On rural healthcare in Iowa

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

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

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

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

Hardy puts what has happened in Greenfield in context:

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

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

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

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

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

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

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

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

If we don’t do it, who’s going to?

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

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

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

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

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

Governor Newsom visits rural California, talks housing, broadband, disaster

The Union newspaper of Nevada County, California reported on the new Governor's visit to the League of California Cities gathering in Grass Valley.   Here's an excerpt from Alan Requelmy's report:

Joking that he was out of place wearing a suit, Newsom paused after the meeting to discuss those issues with the media. 

"Trust me. I get it," he said of skyrocketing fire insurance costs. "It's one of many issues that concern us."

Newsom referred to a comprehensive report, which he expects within two months, that will include the issue of fire insurance. He noted insurance for his family's home in Dutch Flat has jumped to $5,000 from about half that. 

The governor also said he wants to create a summit that will focus on emergency planning — a gathering that will bring communities together to address wildfire concerns.

* * *

Newsom said rural counties face different challenges than their urban counterparts. He called it important to visit those rural areas, where he regularly hears about housing and homelessness.

* * * 

Fielding a question about rural broadband, the governor said his administration is exploring an aggressive agenda. He said officials have been discussing it for two decades with few results.

Newsom said,

It's like an applause line for politicians.  We've got to get serious about it.

Newsom is famously liberal--more liberal even (especially fiscally) than his (also Democratic) predecessor Jerry Brown.  Brown tended to be  shunned by locals when he visited rural California, including Colusa County, where he owns family land, and where he and his wife Ann Gust Brown are retiring.  See two related posts here and here.  Lisa Swarthout, the mayor of Grass Valley, in contrast, seemed to gush about Newsom's visit, commenting: 

Grass Valley is very pleased the governor took his time to speak to the League of Cities.   I think he likes this area a lot.

Grass Valley, California is just about an hour from greater Sacramento, so Newsom didn't have far to go.  

On defining "rural," in the context of Wisconsin local government

The Wisconsin Supreme Court heard a case last week regarding the meaning of rural in relation to an ordinance passed by the Marathon County, Wisconsin government.  Courthouse News Service reports: 

For the Wisconsin Supreme Court, the definition of “rural” versus “town” constitutes a legal distinction that could determine the outcome of a lawsuit brought against Marathon County, Wisconsin, by the unincorporated town of Rib Mountain. The case involves a dispute over the county’s requirement that all unincorporated areas of the county have uniform addresses to aid emergency responders. 

In 2016, Marathon County enacted an ordinance to create a uniform addressing system, giving each location in the unincorporated portions of the county – including unincorporated towns – a unique address primarily to guide fire protection, emergency medical services and law enforcement to homes and businesses. 

Rib Mountain’s town board objected to the requirement and sued the county. Marathon County Circuit Court upheld the county ordinance, but the Wisconsin Court of Appeals reversed. 

Now the county has asked the state’s Supreme Court to consider whether the unincorporated town fits under the definition of “rural,” which would make it subject to the new addressing requirements.

Rib Mountain is said to be a suburb of the county seat, Wausau, and its population is about 7,000 according to the Courthouse News story.  The population of Marathon County is about 135,000, but it covers a vast land area.  According to Wikipedia, Wausau has a population of nearly 40,000, and Rib Mountain is but one of its six suburbs. 

Marathon County Corporation attorney Scott Corbett, responding to a question from a Supreme Court Justice during oral arguments, conceded that the statute in question "uses ‘rural’ in a couple of different ways.”  Justice Rebecca Frank Dallet had asked, "Are you saying 'rural' means 'town' means 'unincorporated'?"    

On aspect of the confusion here is that the Wisconsin statute that authorizes counties to require uniform addresses does not define “rural.”  The Wisconsin Court of Appeals, considering the issue, used the dictionary definition.  

The Chief Justice of Wisconsin, Patience D. Roggensack, asked Rib Mountain's attorney, David Dietrich, why the town objects to uniform addresses.  

What is the big problem for the town to go along with the ordinance? The county is not being punitive.

