Old-style Catholics' migration to Kansas town an example of 'cultural secession' that has implications for societal diversity

Students at the local Catholic school sing with Father
Paul-Isaac Franks (Atlantic photo by Bryan Schutmaat)

We've written more than once about how a person's political views can influence where they move, but a small Kansas town dominated by old-school Roman Catholics is an extreme example of the desire to live among like-minded people, Emma Green reports for The Atlantic.

In St. Mary's, Kansas, a town of about 4,000, the vast majority of people are Catholic. That's not an accident: In the 1960s, many Catholics objected to the liturgical changes made by the Second Vatican Council and sought to practice their faith more traditionally (saying Mass in Latin, for example). So they formed the Society of St. Pius X, commonly called SSPX, named for a pope (1903-14) who opposed modernism, and have settled in a number of small communities all over the world.

Catholics from all over the country have settled in St. Mary's over the past 40 years, drawn by the opportunity to practice their faith apart from mainstream America. The town isn't cut off from modern life—people watch Hulu and shop at Sam's Club—but SSPX Catholicism permeates the town. The mayor and the entire city council are SSPX Catholics. Few women work, and families are large, since they don't believe in using birth control; so many children have been born in St. Mary's that the SSPX population has more than doubled the town's size since the 1960s, Green reports.

SSPX communities aren't a new concept. "Throughout American history, religious groups have walled themselves off from the rhythms and mores of society . . . These groups ostensibly have little in common, but they share a sense that living according to their beliefs while continuing to participate in mainstream American life is not possible. They have elected to undertake what might be termed cultural secession," Green reports. "Katherine Dugan, an assistant professor of religion at Springfield College, in Massachusetts, who studies Catholicism in the U.S., describes the desire for protected, set-apart communities as 'a natural American response to not liking what the cultural context is.'"

St. Marys, Kansas (Wikipedia map)

SSPX followers told Green they felt isolated by their faith before they moved to St. Mary's, that they were concerned about being labeled bigots by co-workers or friends, and that they worried about raising children in an increasingly secular society.

It's hard to measure just secular a nation is, but there's something to the SSPX followers' fears that the U.S. is becoming more secular. Millennials (those aged 23-38) are almost as likely to say they have no religion as they are to identify as Christians, Daniel Cox and Amelia Thomson-DeVeaux report for FiveThirtyEight. That's perhaps unsurprising, they note, since a new national survey found that millennials are less likely than other generations to have been raised with strong ties to religion in the first place.

"In 2000, 41% of the country said they attended religious services once a week or more, compared to 14% in 2000 who said they never did. This year we found less than 30%; 29% of Americans say they attend religious services weekly or more, compared with 26% who now tell us they never attend," said Chuck Todd on Meet the Press last week, referring to a NBC News/Wall Street Journal poll.

So, SSPX residents of St. Mary's aren't wrong when they say American society is changing. But, Green cautions: "The rise of more radical self-sorting poses a challenge to America’s experiment in multicultural democracy, enshrined in the motto e pluribus unum—'Out of many, one.' The dream of a diverse society is replaced with one in which different groups coexist, but mostly try to stay out of one another’s way. The ongoing experiment in St. Marys suggests what might be gained by such a realignment—and what might be lost."

Webinar tomorrow at 1 ET on USDA rural broadband funds

The Rural Development office of the U.S. Department of Agriculture will host a free webinar at 1 p.m. ET on Dec. 18 to discuss USDA's ReConnect Program, which offers grants and loans to improve rural broadband buildout.

A second round of ReConnect funding was announced on Dec. 12. The USDA will provide up to $200 million in grants, $200 million in low-interest loans, and up to $200 million for 50/50 loan/grant combinations. Applications must be submitted by March 16.

In the hour-long webinar, Rural Development staff will go over types of funding, eligibility requirements, the application process, and more. They will also talk about the program requirements as outlined in the 2019 Funding Opportunity Announcement published on Dec. 12.

Click here to register. If you are unable to attend, a recording may be available afterward.

Speaker of Nebraska Legislature proposes increasing number of state senators to help rural districts

Jim Scheer, the Speaker of the Nebraska Legislature, has proposed increasing the number of senators in the state's unique, unicameral body, Paul Hammel reports for the Omaha World-Herald.

The state legislature now has 49 senators, the smallest number of such representatives in the nation. Scheer "said that allowing the body to expand to up to 55 senators would not only ease the process of redistricting after the 2020 Census but would also ensure that some rural districts don’t grow so large geographically as populations shift that constituents lose contact with their state senator," Hammel reports.

The state constitution requires districts to be evenly divided by population and calls for counties to be left as whole as possible, which can make for huge rural legislative districts that sometimes dip into suburban or urban areas. Scheer said some legislative districts in the central and western parts of the state spread over hundreds of miles, and that the problem is expected to worsen when the Legislature draws up new districts in 2021, Hammel reports.

While increasing the number of senators would not necessarily preserve rural influence, the mere fact that more individuals are in the Legislature could avoid a possible reduction of rural voices. 

How Sandy Hook helped alter the gun-control conversation: more state and local gun-control laws in the last 7 years

A snapshot of the range of gun-control laws in the states as of 2018.
(Business Insider map; click to enlarge it)

It's been seven years and two days since 26 people — 20 of them children — were killed at Sandy Hook Elementary School in Newtown, Connecticut. The shooting was so shocking that it touched off a major shift in the national conversation about gun control and has led to new laws in many states and localities, Reid Wilson reports for The Hill.

