Forget the shortage of rural doctors and lawyers: A Maine town offers to pay for a plumber

NPR reports today from Jackman, Maine, population 862, where local benefactors are offering to educate a student to become a plumber--as long as s/he will return to Jackman to work.  The town's only plumber retired recently.  

To fill the void, one family has partnered with the local school district to create a scholarship. The 2015 Inza and Harry Hughey Memorial Scholarship will award $2,000 to a local graduate willing to become a certified plumber and come back to work in the town. 

Sheryl and Larry Harth run the scholarship fund and decided to focus it on plumbing once the void hit them acutely. They moved back to the area about two years ago and built a house, hiring a plumber who lived in that town about 50 miles away to work on the project. Last year, they needed more work done and they were promised that that plumber would return.

Harth reports:  

Well, it's been two years and we still have not seen that person.  

The Harths hope that a graduate of the local Forest Hills High School will take up the offer:  

With that, then we have somebody who is established, who knows the town, has a love for the Great [North] Woods.  

The most recent graduating class had just 12 students, and 168 are enrolled, K-12, for the coming academic year.  Jackman is part of the Moose River Valley. The State of Maine has designated Jackman an "on-shore island," meaning it is surrounded by trees instead of water.  Jackman is in Somerset County, population 51,706.  The poverty rate is 18.2%.     

Posts about the rural doctor shortage and rural lawyer shortage, respectively, are here and here.  

Abortion litigation in the news, but with little acknowledgement of impact on rural women

The past 10 days have been momentous regarding litigation of the constitutional fate of abortion regulations that have proliferated in the past few years.  First, on July 29, a three-judge panel of the Fifth Circuit Court of Appeals struck down as unconstitutional a Mississippi law that required abortion providers to have admitting privileges at a hospital within 30 miles.  The law would have closed the state's only remaining provider, in Jackson, forcing women to travel out of state to get an abortion.  The court held that the state could not foist its constitutional obligations onto other states in that way.  Judge E. Grady Jolly, joined by Judge Steven Higginson, wrote:

A state cannot lean on its sovereign neighbors to provide protection of its citizens’ federal constitutional rights.

Judge Jolly observed that the law "effectively extinguishes [a woman's constitutional right to end a pregnancy] within Mississippi's borders."  The court did not, however, overturn the law or decide whether it was justified on grounds of safety, which was the justification offered by the State of Mississippi.  The opinion preserved a federal district court stay of the law while the federal district court considers the constitutionality of the law's substance.  Although I have called attention here (and elsewhere on this blog) to the impact of these admitting privilege laws on rural women, the Court did not mention that group of women in particular.  The New York Times coverage by Campbell Robertson and Erik Eckholm, however, closed their report on the case with a rural note:

Other hospitals, especially in conservative and rural areas, have refused to grant privileges to abortion clinic doctors in order to avoid controversy.

This statement hints at stasis and religion in rural communities but does not touch on the issue of material spatiality as a hinderance to abortion access.  Read full New York Times coverage of the Fifth Circuit decision here.

Erik Eckholm and Manny Fernandez also mentioned rural women in their August 4, 2014 NYT story about the ongoing trial in federal district court in Austin, Texas regarding a requested injunction against a part of Texas H.B. 2 which is set to go into effect on Sept. 1.   That part of the H.B. 2 law requires abortion providers in Texas to meet the requirements for ambulatory surgical centers (ASC).  Litigation about the requirement follows hot on the heels of litigation about other provisions of H.B. 2--one requiring hospital admitting privileges and the other regulating medication abortions.  Those other provisions of H.B. 2 were upheld by a three-judge panel of the Fifth Circuit this spring in a decision which opined that traveling 150 miles each way to procure an abortion does not constitute an undue burden.  (Read my further commentary on that decision here). In any event, the Eckholm/Fernandez coverage is accompanied by useful maps that show how many abortion providers Texas had before H.B. 2 and how many they will have if the ASC requirement goes into effect.  The earlier upheld provisions of H.B. 2 arguably had the greatest detrimental impact on providers in the lower Rio Grande Valley in particular because at least one clinic remained open in most of Texas's major cities.  This ASC provision would close, among others, the only remaining clinic in the upper Rio GrandeValley, in El Paso. 

Attending to the rural, Fernandez and Eckholm note that just 10 facilities are expected to remain open if the ASC provision is not enjoined by the federal district court.  Here they touch on the rural-urban issue.  

All of those remaining facilities will be in major metropolitan areas such as Dallas and Houston, and there will be no site providing abortions in the largely rural regions west or south of San Antonio. Many women who live near the border in McAllen and other cities in the Rio Grande Valley — one of the poorest sections of Texas — have already been making roughly four-hour, 240-mile trips to a facility in San Antonio to get an abortion.