Dietrich responded by noting that Rib Mountain “was given the opportunity to cooperate... and in the end it chose to keep portions of the town the way they are, and they have the right to do that.” So, it seems the sensitivity is partly about the local politics of one entity telling another what to do

This debate over how to define rural reminds me of entire sections of past law review articles where I have sought to define rural for various legal purposes, sometimes surveying judicial and legislative definitions in the process.  See my Rural Rhetoric and Gender, Geography and Rural Justice articles, for starters, which both include not only ecological definitions but also cultural ones.  Here's one of my favorite definitions of rural from a judicial opinion, this from the West Virginia Supreme Court in  Stephens v. Raleigh Country Board of Education (1979):

[A] “rural community” may be distinguished by its dominant character as a social and economic unit founded in rural, land-based interests. It is inhabited, in the main, by country people, who live a country life, and who engage in country pursuits. Its residents are removed from the immediacy of urban and suburban environs, and are not immediately tied to any city or urban area; they work, socialize and politick as an independent, integral community. There will, of course, always be some exceptions. In nearly every community there will be at least a few people who commute to a city for business or social purposes. However, the presence of a few such people does not destroy the rural character of a community, so long as development has occurred in such a manner as not to exclude the predominance of agricultural pursuits and rural activities.

Local governments unable to cope with low-cost housing mandate

California's requirement that municipal and county governments build low-cost housing gets a fair amount of attention here in the Golden State.  Our new Governor, Gavin Newsom, recently sued a posh city in Orange County for failing to meet this requirement, and that suit seems to have inspired a story in the Sacramento Bee a few days ago under the headline, "Newsom's housing lawsuit puts several of state's cities on notice."  But the story and it's accompanying map don't just discuss "cities"; they also feature counties, including Plumas and Lake counties, as well as some small towns.

This excerpt from the Bee explains what's going on:

The roster of [47] out-of-compliance cities includes fairly wealthy ones on the coast. It also has dozens of communities in the Central Valley, Sierra Nevada, Mojave Desert and eastern Los Angeles County that generally are known as affordable places to live in California. 

Dos Palos in Merced County, for instance, is on the list of cities with inadequate housing plans. It has a population 5,000 and 27 percent of its residents live below the poverty line. 

Its city manager said the city simply can’t afford to hire the kind of consultant who would draft a study showing that the city’s zoning complies with state law. He said the city’s budget totals about $3 million a year and hiring a consultant would be a tremendous burden because most of its spending goes toward essential services like public safety and utilities.

The story quotes city manager Darrell Fonseca:

I don’t know how we’re gonna come up with that, but we have to.  We are a very tiny city, and we have been building, we just don’t have a fancy binding on the housing element that shows that we’re in compliance.

The Bee also quotes Randy Wilson, planning director in Plumas County, who says it would cost the county about $60,000 to pay a contractor to update its affordable housing plan. 

With the recession and the tight budget, we just haven’t addressed it.

Plumas County, population 20,007, has just about eight residents per square mile. It covers about the same land area as the State of Delaware.  According to the Bee, the "state wants it to support construction of 20 affordable housing units."

One of the other places featured on the map showing "problem" local governments is Amador City, population 185, the smallest city in California by size. It's less than an hour from Sacramento in the region known as the Mother Lode because it was settled during the Gold Rush.  The map accompanying the story also features "dots" suggesting that the failure to build affordable housing is a problem in Alturas (Modoc County), Yreka (Siskiyou County), and a couple of places in Humboldt County, all relatively sparsely populated.

Local media spin spreads false information about NC election fraud controversy

For the past couple of months, the residents of North Carolina's 9th Congressional District (which includes my home county of Robeson) have been left without a representative in Washington. After allegations of election fraud surfaced against Republican candidate Mark Harris, the State Board of Elections refused to certify his election. After a hearing on Monday, the Executive Director of the State Board of Elections found that Harris's hired operative, McCrae Dowless, knowingly engaged in fraudulent behavior and that Harris hired him despite knowing that he had done so on previous campaigns. Since it has not been definitively proven that Dowless's actions changed the results of the election, Harris currently holds a very narrow ~900 vote lead, Republicans are clinging to the hope that Harris would ultimately be seated in Congress.

Much as I did yesterday, I want to highlight some misleading rhetoric surrounding an issue. On February 15th, The Robesonian, the primary newspaper of record in Robeson County, one of two counties where Dowless operated, published an editorial that made a huge false equivalence. In this op-ed, they point to a local judicial race where the Democrat leads by 67 votes. They attempt to allege that the Democrats may have committed fraud by pouring lots of money into "get-out-the-vote" efforts. Anyone who has worked on, volunteered for, or even gotten lost and somehow wondered into a campaign office knows that that statement should amount to journalistic malpractice. 