"In the years since Sandy Hook, 21 state legislatures have expanded background-check requirements on various types of gun sales," Wilson reports. "Seventeen states, mostly those controlled by Democrats, have passed red-flag laws that allow law enforcement to take guns away from someone who may pose a danger to themselves or others. And 28 states have enacted laws requiring those convicted of domestic abuse to give up their firearms."

The move toward more gun-control measures has also sparked pro-gun rights measures in more conservative states and localities. "Several states have passed measures expanding the right to carry concealed firearms, even without a permit, and others are moving to allow firearms on school grounds as part of a response to mass shootings," Wilson reports. "In the last seven years, the NRA counts more than 460 pro-gun measures that have passed state legislatures."

The biggest change is that guns are no longer the "third rail of American politics," Wilson writes. Gun control used to be mainly a rural vs. urban issue, and Reid notes that rural Democrats were once the source of some of the most vehement gun-rights legislation. But gun control has become increasingly a partisan issue over the past few decades, and these days, "backing stricter gun laws, once a sure path to defeat in rural and suburban communities, has become a winning issue — or at least a neutral issue — for some candidates."

That might have to do with the increased political spending from anti-gun and gun-safety groups as the NRA becomes less popular (and has less money to spend on lobbying). "In 2018, gun-control groups spent more than the NRA on campaigns and elections for the first time in recent memory," Wilson reports. "The following year, those groups outspent the NRA by a huge margin in Virginia, home of the NRA’s headquarters."

Agriculture-purchase details in trade deal remain murky

U.S. and Chinese negotiators unveiled an interim trade agreement last week, but some trade issues still remain unresolved, and the details of the agreement are unclear. The 86-page agreement, which hasn't been made public yet, is expected to be signed in January, Evelyn Cheng reports for CNBC.

Because trade issues between the two nations are so contentious and wide-ranging, negotiators agreed to break the talks into phases. Both countries announced they had agreed on a "phase one" deal that includes agricultural purchases, which could boost President Trump's re-election bid. China reportedly promised to buy $40 billion in U.S. farm goods per year; Trump said he expected that to increase to $50 billion "pretty soon" and "U.S. Trade Representative Robert Lighthizer told reporters that China would buy at least $16 billion more agricultural goods in each of the next two years. The report said that could bring total purchases to near $50 billion in 2020 and 2021," Cheng reports.

But economists from Japanese finance company Nomura Holdings Inc., including its chief China economist, Ting Lu, said over the weekend, "That scale of purchases seems implausible and Chinese officials were reluctant to mention any specific target during their press conference," Cheng reports.

Both nations are making conciliatory gestures. "The U.S. held off raising tariffs on Chinese goods on Sunday, and Beijing did not go ahead with planned retaliatory tariffs," Cheng notes. "China has also been increasing its purchases of American soybeans this year, despite an overall expected decline in Chinese demand for the product, according to the U.S. Soybean Export Council."

However, "It’s still unclear how and when the U.S. will roll back other tariffs, a condition for a phase-one deal that the Chinese side has firmly maintained," Cheng reports. "The Office of the U.S. Trade Representative said in a statement that the United States will keep 25 percent tariffs on about $250 billion of Chinese imports, along with 7.5% duties on roughly $120 billion of Chinese imports."

"Lighthizer said Beijing has also agreed to reduce longstanding non-tariff barriers to U.S. farm exports, including trade restrictions on beef, poultry, seafood, dairy, rice, infant formula, animal feed, pet foods, feed additives and a variety of biotechnology products," Ryan McCrimmon reports for Politico's Morning Agriculture. "Farmers have long been frustrated by China’s slow approval process for approving biotech crops, which has impeded U.S. exports of certain corn and soybean varieties."

USDA releases 2019 report on family farms

On Friday the U.S. Department of Agriculture's Economic Research Service released a new report with updated data on family farms in the United States. "America's Diverse Family Farms: 2019 Edition" aims to give stakeholders a more granular view of farm life in 2018, since huge farming operations can skew averages. The report is based on a sample of about 15,800 farms.

"In 2018, the average value of production on the 2 million U.S. farms amounted to $174,038," the report says. "Few farms, however, are near the average; half of farms had production valued at $6,000 or less, while more than half of all production occurred on farms with at least $1 million of agricultural production."

USDA defines a family farm as one where the principal operator, and possibly some relatives, own the majority of the business and make most day-to-day decisions. Farm size is measured by gross cash farm income, which includes sales of crops and livestock, government payments, fees from production contracts, and other farm-related income. Here are a few highlights from the report:

• Family farms accounted for 98 percent of farms and 88% of production in 2018.
• Large-scale family farms accounted for the largest share of production, at 46%.
• About 90% of U.S. farms were classified as small, meaning they have a gross cash farm income of less than $350,000.
• Small farms accounted for 48% of the land operated by farms. 
• Between 58% and 81% of small family farms, depending on type, were deemed at high risk of financial problems. However, the report notes that the operators of many small farms don't consider that their primary occupation and receive substantial income from off-farm sources.
• Midsize and large-scale family farms accounted for 82% of cotton production, 74% of cash grains/soybeans production, and 66% of hog production.

Read the full report here.

FCC OKs 3-digit number for suicide and mental-health crisis calls, to start in 18 months; could also help thwart overdoses

The Federal Communications Commission voted unanimously Thursday to move ahead with a plan to set up a suicide-prevention and mental-health crisis hotline. It's similar to the 911 hotline, but "instead of dialing the police, the number would connect callers to experts in suicide prevention and mental health," Colin Dwyer reports for NPR. "The proposed number, 988, would link callers to an already existing network of crisis centers around the country set up by the Department of Health and Human Services."

