Thursday, October 26, 2017

On Trump's declaration of a public health emergency over opioids--and rural angles on same

I heard several radio stories today on Trump's public health emergency declaration, stories that mentioned particular challenges associated with the crisis in rural America.  Several mentioned the shortage of physicians there, and the first report I heard on NPR this morning shortly after Trump's announcement mentioned a loosening of the restrictions on telemedicine to respond to this fact.  But searching around the Internet, I can now find very little "in writing" on these issues.  Here's a short excerpt from the New York Times coverage, which gets to rural in the eighth paragraph:
The designation of a public health crisis, formally made by Eric D. Hargan, the acting health secretary, would allow for some grant money to be used to combat opioid abuse, permit the hiring of specialists to tackle the crisis, and expand the use of telemedicine services to treat people in rural areas ravaged by opioid use, where doctors are often in short supply.
I also found this from In These Times, which reports regularly on rural issues:
CDC reports rising rates of drug overdose deaths in rural areas 
Rates of drug overdose deaths are rising in nonmetropolitan (rural) areas, surpassing rates in metropolitan (urban) areas, according to a new report in the Morbidity and Mortality Weekly Report (MMWR) released today by the Centers for Disease Control and Prevention (CDC). 
Drug overdoses are the leading cause of injury death in the United States, resulting in approximately 52,000 deaths in 2015. This report analyzed trends in illicit drug use and disorders from 2003-2014 and drug overdose deaths from 1999-2015 in urban and rural areas. In 1999, drug overdose death rates for urban areas were higher than in rural areas (6.4 per 100,000 population versus 4.0 per 100,000). The rates converged in 2004, and in 2006 the rural rate began trending higher than the urban rate. 
In 2015, the most recent year in this analysis, the rural rate of 17.0 per 100,000 remained slightly higher than the urban rate of 16.2 per 100,000. 
Urban and rural areas experienced significant increases in the percentage of people reporting past-month illicit drug use. … The new findings also show an increase in overdose deaths between 1999 and 2015 among urban and rural residents. This increase was consistent across sex, race, and intent (unintentional, suicide, homicide or undetermined).
That story also quotes CDC Director Brenda Fitzgerald, MD: 
The drug overdose death rate in rural areas is higher than in urban areas.  We need to understand why this is happening so that our work with states and communities can help stop illicit drug use and overdose deaths in America.
I'm looking forward, in the coming days, to more analysis of rural issues/rural health care delivery.  Meanwhile, here is part of the New York Times editorial criticizing Trump for not doing more to counter the opioid crisis:
He declared the opioid epidemic a national public health emergency, which sounds urgent but doesn’t free any significant new money to fight it. In doing so, he ignored the plea of his own opioids commission to declare a full-on national emergency, which would immediately free billions of dollars for emergency response, addiction treatment and efforts to stop the flow of illegal opioids into the country — a comprehensive approach that is so far missing.
Here is the New York Times news coverage of Trump's announcement and here is NPR's.  Here's more coverage from the Times on the crisis, an op-ed from late September, and this feature mapping the crisis and its acceleration in recent years.

Wednesday, October 25, 2017

On timber and Trumplandia: "timber is a real thing when you get out of New York and Washington DC, right?"

This Q & A feature from the Princeton Alumni Weekly is annoyingly hard to read because it captures the spoken word, unedited. Still, I found myself wanting to share this excerpt from the interview with Carolyn Rouse of Princeton University's Anthropology Department because in some ways it captures beautifully the rural-urban divide in our country.  In particular, it sums up urban folks' failure to understand rural economies, rural labor markets, rural residents, rural concerns.  
...being in California, I was staying in a motel next to a timber mill. We would pass cars with, you know, trucks with timber. Timber is a real thing when you get out of New York or Washington DC, right? And so, how do you frame [a scholarly paper/inquiry] in a way that makes readers in your audience — I mean, the concern is the audience, right? Well, who’s going to read a paper if they’re not interested in timber? So, but timber’s really important. We use it to build houses and buildings, and there’s an ecological element to it, right? So where are we with — I don’t even know. I don’t know where we are with respect to timber in terms of global warming, in terms of — right, the economy, nothing, right?
Rouse is talking about timber, but it seems to me we could substitute lots of rural "products"--perhaps even food/farming/agriculture--for "timber" in Rouse's comment. 