Get out the vote campaigns focus on door knocking, making calls, and doing visibility in the local community in order to motivate people to get out and vote. These actions are are all completely legal. What Dowless did, actively falsifying ballots and ballot requests, is pretty clearly not. Further, regardless of how or why a person goes to vote, their decision in the booth is ultimately theirs. Unless a candidate is violating other laws such as paying you to vote for them, there is nothing illegal here. 

It is journalistic malpractice for the editorial board of a newspaper to falsely equate a legal and accepted campaign practice with a tactic that is against the law and deprives someone of their right to vote. If a new election is ultimately called, the people in the 9th District would be ill-served by this type of rhetoric coming from what are believed to be legitimate news sources. 

Education news out of West Virginia: second teachers strike in two years

NPR reports today on a(nother) teachers' strike in West Virginia.   NPR summarizes the national media perspective on what is at stake:

West Virginia public school teachers are striking over a new bill that paves the way for charter schools and private school vouchers in a state that relies primarily on public education. 

In anticipation of the strike, almost all of the state's 55 public school systems have canceled classes for Tuesday. 

The state's House of Delegates and Senate have been going back and forth on different versions of a bill that would overhaul West Virginia's educational system. According to the Charleston Gazette Mail, the education bill raises pay for teachers and increases funding for public schools, but also permits the creation of charter schools in the state, which currently has none.

I wrote about last year's WV teacher's strike, which was mostly about teacher salaries, here.  It appeared to end with a considerable victory for teachers, but a new bill before the West Virginia legislature could ultimately claw back some of that win for educators, especially over time and in rural districts.

Over at his education blog, Joshua Weishart of the University of West Virginia College of Law and Rockefeller School of Policy and Politics has written two posts, here and here.  These provide a much more sophisticated, nuanced, and local perspective on the teacher's strike and the the proposed new law.  This first post, now a few days old, focuses on population loss, rural schools, and the impact of the proposed new law on rural districts.  In short, it would almost certainly lead to consolidation over the medium-term and generally undermine the health of West Virginia's rural communities and rural schools. 

Rural ATJ (Part II): Daedalus special issue on "Access to Justice" neglects rural

Daedalus, the Journal of the American Academy of Arts and Sciences recently published its Winter 2019 issue, which happens to be on the topic, "Access to Justice."  Lincoln Caplan and Rebecca Sandefur (who recently was awarded a MacArthur Genius Grant and interviewed for the New York Times here) are guest editors.  As a lawyer who attends to poverty and access to justice, I was and am excited by the special issue.  My enthusiasm was dashed, however, when I saw how little attention the sub-issue of rural ATJ was accorded by the special issue.  In short, across 24 short pieces (including Introduction and Coda), the word "rural" was used in only six of the contributions.  Of those, one was simply a reference to the Rural Summer Legal Corps program in LSC President James Sandman's contribution, and three were references to California Rural Legal Assistance, a legal aid organization that angered President Ronald Reagan, leading him to seek devastating funding cuts to the Legal Services Corporation.  For example, Lincoln Caplan, in The Invisible Justice Problem, writes of early opposition to the Legal Services Corporation:

The favorite punching bag was California Rural Legal Assistance (CRLA), a network of offices in rural parts of the state set up to represent migrant farm workers against agribusiness, to which the program gave a million-dollar grant (about $7.5 million today). Ronald Reagan, as California’s governor, vehemently opposed the network and the legal counsel it provided. 

Robert W. Gordon and Luz Herrera also refer to California Rural Legal Assistance in their contributions, Gordon's a historical perspective on access to justice and Hererra's on Community Lawyering.

Apart from references to a program and an organization with "rural" in their name, the only two uses of the word rural were in Karen Lash's piece titled Executive Branch Support for Civil Legal Aid. Lash writes of the various roles for government, specifically state government, including the need to respond to rural residents' needs:

Federal government objectives, like getting Americans working and keeping children in school, also animate policy discussions at the state level. Governors call for increased commitment to greater effectiveness amid severe fiscal challenges.  They talk about what effective government should do: increase opportunities for job-seekers; increase ac- cess to health care; attack the opioid crisis; expand housing and aid to homeless people; improve foster care; give second chances to people leaving the criminal justice system; help disaster recovery; prevent violent crime; ensure services for children, seniors, and homeless veterans; and address the needs of rural residents.

Subsequently, Lash circles back to talk about how statewide models of Legal Aid Funding may better serve rural areas, writing:

The statewide models show great promise to raise the overall standard of care through joint provider trainings, data-sharing to better identify statewide patterns and trends, greater collaboration among legal-aid providers, and perhaps most important, extending legal aid to rural areas and communities where it has not been available due to fragmented and limited legal-aid funding.

