Rural people less likely to get some cancers, more likely to die from them; need access, screenings

A new study from the Centers for Disease Control and Prevention found that you're generally less likely to get cancer if you live in a rural area, but more likely to die from it, than someone living elsewhere in America. Though rural Americans are less likely to get most cancers, they are more likely to get colorectal and cervical cancer, as well as cancers related to tobacco use. And they're more likely to die from lung, colorectal, prostate, and cervical cancers than urban and suburban Americans.

The CDC says the rural death rate could be higher because people don't have access to health care services, or if they do have access, don't get screened, or wait until too late to get screened. The keys are getting people screened and getting them access to treatment, Dr. Electra Paskett, co-leader of the cancer control research program at The Ohio State University Comprehensive Cancer Center, told Ann Pietrangelo of Healthline.

The CDC researchers' suggestions for reducing rural cancer incidence and death include promoting healthy behaviors and increasing screenings and vaccinations. Government must get involved too, they say. States need to participate in comprehensive cancer-control programs and work with local governments, researchers, health-care providers and advocates to enact better health policies.

Paskett worries that as some people or regions gain better access to health care, others will be left behind. She told Healthline that urban Chicago, which has also suffered from a lack of access to health care, is a good example of such coordination. "Chicago reduced disparity significantly. There’s still work to do but you can see that what they’re doing is working. We need buy-in from the top governors’ offices and state legislators. That’s what has to happen. When you have a whole city or state working on this problem together, you have an impact on disparities." (Read more)

Could Pruitt's religious beliefs shape EPA policy?

Scott Pruitt, center, prays at his church in Broken Arrow, Okla.
(First Baptist Church Facebook page photo via E&E News)

Environmental Protection Agency Administrator Scott Pruitt is famously skeptical of climate change; Niina Heikkinen of Environment & Energy News recently explored whether Pruitt's religious beliefs might help shape his attitude toward his work. She spoke with his pastor, Nick Garland, of the First Baptist Church in Pruitt’s home of Broken Arrow, Okla. Garland said Pruitt, a deacon who taught Sunday School, “came with deep, deep convictions. His Christian training and strength has always been significant. . . . He's not a wild-eyed weirdo. There are some weird ducks out there. Scott is a great student; he doesn't do anything on hearsay.”

Pruitt is a trustee of fundamentalist-run Southern Baptist Theological Seminary of Louisville, in his native state. The Southern Baptist Convention places great importance on the virtues of both human beings' stewardship of the earth and their dominion over it, Heikkinen says in an Environment & Energy News video interview. That may pose conflict, especially on a political level. Stewardship is the idea that God wants people to take care of the earth and be responsible for what is done to it. Dominion emphasizes that God has granted man control over the earth and everything on it, Heikkinen says, “so that gives a little bit more leeway, in a way, to act differently, to, for example, maybe engage in hydraulic fracturing because you are using the resources of the earth to benefit people.”

Pruitt attended three Bible study sessions in March run by Capitol Ministries, whose president is more fundamentalist than the SBC and issued a supplemental reading that strongly stressed a dominionist attitude. "EPA did not respond to numerous requests for comment," Heikkenen reports. "Requests for Pruitt's schedules past March 31 have not yet been returned."

In the video, Heikkinen shies away from saying that this admittedly circumstantial evidence describes Pruitt's feelings: "I haven't spoken to Mr. Pruitt about his beliefs, and so I'd be hesitant to say exactly how his religion may play into it. But people who I spoke to for this article were saying that, you know, if someone really strongly holds this idea of dominion, then you might have this idea that you have authority to use the earth . . .  instead of focusing on more of the stewardship side. There's also this idea that if God is in control and has a divine plan for the planet, that there isn't really a need to act as a person because God has already preordained what will happen."

Defeat of health-insurance bill is a relief for many rural health interests, but debate will go on

Provisions that would reduce Medicaid coverage may have helped kill Senate Majority Leader Mitch McConnell's health-insurance bill. Sen. Jerry Moran of Kansas, one of two Republicans whose joint announcement Monday night killed McConnell's revised bill, "faced pressure at home about how the bill would affect Kansas, including its rural hospitals," The New York Times noted. "The Kansas Hospital Association said last week that the latest version “comes up short, particularly for our most vulnerable patients.”