Monday, October 23, 2017

On rural and urban in Catalonia

Several weeks ago, the New York Times ran this story about the tractor having become a symbol of the Catalan secession movement.  It discusses the role of the “tractorada,”or tractor armada, in the Catalan independence movement.  On the occasion that is the subject of this report from early October, a tractorada had convened to block an intersection of two major highways that carry Catalan farm products to other parts of Spain and to nearby France.  The dateline is Vic, Spain (population 41,956), which is the center of a valley of hundreds of family-owned farms.  The story's lede follows:
Rolling his rickety red tractor through a rural valley in Catalonia, Jordi Colom seemed like just another farmer heading to the fields. Except that he was in a line of dozens of tractors lumbering along. And cars honked in approval. People on the side of the road waved red-and-orange Catalan flags and cheered.
The story then quotes 39-year-old Imma Colom, the sister of Mr. Colom.
Today, everyone wants to be a farmer.
Ms. Colom's husband, too, is driving a tractor.  Her brother is also quoted:
People who are Catalans are very Catalan here.
Elsewhere the story picks up the urban v. rural theme, noting that Barcelona, the capital of Catalonia, is highly global and cosmopolitan. That status is the theme of this more recent New York Times story from Oct. 20:  Barcelona: A Global City in the Eye of a Separatist Storm.  Here's that story's lede:
These days, the city of Barcelona wears two hats. And not too comfortably. 
On the one hand, Barcelona is a global city, a former host of the Olympics, and the home of one of the world’s most famous soccer clubs, F.C. Barcelona. It is a magnet for more than 10 million visitors a year, an example of the ways large cities increasingly influence global politics, economics and culture. 
On the other hand, Barcelona is the capital of Catalonia, Spain’s restive northeastern region, and the nerve center of a drive for Catalan independence that is described by its opponents as parochial, exclusive and nationalist.
It is the "parochial, exclusive and nationalist" that suggests "rural."  I am reminded of other political movements driven (at least partly) by "rural" concerns, such as Brexit, the State of Jefferson, and Donald's Trump's election.   Other related stories are out of Germany and Poland.

Sunday, October 22, 2017

On lack of services in the midst of (and following) a natural disaster

The Los Angeles Times reports this morning on the Redwood Valley fire, in Mendocino County,, California (population 87,841) which claimed eight lives earlier this month.  One focus of the story is on the lack of services--the lack of warning in this case--as the fire bore down on the valley.  Joe Mozingo writes:
The escape from Redwood Valley began with no evacuation orders, no reverse-911 alerts, no warning whatsoever from authorities. Residents were left on their own to flee for their lives. 
A mechanic trapped by fire on the ground climbed a tree until it passed. An elderly woman raced out in her underwear. A mother and her four children hiked through the brush of a steep mountain ravine to safety. 
Most who survived had to thread a narrow road with trees ablaze on both sides. Burning debris rained down on them as they drove over fallen limbs in the smoke.
And I can't resist including Mozingo's description of Redwood Valley, population 1,729, which is just north of the county seat of Ukiah. He calls it "bucolic" and then continues:
The braided West Fork of the Russian River wends through it from the north as the valley opens from a narrow canyon to a flat bottom-land of vineyards, pastures, modest new homes and old farmhouses.
As for who live(d) in the valley, Mozingo writes of "teachers, firefighters, mechanics, shop owners, contractors, at least one pot grower and several retirees. They had swimming pools, ATVs and backyard work shops."  The story is also chock-full of tales of local, neighborly heroism, just like you would expect in a rural community like this one.

One family hit by the Redwood Valley fire has been the subject of quite a bit of media coverage because they lost their 14-year-old son Kai, the youngest victim of the California fires.  His 17-year-old sister lost both of her legs to amputation below the knees because she was so badly burned in the fire, and the parents are in hospitals in Sacramento and San Francisco with burns over about half of their bodies.  As the family headed down their narrow driveway, their cars caught fire and they scattered on foot.  Read more hereThis story reports that Napa and Sonoma Counties also did not issue Amber alert-style warnings.