The network of 163 call centers can already be reached through 1-800-273-TALK, or online, but the FCC believes that dialing 988 will be easier to remember, will make suicide prevention efforts more effective, and will reduce the stigma surrounding suicide and mental-health conditions, the FCC said in a study prepared in collaboration with the federal Substance Abuse and Mental Health Services Administration. "Congress requested the report as part of the National Suicide Hotline Improvement Act, passed and signed into law last year in a rare display of bipartisan agreement," Dwyer notes.

It could be a while before the 988 hotline goes live; the public comment notice proposes an 18-month time frame for the project. Right now, the proposal is open to public comment, then the commission will finalize the rules, Dwyer reports.

The notion of treating mental-health crises more like physical-health crises seems to be catching on, as more lawmakers and stakeholders recognize that stigma is a major barrier to treatment. In Kentucky, the chair of the state House Health and Welfare Committee, Rep. Kim Moser, has filed a bill to create a program to train people in first aid for mental-health and substance-use crisis situations, Melissa Patrick of Kentucky Health News reports.

Dec. 19 webinar to discuss 2020 agriculture outlook

A free webinar on Dec. 19 at 12:30 p.m. ET will discuss the 2020 agricultural economic forecast.

Purdue University ag economists Jim Mintert and Michael Langemeier will go over updated corn and soybean supply and demand estimates and price projections, marketing strategies for 2019 and 2020 crops, profit projections for 2020, and the relative merits of signing up for the different types of federal crop insurance.

The one-hour webinar is free, but registration is required. If you are unable to attend, the hosts say they will email you a recording afterward. Click here to register or for more information.

Rural Minn. woman sues after two pharmacists refuse to fill morning-after pill prescription because of religious beliefs

McGregor in Aitkin County (Wikipedia)

A rural Minnesota woman has filed suit after two pharmacists refused to sell her emergency contraception because of their religious beliefs. She says the issue highlights how religious-objection rules hurt rural women, Katie Shepherd reports for The Washington Post.

Andrew Anderson, 39, lives in McGregor, a town of about 400 people. She and her longtime partner have one biological child and four adopted or foster children. When their condom broke in January 2019, Anderson called her gynecologist the next morning and received a prescription for Ella, an emergency contraceptive. The prescription was sent to Thrifty White Pharmacy, the only one in McGregor.

The pharmacist at Thrifty White, George Badeaux, refused to fill Anderson's prescription because he said it would be against his religious beliefs. Badeaux, who is also a pastor at a nearby church, advised her not to go to a nearby pharmacy because the employees there would also probably refuse to fill the prescription, Shepherd reports.

"Anderson did not give up. She drove about 20 miles to a CVS pharmacy in a neighboring town, where another pharmacist declined to fill her prescription," Shepherd writes. "Anderson said that pharmacist, who is not named in the suit, told her the pharmacy did not have Ella in stock and could not get it from a wholesale provider in time for her to take the pill, which must be taken within five days of unprotected sex.

Anderson said the CVS pharmacist called a Walgreens in Brainerd, more than 50 miles from her home, and told her that it didn't have the pill. However, when Anderson called the Walgreens herself, the pharmacist there confirmed that the CVS pharmacist had just called, and said the store did have Ella in stock and would be happy to fill her prescription the next day, Shepherd reports. She and her young son made a three-hour round trip in a blizzard to fill the prescription, he writes.

Anderson sued Badeaux, Thrifty White, and the unnamed CVS pharmacist who refused to fill her prescription and misinformed her about its availability at the Brainerd Walgreens. She notes in her lawsuit that, though Minnesota allows pharmacists to refuse to fill emergency contraception prescriptions because of personal beliefs, the law requires the objecting pharmacist to help the patient find another way to fill the prescription, and neither pharmacist did that, Shepherd reports.

"The lawsuit argues that refusing to provide women access to the morning-after pill is a form of sex discrimination and violates people’s civil rights," Shepherd reports. "Anderson said she believes rural women are particularly at risk to have their medical needs overshadowed by a pharmacist’s personal beliefs because there are so few places to buy medication."

More farmers believe in climate change, but it may not change their votes; Dems try to appeal to them anyway

Washington Post map based on National Oceanic and Atmospheric Administration data

The U.S. is beginning to see extreme effects from climate change, as a multimedia piece from The Washington Post illustrates. A United Nations climate change panel warns, "If Earth heats up by an average of 2 degrees Celsius, virtually all the world’s coral reefs will die; retreating ice sheets in Greenland and Antarctica could unleash massive sea-level rise; and summertime Arctic sea ice, a shield against further warming, would begin to disappear," the Post reports. "But global warming does not heat the world evenly. A Washington Post analysis of more than a century of National Oceanic and Atmospheric Administration temperature data across the Lower 48 states and 3,107 counties has found that major areas are nearing or have already crossed the 2-degree Celsius mark." That affects everything from agriculture zones and invasive species to disappearing farmland.

According to another recent Post story, climate change will likely trigger extreme heat waves in the "breadbasket regions of western North America."

Partly because of this year's terrible weather, more farmers now believe in climate change, Ryan McCrimmon reports for Politico's "Morning Agriculture." But, a recent study found that increasing belief in climate change may not prod staunchly Republican farmers to vote for a Democrat, Bryce Oates reports for The Daily Yonder: "Instead, farmers tackle to the impact of climate change as a business challenge that they address through standard farming practices, like applying more fertilizer after heavy rains." Nevertheless, Democratic presidential candidates are trying to appeal to rural voters by touting plans to give farmers incentives for adopting greener practices, notes Editor Art Cullen of The Storm Lake Times in Iowa.