"Moran said he was concerned the bill wouldn't lower overall consumer costs and wouldn't provide adequate protection for those with pre-existing conditions. He also expressed concerns that deep cuts in Medicaid over the next decade could threaten the survival of already struggling rural hospitals and nursing homes," Jim McLean reports for NPR.

Because President Obama was unpopular in rural America, many loyal Republican voters criticized the Patient Protection and Affordable Health Care Act, but it helped rural communities deeply, Jennifer Steinhauer writes for the Times: "This was true for communities ravaged by the opioid crisis, which health care money helped treat; for rural states where hospitals had become all but dependent on increased Medicaid payments that covered the bulk of their patients; and for poor constituents with chronic medical conditions who had come to take it as an article of faith that their insurance companies could not deny them coverage for pre-existing conditions."

Many Republican governors expanded Medicaid under the ACA and have worried in recent months about how to keep their constituents covered if the Senate bill passed. Moderate Republicans such as Susan Collins of the very rural state of Maine, who was one of four to publicly oppose the bill, said she had been inundated by messages from Republican voters who urged her not to support the plan.

McConnell did not follow through on the warning he gave Republicans last month, that if they couldn't pass a comprehensive bill on their own, they would have to join with Democrats to stabilize the market for private health insurance. Instead, he said he would use the bill the House passed May 4 as a vehicle for a repeal-now, replace-later strategy advocated President Trump. But that strategy fell apart Tuesday, as three senators from rural states -- Collins, Shelley Moore Capito of West Virginia and Lisa Murkowski of Alaska -- said they could not support it, the Times reports.

Rural Kentucky hiking club is changing local attitudes about health and the community

The Breathitt County Hiking Club in the nearby Red River Gorge. (Photo by Josh Mauser)

Central Appalachia is the unhealthiest place in the country by most metrics, but 45-year-old librarian Stephen Bowling is trying to help Breathitt County buck the trend with a hiking club. An avid hiker, Bowling has been hosting monthly hiking trips one Sunday a month since the beginning of the year, Lyndsey Gilpin reports for Outside Online. His employer, the Breathitt County Public Library, sponsors the club and serves as a meeting place for members that range in age from 14 to 74.

Bowling says the monthly trips usually attract about 20 people, most of whom don't have much experience hiking. But he believes that even something as small as a hiking club can affect not just attitudes about fitness, but about the long-suffering community's ability to improve. “It’s a depressed area economically, but also emotionally and physiologically,” Bowling told Gilpin. “We’re told constantly that we’re the least healthy people, we are this, we are that, and people don’t feel empowered to change that. Some people aren’t willing, and some people aren’t able.”

Breathitt County, Kentucky
(Wikipedia map)

Appalachia is a prime example of the wellness divide between rural and urban America. Eight of the top 10 counties in the U.S. with the largest recent declines in life expectancy are in Kentucky, and one of them is Breathitt. About 14,000 people live in the county, most are white, and most are over 40. "Nearly half the population is obese, about a third smoke, and a third are physically inactive. The unemployment rate is almost 12 percent," Gilpin reports.

Most outdoor adventure spaces are under private control in rural areas, leaving people with far fewer options for outdoor recreation than residents of urban areas. "Most Southeastern states have less than 5 percent federal public land. In Kentucky, less than 4 percent of land is federally owned, and there are only a few state parks, most of them a half-day’s drive from Breathitt," Gilpin reports. "Only 17 percent of Breathitt County residents live within a half-mile of a park or within three miles of an accessible recreational facility; meanwhile, 98 percent of New York county [Manhattan] residents and 100 percent of San Francisco county residents have such access to a park within a half-mile or a recreational facility within just one mile."

Private landowners rarely create trails, and those that are created are mostly for all-terrain vehicles and aren't used by hikers and bikers, Gilpin reports. The area's walking trails are not often safe and well-marked, and local gyms are usually small with limited hours. Most exercise buffs instead rely on using local high schools' running tracks.

The rural South is studying how states like North Carolina and Colorado have boosted outdoor recreation to figure out how to make public lands accessible and profitable. "In July, legislation will go into effect to create the Kentucky Mountain Regional Recreation Authority, a group run by community members from around the state that will develop, maintain, monitor, and promote local trails," Gilpin reports. Republican State Rep. Chris Fugate introduced the bill, and says he wants to connect 17 counties through a walking trail system. "“Some of the most beautiful places are hidden away,” Fugate told Gilpin. “We haven’t done a good enough job of promoting and taking care of ourselves here.”