On the other hand, mentions of"urban" and "city" are far more plentiful in this special issue, including in articles by Elizabeth Chambliss (Marketing Legal Assistance), Luz Herrera (Community Law Practice), Gillian Hadfield (More Markets, More Justice), Tonya Brito (The Right to Civil Counsel, referencing New York City), D. James Greiner (The New Legal Empiricism & Its Application to Access-to-Justice Inquiries, who also refers to distance); Sameer Ashar & Annie Lai (Access to Power); Robert W. Gordon (Lawyers, the Legal Profession & Access to Justice in the United States: A Brief History), and Margaret Hagan (Participatory Design for Innovation in Access to Justice). Rebecca Sandefur, in her contribution, Access to What? uses the word "urban" only in the title of an article she cites; ditto Colleen F. Shanahan & Anna E. Carpenter (Simplified Courts Can't Solve Inequality), who cite to the Urban Institute.

This neglect of rural in this special issue is disappointing; the collection is implicitly (and sometimes explicitly) urbannormative. Countering that orientation of the Daedalus issue, I am glad to say that my co-authored piece on rural ATJ, Legal Deserts: A Multi-State Perspective on Rural Access to Justice is now out in the Harvard Law and Policy Review's special issue on "Revitalizing Rural." The article is available for free download here, and the citation is 13 Harvard Law and Policy Review 15 (2019).

I will also add that the flip side of this Daedalus issue on access to justice overlooking rural is a recent special issue of the Boston Review, Left Elsewhere, about rural America, which appears to overlook the role of law and legal institutions.

People should vote where they live - New Hampshire's new voting law under scrutiny.

As I reported (and critiqued) last July, New Hampshire is set to enact a voting law that will restrict who will be allowed to vote in the state. The law, which changes the definition of "resident" for voting purposes, places arduous requirements on college students in the state and looks almost certain to restrict who is allowed to vote in the state. The ACLU and two Dartmouth students have responded by filing lawsuits. As you may recall, the law was sold to Granite Staters with the idea that it would bringing NH in line with other states across the country. This was misleading.

However, "misleading" is a fair characterization of much of the dialogue around the law. Just yesterday, the New Hampshire Union Leader published an editorial with the headline, "Here's a novel idea: People should vote where they live." I agree with the headline but not the contents of the article. After all, college students do not live in their childhood hometowns but rather in the towns where they attend college. During my time as a New Hampshire college student, I was there for at least 9 months out of the year because of the need to be physically present to take classes. However, many students, myself included, spent the entire year in New Hampshire because we pursued internships or other opportunities that kept us in the state, even when we weren't taking classes. By almost every conceivable definition, we "lived" in New Hampshire.

The article states, "[i]f they want to vote here, they need to show proof that they actually live here." I also agree with this line. However, I disagree with its framing. A New Hampshire college student needs to only show a class schedule to prove that they live in the state. In fact, the initial iteration of New Hampshire's voter ID law recognized this when they allowed students to use a college ID to vote. The article's points and its proposed remedies are remarkably out of step with each other.

As I have said before, this law also undercuts efforts to recruit and retain talented young people in New Hampshire. Students should be encouraged to participate in local governance, begin to get involved in the community, and put down local roots. By being systemically excluded from the dialogue in the place where they have chosen to spend at least four years, they are increasingly likely to silo themselves onto their campus communities and leave the state after graduation. This would be a huge net negative for New Hampshire, which is already one of the oldest states in the country.

It is disheartening to see such disingenuous rhetoric surrounding a law that deals with the exercise of a fundamental right, the ability to vote in a place where you live.

Major media reveal cover up of pedophile doc in Indian Health Service

Read more here on the Wall Street Journal and Frontline story  An excerpt follows:

The investigation ... detailed the career of Stanley Patrick Weber, a pediatrician who in 2018 was convicted of sexually assaulting Native American boys. The IHS transferred him from one agency-run hospital to another after officials concluded he was molesting children in 1995, and he continued working for the federal agency for 21 years. 

The news organizations’ documentary about the doctor, Predator on the Reservation, premiered Tuesday.

* * * 

In the case of Mr. Weber, information about the allegations against him at one IHS hospital were never recorded in his credentialing file at the second facility where he worked, according to people who had seen those records. As a result, some officials who subsequently investigated his conduct said they were unaware of prior allegations.

In January, 2019, Weber was sentenced to 18 years in prison. 

Weber worked for the Indian Health Service for 30 years.  No one knows how many Indian youth Weber victimized over those decades. 