Pro-rural bias of the Constitution stands in the way of Trump's Senate removal after likely House impeachment

Estimated net support for impeachment
(The Economist chart; click to enlarge)

The pro-rural bias of our Constitution helped elect President Trump, and now it's insulating him and his party from removal by the Senate after likely impeachment by the House, The Economist magazine reports.

Trump won the election despite losing the popular vote by 3 million because of the Electoral College, which has a slight rural bias. It "is only mildly anti-majoritarian, [but] the Senate often deviates wildly from the popular will," the magazine says. "Because each state is weighted equally, voters in less-populous states are over-represented relative to those in large ones. Now that Republicans derive an outsize portion of their support from rural voters, their share of senators exceeds their share of total votes cast in Senate elections."

The Economist notes that the Senate would still not likely have the two-thirds majority needed to convict Trump even if it were apportioned by population like the House of Representatives: "However, if the chamber reflected public opinion more closely, some Republican members seeking re-election might feel obliged to support his removal."

As the system stands now, Senate Republicans are likely to benefit from backing Trump, The Economist says. Researchers from the publication base that opinion on a statistical estimation, which you can read about in the article (along with plenty of great charts); the bottom line is this: In 29 of the 50 states, a plurality of voters are estimated to oppose impeachment. The lack of a clear majority opinion, overall, means Republican senators have little reason to oppose impeachment.

Sinclair axes 'must run' political segments for affiliates

Sinclair Broadcast Group, which serves much of rural America, has been criticized for requiring affiliate stations to air conservative political content, sometimes not labeled as such, including segments by former presidential adviser Boris Epshteyn. The company initially responded by hiring a liberal commentator, Ameshia Cross, in January and requiring her content to be aired as well.

But now Sinclair says it's ending the "must-run" political segments for Epshteyn and Cross. "The move is part of a company-wide effort to move away from political commentary in favor of investigative journalism, the network said Wednesday," Claire Atkinson reports for NBC News.

A former Sinclair producer, speaking on condition of anonymity, told NBC that, if Sinclair wants to truly look impartial, it must "abolish the whole concept of must-run news stories . . . Getting rid of commentary is a good first step, but securing trust among viewers, you have to get rid of mandated stories."

U.S. coal employment decline led by Appalachia

U.S. Energy Information Administration chart; click on the image to enlarge it.

Coal mining employment in the U.S. has declined 42 percent since 2011 as coal demand has decreased. Appalachia has by far the largest share of coal miners among the three U.S. coal regions, but it has also seen the most dramatic drop in coal jobs, according to an article about one facet of the U.S. Energy Information Administration's Annual Coal Report. Nationwide, U.S. coal mining employment fell from a high of 92,000 in 2011 to 54,000 in 2018. In Appalachia, it was almost cut in half, falling from 60,269 in 2011 to 30,620 in 2018.

"Appalachian mines tend to be smaller than mines in the Interior and Western regions and to use labor-intensive underground mining techniques, as opposed to machinery-intensive longwall mining and surface mining operations," the report notes. "A slight increase in coal-mining employment in the Appalachia region from 2016 to 2018 corresponded to an increase in coal exports because this region is the dominant source of coal shipped overseas." But most export coal is metallurgical, used in steelmaking, not thermal, which is burned in power plants to make electricity.

The number of operating coal mines has also declined over the past decade, with Appalachia also seeing the biggest drop. And though coal production declined nationally, and Western coal fields have long been the most productive,the production decline was concentrated in Appalachia, which lost almost half its production. "More than half of the region’s mines have closed since 2008, and production has fallen from 390 million tons in 2008 to 200 million tons in 2018," the report says.

Quick hits: Podcast talks about HIV in rural America; coal company that hired laid off Blackjewel miners lays off some

Here's a roundup of stories with rural resonance; if you do or see similar work that should be shared on The Rural Blog, email us at heather.chapman@uky.edu.

The coal company that hired some laid off Blackjewel coal miners has now laid off some of them. Read more here.

Most Americans say they want more oversight of large-scale livestock operations, according to a new poll. Read more here.

A new podcast discusses HIV's threat to rural America. Read more here.

Oil and gas sites release enormous amounts of methane, which contributes to climate change, but it's hard for people to see the phenomenon because the gas is invisible. A crew from The New York Times used an infrared video camera to make methane leaks visible, revealing a troubling amount of pollution. Read more here.

New albums from rural Kentucky artists shed light on the soul of rural America, says Paste Magazine. Read more here.

Because we're not all doom and gloom here at The Rural Blog, here's some fun stuff: a church in southeastern Kentucky created a fake ad for the Amazon Echo: Eastern Kentucky Edition. Does it play on rural stereotypes? Yes. Is it hilarious? Also yes. And, this blogger with Harlan County roots can confirm that a few parts hit pretty close to home. Watch the video here.

Privately funded nonprofit is building huge, controversial wildlife sanctuary in Montana

American Prairie Reserve's purchased and leased land is shown in green with white borders, adjacent to Upper Missouri Breaks National Monument and Charles M. Russell National Wildlife Refuge. Together, these parcels complete a network of land larger than Yellowstone National Park, the second-largest national park in the Lower 48 states (NPR map)

"A privately funded, nonprofit organization is creating a 3.2-million-acre wildlife sanctuary, American Prairie Reserve, in northeastern Montana, an area long known as cattle country," Nate Hegyi reports for NPR, with support from the Pulitzer Center on Crisis Reporting. "The reserve is facing fierce opposition from many locals because . . . the organization is slowly purchasing ranches from willing sellers, phasing out the cows and replacing them with wild bison. Those private properties are then stitched together with vast tracts of neighboring public lands to create one giant, rewilded prairie. The organization has purchased close to 30 properties so far, but it needs at least 50 more."

