Saturday, September 27, 2014

Considering future regulation of groundwater and such regulation's effect on rural communities.

Earlier this month, Governor Jerry Brown signed historic groundwater legislation that will charge local water basin managers with the responsibility of protecting California’s groundwater aquifers from overdraft. There is no doubt that this legislation was the state legislature’s response to the severe, three-year drought California has been facing. As the state has experienced low amounts of rain and snowpack the past few years, Californians have turned to groundwater to meet their water needs. This increase in groundwater pumping has depleted groundwater supplies to their lowest level in a century and has caused the San Joaquin Valley to sink in certain areas. The recent groundwater legislation in California has motivated me to investigate where state legislatures might move next in their regulation of groundwater as environmental concerns around groundwater heighten and how that potential regulation might affect rural communities.

For those who do not know, groundwater is simply rainwater or surface water that has percolated and gathered in subsurface cracks and spaces. Groundwater supplies drinking water for 44% of the total US population and 99% of the rural population. In 2005, 68% of groundwater was used for irrigation. Considering the percent of groundwater used for rural drinking and irrigation, it seems that any regulation on groundwater will have a drastic effect on rural populations.

In my search to uncover information that could potentially provoke legislatures to develop future groundwater regulation, I began examining the environmental impacts of groundwater pumping.

According to G.L. MacPherson with the Department of Geology at the University of Kansas, Lawrence, groundwater contains 10-100 times higher concentrations of carbon dioxide than the atmosphere; thus, when groundwater contacts the atmosphere, that carbon dioxide degases into the atmosphere. This means that pumping groundwater to the surface adds to the production in greenhouse gas emissions. In his public comment submission to the California Air Resources Board, William Bourcier, Ph.D., sited MacPherson stating that MacPherson estimates that the carbon dioxide produced from pumping groundwater is equal to the sum of all volcanic carbon dioxide release. If this is accurate, then the carbon dioxide emissions produced by groundwater pumping may be something that is regulated by states concerned with greenhouse gas emissions.

What type of effect might regulation of emissions produced by groundwater pumping on rural communities in a state like Nebraska, where 50 of the state’s 93 counties are rural? Nebraska is a state that, in 2005, accounted for 9% of the nation’s groundwater withdraws despite being less than 1% of the nation’s total population.

The overall impact of regulation of this type on rural communities will, likely, depend on the amount of carb dioxide that is actually being produced by pumping groundwater to the surface and the individual state’s environmental regulation tendencies. It is tough to say whether a state, like Nebraska, so apparently dependent on groundwater will implement such a regulation.

Rural workers unqualified for high skill manufacturing jobs

Many rural areas are among the poorest in the nation. One reason for this problem is availability of jobs. Further, high paying jobs in rural communities are scarce. But another obstacle rural workers face is the increase in knowledge-based jobs. Today's manufacturing jobs often require skill sets unlike the assembly line days of the past.

Indiana is home to many rural communities. Almost half of Indiana's counties are classified as rural. Indiana is also the top manufacturing state in the nation. In Indiana, the number of manufacturing jobs has been restored to pre-recession levels, but the labor force available in rural communities cannot fill them. Many of these manufacturing companies are related to the automotive and metal machining industry. For example the Fortune 500 companies Cummins Engines and Steel Dynamics are located in Indiana. 

Brazil, Indiana is the county seat of rural Clay County. Brazil is home to three companies that fit Indiana's high tech manufacturing profile well. Great Dane TrailersBritt Aero, and Morris Manufacturing are all located in Brazil. Great Dane makes trailers for big rig trucks, while Britt Aero and Morris Manufacturing make tools and metal parts. 

Brazil has an interesting economic problem: they have jobs, but an insufficient qualified labor force. These three companies are searching nationwide for qualified workers because local workers are not qualified for their jobs. Economist Robert Guell says “You have a group of people who need jobs, want jobs. They’re ill-suited to the jobs that are available.” 

