions specific to rural children, adolescents, and adults.

All-Cause Mortality Rate by Race and Ethnicity in Urban/Rural
Areas, California 2022-2024 (Cal. DPH Rep., p. 32)

This post focuses on one paper from the Aspen Institute Report titled Population Health in Rural America: Changes, Challenges, and Opportunities, authored by rural demographer Shannon M. Monnat and sociologist Tim Slack. Their paper tees up several useful policy proposals, which provide a path to remedying the so-called "rural mortality penalty" – the name for a widening disparity where rural U.S. residents experience higher age-adjusted mortality rates than urban counterparts. The authors suggest that the relative recency of the rural mortality penalty, which emerged in the data only four decades ago, "provides reason to believe it can be reversed." (Aspen Inst. Rep., p. 5). 

Systemic Risks and Opportunities 

Each report does a thorough inventory of factors driving mortality rates across the lifespan, from infants to working-age adults to the elderly. Unsurprisingly, barriers like lack of access to healthcare, transportation, healthy food, broadband internet, and other social services are central to their findings. But each goes a step further to do some accounting of recent social and economic trends driving the numbers: substance abuse and misuse; growing gaps in educational attainment; and persistent economic disinvestment that has hollowed out local institutions and workforce pipelines. Environmental risks (including climate change) and exposures also explain recent losses in resilience and increases in mortality rates. These overlapping stressors compound, reinforcing cycles of poor health outcomes that are difficult to interrupt through healthcare access alone. 

Adult Mortality Rates in Nonmetropolitan (Rural) Counties,
2000-2022 (Aspen Inst. Rep.)

Writing for the Aspen Institute, Monnat & Slack characterize "rural economic and human health" as "intertwined." The data in both studies bears this out. Lower income, wealth, and levels of educational attainment correlate strongly with shorter lifespans and fewer years lived in good health. Importantly, both reports frame these outcomes not as inevitable features of rural life, but as the product of policy choices and disinvestment patterns that can be changed. The California report, in particular, emphasizes that upstream interventions–those that target education, early childhood development, and economic stability–offer some of the highest returns for improving long-term health outcomes (Cal. DPH Report). 

The reports identify education policy reform as a major inroad for uplifting rural communities struggling with economic disinvestment and population decline. 

Education, particularly possessing a bachelor’s degree, has become an increasingly important determinant of health and longevity in the United States. Higher education confers economic, social, and lifestyle advantages that manifest as a “personal firewall” that protects health, even in the face of external and unpredictable threats, such as pandemics, recessions, and natural disasters.

(Aspen Inst. Rep., p. 76). Investments in vocational programs, community colleges, and early childhood education programs like Head Start not only improve education and employment outcomes, but also provide measurable health benefits over time. Many health outcomes and disparities in adulthood are rooted in childhood conditions such as family and community health, neighborhood safety, policies, and systems" (Cal. DPH Report, p. 58). By strengthening local economies and expanding opportunities, these interventions address root causes of poor health, rather than treating symptoms as they occur. In this way, rural public health policy begins to function as a cross-sector strategy for community resilience. 

Conclusion 

The current crisis in rural healthcare access underscores the need for action, but it also highlights the limits of a healthcare-only response. As the reports analyzed in this post make clear, improving rural public health outcomes requires sustained investment in the social and economic conditions that shape health, long before a person ever becomes a patient. Public health offers a framework for identifying upstream opportunities and making interventions where they can have the greatest impact. In the face of hospital closures and shrinking coverage, this broader approach might provide a path forward: one that treats rural health not only as a medical issue but as a function of place, policy, and long-term community investment.

A modest proposal: Leaving

Torn down building in Shiloh Mountain area, Arkansas
© Lisa R. Pruitt, 2011

The Washington Post's 2017 article "Disabled and Disdained" tells the story of the McGlothlins, residents of Grundy, Virginia, who have fallen on hard times. The patriarch of the family is in jail after struggling with addiction. One of his sons shared the same fate. Sheila, the matriarch, lives on $500 a month in disability payments. Tyler, her 19-year-old son, lives in the household with his wife Morgan. Neither works. Tyler panhandles to supplement his mother's income. The article wants the readers (or at least that it is my impression) to feel sympathy for Tyler. Tyler did things right. He graduated high school, stayed clean, avoided unwanted pregnancies, got financial aid, enrolled in community college, and bought a car. Then, he lost his license as the result of a car accident, and as a result was unable to keep going to school. The article also describes a man named David Hess. Hess is an almost absurd character. He crossed paths with the McGlothlins when Tyler's father was out on the streets panhandling. Hess offered McGlothlin a job, but the McGlothlin patriarch refused on account of his work injuries. Outraged, Hess proceeded to chastise him (both in person and online) for his idleness. And yet, by the end of the article, I found myself sympathizing with Hess more than I did with Tyler.

Being 19 years old

In 2018, I was 19 years old, just like Tyler. I had been in the country for a couple of years by then. I rented the living room floor of a relative's apartment for $350 a month. I say floor because I slept on the floor. I did not have to, but doing so was more comfortable than sleeping on the couch, and so that's what I did. In those days, I worked full time as a shift leader at Carl's Jr. (although, due to my coworkers' chronic absenteeism, I often worked overtime), and I was simultaneously enrolled full time at Sacramento City College. I took the bus to both, spending several hours a day on it. I met a lot of curious characters on those buses (e.g. a man, who by my best guess was from Panama, who had made it routine to tell me he was going to kill me). I thought life was pretty good. One of my classes that semester was English Composition II. The class was taught by a professor whose name I have unfortunately long forgotten. The professor was a South African woman, advanced in years, and clearly well read. She taught us how to make proper use of the English language. She taught us about how we were not supposed to say "terrorist," since "freedom fighter" was the correct term. When asked whether Osama Bin Laden was a terrorist or a freedom fighter, she said he was a terrorist. English is a complicated language. The overarching assignment for the semester was an essay on a book titled Nickel and Dimed by Barbara Ehrenreich.