Local ranch owners who aren't willing to sell worry that they won't be able to hold out, as land prices increase and many ranchers have a hard time finding an heir to pass their land to when they retire. But wildlife advocates from other states and countries have given the project a lot of attention and financial support because, at 5,000 square miles, the sanctuary will be the largest in the contiguous U.S. once completed. Hegyi reports.

"The project's goal is to rewild this swath of the Great Plains and return all the animals that lived on this landscape more than a century ago, before white settlers arrived. Wolves, grizzly bears, thousands of genetically pure, wild bison," Hegyi reports. "The reserve is a new kind of national park, one that's free to the public and privately funded through both small donors and some of the wealthiest people in the world."

Sean Gerrity founded APR more than 18 years ago after he moved back home to Montana after running a Silicon Valley tech firm. "This wildlife habitat is going away and there is almost none left," he told Hegyi. "This is the last bit in the Great Plains, for the most part, where we can do a project of this size."

Newspaper's in-depth watchdog piece on worst U.S. prison riot in 25 years explains system flaws that led to it

A guard was trapped in a prison control room for more than eight
hours that night. (Post and Courier photo by Andrew Whitaker)

As states have built more prisons in rural areas and metropolitan newspapers have cut back their regional reporting, prison goings-on have probably gotten less attention, but  The Post and Courier in Charleston, S.C., did an in-depth investigation into the worst violence in a U.S. prison in 25 years, showing how flaws in the prison system led to it.

Seven men died on April 15, 2018, at the Lee Correctional Institution in Bishopville. The article by Jennifer Berry Hawes and Stephen Hobbs is accompanied by a detailed timeline, with background information, illustrations, photos, videos and audio from the riot.

To understand how two prisoners crossed paths and sparked the historic night of violence, "You must understand a crisis that prompted the mass transfer of men into Lee," the reporters write. "You also must understand the gangs among them that control violence, money and contraband — which is to say, power. And a door-locking system those men could easily defeat. And a security staff with little control. And so many hopeless, angry men." 

The paper also notes that no charges have been filed for the deaths and injuries, and that there has been little accountability or change in the prison system. It's a worthy read.

Though new SNAP rules target able-bodied people without dependents, those with informal dependents could suffer

Changes to the Supplemental Nutrition Assistance Program could have a substantial ripple effect in a small town. In Letcher County, Kentucky, pop. 25,000, the new rules could cost up to 400 residents their SNAP benefits and could potentially affect their families, Sam Adams reports for The Mountain Eagle in Whitesburg, Ky. The piece is an excellent example of localizing a national story.

Letcher County, Kentucky (Wikipedia map)

The changes, set to take affect April 1, are expected to cost more than 3 million Americans their SNAP benefits. Rural areas could be disproportionately affected since rural households are more likely to use the program, formerly known as food stamps. In 2018, 85 of the 100 counties that relied most on SNAP were rural.

The changes have widespread support because they target able-bodied adults without dependents who are under 50 and don't work 20 hours a week. But many "ABAWDs" still have unofficial dependents, such as elderly parents, step-children, a spouse who's between jobs, or children who live with another parent, says Dustin Pugel, an analyst at the Kentucky Center for Economic Policy. "If you take SNAP away from one person, it affects the food budget for the entire family," he told Adams.

An article in The Atlantic affirms Pugel's observation on informal dependents, though in an urban setting. "The administration paints ABAWDs as a group of people who can justifiably be cut off from assistance because they ought to be working, Maggie Dickinson writes. "But taking people who are unemployed off SNAP often does harm to more than just those who directly receive food assistance. Many of these people share their benefits with their family and social networks, including children and elderly family members. The ripple effects of the planned cuts will hurt this larger group of people too."

Dickinson ran a hunger outreach program in New York City during the last recession; the city was one of the few places that enforced SNAP work requirements then, giving her an on-the-ground view of how ABAWDs often used their benefits. "I met lots of men who used their SNAP benefits to feed their children. Many of them lived with their kids, but many did not, and the government categorized this latter group as single adults without dependents," Dickinson writes. "Among the people I encountered, these men reported some of the most severe problems with hunger, because they used their meager benefits to fulfill family obligations that the welfare administration did not recognize."

In Letcher County, the impact of the changes is still unknown. Other state and local policies may help. The county has a waiver that lets it give benefits to people who qualify for other income-based benefits, and the local farmers' market allows SNAP recipients to buy up to $40 of food for $20 in SNAP money. "The market also participates in a 'Farmacy' program with Mountain Comprehensive Health Corp., through which people with certain illnesses who meet income requirements obtain vouchers from their doctors to buy fresh food at the farmers' market," Adams reports.

Dec. 17 webinar will discuss challenges rural seniors face with social isolation and getting reliable medical care

Rural senior citizens routinely face problems with obtaining transportation to reliable medical care, being able to pay for it, and social isolation. The Rural Health Information Hub will present a free webinar at 1 p.m. ET Dec. 17 to discuss how such challenges can be overcome in order to provide supportive services and caregiving for rural seniors.

The presenters will also talk about policy recommendations for improving the lives of rural seniors, as detailed in a report from the National Advisory Committee on Rural Health and Human Services to the Department of Health and Human Services.