Mine workers union says new voluntary training won't help safety if inspectors can't cite vioations

UMWA President Cecil Roberts

The United Mine Workers of America is concerned that the U.S. Mine Safety and Health Administration's new voluntary training program won't help create a safer environment for coal miners.

In a recent letter to acting MSHA chief Pat Silvey, UMWA President Cecil Roberts said he is concerned that agency staffers who visit mines as part of this program will not be able to write violations. "To take away an inspector's right to issue a violation takes away the one and only enforcement power the agency and the inspector has," Roberts wrote, going on to say, "To believe that an operator will comply with the law on their own free will is contrary to historical experience and naive on MSHA's part, to say the least."

The voluntary training program was created to help new and inexperienced miners after a spate of recent coal-mining deaths. Six of the seven miners who have died this year had less than a year of experience at the mine where they died, but had at least six years of experience as miners in general, Kevin Ward Jr. reports for the Charleston Gazette-Mail. The training program follows a national trend of reducing formal inspections in favor of coaching miners on safer practices. But some critics say such programs don't help when, they believe, mine operators deliberately put miners in unsafe positions.

Utilities may try to sidestep EPA regulations using law that grants states control over coal-ash disposal

Coal ash at the Tennessee Valley Authority's
Gallatin Fossil Plant (Associated Press)

A 2016 law that granted states oversight authority over disposal of coal ash from power plants was meant to let them tailor disposal approaches to local conditions, but it may also serve as a way for states and industries to challenge Enivronmental Protection Agency regulations they find financially burdensome, Sean Reilly reports for Environment & Energy News.

The Utility Solid Waste Activities Group, an informal consortium of about 80 utility companies, cited the 2016 law, called the Water Infrastructure Improvements for the Nation Act, in a recent rulemaking petition asking EPA to reconsider or delay enforcing extensive regulations passed in 2015. "The rationale: Because states now have the leeway to craft their own coal ash permitting programs — conditioned on an EPA finding that those programs are at least as protective as the federal standards — they can tailor more flexible 'risk-based' provisions around conditions at individual sites," the petition said.

Environmental groups say the industry is trying to take advantage of the Trump administration's dislike for environmental regulations. They note the USWAG petition's allusion to recently adopted administration policies. "Those include an executive order intended in part to promote the use of fossil fuels and EPA's recent decision to postpone implementation of effluent limitations guidelines. The future of coal-fired power production is at risk, the petition warned, 'if there is no economical option for managing the residuals from its use,'" Reilly notes.

Easy-to-misuse weed killer pits Delta farmers against each other, may have led to a murder

Mike Wallace: shot to death
after arguing about dicamba.

The dispute over a common pesticide is causing bad blood between neighbors in farming communities. "The furor surrounding the herbicide known as dicamba has quickly become the biggest controversy of its kind in U.S. agriculture," reports Andrew DeMillo for The Associated Press. Dicamba was temporarily banned in Arkansas and Missouri on July 7, and Tennessee soon after announced new restrictions on when and by whom it could be sprayed.

Dicamba has been in use since World War II, but the recent problems began after farmers started spraying it on soybeans and cotton genetically modified to resist dicamba, in an effort to kill weeds that have become resistant to the most common herbicide, glyphosate (Roundup). Dicamba evaporates easily and drifts into other farmers' fields, causing damage to non-resistant crops and injury to farm workers. The Arkansas Plant Board "has received more than 630 complaints about dicamba so far this year, many more than the 250 or so total complaints normally received in a full year," DeMillo notes.

The chemical "has made good neighbors look like bad neighbors," Arkansas farmer Reed Storey told DeMillo. Storey says half his soybean crop has been damaged by drifting dicamba. Other farmers say that they need dicamba to kill pigweed, which can rapidly threaten a soybean crop. “We cannot lose this technology,” Arkansas soybean farmer Perry Galloway said to DeMillo. “We’ve come too far at this point to just throw it away.”

The dispute is even suspected as a factor in the murder of another Arkansas soybean farmer, Mike Wallace, in Mississippi County in northeast Arkansas. "Farm worker Allan Curtis Jones, 27, is accused of shooting Wallace, 55, in a confrontation over dicamba, which Wallace believed had drifted from the farm where Jones worked to damage his soybean crop," DeMillo reports.

Intern and editor at weekly respectfully stand their ground against criticism, get 'through to someone!'