Shepard's job of choice in Scratch Beginnings
© Aim 2 Please Moving

Ehrenreich and Shepard

Nickel and Dimed follows journalist Barbara Ehrenreich as she goes undercover working a variety of minimum-wage jobs. In the book, Ehrenreich describes her experience in those jobs as difficult, injury-inducing, and soul-crushing. The wages she earned were not enough to cover her basic needs, and Ehrenreich, despite her best efforts, ate into the modest amount of savings she set aside for the experiment. The book's conclusion is grim: the American working poor are trapped, with very little-to-no hope of escaping despite their best efforts.

I was not convinced. My task that semester was to write a four- or five-page essay on the book. On account of a flare up of chronic contrarianism, I set out to find a book which was the antithesis to Nickel and Dimed, one which I could wield as a club against it in my essay writing process. I did not have to look for very long. Scratch Beginnings, by Adam Shepard (who, according to his LinkedIn page, is the co-founder of a brand named "Practice Empathy"), is a direct response to Ehrenreich. Shepard, a 23-year-old recent college graduate, started from scratch in Charleston, SC (a city he was unfamiliar with) with nothing but $25 in his pocket. He deliberately avoided using his degree, his connections, or any advantage not available to the general public. Ten months later, he had bought a truck, saved over $5,000, and by his account made friends and even gotten physically stronger. I echoed Shepard's criticisms of Ehrenreich in my essay and got a B. Curiously, I was not docked for the blatant contrarianism or lack of effort, but for using male pronouns a bit too much (such as when saying "if he did so..." instead of "if she did so..."). I explained to the professor that I only wrote that way because my own inner voice was male, and that was being reflected in my writing, but such an explanation was not sufficient. My core criticism of Ehrenreich, then and now, is that her experiment was unrealistic. Sixty-year-old women do not spawn into the world with nothing. In sixty years, a person accumulates skills, connections, and at least the opportunity to save. Her starting point was not a true starting point. Almost every story is a tragedy when the only thing you write is the final chapter. 

Who keeps Tyler home?

Tyler is the opposite of a 60-year-old woman. His story has really just begun; at 19, he has just entered the "agency" part of the human experience. And yet, throughout the article, I couldn't avoid the feeling like I was reading the last chapter of a story, not the first. What exactly could be the reason for that? My main suspect is the town of Grundy itself. Grundy has a population of 875 residents, distributed among 300 households and a bit under 200 families. Of these households, only about one-fifth have children at home. In the last decade, Grundy lost almost 15% of its population. With such conditions, it is not entirely unexpected that there is a lack of good jobs there. Explaining why there are no good jobs is harder. It certainly is at least partially caused by a variety of policy choices made by people far away from the McGlothlins (deindustrialization, climate policy, trade, and many more). Maybe it's just bad luck.

But a lack of good jobs cannot be the end of the inquiry. Tyler's life was more or less on rails before a few events derailed it. He lost his job at McDonald's after missing a shift due to a snowstorm, and he lost his ability to go to school after losing his license as the result of a car accident. Perhaps I am being a bit too cynical, but I doubt that a simple snowstorm and a "car accident" is all that happened. To be clear, I am not accusing Tyler of anything. However, these descriptions do not match at all with my lived experience. What kind of employer fires an employee over missing work once because of a snowstorm? I have worked a variety of jobs in food and retail, and I cannot remember even a single instance of someone being fired due to one episode of (justified) absenteeism. In all the jobs that I have had, when a person missed work due to other commitments, forgetfulness, or just being too busy doing drugs, nothing happened. At worst, they got a write-up. Businesses generally don't like to get rid of  good (or even mediocre) employees for minor absences or tardiness. Training new employees is a cost that most businesses would rather not bear too frequently. Similarly, it seems unusually harsh to take away a person's license over an accident in which they had little fault. Virginia is perhaps harsher than California in this regard, but this is still suspect. Here we come to two policies that could help a person such as Tyler, but which I am unconvinced would do the trick: (1) more stringent laws against wrongful termination, and (2) more lenient penalties for traffic infractions that result in accidents.

But even the lack of any jobs and a driver's license cannot be the end of the inquiry either. If the idea is that rural areas have a high density of acquaintanceship, was there truly not a single person in Tyler or his family's entire social network who could get him closer to a bus, or to school, or a place with jobs? Is Grundy really so far from everything? A quick search reveals that the closest metro area to Grundy is Kingsport, TN (population ~55,000), about a 2-hour-drive. This is a significant (but not insurmountable) distance, and it may explain the lack of opportunities. There are seemingly no public transportation options that would cover that trip either. Here we arrive at yet another policy that could help Tyler's situation: more extensive public transportation options. Admittedly, I have not seen a "commuter" route that stretches as far as the one Tyler would need, so its feasibility is debatable.

Rural people, immigrants, and subsidies

Venezuelan immigrants in Ecuador.

Assuming, for the sake of argument, that there isn't a single job available in Grundy; and, assuming also, that Grundy is simply so remote that it is literally impossible to commute by any means (whether public or private) to any other place where a job might be found, that raises the final question: why not move? How could things be worse anywhere else? I have looked for a satisfying answer to why people in economically depressed areas resist moving, and I have not found one.