Most puzzling of all the abortion news this week--at least from a ruralist perspective--is the decision made by Judge Myron Thompson of the federal district court in Alabama on Monday.  The great news is that Judge Thompson struck down Alabama's admitting privileges law as unconstitutional.  What I still have not sorted out is the part of his opinion that dealt with rural women and urban women, which I found puzzling.  In short, Judge Thompson focused on the fact that the incremental harm of the admitting privileges law would be much greater on urban women than on rural women, noting that the former already faced considerable burdens on getting an abortion.  Thompson expressed particular solicitude for the women in Mobile, Montgomery and Birmingham, all cities that would lose abortion providers if the Alabama law went into effect.  Whatever his spin on abortion access along the rural-urban continuum, Thompson did offer this heartening conclusion:

If this requirement would not, in the face of all the evidence in the record, constitute an impermissible undue burden, then almost no regulation, short of those imposing an outright prohibition on abortion, would.

 I'll return to his opinion and discuss it in more detail in a future post. 

Meanwhile, I note that the New York Times coverage of Judge Thompson's decision did not note the rural angle--perhaps not surprising given his somewhat confusing spin on the rural-urban issue.  Other media coverage of abortion news this week has also entirely overlooked these laws' disparate spatial impacts.  See NPR's story yesterday here, and today's NYT coverage of the trial in the Texas case.  The good news is that some judges and some journalists are talking about distance, about material spatiality.  For the most part, however, they're still managing to overlook rural women …  

Rural others "subsist on [urban] trash"

That was a line from Joe Williams's review of the just released documentary Rich Hill, which I featured yesterday here.  I  have been pondering film critic Williams's invocation of the tension between rural and urban--the "us vs. them" phenomenon across the rural-urban axis, as in his review's opening line:

Exit the interstate to venture across the moonscape of rural America, and you may glimpse a breed of alien that looks vaguely human but subsists on our trash.

This strikes me as a powerful--and rare--admission from an urbanite (Williams writes for the St. Lois Post-Dispatch, so I assume he dwells in that city's urban milieu, and he does use the pronoun "our").  He is essentially stating: "We urbanites are using you ruralites."

Of course, rural America subsists on the scraps from metropolitan America's table in more ways than one … think the rural prison building boom, toxic waste disposal, etc.  See related posts here, here, and here and a Call for Papers about "Rural as a Dimension of Environmental Justice" here).

Reminds me, too, of this week's story out of Loving County, Texas, population 95.  That county's leaders are seeking to bring all of our nation's nuclear waste there as a way of bolstering the local economy.  Here's the lede for Matthew Wald's story, headlined "County of 95 Sees Opportunity in Toxic Waste":

Loving County is big, dry and stretches for miles, and is the perfect place, local officials say, to store high-level radioactive waste. 

Officials here hope to entice the federal government — with $28 billion to spend on the disposal of high-level radioactive waste — into considering the possibility. 

The federal government canceled it lag to store the waste at Nevada's Yucca Mountain site.  Wald quotes Skeet Jones, Loving County judge (chief elected official):

With the money that this would generate for the county, we might even be able to pay the taxpayers back. We could build some roads. We could bring in some more water. We could have a town that’s incorporated, have a city council, maybe even start a school. … Maybe even a Walmart.

Loving County's school was closed years ago, and the few young people there are sent to nearby Winkler County's schools by bus.  According to a 2006 New York Times story about Loving County being the nation's "emptiest place," a plaque on the county courthouse declares:

Mentone [the county seat] has no water system (water is hauled in) nor does it have a bank, doctor, hospital, newspaper, lawyer, civic club or cemetery.

A quick search on nytimes.com for this August 2014 story about Loving County also brought up a 1998 story, which labeled Loving County and Mentone the nation's richest place because it had the highest per capita income in the nation.  Loving County's affluence is attributable to oil and mineral wealth:  

360 producing gas and oil wells and 18 more being drilled [as of 1998], creating an enviable problem for the county — forcing it to keep lowering its tax rate.

Indeed, theres more good economic news about Loving County.  This 2012 story indicated it has the lowest income inequality in the nation, and I note that the county's poverty rate is a low 10.6%.

In the sense that Loving County is affluent, it is odd that the county is willing to make its populace vulnerable by seeking the nation's nuclear waste.  The more typical environmental (in)justice story is the purveyor of a negative externality seeking out of a powerless and poor rural place on which to dump the externality (see links above).

Sounds to me like the affluent Loving County residents simply don't want to pay the higher taxes that would help provide the infrastructure the county needs.