And here's a story from last week about a struggle to get relief aid to the more remote parts of Puerto Rico following the devastation wrought by Hurricane Maria.

Saturday, October 21, 2017

A rural hospice, regulated by its neighbors, not the state

NPR ran this story yesterday about a volunteer hospice in Port Angeles, Washington the county seat of nonmetropolitan Clallam County, population 71,404.  Though the feature is ultimately about death, it's actually a feel-good story of a non-profit that is serving its community very well.  Rose Crumb, a retired nurse who is now 91, founded Volunteer Hospice of Clallam County some four decades ago:
"[Rose] let people know hospice is not all about dying," said Bette Wood, who manages patient care for VHOCC. "Hospice is about how to live each and every day." 
In a nation where Medicare pays nearly $16 billion a year for hospice care, and nearly two-thirds of providers are for-profit businesses, the tiny volunteer hospice is an outlier.
* * * 
She was the first in the region to care for dying AIDS patients in the early days of the epidemic. 
But the real rural angle on the story is here, regarding the exemption from state regulation for hospices like the one in Clallam County.  The story quotes Leslie Emerick, director of public policy and outreach for the Washington State Hospice and Palliative Care Organization.
They don't have a reputation of negligence or complaints as far as I'm aware, but there's always the possibility of that when they're unlicensed or unregulated.   
But Astrid Raffinpeyloz, VHOCC's volunteer services manager, points out that the hospice wouldn't have lasted long in a small town if there were problems.
We don't have oversight from the government, but we have minute oversight from the community. 

Friday, October 20, 2017

#MeToo social media phenomenon resonates in rural America, too

Don't miss Ashley Westerman's story this morning out of western Kentucky, which is where Westerman happens to have grown up.  Indeed this story arose from Westerman's observation that the hashtag #metoo had caught on among those in her home community, something she says is unusual.
People don't usually jump onto social media campaign bandwagons like that ... This is the first time I've noticed an issue campaign like this trickle down in my home community.  
This phenomenon would suggest a greater "feminist consciousness" than is typically associated with rural people and places--though those rural women might not label it "feminist."

One woman Westerman interviewed was Julie Martin, who is probably middle-aged because she has three daughters and four granddaughters.  Martin reported that, especially when she was younger, she was subject to unwanted behavior from male colleagues.  Martin initially worked as a grocery clerk and then in the medical field, but she has spent the last 14 years working at the local school.  Martin is quoted:
They would refer to you as sugar [expletive] or honey bun and sweetheart and darling. And I'm not your sweetheart. And I'm not your darling, you know (laughter)? I had one grab my behind. And after I jumped him and explained sternly that that was not acceptable, I never had that problem with him again. But you always have the verbal harassment--that some guys just feel they have that privilege.
Martin never reported any of the behavior.  Why not?  Well, her answer echoes the rural ethos of  self-reliance:
I've always been one of those that was taught that you deal with problems yourself. You don't shove them on someone else. When he grabbed me on the butt, I didn't go to my supervisor. And to this day, I still regret not going to my supervisor and saying, hey, we have a problem.
Further, she would encourage her daughters and granddaughters to report.  Martin indicated that she thinks women are now more empowered by social media, which has helped to diminish the stigma associated with these incidents.
It doesn't really matter whether you're in a small community or a larger city. That's something that has just always been not talked about. And so many people have faced that. And maybe they felt that they were the only ones. And then when they started seeing me too, me too, me too, they're like, hey, wait a minute. Me too. And it's nothing to be ashamed of.
Here's a great segment on American Public Media's "The World" about sexual harassment around the world.  One woman talked about how having jobs in the service sector, like restaurants, where sexual banter is common, can leave one thinking that such behavior is normal--and that you just have to deal it. 

Here's a post on how the January 2017 Women's Marches played out in rural places, too.

Cross-posted to Feminist Legal Theory.