As an immigrant, I find the resistance to moving genuinely difficult to understand. If life is so bad where you are and economic prospects are better elsewhere, why stay? I understand loving a place. Most immigrants from my country to the United States that I have met have expressed that they would like to go back some day. Many have expressed that, even if not possible during their lives, they would like to at least be buried back at home (it almost never happens, but it is a really nice sentiment). However, even with attachment considered, isn't leaving and returning with more resources a more productive approach? From my perspective, the McGlothlins' situation resembles something close to the natural, baseline state of things. What historically propels families out of such circumstances is a willingness to take risk, usually when things cannot get any worse. Usually, one member, often male, ventures somewhere harder and less comfortable, lives cheaply, saves aggressively, and slowly creates a foothold for others to follow. It is usually not pretty, but it's also a practice not unique to international migrants.

What I cannot relate to, in terms of my own lived experience, is the $500 in disability payments. Sheila's disability payment is also a policy choice. So is every other federal and state subsidy or program that flows into a place like Grundy. I want to be careful with my words, lest the spirit of David Hess fully take over me. I am not arguing that the government should abandon people in hard circumstances in order to force a sink-or-swim outcome. If the government did, a lot of people would undoubtedly just sink. I am asking whether support sometimes functions as an anchor. Tyler is not facing a choice between certain misery (staying) and possible misery (leaving). He is facing a choice between possible misery (leaving) and a small, predictable share of $500 (staying). There is a Spanish refrain which roughly translates to: "A bird in your hands is worth more than 100 in the sky."

Conclusion

Which brings me to a question that has loitered in my mind for the entire time I spent writing this post: at what point does subsidizing rural and remote areas just become subsidizing misery? Maybe the "death" of places like Grundy (or in less scary terms, their transformation) would benefit everyone, especially the people who live there. And maybe, what is slowing that transformation down is the accumulated weight of everyone's personal share of $500. I did not mean for this post to sound so negative. I do not think the McGlothlins are contemptible people. But perhaps there is something to the contempt that the David Hesses of the world display.

Back-to-the-land has come...back?

Barn in Benton County, AK. Credit: Lisa Pruitt (2011)

If you're a young woman on TikTok, the algorithm likely feeds you some flavor of "tradwife" content. Names like Nara Smith and Hannah Neeleman have become household names among twenty-somethings in the last few years. These women use their online platforms to play out a fictional reality of subservience to their husbands on gorgeous rural acreages, all while raking in millions from sponsorships and $70 bone broth powders. They espouse live simple, pared-down lives, cooking everything from scratch for a big, happy family, while finding time to spend their afternoons barefoot in the grass. They want you to believe that their life is good, and that more young women should aspire to be homemakers and homesteaders. 

These young women are the most visible group of young people promoting a modern "back-to-the-land" movement. They often root their desire in religion and "traditional" roles of men and women. Many scholars and commentators criticize the tradwife movement, saying it is regressive and uninformed. You can read excerpts of an New York Times article about modern "rural" aesthetics centered in patriarchy here. While some of the criticism rings true, this practice isn't new. Americans have demonized processed foods and dreamt of homesteading for decades. Back-to-the-land movements have drawn people's attention since their inception, inspiring families with traditional values as well as environmentalists and counterculturalists. 

The origins of back-to-the-land

America began its foray into the homesteading movement with the Homestead Act of 1862, which offered full title to government lands taken from Indigenous tribes to any settler who lived on and improved the land for five years. The back-to-the-land movement, however, originated in the 1900s. 

Many scholars cite Bolton Hall, an American lawyer and activist, as the origin of the back-to-the-land movement. In the early 1900s, he formed the Little Land League, which wanted to make land ownership and homegrown food a reality for low-income New Yorkers. This organization existed to "assist in the acquisition of land and show how to make the best use of it." He allegedly planned a $70,000 endowment for a program that would teach people how to farm and help them purchase the land. His book, A Little Land and Living, extolled the virtues of rural living and explained how to begin to make a living for yourself off the land. 

John Korvola's Homestead in Valley County, ID from the early 1900s. Credit: Jerrye & Roy Klotz, MD under a CC BY-SA 3.0 license.

A group of reformists picked up Bolton Hall's work, arguing that subsistence farming could help white Americans survive during the Great Depression and avoid the dangers of urbanization. Their writings sparked a the "third wave" of back-to-the-land in the 1960s and 70s. The third wave originated from the protest movements of that era, and grew into a "rural antimodern counterculture". As Jinny A. Turman-Deal's article We Were an Oddity: A Look at the Back to the Land Movement in Appalachia identifies, many third-wave participants were driven by non-economic factors: a desire to "leave the rat race" or political and social turmoil in the city. Their migration created a 4.5% increase in West Virginia's population. 

A New York Times article from 1975 posits that these new, young farmers desired hard work and an escape from American capitalism. They generally eschewed tractors and other "labor-saving devices." This movement reached across the country, with people from Maine to Oregon allegedly growing up to 75% of their food in their backyard. While this article states that most farmers relied on their families' middle-class incomes to make this a reality, a 1991 article states that about 48% of participants came from a middle-class background. 

Modern takes on back-to-the-land

Homesteading, a popular part of the back-to-the-land movement, has picked up considerable steam in the last 10 years. A November 2024 report from Fannie Mae shows that interest in rural mortgages has increased almost 80% since the start of COVID-19. Homesteaders of America, a conservative, Christian-adjacent homesteading advocacy group, conducted a poll in 2022 to assess the state of homesteading in America. They found that approximately 50% of their respondents were under 40 years old, and about 50% identified as conservative. Most were employed full-time, making at least 50,000 a year. Over 80% were married.

