Wednesday, May 15, 2019

Rural poverty and its consequences: Here, there and everywhere

A few major stories about rural poverty and related aspects of rural disadvantage have caught my eye in the past few days, first from the United States and then yesterday out of the north of England.  Population loss, the elderly, and the high cost of service delivery to rural populations are implicated in them.  Two of the stories feature extraordinary photography.

The first is this major piece in the Washington Post on the looming closure of a hospital in Fairfax, Oklahoma, population 1,380.   Eli Saslow, journalist extraordinaire, brings us not just another story of a down-on-its-luck, near death rural hospital, but of the juxtaposition of this pending closure against the circumstances of community:
Childhood poverty climbing up above 30 percent. Accidental deaths doubling in the past decade. Increasing rates of diabetes, heart disease, drug addiction and obesity.
Saslow then puts what's happening in Fairfax, a town in Osage County, population 47,987, and co-terminous with the Osage Nation, in national context:
More than 100 of the country’s remote hospitals have gone broke and then closed in the past decade, turning some of the most impoverished parts of the United States into what experts now call “health-hazard zones,” and Fairfax was on the verge of becoming the latest. The emergency room was down to its final four tanks of oxygen. The nursing staff was out of basic supplies such as snakebite antivenin and strep tests. Hospital employees had not received paychecks for the past 11 weeks and counting. 
The only reason the hospital had been able to stay open at all was that about 30 employees continued showing up to work without pay, increasing their hours to fill empty shifts and essentially donating time to the hospital, understanding what was at stake.
In 2016, the 15-bed Fairfax Community Hospital had been purchased by EmpowerHMS, a Florida-based company that held itself out as “a savior for struggling rural hospitals.” Soon after the takeover, however, Empower began to default on some of the hospital's bills.  Fairfax was one of nine of Empower's hospitals that had since declared bankruptcy; another four had already closed.

The story includes an interesting profile of Dr. James Graham, 67, who has served the hospital and community for 41 years.  Yet with his malpractice insurance premium unpaid by Fairfax Community Hospital, Graham was on the verge of losing his license.  Be sure to give the story a read in its entirety.  Another recent story about a rural hospital closure is here, those one from NPR, featuring Fort Scott, Kansas, population 8,087, and county seat of Bourbon County.

The second big story is out of the United Kingdom's Lake District, in northern England.  Specifically, it features the town of Alston, population 1128, in northeastern Cumbria.  Wikipedia notes that Alston is a market town with several "listed buildings" and also an Area of Outstanding Natural Beauty, surrounded by moors.  Yet the story reported by Ceylan Yeginsu is as depressing as they come, as are Laetitia Vancon's extraordinary photos, particularly those of elderly residents and their living conditions.  A major cause of the human suffering:  government austerity.  The opening excerpt features 77-year-old Trevor Robinson:
Mr. Robinson’s isolation, shared by thousands of older people in Britain, is the result of a chain of cause-and-effect that stretches from rural Cumbria to the halls of power in London. He used to ride a subsidized bus to town until the local council discontinued the route. The council was responding to steep budget cutbacks stemming from the Conservative-led government’s decade-long austerity program.
* * *
But a free bus pass [for the elderly] is of little use if buses no longer reach you, and many retired people have discovered that apparently minor cuts — the elimination of a bus route, the closing of a tiny health care center, community center or post office — can profoundly upend their lives.
Cumbria is impoverished and rapidly aging, yet Alston is an hour from the nearest hospital bed. Yeginsu quotes Peter Thornton of the Cumbria County Council:
It’s always been expensive to deliver services to rural communities because the population is so spread out. But since the central government cuts that started in 2010 this becomes more of a challenge each year.
Cumbria is in the part of England commonly referred to as the Lake District, where tourists have long flocked to walk the moors and enjoy lakeside mansions.  But one of the photo captions observes: 
The idyllic landscape masks pockets of deprivation, inequality and poor health comparable to some inner-city areas.
This reminds me of a thread of the work of British geographer, Paul Cloke, who wrote about the juxtaposition of rural poverty with natural beauty.  I quoted him in my article about rural environmental injustice a few years ago:
Hard times” can be “naturalized in to [such] landscapes” (Cloke, 1997:264), causing rurality to “signify itself as a poverty-free zone” (Cloke, 2006:381). The idyll-ised rural thereby “both exacerbate[s] and hide[s] poverty in rural geographic space” (Cloke, 2006:381).
The third story I'll excerpt here is a bit older, having been published in the wake of California's Carr wildfire last year.  That fire struck Shasta and Trinity counties.  Sam Harnett reports for KQED, the San Francisco area NPR affiliate, "Low-income Communities Struggle to Recover after a Wildfire."  His vignettes of fire victims are nuanced and haunting, but he also provides extraordinary data such as this:
A paper published last year by the National Bureau of Economic Research analyzed 90 years of natural disaster data. It found that major catastrophes increase a county's poverty rate — the percentage of people living below the poverty line — by an average of 1 percent. That's because disasters encourage those who are well off to leave, and it makes those with low income poorer.  (emphasis added)
Indeed, I see Harnett has reported frequently on various aspects of California wildfires.  Another story about disparities in disaster recovery is here, from High Country News.  Sara Viner reports, "Fires are indiscrimiant.  Recovery isn't."


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