Many small, rural hospitals are having a hard time fitting into new accountability standards of the Affordable Care Act. Critical-access hospitals aren’t yet part of Medicare’s pay-for-performance plan, and Congress never provided money for testing how to tie bonuses and penalties to hospital performance.
Maine writer Meriwether O’Connor is packed and ready to depart on a multi-state book tour. Instead of reading in bookstores and libraries, she hopes to share her work with her fellow Greyhound bus passengers. It’s a trip too good to pass up, so the Daily Yonder tags along
An Oklahoma study finds that more rural residents prefer to get information via their newspaper (either print or online) than any other mode of communication. For groups trying to reach rural constituents, that’s important to keep in mind.
Efforts to increase foundation grants for rural work need to start with correcting misperceptions about rural capacity, say panelists. Foundations also need to learn more from their rural grantees, says one leader.
The chore of bringing cows down from high summer pasture becomes the celebration of viehscheid in the Alpine villages of Germany and other European nations. Festivals may differ, but they all include the essentials: bovines and beer.
Farmers’ complaints about railroad practices are nothing new. The latest round of criticisms says railroads are favoring Bakken oil over grain shipments. As a result, farmers worry they will watch their harvest spoil on the ground.
Photo courtesy of Pacific Northwest National LaboratoryScientists at the Pacific Northwest National Laboratory are developing a model of the microbial environment inside the human gut. The model will be composed of three-dimensional human intestinal cells cultured with specific gut bacteria.
Americans are getting bigger. There's no doubt about it. At 5 feet 8 inches and 150 pounds, I was one of the biggest kids in my freshman class. It was that fact, rather than my doubtful athletic ability, that earned me one of about 40 spots on our High School football squad.
That's because the coach wanted to impress opposing teams with our size.
But today I have grown. At a couple inches under 6 feet and 195, I am dwarfed by as much as four inches and 40 pounds. My grandsons are bigger and stronger now than I have ever been.
Is that because they have “bigger” genes or have human diets changed that much over the years?
Volumes have been written about modern diets, rich in sugar and salt, by writers like Mark Bittman, who recently wrote a New York Times column titled "The Drinkers Manifesto".
Bittman has devoted much of his writing to pointing out nutritional deficiencies, especially the presence of high fructose corn syrup and other applications of corn in modern fast food diets. In his drinker’s manifesto he qualifies perceived overindulgence in distilled spirits, pointing out that national health costs from obesity are nearly 25% greater than those of alcoholism.
(For the record, corn-hater Mark left out that a lot of the alcohol humans consume starts out as corn.)
What's missing from the food debate are new revelations regarding the human biome and ways bacteria interact with our bodies to make us healthier … or not.
The probiotic movement has been around for years. That's why some people eat types of yogurt that are believed to help digestion and sustain favorable fauna in the gut. Research supports that.
Bacteria can harm or hurt. That's also why we have antibiotics, to help eliminate infectious bugs that attack our bodies. But now researchers say we need the right bugs, not only for good digestion, but to keep us healthy by advising our bodies on how to behave. They've gone so far as to say that good bacteria communicate with human brains and the bodies they inhabit, to call for antibodies--or call them off as with autoimmune disorders--or even help ward off cancer.
And there is proof that some conditions, like autism and its side effects, can be improved simply by changing or adding bacteria located inside the bodies of autistic people.
Photo by Tom KellyThe Mitchell Corn Palace sports a new look every year, always hand-crafted with ears of South Dakota corn. This year the corn palace began a year-long remodeling project to modernize its appearance and amenities.
It’s hard to talk about Mitchell, South Dakota, without getting just a little, well, corny. This city of more than 15,200 residents in the state’s south central I-90 corridor boasts a long tradition of using its ears to lure travelers off the highway. Since 1892, Mitchell has been home to the “World’s Only” Mitchell Corn Palace, a large auditorium and cultural center decorated each year with a-maize-ing new corn-based art.
If these puns seem a little tired, Mitchell’s economic outlook should wake you up. While some might only know Mitchell as a tourist trap on the way to Mt. Rushmore, or as the boyhood home of former Senator and unsuccessful presidential candidate George McGovern, this city has quietly reinvented itself as an economic center for technology, marketing and manufacturing. The nation’s leading supplier of rural telecommunication services developed itself right here, and billboards for miles around tout new high-paying jobs in Mitchell.
My family and I passed through Mitchell on our way west this summer. My wife and I were impressed with the city’s growth since we had been there 10 years earlier. The changes include new housing starts and a large technology center. The downtown was busy, traffic brisk and people were pedaling, walking and enjoying the summer sunshine. Then there were the radio ads: ultra-high speed Internet to every home and business for a fraction of what it costs us for satellite Internet back in our rural northern Minnesota home. This little town in the corn had suddenly become a poster child for what many rural places across the country want to be.
So how did this happen? And what can rural cities all over American learn from Mitchell, South Dakota?