These findings align with the prevailing modern conception of homesteading. Conservative, young families with enough capital to secure property are the ones moving out to a subsistence farm. While I used the example of tradwives as the group most visible in mainstream media, queer and trans homesteaders utilize social media to share their experiences of living off the land, too. A recent CNN article highlighted some of these influencers, who stated they didn't see homesteading as a "conservative, separatist" movement, but rather a community-centered endeavor to build something they're proud of. 

Regardless of politics, many young aspiring farmers and homesteaders take up homesteading for similar reasons: increased health and well-being, an escape from tumultuous politics, and a desire to be more in touch with nature. These groups face a common challenge: a daunting rural real estate market. A 2022 Study from the National Young Farmers Coalition, however, found that 59% of young farmers stated that finding the land to farm was their biggest hurdle. Young farmers are being outbid by more established farmers, as well as large agricultural corporations. This statistic has been true for decades (as this 2012 blog post explains in an analysis between the United States and Greece). In some communities, leasing from community members or land trusts makes homesteading more accessible. In major cities, organizations exist to help low-income residents urban homestead in community co-ops. 

Homesteading and back-to-the-land movements draw new converts every day. While the media continues to criticize the tradwives from a feminist perspective, we should recognize that their lives resonate with so many young people. So many of the political pressures of the late 60s and 70s exist today: high inflation, declining trust in politics, and foreign wars impacting oil.

Back-to-the-land has come and gone as a desirable life path for over a century. It seems as if proponents, for decades, have thought  it is the cure to all of societies Interestingly, the draws are the same, regardless of politics, though each group seems to try and fit their politics to their reasons. At the end of the day, tradwife or drag queen, some people want to put their hands in the dirt.

Rastafari roots of plant-based eating

An Ital meal of rice, ackee, callaloo, and veggie chunks.

Source: Wikimedia Commons (2009)

In considering a vegan diet, I imagine a young, progressive urban consumer motivated by environmental or animal welfare concerns. In other words, someone who likely shops at a Whole Foods. In the West, veganism is packaged as something performed through individual consumer choices. That framing obscures the structural conditions shaping diets, and reinforces the mistaken belief that veganism is a modern invention. The “Ital” tradition complicates the popular narrative of modern veganism. Long before plant-based eating carried a price premium in Los Angeles, it was ordinary in the hills of rural Jamaica. 

The Rastafari movement began in the 1930s in Jamaica among the working poor who had been devastated by the global financial crash of 1929 and prolonged colonial mismanagement. These forces created mass unemployment and rural-to-urban migration into the slums of west Kingston. Rastas fled to the rural mountains where they could access land and practice self-governance without persecution.  

Leonard P. Howell, an early Rastafari leader, drew on the practices of Hindu indentured laborers in Jamaica to promote what became known as Ital living. The word “Ital” comes from “vital,” dropping the first letter to emphasize the pronoun “I”. This linguistic practice signals unity with the speaker, the listener, and Jah (God). Ital eating is an expression of “livity,” a Rastafari concept that the individual can embody and express spirituality through the practices of daily life.  For Rastafarians, Jah exists in all of creation, including plants, animals, and people. As such there is a divine force or energy in all. 

What one puts in one’s body either enhances or degrades this life force. Food that has been processed or chemically altered is considered corrupted and further from Jah’s creation. Life force does not begin at the moment of consumption. Powell’s research participants described farming, cultivation, and conservation as the literal pouring of one’s energy and emotion into the earth. The sincerity of this effort determines how the earth responds and reciprocates that energy. 

Rural Rastafari food is shaped by what the land yields. Coconuts are naturally abundant across Jamaica. They are cracked, drained, grated, and squeezed into milk that forms the base of most dishes. Vegetables and aromatics are sautéed in coconut oil. The food typically contains beans, spices, chili peppers, and the coconut milk, stewed for hours over low heat and eaten communally. A strict Ital diet rejects salt as “a needless adulteration” of what Jah placed on the earth, so herbs and dry seasonings are key. Scotch bonnet peppers, thyme, lemongrass, allspice, and nutmeg build complex flavor without salt. 

The one pot stew is a practical response to the rural conditions of Rastafari life. Land access is limited, so the range of available produce is narrow. A single pot stretches what is on hand to feed the community. Cooking takes place outside in clay pots often balanced over a wood fire by three stones. Metal cookware is avoided on the belief that it harms the body. 

In Saint Lucia, a young Rasta farmer described conversing with plants throughout their life cycle to transfer positive energy to them. He explained that during planting one must ensure a positive heart is present because this very energy will be transmitted to the earth. The same is true of cooking. Ital food involves preparing food with a clean heart to transfer life force into the food. Food must be cooked slowly, with intention and gratitude. This preserves and transmits the life energy that began in the soil. Food is not just physically nourishing; it is also spiritually nourishing.

Food that is rushed or processed severs the energy force and transmits a lower form. It follows too that food grown under corporate conditions is spiritually degraded. Jahson Peat, who runs a vegan restaurant in London called Zionly Manna, presents Ital as a process of relearning that strips away the method of eating brought about by colonialism. This is inseparable from a rejection of capitalism itself. Commitment to Ital eating is tightly linked to a broader turn away from the imported industrial and materialist ways of life, which are all combined under the Rastafari concept of “Babylon.” 

By contrast, mainstream veganism operates according to market logic. It converts diet choices into an ethical identity. For some, it is an exercise of personal branding, where what you eat signals who you are. This channels genuine ethical concerns for animals and the environment into demand for plant-based products. In this sense, the market-based vegan movement can be seen not as a challenge to the current food system, but a force that risks expanding it further, as seen through the IPO of Beyond Meat. The Ital diet is not a consumer identity. It seeks to reject the economic system and the very notion of consumerism that it relies upon. 