How prison is like a small town: lack of anonymity

That was a comparison made in this NPR story yesterday.  The transcript is not online, but the quote I wrote down went something like this:  Prison is like a small town.  Everyone knows everyone else's business.

This is relevant because the story is about distributing playing cards featuring details of unsolved crimes in the hope that some prisoner will have information that can help to solve the crime.

Thursday, October 19, 2017

Where health care fuels a rural economy

The New York Times ran this story a few days ago about a rural community where healthcare provision--and in particular the Baxter Regional Medical Center--is a huge economic engine.  I know the place well; it is Baxter County, Arkansas (population 41,513), about 50 miles from my own hometown, Jasper, Arkansas.  As the story by Patricia Cohen points out, this is a place rich in natural amenities that has drawn many retirees over the years.   (Thankfully, it's also drawn some highly qualified physicians who want to raise their families in a rural area.)

Cohen's angle in reporting on Baxter Regional Medical Center is that this is Trump Country, though his plan to repeal and replace Obamacare would endanger their jobs.
The hospital is the single largest employer, with 1,600 people paid to mop floors and code insurance forms, stitch wounds and perform open-heart surgery. 
* * *  
Across the country, the health care industry has become a ceaseless job producer — for doctors, nurses, radiologists, paramedics, medical technicians, administrators and health care aides. Funding that began flowing in 2012 as a result of the Affordable Care Act created at least a half-million jobs, according to an analysis by Goldman Sachs. 
In many rural areas, where economies are smaller and less diversified, the impact is magnified. ... But its significance has grown since the Affordable Care Act passed. The hospital alone has added 221 employees, a 16 percent increase, since 2011.
While health care accounts for about 12% of jobs nationwide, it is accounts for more than twice that--about 25% of jobs--here.  The share of jobs in the health sector is "roughly equal tot he share employed by the county's manufacturer and retailers combined." 

Of course, rural hospital closures have been rampant in recent years, but Baxter Regional has fared better than many, maintaining its ability to provide specialized services such as "neurosurgery and an emergency cardiac catheterization lab, the state’s first 3-D mammograms and magnetic resonance imaging."  Cohen explains how Baxter Regional is somewhat different from many rural hospitals--basically because it relies as much or more on Medicare than on Medicaid. Remember that much of the population are retirees.
The financial effect of the Affordable Care Act on the hospital has been mixed. The Medicaid expansion in Arkansas allowed residents earning 138 percent of the federal poverty level — $16,643 for an individual or $33,948 for a family of four — to buy private insurance paid for primarily by the federal government. That extended health care access to people in the hills and surrounding counties who had never been insured, and shrank charity-case costs. 
Indeed, the adult uninsured in Arkansas shrank 12.3% after the Medicaid expansion, "more than in early every other state."
But [the ACA] also reduced Medicare reimbursements, which cover the elderly. This trade-off left many hospitals ahead, but not Baxter Regional, which has an unusually large share of Medicare patients — 67 percent compared with a national average of 40 percent. 
The added $4 million in Medicaid payments did not make up for the $12 million lost through Medicare.
Cohen quotes Ron Peterson, the hospital's president and chief executive: 
We are the economic anchor of the community.  When we downsize, the whole community downsizes.
Another part of the story that resonated with me as a ruralist is the depiction of many members of extended families working at Baxter Regional.  You can see the local networks of kith and kin that help get people jobs--the rural lack of anonymity--just humming throughout this story.

Sunday, October 8, 2017

The feel good rural story of the day comes to us from Alexandria, Minnesota

I read with horror last month about the kidnapping and later recovery of a 15-year-old girl who had disappeared on August 8.  Three men held the young woman for 29 days in one of their homes; two of the three men have been charged not only with kidnapping, but also with sexual assault.  The teenager ultimately escaped, only to have to swim across a lake in search of someone to help her.  Finally, a farmer saw her running across his field in rural Grant County, Minnesota (population 6,018).  The farmer, Earl Melchart, immediately recognized the young woman from the missing person posters and television coverage of her disappearance.  He called the police.  Read more here, here and here.  One of my initial responses to the story was that it validated my theory that rural spatiality conceals--and crime is among the "things" it conceals.   Another illustration is here.