Bryan Hisel, executive director of the Mitchell Area Development Corporation, said Mitchell’s success has been a combination of existing local talent and a collective focus on improving quality of life and infrastructure in Mitchell.
Photo via Thirteen MoonsAn aerial view of Perch Lake, on the Fond du Lac Indian Reservation.
For hundreds of years Native Americans have fought colonization and banishment from their own lands. Now, in an ironic twist, some Native Americans are being banished from their reservations back to these same stolen lands in an attempt to address problems with violence and crime.
Tribal banishment is not new, but it appears to be gaining renewed attention because of tribes’ use of the practice to deal with contemporary issues.
In early tribal communities banishment was seldom used. A value that is shared by many Native communities includes staying out of others’ business and offering your opinion on a subject only when asked. This value allowed for harmony among the tribal members.
According to our tribal elders, there was no drug use or abuse, because drugs and alcohol were introduced to Native people by Europeans. Child abuse was very rare because parenting was shared by many members and children were treated as sacred gifts from the creator. Domestic violence was a problem only on occasion. If a situation wasn’t resolved, a relative or often a trusted elder was sent to speak to the offender and harmony was usually restored. If the situation continued unresolved then, banishment was used.
When a tribal member was banished, it amounted to a death sentence; survival depended on support from the tribe working together. On one’s own, a person was exposed to the elements, wild life and warring, rival tribes.
Now, banishment seems to be increasing across the country as tribes look for effective means to deal with increasingly violent criminals and the gang and drug trade that often accompany this criminal behavior. The tribes have fought for sovereignty and the right to banish under certain conditions.
The recent algae bloom that created a drinking water crisis for Toledo should serve as a wake-up call. Farmers need to start following good nitrate application practices or more regulation could be in store.
Photo by Joshua Lott for The New York TimesLake Erie's algae bloom washed ashore at Maumee Bay State Park near Toledo, Ohio.
Growing up, one of the events we looked forward to was the church pot luck dinner.
There were so many delicious choices as we worked out way down the table. It was easy to overfill the plate, and the desserts were still ahead.
It took more than one pot luck dinner to finally come to the conclusion (well, mothers and a stomach ache or two helped) that it was possible to have too much of a good thing.
The Lake Erie algae bloom that shut down the public water system of Toledo, Ohio, from August 2-4, forces us to face the problems caused by too much of a good—and necessary—thing: excess phosphorus, some of which came from agricultural production, which fed the algae bloom.
A United States Department of Agriculture (USDA) Economic Brief, “Nitrogen Management on U.S. Corn Acres,” points out that while nitrogen is an important input that allows farmers to “produce high yields profitably,” excessive application can lead to problems. They note that “nitrogen compounds released into the environment can also be a source of environmental problems, including eutrophication and hypoxia in aquatic ecosystems, visibility-impairing haze, and the loss of biodiversity.”
(When we we talk about how to manage the application of nitrogen, we're also talking about how to control phosphorous and potassium, because the chemicals are often applied as part of a compound.)
Most of the reactive nitrogen emissions in the United States comes from agriculture, according to another USDA publication. Agriculture is responsible for 73% of nitrous oxide emissions, 84% of ammonia emissions and 54% of nitrate emissions.
Despite all that we know about the problems created by crop nutrients that make their way into the environment, about two thirds of the cropland producing eight major field crops did not follow best management practices for nitrogen, according to USDA.
Burger King is in talks to buy Canadian coffee and doughnut chain Tim Horton. In Wall-Street Banker lingo, this deal will be a “tax inversion,” moving Burger King’s headquarters from the U.S. to Canada
Tax inversions are on the rise because they allow the parent company to escape or reduce U.S. corporate income taxes. That is a Whopper of a Deal for Burger King but not for U.S. government coffers.
The tax inversion is just one example of the many economic policies and tax laws that favor corporations over individuals. These policies help corporations squeeze out more profits at the expense of the middle class, shift the tax burden to working families and hinder government’s ability to provide basic services to the nation. It’s a bad deal for both rural and urban communities.
Why would Congress go along with a plan like this? Simply put, because corporations pay them to. Businesses donate billions of dollars to political campaigns because the benefit cost ratio is considerably greater than 1.
What do they get for their “investment”? Plenty.
Tax Inversions Tax inversions have been happening since the late 1800’s but are much more common in recent years, with almost 50 companies inverting in the past decade. Congress considered legislation in 2004 to stop inversions, but the watered down law they passed left a gaping loophole that allowed U.S. corporations to become a foreign corporation, if they merged with a foreign partner, even a much smaller foreign partner.
Corporate executives refer to ways of hiding profits in words like “stripping” and “hopscotching,” but to most of us this is plain old “cheating.” Cheating reduces tax revenue to the government, which eventually means cuts in government services or raising taxes on most of us.
Instead of litigation and animosity, an Idaho organization uses collaboration to restore the region’s forests. In the process, they helped turn back a fire that ravaged nearly 340,000 other acres. The coordinator of the stewardship project explains how diverse stakeholders work together for common good.
