Thursday, October 23, 2014

10/06/2014 at 1:21pm

Photo by David Stephenson Samuel Riley, right, a mechanic, buys cigarettes at the Valero gas station in Booneville, Ky. Owsley County is statistically one of the poorest in the country.

The Miami Herald’s Leonard Pitts Jr. visited Owsley County, Kentucky, and filed a piece on the invisibility of white poverty. Pitts found a county filled with a reporter-averse population, an understandable reaction after decades of being attacked and blamed for the region’s problems. But his reporting is both insightful and humane. He talks to folks who are struggling with drugs, poverty and the lack of jobs in the region but never slips into ridicule or condescension. Here's his take on some of the media stereotypes that swirl around poor, rural whites:

The thinking goes that the white South — and in particular, the poor white mountain South — is a land of primitives, a land of people who never quite evolved. “Our contemporary ancestors,” one author dubbed them. Another called them “yesterday’s people.”

Nor is the image of “yesterday’s people” solely yesterday’s concern. Consider the Hillbilly to English Translation Dictionary. Its cover depicts a woman with pigtails and a missing front tooth, clutching a scraggly bouquet. She is wearing a dingy white wedding dress. She is barefoot and pregnant. This was published in 2010.

There is no national advocacy group to defend the white poor against such libels as this, no analogue of the NAACP or the National Organization for Women to assert their dignity. You may malign them without a whisper of complaint.

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Nebraska Senator Deb Fischer pokes the Federal Communications Commission for what she says is its failure to make progress on rural call completion.

“Unfortunately, after sending the signal that fixing these problems would be a priority, the FCC neglected to take necessary administrative steps to move forward with plans to address this issue,” Fischer wrote in a column. The senator supported a bipartisan resolution asking the FCC to correct the problem with dropped and poor-quality calls to rural numbers.

It’s not good enough for a federal agency to pay lip service to a real and persistent problem, but then stop short of finding a solution. Too often federal officials are willing to talk about problems, but when it comes time for them to act, the government misses the mark — either by forcing unnecessarily burdensome regulations that fail to target real problems, or by simply not following through with the promises they’ve made.

10/06/2014 at 6:00am

Click map for an interactive version that shows county-level data. 

Rural and urban American both gained jobs in the last year, but the job growth rate in rural counties has been only about half that experienced in metropolitan areas, according to new figures from the Bureau of Labor Statistics.

In the 12 months between August 2013 and August of this year, the number of jobs in metropolitan counties increased by 1.6% — or a total of 1.97 million jobs.

Nonmetropolitan counties added 67,800 jobs in that same period, but the rate of increase was only 0.8%.

The map above shows the rate of increase in jobs since last August in all U.S. counties.

  • Blue counties had a rate of job increase at or above the national average of 1.5%.
  • Yellow counties increased their number of jobs, but at a rate less than the national average.
  • Red counties had fewer jobs this August than in August of 2013.

Click on the map, and you’ll jump to an interactive version. Then click on any county to see the pertinent information: number of jobs, job growth, current unemployment rate and whether the county is metropolitan, micropolitan or noncore.

10/03/2014 at 6:30am

Click the graph for a larger version.

Americans who don’t use the Internet have more than just their lack of digital communication in common. They are also more likely to be rural, elderly and poor.

About 48% of the 50 million Americans who haven’t gone online in the last year live in nonmetro areas, according to a new report from McKinsey & Company, a management consulting firm. In contrast, only about 15% of the overall U.S. population lives in nonmetro areas.

That means the average rural resident is three times more likely to be offline than the average urban resident.

Eighty percent of people who don’t use the Internet are lower income, and more than half of the offline population is aged 55 and up.

The figures are based on a variety of federal data sources, as analyzed by McKinsey in the report “Offline and Falling Behind: Barriers to Internet Adoption.”

Opinions vary about just how much of a world leader the United States is in online use. A Pew Research Internet Project survey from September 2013 shows about 70% of Americans aged 18 and older had broadband at home, up from 66% the year before.

The Federal Communications Commission’s national broadband map says more than 91% of U.S. communities have a broadband-speed connection.

But a report from the World Economic Forum ranks the United States 34th globally in Internet bandwidth. And another report ranked the U.S. 17th in peak connection speeds during the first quarter of 2014, according the McKinsey and Company.