Now, today, we get this follow up story from the New York Times and many other outlets reporting that Melchart has donated to the girl and her family the reward he got for helping to rescue her.  Here's an excerpt from the Times report:
On Friday, the Alexandria Police Department presented Mr. Melchert with a $7,000 reward that had been offered for information leading to Ms. Block’s return; $2,000 had come from Ms. Block’s family and $5,000 from an anonymous donor. 
Mr. Melchert said he knew exactly what to do with the check: He gave it to Ms. Block.
“It’s the best thing I’ve ever done,” said Mr. Melchert, who went to dinner with Ms. Block, her mother, her two sisters and her aunts after the presentation on Friday. 
The story quotes Melchart, who retired last week: 
The family needs the money.  To me, yeah, that’s a lot of money, but they need it way worse than I do. ... What a retirement present, to hand over some money to people that really need it.

Saturday, October 7, 2017

Part V of the Washington Post's series on disability and rurality: a focus on the informal economy

The latest in Terrence McCoy's series in the Washington Post about disability as a rural phenomenon appeared yesterday.  Here's one of the most salient excerpts from a story about Donna Jean Dempsey and her brother Bobby, in Mallory, West Virginia (population 1,654), in Logan County:
And where [Donna Jean and Bobby] were going was deep into the underground American economy, where researchers know some people receiving disability benefits are forced to work illegally after the checks are spent — because they can’t hold a regular job, because no one will hire them, because disability payments on average amount to less than minimum wage, sometimes much less, and because it’s hard to live on so little.
The underground economy has long been a part of rural America, but it has become vital in counties such as this one, deprived of the once-dominant coal industry and redefined by a decades-long swell in the nation’s disability rolls that, in its aftermath, has left more than 1 in 5 working-age residents in Logan County on Social Security Disability Insurance, which serves disabled workers, or Supplemental Security Income for the disabled poor.
Here's another excerpt that provides context for the Dempseys' "place" in that community:
Five miles below, in the hollow of Mallory, is a thin road lined with junk cars and mobile homes, several of which belong to Dempsey family members, who have lived here longer than nearly anyone, through everything that has happened. Seven of the 13 children died. The family house burned down. And Donna Jean, the eighth child, underwent one misfortune after another: rape survivor at 12, mother and illiterate dropout at 13, and, after years in special education, disability beneficiary at 22, the exact reason for which she can’t recall but summarizes as, “I’m not that smart, buddy. Kids made fun of me.”
The "everything that has happened" presumably refers, at least in part, to a 1972 coal slurry dam break here.  It is often referred to as the Buffalo Creek Flood, and it killed 125.

Separately, I see, on his Twitter feed, McCoy writes that Logan County is like no other place he has ever visited.

I see that Logan County, West Virginia's 15th largest county in population, is a persistent child poverty county, though not a persistent (general) poverty county.

The entire story is well worth a read, along with others in McCoy's series (the most recent, set in Roanoke, Alabama, is here).  I blogged about another story in this disability series here, and another here

Friday, October 6, 2017

Small States, Political Power, and Economic Recovery

A recent story on NPR's "All Things Considered" prompted me to conclude my long-neglected series on small states' outsized political power. I'll let NPR set the stage: 
It's more than a three-hour drive now to the nearest airport. But Mayhew doesn't miss the traffic in cities and the crime, she says. People here don't lock their doors, and everyone knows everyone else.

Now, what's going on in Valentine - while it's way too early to call it a trend - does get at this broader cultural thing I'm noticing in parts of rural America. Young people who grew up in small towns and have been seeing them struggle feel this sort of calling to move home. Even Valentine's own mayor, 35-year-old Kyle Arganbright, moved back a few years ago.
The report describes a nascent hip(ster?) culture in Valentine, Nebraska (population 2,800) built on craft brewing, outdoor recreation, and a halt–however slight–in the reversal of the country's century-long trend toward urbanism. Time may weather this snapshot, but if fluke becomes fad this trend has potential to reshape American politics.