However, Ital does not operate entirely independent of market forces. Jaffe’s concept of “Ital chic” describes the convergence of middle-class consumerism and the Ital diet. In Kingston, Rasta symbols have been used to market artisanal soap lines, and premium vegetable products. When a brand sells coconut-milk products with Rasta packaging, it co-opts a tradition built on self-sufficiency and places it inside the very market that tradition was designed to refuse. This dynamic is similar to that explored in a blog post from this semester about rural tourism. It noted that rural culture is often packaged to meet consumer expectations, with authenticity operating as a selling point. 

Plant-based eating did not begin with a farmer’s market or with a marketing campaign. It owes some of its roots to rural Jamaica, where people grew what the earth offered based on a theological conviction. That story deserves to be remembered before it is repackaged.

The fast and the curious-ly large urban pickup

Acura Integra, Outside of Yosemite, Spring 2025

I have more than a passing interest in classic cars, particularly those of the Japanese domestic market (See some “JDMs” here). I inherited this interest from my father, who has raised me in an exclusively Honda/Acura household. His affinity for Acura began in the 1980s when he lived and worked in Osaka, where he purchased a Honda Quint (now known as a first generation Acura Integra).

My father’s Integra was an original model three door coupe, with a four-cylinder engine that displaced 1.6L of standard 87 octane and produced about 91 horsepower at a base weight of 2,000 pounds. In the thin, often crowded streets of Osaka - and most of Japan, for that matter-  that compact size and its modest horsepower were more than sufficient for his needs. This design philosophy can be found in many JDM cars, with the informal gentleman’s agreement capping original JDM output at around 276 horsepower at the wheel.

Acura watch given to salesperson
for making quota, circa 1990s

Today, I also drive an Integra. It is ostensibly of the same lineage as the original production. (Read more about the fifth generation Integra here). However, despite the fact that my Integra is classified as a “subcompact,” it weighs 1,200 pounds more than the original JDM Integra, typically cruising around 3,200 pounds. Despite this (in my mind unnecessary and deeply upsetting) size update for modern tastes in cars, it remains one of the smallest vehicles on asphalt, with American markets now dominated by SUVs and pickup trucks.

As anyone who drives on country roads in America can attest, one of the common classes of vehicle on the road today is a full-size pickup; think the F-150, the Ram 1500, or the Chevrolet Silverado 1500. Read more about driving in rural spaces on this blog here. ]. Looking closer at the 2024 F-150 as an example, the standard powertrain is a 325Hp 2.7L V6, with the typical model weighing in around 5,500 pounds. That is by no means the top of the scale. Many non-commercial super pickups can go upwards of 7,000 pounds. (For example, read about the F-250.)

In many rural contexts, these vehicles serve legitimate irreplaceable needs. Pickups are necessary for anyone who has to haul in day-to-day life, whether from hunting. (Read more about hunting to eat on the blog here) or work, and their standard four wheel differential transmission is more suited for off road travel than a forward wheel drive or a rear wheel drive. However, these justifications simply do not apply to urban environments. Urban roads are well developed; urban spaces do not typically require hauling of loads in daily life.

Cultural factors help explain the popularity of these monster trucks in situations where their practicality is in question. Much has been said about the cultural ethos associating rural practices with country, blue collar work and conservative politics. Read more on this association. As mentioned, you can’t listen to a modern country playlist without hitting three allusions to a truck. Trucks are one of the most popular vehicle types, owing I believe some amount of success with this association.

That said, I have a serious interest in limiting these vehicles to urban environments. If vehicle choice was purely aesthetic, then I’d let it rest there, with the only discomfort being visual. However, this choice of vehicle is not harmless in an urban environment.

Larger vehicles increase the survival rate of their own occupants while increasing the mortality for others from a collision (A study about increasing vehicle sizes and lethality here). Increased fuel consumption, wear on roads, and congestion are negative externalities that are put onto the public. With every pound that a car carries, its wear on asphalt becomes exponentially greater).

Today, addressing pickups and other automobiles through regulation has regrettably become a culture war problem. Current contentions surrounding car emissions and sizing are much the same as the rural/urban divide elsewhere: idealistic urban elites are intruding on the necessities of rural life. Read more about rural contentions on emissions standards and the adoption of electric vehicles here and here. 

To address this issue in a less controversial way, I propose to localize vehicle regulation. Municipal policymakers should have greater authority to regulate vehicles purchased and used within counties, rather than this power being solely vested in the state and federal systems and resulting in deeply unpopular legislation between rural and urban areas. (One such example involving taxing larger vehicles at the state level here). As such, localized vehicle standards would no longer place unnecessary burdens on rural communities. At the same time, vehicle emission standards should remain federal and state, as air remains shared amongst both rural and urban areas and across state lines.

This increased municipal power could come in many forms. The simplest would be a increased municipal tax of some sort on the purchase and registration of larger vehicles in urban areas. The easiest way to implement this would be an excise "sin tax" on vehicles of a certain size that are deemed unnecessary outside of work purposes. Alternatively, or in addition, bylaws that regulate the usage of vehicles over a certain size in some areas such as parking lots and school zones would serve to decrease congestion and potential safety risks.

My final proposal is to allow the local importation of JDM vehicles that are not marketed in the United States. As these vehicles are often smaller, their fuel consumption and negative externalities are correspondingly smaller. Read about “Kei trucks,” a JDM only smaller pickup, here. Subsidies could also be incorporated into prices for subcompact automobiles and their drivers, preferably those who drive Hondas or Acuras.