A report by the Rural Urban Entrepreneurship Institute at Indiana State University explains this conundrum. According to the report advanced manufacturing is among the areas leading the resurgence in manufacturing jobs. But these advanced manufacturing jobs require higher education and training. 

Rural economies need jobs, but they also need training. Proper training of local workers can help manufacturers keep jobs local and improve rural economies. The manufacturing business should support vocational and trade schools to come to Indiana. These businesses could also lobby the state legislature to provide more funding for high school shop classes. This will provide students with unique job skills before they enter the workforce.

Tuesday, September 23, 2014

The shortage of doctors in rural areas and medical schools’ attempt to fill this gap

The United States has a serious shortage of doctors, and rural areas are hit harder than most places. According to the U.S. Department of Health and Human Services, there are 6,100 federally designated health professional shortage areas in the United States. Urban areas have approximately 84 primary care doctors per 100,000 people. However, rural areas have only 68 primary care doctors per 100,000 people. To put these numbers into perspective, approximately 20% of the population lives in rural areas, while only 9% of doctors practice there. The future looks even bleaker; the Association of American Medical Colleges warned that by 2020, the United States will have a shortfall of 45,000 primary care physicians and 46,000 surgeons and medical specialists.

If medical school applicants are increasing, then why is the severe shortage of doctors in rural areas? Dr. Howard Rabinowitz, professor of family and community medicine at Thomas Jefferson University's Medical College, has studied this issue for over 30 years and cites several reasons. For current doctors, commonly cited reasons for leaving rural areas include insufficient insurance payments, administrative hassles regarding insurance claims, and rising business and malpractice insurance expenses. Additionally, fewer people from rural areas are applying to medical schools, and approximately half of the students from rural areas want to practice in metropolitan areas instead of returning to their rural communities.
When a rural area loses a doctor, the consequences can be particularly problematic for the community because that doctor may be the only one around within an hour (or more!) drive. For a family, that means not only time spent driving to the doctor, but also the gas expense and lost wages if one must take time off of work to go to the doctor. 

Medicare and medical schools have taken steps to try to control the shortage. Medicare gives a 10% bonus to doctors who serve communities with physician shortages. From 2011-2015, these doctors are eligible for additional bonuses depending on the type of care they provide. Medical schools are thinking even more proactively by influencing students during the educational stages of becoming a doctor. For example, the University of Missouri School of Medicine’s Rural Track Pipeline Program targets students who want to practice in rural areas and offers repeat exposure to these areas. More than 450 medical students have participated in the program, and more than 57% of students practice in rural areas both inside and outside Missouri. The University of Colorado School of Medicine’s Rural Track program helps students understand the benefits of practicing medicine in a rural environment. Applicants are up from 62 in 2006 to 190 in 2010. Lastly, Kansas, a state that has five counties without any doctors, opened a medical school devoted to rural medicine. (See this blog post on the University of Kansas and this blog post describing other similar programs).

Medical schools’ rural track programs offer a better solution by developing students’ interest in rural areas early on. Research shows that only 3-4% of medical school graduates plan to practice in rural areas, while schools with rural track programs, such as University of Missouri School of Medicine, show more than 50% of matriculates work in rural areas. This outcome is quite promising.

Will legislative and medical school efforts be enough? For current doctors, especially those with families, the bonuses may not be enough to draw them to a rural area. Uprooting a family often means the spouse finding another job, children having to start new schools, and leaving family and friends – essentially leaving an established life. For many, moving to a rural area may not be worth the effort. Additionally, many of these doctors likely did their residency in metropolitan area hospitals and became accustomed to certain aspects of urban areas, such as more extensive cultural or educational opportunities. Arguably, medical schools' rural track programs offer a better solution by beginning students on a rural track before residency. Although the current number of rural track programs is limited, hopefully other medical schools begin to adopt this idea so we can begin solving a problem before it's too late.