Haksgaard on homestead laws

Prof. Hannah Haksgaard of the University of South Dakota has a new article out about homestead laws, "Defining 'Home' Through Homestead Laws."  It appears in a special symposium issue of the Berkeley Journal of Gender Law and Justice on Home and Homecoming.  The abstract follows:

A home is important — for individuals, for families, for societal structure. But, the law does not provide a clear definition of “home.” The Home & Homecoming symposium asked, in part, how the law defines “home.” This article provides one answer by looking at homestead laws. After analyzing the protections and parameters of homesteads — especially the urban/rural parameter distinction — this article concludes that a “home” is more than a mere dwelling place, a “home” is the real property that allows a family to remain stable through difficult times.

Haksgaard has previously written on Rural inheritance: Gender Disparities in Farm Transmission, and I know she has a work in progress on Solo Female Homesteaders. She's workhopping the latter next week here at UC Davis, at an event we're sponsoring on Law and Rurality. 

Rural economic struggles should not be fodder for partisan attacks

While perusing the news this morning, I came across an interesting story from The New York Times, President Donald Trump, a person who styles himself as a champion of rural communities, is advising residents of economically distressed areas of Upstate New York to leave the state. Surprisingly, President Trump is finding allies in Upstate New York Republicans who are using the President's comments as an excuse to attack Governor Andrew Cuomo's leadership in Albany.

This is incredibly dangerous. The economic struggles of rural spaces should not be fodder for partisan attacks. In a state like New York where urban interests dominate, it further serves to marginalize the voices of rural people. When local politicians are not acting as advocates but rather as partisan attack dogs, it represents a derelict of duty to their constituents. When politicians and leaders are telling residents to leave, it shows a recognition that they cannot and will not advocate to make their communities a better place. Rural New Yorkers are ill-served by this scheme.

It is also blindly partisan to insinuate that Governor Cuomo's administration does not care about the people of rural New York. The state has committed significant resources to ensuring that all New Yorkers have access to broadband, which represents the breaking down of a significant barrier to economic development. I have covered this initiative, as well as the importance of expanding broadband in this space.

How bad are economic conditions in rural New York? In a lot of ways, measurably worse than the rest of the state and even the country. For example, wage growth is stagnant and the median income falls well below the national average. The region is also already seeing a decline in population. Rural New Yorkers do not need to become a shuttlecock in partisan badminton, they need leaders who are dedicated to finding solutions to their problems. As the farmer in the New York Times article says, leaving is simply not realistic.

By weaponizing the economic maladies of rural New Yorkers and using it to attack Democrats in Albany, the President and his allies are disregarding the actual problems that they face. This is an area where there is no room for partisanship.

Literary Ruralism (Part XIV): A thriller from down under

I read a review of The Lost Man in today's New York Times.  The new novel, by Jane Harper, is being published this week in the United States.  Harper is a novelist I'd never even heard of before today, and I'm not really into crime novels/thrillers.  That said, the review is quite positive, so I have ordered the book.  Here's the part of Charles Finch's review I want to highlight for this blog:

“The Lost Man” is set in Queensland, a ranch’s distance off from a town called Balamara, itself “a single street, really,” 1,500 kilometers west of Brisbane. (For those of you still using imperial units, 1,500 kilometers is roughly equivalent to one billion miles.) In this remote country, Nathan Bright is isolated further still by an ancient transgression whose nature Harper doesn’t immediately disclose. 

* * *

“Human relationships are vast as deserts,” Patrick White, perhaps Australia’s greatest writer, once wrote. “They demand all daring.” Harper’s books succeed in part because she conveys how even now, geography can be fate. Heat and empty space in her work defeat modernity, defeat logic, technology and even love, throwing us back upon our irreducible selves.

Ah yes, this reminds me of what I wrote here, an idea much resisted by some of the North American academics who edited the volume, that technology (or "modernity" in the lingo of the reviewer) does not in fact easily or readily (or inexpensively) tame material distance. 

As for Harper as an author and a force, the reviewer writes:

Book by book, she’s creating her own vivid and complex account of the outback, and its people who live where people don’t live.

What a powerful way of expressing that one lives in a truly remote, barely populated place.

I'm linking to two posts (here and here) about my own travelogue/journey through Queensland's interior in 2012, when I was a visiting scholar at the University of Southern Queensland in Toowoomba, the nation's largest inland/non coastal population cluster.