By making these vehicle regulations local, cities can better manage their own safety, infrastructure, and environmental concerns without deepening the cultural divide that often accompanies broad, uniform mandates between the rural and urban. I am happy to report that I have no conflicts of interest in any of these proposals.

Acura Integra, Yosemite, Spring 2025

Energy poverty burdens rural America, especially as the climate warms

Mt. Sherman, Arkansas 

Credit: Lisa R. Pruitt, 2009

Rural areas produce much of the energy that our nation relies on. 60% of coal plants are located in and 83% of wind, solar and geothermal energy is produced in rural areas. Even so, families living in poverty in rural areas are more likely to experience energy poverty. Energy poverty is the inability to pay utility bills to heat or cool a home. A report by the Island Institute explained that the median energy burden (percent of income spent on energy bills) is 33% higher for rural households than the national median. 

Inability to pay for utilities can increase exposure to heat or cold, leading to various health risks such as respiratory issues, heart problems, allergies, and kidney disorders. Climate change has exacerbated exposure risks due to a greater frequency of extreme weather conditions.

Rural areas face these energy inequities because of rising energy costs and a lack of investment. Across the country, residential electricity costs have increased 30% since 2021 and residential gas costs have increased 40% since 2019. The geographic isolation of many rural areas makes it more expensive to deliver energy and provide energy efficiency upgrades. 

Investor-owned utilities in the early twentieth century didn't want to provide the same service in rural areas as in urban areas because the lower population densities in rural areas made profits too low to justify construction and investment. In 1935, the Rural Electrification Agency (REA) was created. The REA utilized a "rural cooperative model" which allowed for publicly owned and controlled electricity. Although, these rural cooperatives often lack capacity and resources to invest in more comprehensive energy efficiency programs. 

Additionally, rural areas are more likely to have older homes with worse insulation. On top of older homes, 20% of rural households live in manufactured homes (commonly mobile homes), which are significantly less energy efficient and more costly to repair than traditional housing. 

AC Unit on Mobile Home

Credit: Creative Commons

How do we currently address energy poverty?

The Low Income Home Energy Assistance Program (LIHEAP) is a federally funded program that provides assistance to low-income households who face a high energy burden. Assistance can range from one-time financial assistance to free energy efficiency upgrades. A study done by the American Council for an Energy-Efficient Economy (ACEEE) found that weatherizing a home for families living at or below 200% of the federal poverty line can save an average singe family household $283 per year and manufactured home households $458 per year.

Katrina Metzler from National Energy and Utility Affordability Coalition explained that rural areas have a harder time accessing LIHEAP benefits because the resources are not centralized as they are in urban areas. A 2024 survey found that only 17% of households that qualify for LIHEAP assistance utilize the program. 

LIHEAP's funding formula has historically provided more funding to cold-weather states. But climate change has caused a shift in the historical energy burden being faced by rural communities. Extreme heat is now the primary cause of weather-related deaths, with 2,302 heat-related deaths in 2023. This is a 44% increase from 2021. With rising temperature, regions such as the South and Southwest have greater cooling needs, while the heating needs in regions such as the North and Northwest become less extreme. 

LIHEAP is still using a funding formula from the 1980s to determine how funding is distributed to states. With changing climate, it may be time to shift the funding formula to better aid states struggling with extreme heat. 

Credit: ACEEE

What are states doing?

9 states have implemented percentage-of-income payment plans (PIPPs). This type of program caps energy bills at a specified percentage of household income for low-income customers to keep them affordable. 14 states provide low-income households energy at a discounted rate to keep costs low.

Additionally, 10 states offer arrearage management plans, which forgive a portion of debt for each timely payment of a new bill. This helps to defeat the energy bill debt cycle than many households in energy poverty face. One missed payment can turn into growing debt that threatens disconnection from service, forcing households to pursue risky options such as emergency aid or high-cost loans. 

The Rocky Mountain Institute modeled the cost of a universal PIPP, capping bills at 4% of annual income. They determined it would only cost $9.3 billion to fund this program, 0.14% of federal spending in 2024.

In 2024, Congress appropriated $4.125 billion in LIHEAP funding. Last April, the Trump administration sought to completely cut funding for the LIHEAP program, but full funding was eventually included in the appropriations package passed in February of this year.

LIHEAP is an essential program to ensure that rural households have some assistance with the crushing costs of utilities. Implementation of PIPPs, ideally at the federal level, could drastically reduce the burdens of energy costs on low-income rural families and prevent them from having to choose between buying food or having air conditioning during severe heat. 

The burden of the "American Dream" on rural communities

Photo Credit - Chelsea Peng 2025 "The end of the American Dream and why it’s OK"

On March 14, the House Committee on Small Business held a hearing called “Empowering Rural America Through Investment in Innovation.” Subcommittee Chairman Jake Ellzey, a Republican representing Texas's 6th Congressional District (a mix of Dallas-Fort Worth suburbs and rural counties like Navarro and Cherokee), told the room that “as the demand for AI accelerates, America’s digital infrastructure is rapidly expanding into rural communities.” He promised that for every data center job created, seven more would follow in the surrounding community.

I have spent this semester writing about technology arriving in rural America. The promise is always the same: innovation, jobs, progress. The pattern is also the same: the benefits flow out, and the costs remain.

Three posts, one pattern

In my first post, I wrote about a $25 billion AI data center planned for Tonopah, Arizona, population a few hundred. Backed by a billionaire venture capitalist and a Trump mega-donor, the project would consume as much electricity as a million homes and drain aquifers that residents depend on for drinking water. The tech consumers served by the facility live in cities. The residents of Tonopah got noise, light pollution, and a fight they lacked the political power to win.