Whatever the nation’s worldwide ranking in broadband use, about 16% of the population remains offline. And getting that group online will mean overcoming some unique challenges, the McKinsey report says.

10/02/2014 at 2:17pm

Photo by Yellowstone National Park The Yellowstone River, shown here near Tower Fall, was one of more than 200 sampled as part of the country's largest water quality assessment project.

Rural rivers are getting cleaner while urban streams are getting more polluted, according to a new study by the U.S. Geological Survey. And that’s good news, because country waterways have a higher percentage of polluted waters as it stands. High Country News reports on the study, which found a 53% increase in urban waters contaminated with pesticides over a 19-year period. They contrast this trend with the number of contaminated "agricultural" waterways during the same period, which fell from 69 to 61%.

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The Washington Post has a thorough look at the drug and crime problem brought by the recent oil boom to North Dakota’s reservations.

“It’s like a tidal wave, it’s unbelievable,” said Diane Johnson, chief judge at the [Mandan, Hidatsa and Arikara] Nation. She said crime has tripled in the past two years and that 90% is drug-related. “The drug problem that the oil boom has brought is destroying our reservation.”

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England’s county councils want to make sure rural areas don’t get left out of British plans to “devolve” some functions of government from national to local levels, reports the Tiverton Gazette.

County councils, which are the local unit of government outside major cities, are sending a letter to Prime Minister David Cameron saying they are disappointed with language he used in a speech about devolution.

Cameron only mentioned empowering “our great cities” and said nothing of the “37 county councils and county unitary authorities [that] represent 47% of the English population – some 23 million people.”

We agree that empowering city regions is essential to any new English devolution settlement.

But the great counties of England have an equal role in ensuring the economic success of the UK and delivering a fairer constitutional settlement for England.

Talking only of devolution to city regions risks alienating a huge swathe of voters.

10/02/2014 at 7:11am

Heartland Rural Health Network Community Health Worker Karen Nutter coaches diabetic patients in their homes to help them improve self-management of their chronic disease.

Carol B. has lost more than 100 pounds and cut her blood sugar averages in half since being diagnosed with Type 2 diabetes. But, she says, her disease is almost impossible to effectively control, so she is grateful for the professional assistance she receives fromHeartland Rural Health Network (HRHN) in Avon, Florida.

“I’ve made 180 degree changes in the way I cook and eat,” Carol said. “I’ve upped my exercise. I’ve learned better how to do my medication. But it’s a daily battle and what affects me negatively one time won’t bother me another time. When my doctor suggested referring me to Heartland, I told him I would love having any help that could give me insight. And they even come to my house.”

Uncontrolled diabetes leads to serious and costly complications such as heart disease, stroke, blindness, kidney failure and lower limb amputations. HRHN’s diabetes program and Kentucky’s KIPDA Rural Diabetes Coalition (KRDC) are among federally funded grant programs with the purpose of helping people prevent development of diabetes and helping already diagnosed diabetics help themselves.

“People who are able to effectively control their diabetes over time have fewer strokes, fewer hospitalizations and less blindness and kidney failure,” asserts Dr. Ed Shahady, a co-founder and current medical director of the Diabetes Master Clinician Program (DMCP). “Diabetes is not taken care of in a one-time office visit. It requires an ongoing relationship between providers and their patients. There is excellent, evidence-based data that shows if you get patients’ A1Cunder control, their chances of going blind are minimal. And when you don’t, their chances of kidney failure get higher.”

Shahady reported in Clinical Diabetes that DMCP has helped its patients attain better control of their diabetes while offering them significant cost savings.  The American Diabetes Association(ADA) sets control goals related to lowering A1C, cholesterol and blood pressure levels. DMCP’s free services for providers include a web-based diabetes registry, in conjunction with education and networking support for physicians. DMCP currently has 23,466 patients and 138,487 visits in its registry. Initiated by the Florida Academy of Family Physicians, DMCP is supported primarily by grants and donations, serving provider practices in Florida, Georgia, Oklahoma, Missouri, Illinois and North Carolina. Seventy percent of members are in rural locations. Shahady said DMCP is also expanding its relationship with physician practices in additional states.