On escapes, literary and otherwise, from Trump country

Don't miss Timothy Egan's op-ed piece in the New York Times today, in which he brings together Hillbilly Elegy (by J.D. Vance) and Educated (by Tara Westover) as documenting how to escape from "Trump country"--namely by access to education.  The piece is titled, "A Hillbilly and a Survivalist Show the Way out of Trump Country."  Here's a short excerpt:

The two great literary bookends of President Trump’s half-term of grift and chaos have come from survivors of the most broken white communities that helped put him in office. They also show us the best way out of the basement of American despair. 

How J.D. Vance, the author of “Hillbilly Elegy,” and Tara Westover, who wrote “Educated,” escaped physical and psychological horror is the dose of Charles Dickens that makes these two memoirs so memorable.

I admit I liked Westover's Educated better than Vance's Hillbilly Elegy, though each resonated with me in powerful ways.  As for the latter, I have written a published response, which is included in a collection of essays just out from West Virginia University Press, Appalachian Reckoning:  A Region Responds to Hillbilly Elegy.  The book is available for pre-order now and has received starred reviews from both Kirkus and Forward Reviews, which called it "[s]tunning in its intellectual and creative riches." Publishers's Weekly also gave it a very positive review.  My chapter is called "What Hillbilly Elegy Reveals about Race in 21st Century America." 

I'll be on a panel discussing the book in March at the Appalachian Studies Association meeting in Asheville, North Carolina.  Below is a screenshot of a Tweet by one of the volume's editors, Meredith McCarroll.  I think we're all still in shock that Ron Howard has paid $45 million for one man's very skewed and partial insights into his upbringing.   

Cross-posted to Working-Class Whites and the Law.

Rural New England's demographics crisis and its impact on higher education

In this post, I am going to talk about something that gets touched upon tangentially in one of my upcoming articles, the role of higher education in driving economic development in rural spaces and the impact of the region's demographics crisis on its decline. The Boston Globe recently published an article that talked the decline of higher education in Vermont. The article talks about many things familiar to readers of this space, particularly the decline in the college aged population and the graying of the population in rural spaces more broadly. The message is clear, rural New England is facing a demographics crisis and rural colleges are feeling the brunt of it. Just last week, Green Mountain College in Poultney, Vermont announced that they were closing their doors, in Rutland, the College of St. Joseph is teetering on the brink of closure after facing accreditation issues because of their funding concerns, Vermont Law School in South Royalton revoked tenure for 75% of its faculty, and just last year, the State of Vermont merged two public colleges, Lyndon State College and Johnson State College in order to form the new Northern Vermont University. In order to survive, schools are also having to dramatically alter their missions in order to attract students. In New London, New Hampshire, Colby-Sawyer College, a liberal arts college, has eliminated English majors in order to focus more on "practical" pursuits like nursing. Small schools across New England are suffering.

In many New England college towns, the college is the economic engine. After World War II, college towns like Plymouth, New Hampshire and Castleton, Vermont saw larger than average population increases because of the growth in higher education that happened in those years. The growth of higher education saw once sleepy, perhaps even declining, towns become vibrant economic centers. As colleges grew, they fed economic growth and it wasn't just colleges that employed people either, they also fed growth in the businesses surrounding the college as the increased numbers of faculty, staff, and students were spending money in town.

Colleges are also magnets for talent. In Lamoille County, Vermont, Northern Vermont University contributes mightily to the local economy and the development of local leadership. It also serves to attract talented people. Schools not only attract talented faculty and staff but also alumni who often remain in the area after graduation or who return later in life. In my alma mater, Dartmouth College's home area of the Upper Valley region of New Hampshire and Vermont, the economic footprint of the College is apparent. Not only is the poverty rate in the immediate area around Dartmouth lower than the broader region but alumni are acting as business owners and local political leaders, driving growth, and contributing to the growth of rural New England. If you remove that pipeline, the quality of leadership in rural spaces will also suffer.

This is just the latest in a string of effects of the demographics crisis currently ravaging Northern New England. A year and a half ago, I noted its effect on the state bar in Maine. Just last year, New Hampshire Public Radio aired a series called "Going Local" on their daily program The Exchange. The series profiled the different regions of New Hampshire and the challenges that they face. In almost every region of the state, the lack of young people was mentioned as a challenge. In Vermont, the state is prepared to pay $10,000 for remote workers to move to the state and work there (as I note here however, I have doubts about the ability of Vermont's broadband infrastructure to truly support this). As fewer and fewer young people move to and live in rural New England, we will continue to see adverse effects on the ability of the states to not only grow but to provide a high quality of life to the people who still live there.