The webinar is expected to last about an hour, and a recording will be made available afterward. Click here for more information or to register.

Report: cutting black lung funding will cost taxpayers billions

A recent cut to the tax coal companies pay to help miners with black-lung disease will cost taxpayers at least $15 billion by 2050, according to a new report from national watchdog group Taxpayers for Common Sense.

"An excise tax rate on mined coal that funds the Black Lung Disability Trust Fund expired at the beginning of 2019 due to inaction by Congress. That led to a reduction in the amount coal companies pay into the fund, which pays benefits and medical bills for miners diagnosed with black-lung disease," Dylan Lovan reports for The Associated Press. "An excise tax rate of $1.10 per ton of underground mined coal was cut by more than half to about 50 cents in the new year. The fund took in about $450 million in revenue in fiscal year 2017."

Autumn Hanna, vice president of Taxpayers for Common Sense, said that Congress was shifting billions of dollars in liability from coal companies to taxpayers; the report said the fund's debt could reach $26 billion by 2050. The Labor Department confirmed earlier this year that a shortfall in the Black Lung Trust Fund would be dealt with by borrowing from the U.S. Treasury, Lovan reports. The fund was at least $4.3 billion in debt in July.

Black-lung disease has killed about 78,000 since 1968, and has seen a major uptick in recent years among younger miners, Lovan reports. However, there has been little movement on meaningful improvement to safety policies meant to protect miners from the silica and coal dust exposure that causes black-lung disease.

North Dakota county votes 3-2 to keep accepting refugees

Burleigh County citizens, many of them refugees themselves, waited in line to speak at the county commission meeting on Monday about whether the county should allow more refugees to settle there. (Bismarck Tribune photo by Will Kincaid)

In September, President Trump signed an executive order requiring state and county governments to give written consent before refugees can be placed in their jurisdictions. Last week, Burleigh County, North Dakota (pop. 81,000 and home of the state capital of Bismarck, pop. 73,000), was poised to become the first county in the nation to reject them, Andy Field reports for the Bismarck Tribune.

Many expected the five county commissioners to bar further refugees, but then people started showing up at the commission chambers. A lot of people. The commissioners had to reschedule the meeting for Dec. 9 in a larger venue, but even that meeting turned out to be standing-room only, Antonia Farzan reports for The Washington Post.

Locals saw the vote as a referendum on their community's values, Farzan reports, and some speakers said they worried that Bismarck would be seen as bigoted if they voted against accepting refugees, Farzan reports. Others who spoke in favor of the ban noted that the recent oil boom has already strained local resources and caused an increase in crime and homelessness.

Bismarck's mayor, Steve Bakken, supported banning further refugees because of financial considerations. But Republican Gov. Doug Burnum agreed in November to accept more, saying the state's severe workforce shortage and would be helped by well-vetted refugees, Farzan reports.

After nearly four hours of debate from dozens of citizens, the commissioners voted 3-2 to continue allowing refugees to settle in the county. "Had the vote gone the other way, Burleigh County would have been the first county in the United States to block refugee resettlement," Field reports.

"The decision largely carried symbolic resonance. The Trump administration has slashed the number of refugee arrivals nationwide, and Burleigh County, which has roughly 95,000 residents, took in just 24 refugees during fiscal year 2019, according to the North Dakota governor’s office," Farzan reports. "The community . . . is slated to receive a similar number of refugees in fiscal year 2020, and the measure that passed on Monday caps the number of new arrivals at 25."

Study: Surface coal miners more exposed than underground miners to silica dust that causes lung disease

Appalachian coal miners who work at surface mines are consistently overexposed to the silica dust that causes a form of black-lung disease, and dust from surface coal mines contains more silica than dust from underground coal mines, according to new research from the National Institute for Occupational Safety and Health. The research shows that, while much attention has been paid to the risk of black lung among underground miners, surface miners are similarly at risk.

"The research is the first to specifically analyze long-term data on exposure to toxic silica dust for workers at surface mines," Sydney Boles reports for Ohio Valley ReSource. "Black lung disease has been identified in coal miners in every coal-mining state at both surface and underground mines. NIOSH researchers were specifically interested in surface miners’ exposure because those mines produce the most coal and, in 2017, twice as many miners worked at surface mines compared to underground mines."

The researchers analyzed more than 50,000 surface mine coal dust samples from between 1982 and 2017, and found that about 15 percent of those samples had too-high levels of silica dust. Silica dust, which comes from quartz in the rock near coal seams, is much more harmful to the lungs than coal dust. Lead researcher Brent Doney told Boles that, while exposure to coal dust declined over time, silica exposure didn't drop.

That could be why black-lung disease has seen a resurgence among coal miners—especially in Central Appalachia—for the past twenty years, after decades of successful reduction in the disease through mining safety regulations, Boles reports. That's straining the already underfunded federal Black Lung Disability Trust Fund and hurting rural Appalachian mining towns.

"Unfortunately, I’m not sure this is a particularly novel finding," NIOSH epidemiologist Scott Laney told Boles. "The evidence is very clear. We know that silica and mine dust are toxic, and we have the technology to suppress it, and yet coal miners are still exposed to way too much of it. So from a public health perspective, there’s ample evidence to suggest that further safeguards are necessary."

New York to ban chlorpyrifos, pesticide linked to brain damage in kids, but with regulations instead of legislation

New York state will ban the use of chlorpyrifos, a pesticide linked to pediatric brain damage, but Gov. Andrew Cuomo insists that it be done via regulations rather than legislation, Keshia Clukey and John Herzfeld report for Bloomberg.