Rich Hill: Award winning documentary set in rural Missouri released today

This film by Andrew Droz Palermo and Tracy Droz Tragos won the prize for best documentary at Sundance this year.  Here's what Joe Williams of the St. Louis Post-Dispatch had to say today, upon the film's opening in New York City.

Exit the interstate to venture across the moonscape of rural America, and you may glimpse a breed of alien that looks vaguely human but subsists on our trash. 

They’re called the poor, and although their city cousins get some occasional, sensationalized coverage in the press, the whiter and more-numerous rural poor are almost invisible.

Williams writes that the three "dirt-poor" boys, aged 12, 13, and 15, whose lives the film follows "are effectively over before they are old enough to drive."   

Williams lauds the film's "exquisite imagery and the bittersweet focus on character."  

 Rich Hill, named for the area's productive farmland, is in west central Missouri between Kansas City and Joplin.  The town's population is 1,396, and it is in Bates County, population 16,500.   Bates County, which rests against the Kansas state line,  has a poverty rate of 17%.  The population is 94.9% non-Hispanic white.  

With a real nod to the significance of place and how geography is destiny, Williams closes his review with this line:  

But perhaps the saddest thing about the film is the thought that nobody raised in Rich Hill could have made it.

Note that Rich Hill is not far (especially as the crow flies) from Taney County, Missouri, setting for  Winter's Bone.  Read more here and here.
 

The film opens tomorrow in St. Louis and Kansas City.  

Could Wal-Mart be key to delivering rural healthcare?

The New York Times reports today on Wal-Mart's move into the health care business with clinics in many stores.  A focus of the story is on rural health care deficits and how Wal-Mart could be part of the solution.  Rachel Abrams's report notes that Wal-Mart has been dabbling in health care delivery for some time, but now it's making a more significant move by setting up clinics in five stores in South Carolina and Texas, with a sixth store opening in Texas by the end of 2014.  

Here's an excerpt that attends to the rural:

Like its competitors, Walmart is looking to grab a bigger share of the billions of health care dollars being spent in the United States and benefit from the changes that have resulted from the Affordable Care Act. 

With its vast rural footprint, Walmart is positioning its primary care clinics in areas where doctors are scarce, and where medical care, with or without insurance, can be prohibitively expensive. If they succeed, the company said, it is prepared to open even more. 

“If they’re rolling it out across the rural stores primarily, they’re actually filling an important gap in the health care ecosystem,” said Skip Snow, a health care analyst at Forrester Research.

Wal-Mart says its clinics can offer a broader range of services than the acute care clinics leased by hospital operators at Wal-Marts elsewhere.  Further, Wal-Mart is presenting itself in these five markets as a primary medical provider, which is fundamentally different to how CVS, Walgreens, and other chains are marketing themselves.  

Missouri barely passes constitutional amendment guaranteeing a right to farm

A "brief and vaguely worded" amendment to the Missouri Constitution guaranteeing a right to "engage in farming and ranching practices" won narrow voter approval on Tuesday.  With all 3,898 precincts reporting, the amendment passed with 50.1% of the vote.  Nearly a million votes were cast, and the difference between those for and against the amendment was just about 2500 votes.  North Dakota is the only state with a similar amendment.  Julie Bosman reports for the New York Times:

Supporters of the amendment said the measure was needed to preserve Missouri’s agricultural heritage, which some farmers believe is under attack from national groups like the Humane Society. The agricultural industry in Missouri, with its nearly 100,000 farms, has been rattled by the push in other states to pass measures regulating livestock conditions and genetically modified crops. 

Opponents said the amendment would benefit only large corporate agricultural interests that are trying to avoid regulation relating to the environment and animal welfare. The amendment had wide support in the Republican-controlled legislature.

The vote is eligible for a recount because it was decided by less than one-half of one percent of votes cast.  Missouri is, according to Bosman, a leading agricultural state with 100,000 farms producing crops like wheat, corn and soybeans.  

Read full New York Times coverage here.  The Times also ran this story by Bosman a few days before the vote.  It included this information about farming regulations in other states.

Backers of the amendment are wary of laws that have passed in other states, like California, where voters in 2008 approved roomier living conditions for hens, and Oregon, where a rural county’s ban on genetically modified crops was overwhelmingly passed in May.

Bosman quotes Prof. Erin Morrow Hawley of the University of Missouri Law School: 

There is a lot of uncertainty with respect to how the amendment would actually work in practice. You could see a state law challenged based on this constitutional amendment. But the biggest aim is to prevent new state laws coming in from outside the state. The idea is to create another legal tool to stop that.

This earlier story by Bosman also featured some colorful quotes from colorful farmers, including this one.