A call for particularized legal services

In Creed and Ching’s article “Recognizing Rusticity: Identity and the Power of Place” they discuss the ways in which the urban/rural distinction affects how identity is expressed. Markers of place influence differences in social identification and how identity is experienced within broader minority groups. Creed and Ching aptly state:
“The resulting representation of social distinctions primarily in terms of race, class, and gender thus masks the extent to which these categories are inflected by place identification. For example, social theorist generally fail to acknowledge that a rural woman’s experience of gender inequality may be quite different from that of an urban woman, or that racial oppression in the city can take a different form in the countryside.”
An important reason for studying rural livelihoods in a legal framework, and also a significant personal motivator for myself, is to be able to better understand the ways in which the legal needs of rural communities differ from perhaps my own urban-normative understanding of legal services.

One group Creed and Ching do not explicitly mention is the LGBT community, which has been historically discriminated against in rural areas—arguably facing a distinct set of needs and experiences than the metropolitan LGBT community. While LGBT individuals in urban populations seem to feature most mainstream narratives of identity experience, many LGBT people living in rural areas still face systemic inequality. In rural areas, discrimination in access to health care, housing, and employment often leads to an increased risk for poverty and social isolation for LGBT families. This can be particularly crippling in rural communities where jobs are scarcer, health care providers and housing options are limited, and economic status might already be low. Moreover, discrimination in rural communities also creates an additional barrier to accessing critical state and federal social services.

Effectively addressing the intersection between place and identity becomes crucial in being able to provide legal services that account for the distinct needs of specific minority groups. That is not to say this effort is not being made—many organizations are addressing the legal needs of rural LGBT communities in exciting ways. One such attempt to confront discrimination faced by the rural LGBT community includes, for example, the USDA reaching out to the rural LGBT community. Newly-proposed regulations will protect transgender people from discrimination in many USDA programs, including important housing and farming programs with particularly impacts on rural Americans. Moreover, the Human Rights Campaign has recently expanded offices into the Deep South – Mississippi, Alabama, and Arkansas—to address LGBT rights in more rural parts of the country. Such efforts are important in being able to understand the experiences of the rural LGBT community; to better address the specific, particularized legal needs of its members; and to effectively protect and identify ways to ensure they have access to resources they need to thrive.
Native Americans and rural education 
Distinguishing by race is a sensitive and complex endeavor. Race has long been a foremost consideration in the history of our nation. Rural America is growing in racial diversity. Rural and small town areas have traditionally not been as racially or ethnically diverse as the nation overall. The 2010 Census reports that approximately 78 percent of the population in rural and small town-communities are white and non-Hispanic, compared to 64 percent of the population in the nation as a whole.

Less than two percent of the population in rural and small town areas identifies as Native American. Native Americans may seems like the minority in rural areas, however, as a percentage within the race, more than half of all Native Americans live in rural areas or small town area. This concentration of rural living has led to many hardships. One of the more apparent hardships of rural life and poverty is education.

In 2013, 78.8% of single-race American Indians and Alaska Natives 25 and older, had at least a high school diploma, GED certificate or some type of credential in 2012. Only 13.5 percent obtained a bachelor's degree or beyond. Why is this? Historical poverty and social constructs aside, a rural quality of living is a large factor.

According to the U.S. Census Bureau, one-third of American Indians live on reservations.  American Indians living on rural removed reservations have limited access to education. Efforts are made by the government: there are federally funding options, grants, and some schools extend scholarships to Native American children, however, options for small rural tribes are still lacking. This is even truer when it comes to higher education, as there are only 33 accredited Tribal Colleges in the United States and the cost to attend, though low, is beyond what many at the poverty level can afford. 

Higher education within the tribal communities is scarce. However, high education is not the only concern; it is in the early educational years where Native American students are most negatively impacted. Rural impoverished Native Americans are a minority within the minority. Xenophobia and sometimes blatant racism has created yet another hurdle that rural Native Americans have to overcome. This struggle has been evidenced in the classroom student-teacher interaction.

One such case that occurred earlier this year is that of the Northern Californian Bear River Band and the Wiyot tribe. The Wiyot’s reside is in rural Humboldt County and recently, there have been allegations that the Native American students of the district have been subject to harassment by faculty, staff and student based on their race. An investigation into the claim resulted in racial epithets and an allegation of physical abuse. California Indian Legal Services, the National Center for Youth Law, and the American Civil Liberties Union of Northern California filed a complaint on the matter.