On Dec. 10, Cuomo vetoed a bill that would have phased out the pesticide by the end of 2021, and at the same time told the state Department of Environmental Conservation to issue a similar phase-out. "His actions will result in an immediate ban on aerial uses of chlorpyrifos, to be followed by regulations to ban the chemical in all uses, except spraying apple tree trunks, by December 2020. That exception would be lifted by July 2021, he said," Clukey and Herzfeld report. "The governor’s action appears to adopt the legislation’s approach, but on a faster timeline and with opportunity for public comment on the terms."

Cuomo said that he vetoed the bill because it gives legislators more power to vet a product than chemists and other health experts. He also said state law gives the Department of Environmental Conservation broad regulatory powers, "including the ability to restrict the use of a pesticide to certain crops, limit application to specific conditions, and revoke a product’s registration," Clukey and Herzfeld report.

In August, New York and five other states sued the Environmental Protection Agency over its refusal to ban chlorpyrifos.

Extending Medicaid pregnancy coverage could save lives; 'We actually abandon women after delivery,' doctor says

States with extended Medicaid pregnancy coverage, categorized. California's
extension only covers women with mental-health needs, and Missouri's would
would only cover drug-addicted women. (Stateline map; click on it to enlarge)

Medicaid pregnancy coverage pays for nearly half of all births in the U.S., and rural women rely on it more than others. But it expires 60 days after childbirth, leaving many women without health insurance when they're at a higher risk of dying: about 700 American women died from pregnancy-related health issues in 2016. Rural women have a higher risk of poor birth outcomes.

"Nationwide, drug overdoses, suicides and pregnancy-related chronic illnesses such as diabetes, heart disease and high blood pressure are contributing to a rise in deaths among women during pregnancy, childbirth and the first 12 months after delivery," Christine Vestal reports for Stateline. "According to the U.S. Centers for Disease Control and Prevention, three out of five of those deaths could be prevented with adequate medical attention." Women can reapply for Medicaid as a parent after pregnancy coverage lapses, but the income limit is usually much lower, so many women don't qualify.

Some state and federal policymakers are trying to lengthen Medicaid pregnancy coverage. A bipartisan bill in Congress would give states incentives to extend such coverage to a full year after delivery by cutting red tape and increasing federal funding by 5 percent, Vestal reports. Lawmakers in at least six states (California, Illinois, Missouri, New Jersey, South Carolina and Tennessee) are considering extending Medicaid pregnancy coverage to a full year after delivery, and health agencies in Georgia, Texas, Utah and Washington and recommending similar changes.

Maternal mortality rates, which include deaths during and up to a year after pregnancy, are higher in the United States than in other developed nations. "And while pregnancy-related death rates have been dropping worldwide, they’ve more than doubled in the United States in the past 30 years, rising from 7 deaths per 100,000 live births in 1987 to 17 in 2016, according to the CDC," Vestal reports. "The opioid crisis is a contributing factor. Opioid addiction among pregnant women has quadrupled in the past 20 years, the CDC said."

Women with substance abuse disorders generally do well during pregnancy if they have access to social services and health care, but "Where things fall apart is postpartum," said Mishka Terplan, an obstetrician-gynecologist affiliated with the University of California at San Francisco. "We actually abandon women after delivery."

Op-ed: should metro America subsidize rural America?

The editorial board of The Roanoke Times offers a compelling editorial on why metropolitan areas of the United States should invest funding in rural America. It's a great take on the issue from a paper that has produced some of the best editorials and commentary on this topic of any metro paper.

When they write about the lagging economy of southwestern Virginia, the editorial board notes that they sometimes get off-the-record comments from people who say that maybe spending more money on rural America, especially the Appalachian coalfields, is a waste of resources and that the area's residents should simply relocate to more economically stable areas. More recently, Jackson Kernion, a grad student instructor at the University of California-Berkeley got widespread attention by arguing such viewpoints (which devolved into frank rural-bashing) with conservative outfit Campus Reform on Twitter.

"Those responses are uniformly dispassionate ones based on a cold-eyed reading of the bottom line — the costs of subsidizing rural America is simply too high. And let’s be clear: Metro America does subsidize rural America. We don’t like to think of it that way, of course. Those of us who grew up in, or live in, rural America like to think of ourselves as independent and self-sufficient," the board writes, but notes that that's mostly untrue. Rural schools in Virginia, for example, are largely funded by the state and federal governments because rural areas couldn't afford public schools otherwise.

Moreover, "traditional employers in rural and small-town America have been disappearing, while the jobs being created in the new economy are increasingly concentrated in metro areas," the board writes. "Over the past two decades, the United States gained jobs. Yet two-thirds of the counties in the country lost jobs because the job growth was concentrated in a handful of favored metros. That trend is accelerating, too."

Neither Republicans nor Democrats seem to want to talk about the problem because it's not clear how to solve it. When Georgetown University adjunct policy professor Brad Blakeman discussed Kernion's tweets on Fox News, he said that "cities need to take care of their own" because "rural America is doing just great." Though the editorial board disagrees that rural America is doing fine, they note that Blakeman inadvertently defended Kernion with his comment about cities taking care of their own.

"Kernion at least sees a connection between metro America and rural America — and doesn’t like it. Blakeman wants to see the two as unrelated islands. He’s wrong about that and Kernion is wrong, too, but in a different way," the board writes. "We’re all Americans. We’re all in this together. We should all look out for each other and we should do what we can to make sure we all have the same opportunities. It shouldn’t matter what our skin color is, or what religion we practice, or who we love, or anything else. And it shouldn’t matter where we live, either."