“I personally don’t know anybody that’s against this,” said Richard Le Jeune, who raises 200 cattle on his 573-acre property in the tiny hamlet of Halfway, Mo., 30 miles north of Springfield. “Some of these city people don’t have a clue what goes on in the country and how food is produced. We need this to keep the outsiders from trying to run things.”

Another farmer, Darvin Bentlage of Golden City, took a different view, stating that proponents of the amendment "don’t know what kind of can of worms is going to open up.”  He continued:

One thing’s for sure — it’s going to put ag culture above everybody else. We’re going to be a different class of people. You won’t be able to complain about anything that we do. That should never be the case.

Missouri voters also passed on Tuesday a constitutional amendment expanding gun rights, which calls for the right to keep and bear arms to be “unalienable.”

Rural as a Dimension of Environmental Justice: Call for Papers

Abstracts Due: October 1, 2014

Papers Invited for Submission Due: February 1, 2015

Submission: Email abstracts (up to 350-words) to Loka Ashwood (Ashwood@wisc.edu) and Kate MacTavish (kate.mactavish@oregonstate.edu).

Changing community and production dynamics make rural places a state-sanctioned site for some of the most hazardous and toxic industries of our time. From its production treadmill, industrial agriculture has cast onto rural areas a plethora of negative externalities: mounting levels of air and water pollution, farm consolidation, and depopulation. A range of extractive and other risky industries justify the siting of facilities in rural areas because of easy access to ample natural resources, sparse populations that reduce exposure risk, and the possibility of economic revitalization.  State and federal statutes in the U.S. context (e.g., Right To Farm laws, the Federal Code of Regulations for Nuclear Operations) often permit these industries to target rural America based on past practice and low population levels.  

Cities serve as powerful hubs for the global economy, pulling away resources from less prominent urban and rural areas. The growing periphery within core countries, as well as continued resource extraction of rural places abroad, calls for increased attention to the rural facets of injustice in developed and developing countries. 

We invite paper submissions that explore facets of the rural that help explain rural places’ vulnerability to environmental injustices from interdisciplinary perspectives, including (but not limited to) sociology, geography, law, anthropology, public health, and the environmental sciences. We are especially keen to receive papers from scholars working broadly on issues of environmental justice in order to foster conversation between those scholars and scholars whose focus on the rural more generally.

Abstracts of interest will be reviewed and then select papers will be invited for full paper submission on February 1, 2015.  Accepted papers will be published in a special issue of the Journal of Rural Studies.

Barn weddings pit neighbor against neighbor as new types of rural nuisance

The New York Times ran a front-page story today titled,  "Neighbors Say Barn Wedding Raise a Rumpus."  The dateline is Grant, Minnesota, population 4,096, and here's the lede for Julie Bosman's story:

For legions of young couples, there is no wedding venue more desirable than a barn in the country, with its unfussy vibe, picturesque setting and rural authenticity. 

For neighbors of the wedding barns, it is a summer-long agony.

Interesting in spite of that characterization--focus on "rural authenticity"--wikipedia labels Grant a "suburb of St. Paul."  It is in Washington County, population 246,603, part of the Minneapolis-St.Paul-Bloomington MN-WI metropolitan area.  One of the neighbors protesting the the wedding barn in Grant is quoted:

We moved out here for the rural nature, the quiet aspects of it, the open space.

In a similar vein, Bosman quotes Laurie Tulchin, "who lives in a rural part of Iowa City," population 70,000 and the fifth largest city in the state, " next door to a wedding barn."  

They blare music all night long, they have college students out there screaming, and everyone’s drinking.  Rural residents have quiet lifestyles. Sometimes I just think, ‘What the heck happened out here?’ 

Bosman's story continues:

In rural areas across the country, residents have protested that some barn owners flout zoning rules requiring that they operate only as agricultural enterprises. Unlike other businesses, the barns are often not inspected to ensure that they are up to code, and many lack proper sanitation, fire doors and sprinklers, accommodations for people with disabilities and licenses to serve liquor.

Barn owners often argue that these are agricultural enterprises in an era when family farms are rarely economically viable if they don't engage in some agritourism.    They say barn weddings are just a form of that tourism.

Both local government bodies and judges have gotten involved in different places, Bosman explains:

[C]ity council meetings have become stages for disputes in areas where friendly relations are the norm. Some small townships with ambiguous zoning laws have been forced to examine their regulations to figure out whether the wedding barns are legal.

* * * 

In some towns, judges have intervened, leaving trails of anguished soon-to-be-married couples. Last summer, a judge in St. Louis County, Mo., ruled that a historic barn on a property with a view of the Mississippi and Missouri Rivers was a potential fire hazard, leaving a bride and groom who had scheduled a wedding reception there only days to make other plans.