Consider the U.S. Senate, where Republicans currently command a 52-48 majority. In 2016, GOP Senators Crapo (ID), Hoeven (ND), and Thune (SD) were reelected by an average of 48 points. But the total margin of votes for these three seats was just over 630,000. Presidential candidate Hillary Clinton won the districts of Brooklyn, Manhattan, and San Francisco by some 1.3 million votes; if just half of those pro-Clinton urbanites had followed beer and backpacking to Boise, Grand Forks, and Rapid City, the Democrats would control the Senate.
2016 Presidential Election results by county with
result (darkness of red/blue) and population (height of column).
Another way to visualize this is the map above; places that are "deep blue" are much, much more populous than those that are "deep red." Urban Democrats frustrated by persistent under-representation in Congress could vote with their feet, and the effects would be decisive. Not only would such a partisan exodus be effective, it might be the only way to reverse the growing counter-majoritarian trend.

Over 50 years ago, the Supreme Court opined, "Legislators represent people, not trees or acres." (This likely disappoints friend-of-the-blog Brian Dahle, who advocates regional representation in California's state senate.) The people-not-trees view may be a natural dictionary reading, and it may reflect superior policy judgment, and for half a century it has been the law of the land in most cases. But a key piece of the federal policymaking machinerythe Senatebelies this majoritarian notion. Indeed, the Senate defies "one person, one vote" by design.

My purpose in this analysis is not to urge left-leaning urbanites to descend upon rural places and overwhelm their politics. (Although, if they do, they should coordinate so they can permanently disenfranchise their captive states by amending the machinery of the Senate, something that can only be done with affected states' consent.) Instead, I project that the country will become only more urban and the strength of rural America will be even greater. My hope is that rural America's needs are not subordinated to its outlook.

This blog is a living catalog of the perils of rural life. Domestic abuse, gun violence, opioid addiction: forces of death and injury that cry out for a little more regulation, a little more Big Brother in rural lives. As at the outset of this series, I am reluctant to fling myself any further into the thorny debates over these and other issues, but nonetheless it seems that a shortage of government resources and oversightnot an excessdrives many of the social and quality-of-life problems affecting rural America 

As I have alluded to throughout, the economic case is stronger still. While environmental regulations to save the spotted owl and prevent mercury inhalation dealt immediate blows to the timber and coal industries, these sectors were likely doomed in the long run due to trade liberalization and alternative materials. Even if the days of extraction are bygone, rural communities can still exploit nature in 2017 and beyond. Like the eco-tourism that has stabilized vulnerable ecosystems in the global south, many rural places have re-engineered their economies for tourism, recreation, and hospitality. The healthcare industry also sits at the intersection of private-sector growth and economy-shaping policy. As the "Silver Tsunami" crests, healthcare continues to lead job growth. By corollary, reversing the intrusions the Affordable Care Act made into the healthcare system threatens to wrack rural hospitals with job losses and reduced access to care.

While public-sector jobs are anathema to a small-government outlook, the reality is that the federal civil service employs over 1.3 million people. The U.S. Department of Homeland Security (DHS) experienced significant growth in the post-9/11 period, including new service centers for processing immigration benefits. As DHS moved toward more centralized processing of applications, it could have opened more offices in rural places and created stable jobs with upward opportunities. Surely the Vermont Service Center, located in St. Albans (population 6,000) was not sited for its proximity to a critical mass of noncitizens.  The agency could even re-locate its massive California and Texas service centers to rural places with hollowed-out economies. The Internal Revenue Service could adopt a similar model, as could numerous other parts of the federal bureaucracy that review compliance documents, process surveillance data, and perform other tasks that are just as valuable when performed "remotely."
Critics of government employment might point to the map above: already twelve percent of USDA "nonmetro" counties are designated "federal/state government dependent." Siting government agencies in rural communities will only increase this dependence. But this is only problematic as a normative matter if government work is somehow less valuable than comparable private-sector work. Still, such critics might embrace less direct government support such as incentives to entice private companies to place call centers, data farms, and other investments in rural places. (Those who would reject both efforts might explain what government should do for rural communities. The riposte that government needs to "stay out of the way" are hard to reconcile with the narrative of "forgotten" rural communities.)

