Saturday, August 29, 2015

Poor Rural Children: The Forgotten Fifth


William O'Hare The percentage of poor children varies wildly from state to state. Those states in dark blue have child poverty rates over over 25%. Those in pink have child poverty rates under 15%.

Nobody has studied child poverty in rural America more than Bill O’Hare. He has now written a new report, The Forgotten Fifth: Child Poverty in Rural America, for the Carsey Institute at the University of New Hampshire.

One out of five poor children in the United States lives in a rural area, O’Hare reports. (The full text can be found here. While you’re at it, check out other Carsey offerings here.) “Yet this group of vulnerable young Americans is seldom on the minds of the public or policy makers when they talk about child poverty in the United States,” O’Hare writes. “The image, rather, is overwhelmingly an urban one despite higher poverty rates in rural areas for decades.”

O’Hare reminds us that many of the nation’s major social reforms began with reports on rural poverty. Lyndon Johnson’s War on Poverty started with a visit to a cabin in Eastern Kentucky, for example. “In recent decades, however,” O’Hare writes, “rural poverty has been overshadowed by the plight of the ‘urban underclass,’ those impoverished families living in disadvantaged neighborhoods in large cities.”

As Congress was reviewing TANF (Temporary Assistance for Needy Families) in 2002, 1,400 newspaper articles were written on the subject. But not one dealt with welfare in rural communities, according to the Carsey report. “This lack of attention is particularly vexing given that many of the barriers to moving from welfare to work, such as lack of transportation and child care services, are higher in rural than urban areas,” O’Hare writes.

O’Hare’s report for Carsey is worth reading from cover to cover. What follows are excerpts from The Forgotten Fifth:

The child poverty rate—the percentage of children living in families with incomes below the official poverty line—is the most widely used indicator of child well-being. In 2007, the poverty threshold for a family of two adults and two children was $21,027 per year.  By that measure, 22 percent of those under age 18, or 2.6 million children, in rural America are poor, higher than the child poverty rate in urban areas. One in five poor children in the country lives in rural America. These are the forgotten fifth. 

In both urban and rural America, the risk of poverty is greater for children than for any other age group. In 2007, the child poverty rate in rural America was 22 percent, while it was 15 percent for the working-age population (aged 18 to 64) and 12 percent for the elderly (aged 65+). In urban America, 17 percent of children were in poverty, 11 percent of working-age adults were in poverty, and 10 percent of urban elderly were in poverty. 

William O'Hare The gap between rural and urban child poverty has widened in recent years. The relatively high poverty rate for children in rural America today is not new. In 1970, the poverty rate was 12 percent for urban children and 20 percent for children in rural areas. Although the gap between rural and urban child poverty narrowed in the 1970s and 1980s, it has widened from 3 percentage points in 1990 to 5 percentage points in 2007. The rise of child poverty in rural America is consistent with the growing income gap between urban and rural families....Poverty rates in rural areas are highest in counties that are the most remote and lowest in counties that are in or adjacent to metropolitan areas. 

The rural child poverty rates in states range from a low of 8 percent in Connecticut to a high of 35 percent in Mississippi (Savage 2008). In thirteen states, more than one-fourth of rural children are poor. 

The 2007 county-level child poverty estimates from the Census Bureau provide a stark picture of child poverty in rural America; the estimates show that of the fifty-one counties (several counties were tied) with the highest child poverty rates, fifty are located in rural America. Similar results from Census 2000 prompted prominent child advocate Marian Wright Edelman to argue that “Americans tend to picture poor children living in big cities. But there are 38 counties with child poverty rates higher than in the poorest big cities, virtually all of them rural counties”

William O'Hare The counties with the highest child poverty rates are almost exclusively rural. The poorest families benefited the least from the economic boom in the late 1990s, and the major reform of the welfare system in the late 1990s may have exacerbated their plight.

The rural poor tend to be poor for longer spells than their urban counterparts. The median length of poverty in rural areas is 15 percent longer than in urban areas. Nine percent of rural people who became poor at some point between 1996 and 1999 were still poor twenty-four months later, compared with only 7 percent of people in urban areas. 

A significant difference between rural and urban poor children is that rural poor children are more likely to be white. More than one-half (57 percent) of all poor rural children are non-Hispanic white compared with about one-fourth (28 percent) of poor urban children (see Table 4). On the other hand, black children make up only 21 percent of the poor children in rural America compared with 30 percent in urban America, and Hispanic children make up only 15 percent of poor rural children compared with 35 percent of poor urban children. 

William O'Hare Portions of the country have had persistently high child poverty rates for generations. Rural families experienced welfare reform differently than urban families, in part because of the different characteristics of the population and communities and in part because of state choices. In rural areas, particularly those where potential employers are few and far between, child care and transportation costs are serious impediments to single mothers entering or reentering the labor force. For example, in 2007, 1.3 million rural households (7 percent of all rural households) had no vehicle available, and virtually everyone in rural areas lacks easy access to public transportation.



Higher Education and Medical School Probability

Lower income rural American children share the lowest medical school admission rates at 2 to 3 admissions to medical school per 100,000 per medical school classyear. For the 1990s the national average was 8. Most urban, highest income counties with medical schools have 14 - 20 admitted for 2 to 3 times the average probabilty of admission.

Predomonantly African American rural counties demonstrate these lowest admission ratios and also a key part of the solution. Medical education leaders claim that rural and underserved locations cannot recruit and retain the physicians that they need. Of course medical schools are not admitting and graduating the physicians that are most likely to be found where needed. Physicians tracked to birth origins in predominantly African American rural counties were found with 25% in practice in the same counties in 2005. The probability of a return was 50% when the birth origin with the highest probability of return selected family practice.

Current medical schools admit the most exclusive highest income and most urban origin medical students and train them in exclusive careers. Admission, training, and policy drives health workforce away from rural locations, away from underserved locations, and away from the family practice choice that doubles, triples, or quadruples most needed health access careers above birth origin and training impacts.

The solutions for most needed health access are obvious - admit more normal and less exclusive, train more normal and less exclusive, career choice family practice, and health policy that distributes health funding more normally.

The United States admits the most exclusive and is moving even more exclusive in admission. The United States trains students away from health access careers. The United States concentrates 90% of the health funding related to physicians in 4% of the land area where 75% of physicians, 75 - 92% of specialists, and 90% of clinical, research, and graduate medical education funding is sent to 3400 zip codes.

Economic reversals for rural and underserved locations depend upon economic redistributions in the nation, with education funding redistributions and health care redistributions one of the few mechanisms that actually will result in recovery for rural and underserved areas (not grants). The US needs an entirely different health policy design where the current 10% of health resources steadily increases to 20 or 25% over the next decades. Worst case is 10% declining to 9% and 8%, a countdown that is already disaster for those currently left behind.

Recovery through education and through health is essential for the 30,000 zip codes outside of concentrations of physicians and health care, zip codes with 65% of Americans and 70% of America's elderly that will double in the next twenty years.

Robert C. Bowman, M.D.   To understand access and distribution, one must understand the consequences of concentration.