Photo by the Salmon-Challis National Forest A firefighter works around the Hull Creek area during the Mustang Complex Fires in 2012.
Two years after Idaho’s massive 2012 forest fires were brought under control in an area where fire risk had been lessened through better forest management practices, Gina Knudson is leading a collaborative forest restoration group working to make such efforts the norm.
It’s a clear summer morning in Salmon, Idaho, and Gina Knudson is dressed for work in a flower print western shirt, Levi’s and hiking boots. She sits with her morning coffee and a well-worn copy of the Continental Divide Trail map. Looking east from her kitchen window she can see the Beaverhead Mountain Range, where the 3,100 mile trail marks the Idaho-Montana border through the Beaverhead National Forest. Each day before work she plans which section of the trail she’s going to hike next. “That's what I'm here for.”
Youthful with a ready laugh, Knudson, 46, is an avid outdoors-woman. She fell in love with the Salmon River valley when she and her family moved to the small mountain town 12 years ago. “We moved here because my husband, Jeff, got a job with the Bureau of Land Management. He's the fire manager in Salmon,” she explains. “We both grew up in the desert of southern Idaho. Our intention was to live here for two years and then move back to the Boise area after he'd gotten his promotion. Our first night here we realized we were probably going to throw that plan out the window. I was completely captivated by this place. It's not like anything I'd experienced before.”
Salmon, Idaho, is one of the most remote communities in the West, with a population hovering steadily around 3,000. The nearest shopping mall is 150 miles away. Since her arrival in 2002, Knudson has become ingrained in the community. She equates living in a small town to being a member of a small church. “If you don't participate in the choir or teach Sunday school, or whatever, you're not really a member. If you're interested in things and you show up, whether to a city council meeting or to a concert the arts council is putting on, people notice that you’re interested. And hopefully, when you start talking to people they realize you have some kind of life experience that could help their cause or somehow be beneficial.”
The people of Salmon did take notice of the skills that Knudson brought to town. When the local hockey association found out she had grant writing experience, the board of directors asked her help with fundraising. Her participation in city council meetings led to an invitation to fill a vacant seat on the council. And in July 2006, Knudson, who was once a seasonal firefighter and had been working as a freelance writer for a regional newspaper, was invited to fill in for the director of a small non-profit who was taking off for maternity leave.
That temporary assignment became permanent and now Knudson is executive director of Salmon Valley Stewardship (SVS), a non-profit that promotes a sustainable economy and productive working landscapes in the Salmon River region. Among their programs, SVS coordinates the Lemhi County Forest Restoration Group (LCFRG). Members of the group – environmentalists, timber workers, wildlife advocates, landowners and active and retired government forest managers – collaborate with each other and the Forest Service on sustainable management and restoration of the surrounding forests. Knudson leads the group, and her background as a journalist has proven to be a real gem.
Greater distance and less access to technology can make it harder for rural residents to enroll in health-insurance programs. But the biggest barriers may be state decisions about whether to expand Medicaid and operate their own health insurance exchanges. Minnesota and Virginia offer a study in contrasts in rural enrollment methods.
Minnesota ran its own health-insurance exchange called MNsure. Virginia relied on the federal exchange, which operated through healthcare.gov.
Americans living in rural areas will be a key target as states and nonprofit groups strategize how to enroll more people in health law insurance plans this fall.
Though millions of people signed up for private insurance or Medicaid in the first year of the Affordable Care Act, millions of others did not. Many live in rural areas where people “face more barriers,” said Laurie Martin, a RAND Corp. senior policy researcher. Brock Slabach, a senior vice president at the National Rural Health Association, said “the feds are particularly concerned about this.”
Distance is one problem: Residents have to travel farther to get face-to-face assistance from the so-called navigators and assisters hired to help consumers figure out the process. And Internet access is sometimes spotty, discouraging online enrollment.
But the most significant barriers may stem directly from state decisions about whether to expand Medicaid eligibility -- more than 20 states chose not to -- and whether to operate their own health exchanges. States that embraced those parts of the law generally had more federal resources as well as funds generated by their online marketplaces for outreach efforts to boost enrollment, including those aimed at consumers in less accessible areas, and more coverage options, through Medicaid, for which these consumers might be eligible.
About $2.5 million from the Department of Health and Human Services was specifically directed to rural outreach for the initial open enrollment period. For 2015, a total of $60 million will be available to bolster navigators’ work in states that are using the federal marketplace, but it’s not clear what portion of this amount will be directed to rural enrollment.
An examination of experiences in Minnesota and Virginia shows how state decisions continue to shape these efforts. Both states have significant rural populations: about 13 percent of Virginians and 23 percent of Minnesotans, according to 2013 figures from the U.S. Department of Agriculture. In 2012, both had rural poverty rates in the teens: nearly 18 percent in Virginia versus 12 in Minnesota. And between 2011 and 2012, about 9 percent of Minnesotans were uninsured, compared to 13 percent in Virginia, the Kaiser Family Foundation reported. (KHN is an editorially independent program of KFF.)