The leftist candidate in France's recent presidential election argued that workers should have a kind of "first option" to take over closing factories and run them as cooperatives. This is no Soviet daydream: amidst Argentina's fiscal convulsions in the early 2000s, workers seized facilities that they continue to operate today. The history of the Grange Movement reminds us that rural communities were not always sympathetic to free-market ideology.

If this is all too socialist to bear, consider the alternatives. As California confronts climate change and air pollution, neither laissez-faire nor the market-driven approach of emissions credits have spared the Central Valley from the worst air quality in the country. A greater role for regulation seems necessary to keep these rural areas fertile for people and production alike. Signs of the same dynamic elsewhere include the fights over fracking and oil pipeline construction. 

Kansas has pioneered a number of perverse forms of government intervention in the economy. One was its recent and disastrous test of the Laffer curve hypothesis:  cutting taxes at the top super-charges growth and boosts total revenue.  But for its repeated empirical failures, this approach would hold promise as a way to improve rural fortunes. Another Kansas export is the Sales Tax Anticipated Revenue (STAR) bond, which allows private companies to pocket their sales tax receipts over a period of years to service their own construction debt.  This and other species of corporate welfarelike the legal protections and $3 billion Wisconsin has pledged to electronics maker Foxconn to build a mega-factoryare doubly damaging. First, they violate the free-market notions that we ascribe to rural denizens. Second, and more importantly, they embrace a "race to the bottom" where small states often give away more than they gain while shouldering the risk of shiny new investment "baubles." 

As a final act of mercy, I will summarize the argument that I have unpacked over so many posts and months. The U.S. Senate inflates the political might of small states more than the Framers likely intended. (Other aspects of federal politics amplify this.) This tends to strengthen advocates of reducing the reach of government into the economy. Despite these quirks, the Senate is unlikely to change. Thus, rural voices are pronounced in national policymaking and are likely to grow louder over time.  This may be a feature rather than a bug: one aim of this blog is to highlight the urban-normativity of modern life.  Yet the marriage of rurality and anti-government ideology is unlikely to yield domestic bliss.  My observation is no doubt a cliché:  the urbanite certain that he knows what is best for rural folks. But my thoughts are not un-examined or uncritical.  For rural America, Uncle Sam's hand may offer more help than the invisible one.

Wednesday, October 4, 2017

Lancet article on distance to abortion providers spawns some urbancentric headlines

The Lancet Public Health, the prestigious medical journal, published an article yesterday about the distances women in the U.S. have to travel for abortion care, and lots of mainstream media outlets picked up the story.  What initially struck me about several stories was the focus on this fact:  1 in 5 U.S. women must travel more than 43 miles to get to an abortion provider.  This is a factoid that would have the average rural woman thinking, "no big deal," because rural residents travel distances like that for everyday activities--like getting to work.  What burdens many rural women, you see, are much greater distances.

An opening line of the Guttmacher Institute's press release about the article does acknowledge some other key data points:
Nationally, half of all women of reproductive age lived within 11 miles of the nearest abortion clinic in 2014.  However, a substantial minority of women, particularly those in rural areas, lived significantly farther away.  (emphasis added)
The article was written by three Guttmacher Institute researchers, including lead author Jonathan Bearak.  The map accompanying the article shows a big swath running north to south through the middle of America as the most vast abortion desert.

NPR's coverage did a better job of highlighting what I would say is the more salient fact regarding rural women.  Their headline was "For Many Women, the Nearest Abortion Provider is Hundreds of Miles Away." Sarah McCammon's story features a woman in Sioux Falls, South Dakota who elected to drive four hours to Minneapolis for an abortion because the State of Minnesota does not impose a 72-hour waiting period like South Dakota does.