10/01/2014 at 12:07pm

Source: Centers for Medicare & Medicaid Services

Crawford Memorial Hospital, in rural Robinson, Ill., is the only hospital for miles around.

Just like elsewhere, Crawford’s doctors deliver babies, perform routine operations and see thousands of patients in the emergency room.

But Crawford, along with one-quarter of the hospitals around the country, is being left out of some of the biggest shifts in American health care initiated by the Affordable Care Act. These changes are aimed at bringing accountability to hospitals by linking Medicare payments to the quality of their care. They also are encouraging hospitals to monitor patients’ health so doctors and nurses can intervene before problems become acute.

The Department of Health and Human Services has not yet incorporated the 1,256 primarily rural, “critical access” hospitals such as Crawford into Medicare’s pay-for-performance programs. With no more than 25 beds, these hospitals are generally located in isolated areas, making them the only acute-care option for local residents. Medicare repays them their cost plus 1 percent, more than it pays other hospitals, to ensure they do not close.

While some of the facilities deliver exemplary care, a study published last year by Harvard School of Public Health researchers found that death rates at critical access hospitals in 2010 were higher than at other small, rural hospitals and the industry overall.

The health law required the government to start testing how to provide bonuses and penalties to critical access hospitals based on their quality by 2012. But Congress never provided any money.

Other Medicare efforts to improve care also are not making major inroads among rural hospitals.

Fewer than 1 in 20 critical access hospitals are participating in accountable care organizations, or ACOs, in which hospitals and doctors coordinate services with the promise of bonuses from Medicare if they deliver care more efficiently. Another project, to test new ways to deliver rural health care, is limited to five states, and the selection of participants has not been announced even though the deadline for applications was in May.

10/01/2014 at 4:38am

Photo by Alden Jewell Greyhound's annual ridership peaked around 130 million about the time this 1971 Scenicruiser was manufactured. Though many of Greyhound’s rural stops have been discontinued in recent decades, Meriwether O’Connor’s trip is reminiscent of an age when the bus line was synonymous with small-town America.

EDITOR’S NOTE: Writer, columnist and small-farmer Meriwether O’Connor of Maine is embarking on a book tour to promote her new collection of short stories, Joe Potato's Real Life Recipes: Tall Tales and Short Stories. Our interest was piqued when we learned that the author, who has rural Texas and Kentucky roots, planned to conduct her multi-state tour via Greyhound bus. She’ll leave the driving to the professionals (as the characters in her book do) and enjoy the company of her fellow passengers. She hopes to share copies of her book with other riders, in return for hearing some of their stories.

We asked Meriwether to take Daily Yonder readers along for the ride from Maine to (she hopes) Texas. In this article, Meriwhether shares a bit about the purpose and logistics of her trip. Then she provides a long-distance bus-rider’s to do list, which we hope will be of some practical value to Yonder readers, especially those of you who still enjoy packing your own food for a long journey.

But first, we asked Meriwether to explain why she was riding a bus on a multi-state book tour. Don’t authors usually prefer jets and limousines? Here’s her response.

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Greyhound is cost effective for me, it's what the characters in my short stories do, and it's a chance to get the book to, and hear stories from, folks who would probably not go to a reading.

On my last Greyhound trip to New York City this spring, I had a seatmate give me her extra paperbacks. So I thought it might be fun to do the same, but sort of with a twist – bringing my own book to the audience vs. the other way around. (That time I was seeing friends and also researching what weeds grow on the city streets there so my characters would be accurate when they described the foraging for food they did there.)

This trip is much longer. I'm visiting people along the way, and I’ve also passed out my itinerary to others so if anyone wants to come to the station and say hey, they can when I pass through their state. Some of my Texas plans fell through due to illness, so I'm still considering what to do. I'll be in Western Kentucky until October 7 or 8, then looking for stuff to do from there until October 11 or 12 when I need to head back. Should I still go to Texas, head to another state, stay in Kentucky? I can only afford to have livestock taken care of for so long back home.

One story in the book features a woman who takes the Greyhound bus to the city to gallivant around and the drifter who sets up camp in her place while she's gone. Oh, and it also has a recipe for how to make an old fashioned applehead doll, if you in fact needed to know how to do that.