Josh Qualls was having difficulty finding a source to help him explain how the House health-insurance bill might affect seniors on Medicaid in Lincoln County, Kentucky, where he just completed a summer internship with The Interior Journal in Stanford. So he went to the Boone Newspapers weekly's Facebook page.

"The very first response echoed some of the most disheartening, gut-wrenching rhetoric we’ve seen directed toward journalists in recent months. Its author offered a scathing indictment of the news media and accused us of being liberally biased," Qualls wrote in his intern report to the Kentucky Press Association, relying on memory because the poster had deleted the post. "She talked about how much 'Obamacare' didn’t help her health-hindered family, so I saw a way to connect with her."

Josh Qualls

Qualls wrote, “We appreciate your feedback … and we’re sorry to learn about your health problems and your family’s health-care situation. Our hearts go out to you.” He said no one at the newspaper "was happy with the Affordable Care Act allowing premiums to increase at an alarming rate," but said journalists must "seek the truth and report it," as the Society of Professional Journalists' Code of Ethics says.

“The truth, based on what we know about the American Health Care Act so far, is that these proposals may have long-term effects that are even more damaging than Obamacare,” Qualls posted. “The Congressional Budget Office reported last Wednesday that while premiums would likely decrease for younger Americans, older Americans would likely see a substantial increase and lose many of their benefits.”

Then he wrote this, which KPA highlighted in its report to members: “In this newsroom, we all have different political beliefs but respect each other. What we all have in common is that we’re biased against the things that harm the community we serve, and by community we mean people like you.” Those are lines to remember.

"The author quickly wrote back," Qualls reported to KPA. "She said that she never really thought about it that way and would consider what we wrote, that she appreciated our effort to connect with her and to explain what we were trying to accomplish." He and Editor Abigail Whitehouse, who had approved his message, "were ecstatic," yelling "We got through to someone!"

Though the reader soon deleted her post and the comments, Qualls said the episode showed the value of engaging with readers through social media: "People may think now that they have carte blanche to denigrate journalists, but Abigail taught me that we don’t have to cower in fear of what they might say or do — we must respectfully stand our ground. It simply comes down to this: People hate what they don’t understand, and some people unfortunately don’t understand journalists."

Qualls is a May graduate of the University of Kentucky School of Journalism and Media, which includes the Institute for Rural Journalism and Community Issues, which publishes The Rural Blog.

Dollar General crowding out small, rural stores; company has almost as many stores as McDonald's

Distribution of the 13,601 Dollar General stores in the U.S.
nears that of McDonald's, which has 14,000. (MarketWatch)

Mom-and-pop country stores are being increasingly crowded out by Dollar General stores, reports Jeff Sturgeon of The Roanoke Times. Dollar General Corp. is a $20 billion company with stores across the U.S. that average $1.7 million in annual sales each. Discount chains such as Dollar General and its direct competitors Dollar Tree and Family Dollar are expanding rapidly, especially in rural areas.

Over the last 20 years, Dollar General has refined its rural niche by stocking popular national brands instead of the heavily discounted off-brand items often found at the typical dollar store. "Due to their small size, Dollar General locations can go where Walmart can’t but offer a similar lineup of goods," Sturgeon writes. "The company describes its forte as offering product lines and prices that appeal to people from low- and fixed-income households. Its customers depend on government assistance to such an extent that the company’s sales track changes in food-stamp programs, according to filings with the U.S. Securities and Exchange Commission."

Encroaching Dollar General stores have caused some mom-and-pop businesses to close, since they can't compete with the selection and bulk buying power of the mega-chain. "It's unfair competition," country-store owner Wayne Lamay of Copper Hill, Va., told Sturgeon. He said his customers had promised to stay loyal to his store, but he sees their cars in the Dollar General store parking lot.

Local residents, many of whom live in food deserts, say they like the store's prices, but acknowledge it can be an eyesore. But those who dislike Dollar General are generally powerless to stop it, since the store often takes advantage of lax or absent zoning laws in rural areas to build their stores, reports Sturgeon. Rural county governments usually benefit from new Dollar General stores, since they keep retail dollars in the county that might otherwise happen elsewhere, and pay the government sales and real estate taxes.

Paula and Bruce Smith's view from their home in Copper Hill, Va., has changed.
They don't like it, and worry about pollution from light and heavy delivery trucks.
(Roanoke Times photo by Heather Rousseau)