In my second post, I stepped back from tech to look at the framing. I had caught myself thinking that rural investment came at urban expense. That zero-sum instinct turned out to be the wrong lens. The federal government spends $850 billion a year on defense and asked $1.8 billion for the Legal Services Corporation. The scarcity pitting rural against urban is a policy choice, not a fact of nature. Rural and urban working people have lost ground to the same forces and share the same interest in functional public services.

In my third post, I wrote about robotic strawberry harvesters arriving in Salinas Valley. Immigration enforcement had squeezed the farm labor supply. The federal government’s response was to lower guest worker wages, and then automation filled the gap. The robots cost $300,000 each, priced for corporate farms. Small growers and the farmworker communities who built Salinas for generations got nothing.

Each story has different characters and geography. But the structure is identical: federal policy creates or worsens a rural problem, and capital arrives promising solutions. The benefits accrue to investors/urban consumers and the people who already live there absorb the costs.

Photo Credit - Will Robinson 2020 "Is the American dream dead?"

The packaging

This pattern persists because it is wrapped in a story that Americans have been told their whole lives: that progress rewards hard work, that innovation lifts all boats, that the people who struggle simply need to adapt. This is the "American Dream," and I have come to believe it is one of the deepest sources of political paralysis in this country.

I said something like this in class a few weeks ago. I told Professor Pruitt and my fellow students that the American Dream is this country’s “original sin.” She pushed back, fairly, and pointed out that there are things about this country that are more original and more sinful. She’s right. Slavery, land theft, and genocide are the material foundations. But the American Dream is the legitimating story that makes those foundations look earned. It converts structural advantage into personal merit and structural disadvantage into personal failure.

I know this because I lived it. I grew up male, Mormon, white, healthy, and financially comfortable. My family believed fiercely in individual agency. I followed the rules and concluded that people whose lives were less "successful" than mine were in that position because of their own bad choices. It took college and a lot of unlearning to see that my “good choices” were only available because the structure was built for me.

The same logic operates at the community level. When a rural hospital closes after Medicaid cuts, residents blame the hospital, not the lawmakers who voted for the bill. When a farmer in Colorado threatens to mechanize rather than pay overtime, the framing is that labor protections killed the farm, not that the farm’s business model depended on paying workers less than the legal standard in every other industry. The American Dream teaches people to punch down and look away from the hand above them.

What would it look like to say no?

There are signs of resistance. At least 25 data center projects were cancelled across the United States in 2025 after community opposition, four times the number in 2024. Rural school voucher programs have been blocked by rural Republicans who understand that their public schools are the backbone of their communities. Bernie Sanders and Alexandria Ocasio-Cortez drew 10,000 people to Greeley, Colorado, a conservative town in Weld County, on a message of class solidarity across the rural-urban divide.

None of these are sufficient. But they share a feature that the American Dream framework lacks: they start from the premise that rural communities have the right to decide what happens to their land, their labor, and their resources. That premise is incompatible with a system that treats rural space as a site of extraction and rural people as obstacles to progress.

Congressman Ellzey’s hearing (referenced at the beginning of this post) promised rural America seven jobs for every data center. Nobody on the panel asked how many jobs, aquifers, and night skies those same communities would lose. Until that question gets equal time, the American Dream will keep doing what it has always done: blaming the most vulnerable among us for their poverty and lack of resources, while lionizing the most powerful people in this country as they get increasingly wealthy. 

40 hours or 60: Who decides what rural labor is worth?

Sugar beet worker in Colorado (1938). Source: Library of Congress 

In 2011, this blog post observed that farmworkers:

[R]eceive little protection from the law...[and] are excluded from the National Labor Relations Act.

The National Labor Relations Act gives workers the right to unionize, and the exclusion of farm workers is part of a broader pattern. The Fair Labor Standards Act of 1938 similarly exempted agricultural workers from overtime protections; a carve-out that persists at the federal level today. As the National Employment Law Project has noted, Congress approved this exemption as part of a:

[G]rand compromise that excluded farm and domestic workers - who were overwhelmingly Black - from the protections being afforded to other workers.

Colorado is now testing whether states can succeed where the federal government has not; a move is afoot there to extend overtime protections to farmworkers without triggering the very harms those protections are meant to prevent. 

Here's some recent history. In 2021, Colorado Governor Jared Polis signed Senate Bill ("SB") 21-087, the "Farmworker Bill of Rights," which brought agricultural workers under state overtime rules for the first time. The law was phased in gradually, initially kicking in at 60 hours per week, then declining over time. Currently, the law operates through a bifurcated system: workers harvesting outside the peak season are generally paid overtime after 48 hours, while peak-season workers receive overtime after 56 hours. 

Map of Colorado Counties. Source: David Benbennick, Wikimedia Commons

Now, five years later, Democrats in the state legislature are split over what comes next. One bill would lower the threshold to 40 hours, matching the standard for other industries. A competing bill would raise it back to 60, essentially returning to where the phase-in began.  

Senator Jessie Danielson has introduced SB 26-081, which would lower the threshold to 40 hours per workweek or 12 hours per workday, matching the standard for most other Colorado workers. Senate Majority Leader Robert Rodriguez is expected to introduce a competing bill that would raise the threshold to 60 hours before overtime applies. 

Farm operators argue that a 40-hour threshold could be fatal. Don Brown, a Yuma County farmer and former state agriculture commissioner, told Colorado Politics that if the 40-hour bill passes, "we will have to figure out how to eliminate jobs and mechanize more."

Peach picker in Palisade, CA (2015).
Source: Library of Congress. 