In July, President Obama acknowledged that there was a “crisis” in Native American education and announced that he planned to improve the Bureau of Indian Education via additional federal funding.  Federal funding is the key in moving these rural impoverished tribes into a 'competitive' position, that would be comparable to that of other national student. If the children are the future of the tribes, their education is absolutely crucial and they need the support of our government. America needs to recognize that we are one unit, and that to marginalize one group hurts the nation as a whole.

Narratives of rural life in criminal trials

The documentary Brother's Keeper tells the grim tale of a false confession to murder and explains how rural culture can contribute to the phenomena of false confessions in general. The documentary has the potential to help jurors in future trials comprehend why people in rural areas may not have the civic savvy to identify when they are being coerced by police into make a false confession.

In the film, four brothers live in a shack in a rural town of New York. Bill, the eldest, does not wake up one morning. Did he die naturally in his sleep? Or did his brother Delbert mercy kill sick and elderly Bill? Here’s the twist: Delbert confessed to police that he placed his hand over Bill’s mouth and suffocated him.

The defense attorney’s strategy is to show that Delbert is just simple country folk who, due to a feeble mind coupled with police coercion, falsely confessed to the murder of his brother. The prosecution paints a darker story of an uneducated hick that callously murdered his brother like he was a sick animal.   

Although the film never discusses the issue, it is interesting to compare two hypothetical jurors that might be asked to sit on this trial in such a rural area: one is Rudy and he is from a rural town just like the defendant; the other is Larry, from a larger nearby city. Both men receive a jury summons to appear at the municipal courthouse, located in the county seat. Who is likely to end up on the jury? First, the process assumes that both men are literate and fully appreciate the importance of the jury summons. Next, there is the issue of access to public transportation or a car to make the trip to the county seat. Yet another factor is the men’s ability to take time off from work and lose income. Given the statistics on rural life in this country, including lower educational access, lack of public transportation, and long-term poverty, it seems tentative that the “Rudys” of the world will actually be present for voir deer as often as the “Larrys”.

The result is that the defendant may not be tried in front of a group of peers that truly understand the context of his life and motivations.

Unfortunately, it is common in the criminal justice system that the jury is not composed of the defendant’s peers. (A common example is the number of minority defendants that are judged by completely white juries.) In regards to the case in Brother’s Keeper, Delbert’s defense hinges on the willingness of the jurors to believe that someone could falsely confess to a crime. Delbert’s defense battles against the assumption that everyone knows their Miranda rights. His defense fights the presumption that a confession equals guilt. However, Brother’s Keeper does an outstanding job of capturing the circumstances under which an uneducated, unsavvy “country bumpkin” could easily be misguided by coercive police interrogation tactics and ultimately confess to a crime that he did not commit. Most jurors, especially those from large cities with a higher education, would not be able to comprehend how someone could mistakenly admit to a murder. The documentary provides the background culture of rural life that could lead to such a false confession. 

The value of Brother’s Keeper potentially transcends its ability to explain why Delbert, in particular, falsely confessed to a crime. The film could be used in future criminal trials to provide jurors with a look at rural mentality and how that mentality can lead to a false confessions. Currently in California, the courts often allow defense counsel to read from newspapers, books, and magazines to explain the phenomenon of false witness identification and false confessions. The California District Court of Appeals in People v. Woodson explicitly rejected the view that a criminal defense lawyer is limited in closing arguments only to what was said in testimony or introduced into evidence during the trial. The court stated that “[i]f argument is to be so restricted, there could be no use made of the writings of philosophers, patriots, statesmen or judges.” As the law currently stands, lawyers may refer to popular movies and read from printed sources. With aggressive advocacy, criminal defense attorneys representing individuals from rural communities might successfully argue that documentaries like Brothers Keeper should be shown to jurors to provide context to a defendant’s actions.