Here's another excerpt from Guttmacher's press release, which quotes Bearak:
Women and abortion clinics are both concentrated in urban areas, so it is not surprising that most women live relatively close to an abortion clinic.  However, distance may be a significant barrier to accessing abortion care for the substantial minority who live farther away, and especially for economically disadvantaged women, who make up the majority of abortion patients.
The title of The Lancet article is "Disparities and Change Over Time in Distance Needed to Travel to Access an Abortion in the U.S.:  A Spatial Analysis."  One of the "over time" findings is that between 2011 and 2014, distances to clinics remained the same in 34 states, while they increased in 7.  Needless to say, the states where the distances have increased include Wisconsin, Texas, and Alabama, all of which have passed so-called TRAP laws, Targeted Regulation of Abortion Providers, the constitutionality of which have been litigated in recent years.

CNN's coverage of the article featured a more appropriate headline that pleased me for its focus on the extreme distances facing some women.  The headline is "Some US women travel hundreds of miles for abortions, analysis finds."  That story included this additional information, the first line of which states what should be obvious:
"How far a woman has to travel for an abortion is a key measure of access," Bearak said. Other measures include restrictive laws and financial constraints.

To analyze how far women travel to terminate a pregnancy across the nation, the researchers began with data on the location of abortion providers and women. The information on women was based on census block groups, Bearak said: "That is the smallest publicly available geographic unit." Within states are counties, within counties are census tracts, and within tracts are block groups.
This analysis sounds very similar to what researchers did to quantify abortion availability in Texas following the different stages of implementation of House Bill 2, which was ultimately struck down by the U.S. Supreme Court in Whole Woman's Health v. Hellerstedt in 2016. 

My extensive writing about distance, travel, and abortion access is here, here, and here, along with many posts under the "abortion" label on the Legal Ruralism blog.

Cross-posted to Feminist Legal Theory.

Sunday, October 1, 2017

In These Times October cover story: About Keystone XL pipeline resistance

The lede follows: 
OFFICIALLY, THE FATE OF ONE OF THE MOST HIGH-PROFILE CORPORATE INFRASTRUCTURE PROJECTS IN A GENERATION now rests with an obscure regulatory body in one of this country’s most sparsely populated states: Nebraska’s Public Service Commission. Unofficially, the homegrown movement that blocked the Keystone XL pipeline once before is ready to stop it again—even if commissioners give it a green light. 
A ruling isn’t expected until November, but after the commission’s latest hearings adjourned August 10, Jane Kleeb, one of the pipeline’s highest-profile opponents and now the chair of the Nebraska Democratic Party—flanked by landowners who live along its proposed route—made an unconditional pledge: “Standing Rock was a dress rehearsal compared to what this will be. We are not going to let an inch of foreign steel touch Nebraska soil.” 
A gauntlet had been thrown.
Oh, and the headline, the headline is "The Unlikely Alliance That Could Stop Keystone and Transform the Democratic Party" and the subhead is "Natives and ranchers are teaming up to save their water and land from corporate takeover."  Kate Aronoff reports.   She quotes Kleeb, who has worked hard for several years to organize farmer and rancher opposition to the pipeline.  Of those she's brought into Bold Nebraska to oppose the pipeline, Aronoff quotes Kleeb: 
Generally, they hate big.  That’s big government, but that’s also big corporations that want to take their land through eminent domain, or big agriculture.

Appalachian Justice Symposium at West Virginia University: Deadline for abstracts approaching

This notice says the deadline for abstracts is October 8, a week from today, but one of the organizers has told me that it will, in fact, be October 17.  Here's an excerpt from the Call:
The West Virginia Law Review invites proposals for papers and panels for its upcoming “Appalachian Justice Symposium.” The Symposium will take place on February 23 & 24, 2018, at the West Virginia University College of Law in Morgantown, West Virginia. Law Review editors will select essays for publication in a special symposium issue of the West Virginia Law Review entitled “Essays on Appalachia.” The purpose of the conference is to bring together people from various disciplines to have a serious conversation about the legal and public policy issues faced by Appalachia and to collaborate to develop innovative solutions to those challenges in keeping with what Jeff Biggers describes as “Appalachia’s best-kept secret.”
I have committed to deliver the keynote address at this event and hope to see you there!