Bruce Talbott, owner of Talbott Farms, is the largest fruit grower on the Western Slope: a portion of Colorado that is west of the Continental Divide (the mountain ridge that separates rivers flowing to the Pacific Ocean from those flowing to the Atlantic Ocean), and is home to the state's fruit-growing industry. Talbott Farms recently built a new bunkhouse to spread hours across more workers to minimize overtime. In response to the possibility of lowering the overtime threshold to 40 hours, Talbott stated: 

All businesses have to live within their means. In the end, it's the farmworker who gets hurt. 

The industry also faces broader challenges. The director of the Colorado Department of Agriculture's market division noted that net farm income is projected to drop to $1.8 billion in 2026 - $400 million lower than the previous year - citing fluctuating markets and low commodity prices. 

Farmworker advocates see the issue differently. Betty Velasquez of Project Protect Food Systems Workers argues:

[Farmworkers] are the people providing food on our tables. They should have access to earn more money as well. 

Advocates also contend that the industry has not produced data showing overtime rules specifically cause harm, and they point out that reduced hours have given workers more time with their families. Yet, the empirical picture is also contested. 

A 2023 study by UC Berkeley researcher Alexandra Hill found that California's overtime law led to reduced hours and earnings for farmworkers after employers shortened workweeks to avoid overtime costs. Hill's continued research found that by 2022:

[California farmworkers] earned about a hundred dollars less per week on average than they would have without the law in place. 

The Colorado debate exposes a structural tension in rural livelihood policy. Agricultural exceptionalism - the legal tradition of treating farm labor as categorically different - was born of a racist compromise in 1938. States like Colorado and California are now experimenting with alternatives. Those experiments produce uneven results, with some states like New York and Oregon offering tax credits to offset higher labor costs while others press forward without such cushions. Workers and operators each claim to speak for the rural interest. 

Senator Danielson insists the state should be doing more to protect farmworkers. Senator Rodriguez frames the dilemma as "death by 1,000 cuts" - death to farmers, that is - by water shortages, tariffs, and now labor costs. 

Both are Democrats. Both represent rural livelihoods. Neither has a clean answer.

The dual edge of isolation: escaping to and surviving in rural Alaska

Looking at the shore off a cruise ship,
Alaska (2012)

When I was 12 years old, I went on an Alaskan Cruise. Our cruise stopped in Juneau, Ketchikan, Skagway, Sitka, and Haines. While in Ketchikan, a tour guide showed us around town and talked about what it is like to live in Alaska. My cousins and I asked the tour guide what they like to do for fun in Alaska. He replied that many locals enjoy nature, go fishing, and hunt.

When we asked about movie theaters and TV shows, he mentioned that the town didn’t have a theater, and many locals lacked televisions or internet access. As teenagers, we contemplated at the thought of being so disconnected. While I could not imagine myself living in Alaska, this is the reality for some.

It made me wonder, who would live in Alaska? The Census Reporter estimates that Alaska’s current population is just above 740,000 with a predominantly white population (57%), and Native Alaskans (13%) representing the next highest percentage. While the population seems to be increasing, the working-age population is declining.

Tourists visiting Nugget Falls in Juneau, Alaska (2012)

Alaska has long captured the American imagination as the ultimate frontier for a fresh start. The state actively incentivizes newcomers through the Permanent Fund Dividend, which pays residents simply for living there for a calendar year. Beyond financial perks, the profound remoteness of the state offers a unique social refuge. People fleeing restrictive pasts (such as having a criminal record) often migrate to the state specifically because of its remote nature and anti-establishment culture.

For some, this seclusion provides a necessary second chance. J.T. Perkins III tells a reporter for The Marshall Project about how he recommends for someone with a criminal record to flee to Alaska to avoid restrictive public registries and social stigma. J.T. also describes the community created within insolation fosters an environment where neighbors judge each other by current actions rather than past mistakes. However, this "leave me alone" culture has a devastatingly dark side for vulnerable populations.

While property crime in the state has dropped to its lowest levels since 1985, violent crime remains staggeringly high. The Alaska Beacon discusses how Alaska’s rates of violent offenses have outpaced the national average since 1993, driven heavily by very high rates of rape and aggravated assault. In fact, the rate of reported rape in Alaska has consistently hovered between three and four times the national average for the last decade according to the Alaska Beacon. The Alaska Justice Information Center also reported in 2021 on the FBI's Uniform Crime Report comparing Alaska's rates to rates nationwide. It is no surprise that the crime rates in Alaska are so bad considering the lack of law enforcement (read more about that in an earlier blog post here).

This social crisis is compounded by a severe lack of public infrastructure, another direct consequence of rural isolation. NPR investigated the conditions of rural schools in Alaska. Because shipping heavy equipment and housing skilled workers is astronomically expensive, basic maintenance of schools are frequently abandoned by the Alaskan government. As a result, rural Alaska Native communities are left with schools that are literally collapsing into the permafrost, filled with black mold and structural hazards. 

This structural neglect extends to basic household utilities, with more than 200 rural Alaskan communities currently facing inadequate access to water. Residents without piped water are forced to survive on less than six liters a day, severely impacting public health.

Conclusion
Ultimately, the isolation of rural Alaska acts as a double-edged sword. It functions as a hiding place for social outsiders or people with a criminal record who are seeking to relocate, while simultaneously trapping its marginalized residents in a cycle of violent crime and infrastructural decay. 

Reflecting back on that cruise I was on in 2012, it’s wild to think that my biggest concern was just a lack of internet or a local movie theater. I was completely blind to the harsh realities of what extreme isolation means for the people living there.