Rural Iowa paper columnist retires after 70 years

Evelyn Birkby celebrated her 100th birthday earlier
this year. (Photo provided to the Register)

Evelyn Birkby "never dreamed of being a writer, let alone one of the longest-tenured columnists in American newspaper history," Daniel Finney reports for the Des Moines Register. But Birkby, now 100, retired last week after 70 years of writing her weekly column for readers in Shenandoah, Iowa.

Her writing career began in 1949 after her husband Robert saw an ad in the Shenandoah Evening Sentinel (now the Shenandoah Sentinel) seeking a farmer's wife to write a homemaker's column. She never missed a week after that, though sometimes Bob ghost-wrote a column if she was unavailable. 

"Evelyn’s columns were printed efforts to be a good neighbor. She spoke about her family, her community and stirred in wit and wisdom," Finney writes. And though her columns were mostly lighthearted, "she wrote about serious topics, too. She wrote about losing her daughter, Dulcie Jean, to a sudden illness when she was 5. She wrote about losing her sight in old age. She wrote about falling in love with her husband and his love letters, though she would never be so bold as to publish the actual text." 

Shenandoah, Iowa (Wikipedia map)

Birkby rarely wrote about politics, but when she did, it was always a call to be more civil, Finney reports. "Evelyn was also a multimedia star. She made regular radio appearances on the Shenandoah radio station KMA-FM, part of a long tradition of homemakers sharing life tips on the airwaves that dates back to the 1920s. And she published 13 books during her career, three in the past seven years."

House Democrats announce agreement with Trump administration on revised trade pact with Canada, Mexico

The same day Democrats announced impeachment charges against President Trump, House Speaker Nancy Pelosi also announced agreement with his administration on a modified North American trade pact meant to replace NAFTA.

"The California Democrat said the revamped U.S.-Mexico-Canada Agreement is a significant improvement over the original North American Free Trade Agreement, crediting Democratic negotiators for winning stronger provisions on enforcing the agreement," Andrew Taylor reports for The Associated Press.

The agreement is a win-win, politically: Trump scores a major political victory while moderate Democrats get a legislative accomplishment they can tout with voters back home, Politico reports.

"NAFTA eliminated most tariffs and other trade barriers involving the United States, Mexico and Canada," Taylor reports. "Critics, including Trump, labor unions and many Democratic lawmakers, branded the pact a job killer for the United States because it encouraged factories to move south of the border, capitalize on low-wage Mexican workers and ship products back to the U.S. duty-free."

Pelosi was able to bring labor unions to the table, and spearheaded negotiations with the administration to win stronger enforcement provisions likely to be popular with Democrats, especially those from manufacturing areas that have been hurt by job losses. "The original NAFTA badly divided Democrats but the new pact is more protectionist and labor-friendly, and Pelosi is confident it won't divide the party, though some liberal activists took to social media to carp at the agreement," Taylor reports. "Democrats see the pact as significantly better than NAFTA and an endorsement by AFL-CIO President Richard Trumka could be the key to winning significant Democratic support."

For example, the pact requires that 40% to 45% of cars eventually be made in countries that pay autoworkers at least $16 an hour; that will likely bring auto manufacturing jobs back to the U.S. and Canada, Taylor reports. Top trade officials from the U.S., Canada and Mexico are meeting in Mexico City today for an afternoon ceremony finalizing the deal, Politico reports.

Chinese telecom giant, big supplier to rural wireless outfits, challenges FCC ban on use of subsidies to buy its goods

A Chinese telecommunications giant filed a legal petition last week challenging the Federal Communications Commission's recent action against the company.

"The FCC last month voted unanimously to designate Huawei Technologies Co. Ltd. and peer ZTE Corp. as national-security risks, barring their U.S. rural carrier customers from tapping an $8.5 billion government fund to purchase Huawei or ZTE telecommunications equipment," David Kirton reports for Reuters. "It also voted to propose requiring carriers remove and replace equipment from Huawei and ZTE in existing networks."

The ban could hurt rural telecom carriers, which rely disproportionately on Huawei and ZTE because their equipment is generally much cheaper than comparable equipment. Huawei spokesperson Karl Song said the FCC rule threatens rural connectivity in the U.S., would cost hundreds of millions of dollars, and could force some small carriers into bankruptcy, Kirton reports.

"Alan Fan, Huawei vice president of IP strategy and international legal policy, said U.S. rural carriers and groups submitted 90 comments to the FCC, 58% of which opposed action against it," Kirton reports.

In May, President Trump banned domestic companies from supplying Huawei with U.S. components without a special license, citing national-security concerns. "The move came after Washington brought criminal charges against Huawei, alleging theft of trade secrets, bank fraud and violation of U.S. sanctions against Iran. It has also sought to convince allies to ban it from the 5G networks over spying fears -- increasing tension with Beijing amid a tit-for-tat trade war," Kirton reports. "The United States is now considering means of stopping more foreign shipments of products with U.S. technology to Huawei."

Multimedia NYT piece examines impact of opioid epidemic on the Class of 2000 in rural town in southeast Ohio

Jonathan Whitt became addicted to painkillers at 16,
then began using intravenous opioids and heroin in
his late 20s. He has been in jail at least 10 times and has
done multiple stints in rehab, but has been in recovery
for four years. (NYT photo by Matt Eich)

An outstanding multimedia piece from The New York Times examines the impact of the opioid crisis on a group of rural high school graduates in southeastern Ohio who began their freshman year in 1996, the year Purdue Pharma came out with OxyContin.

"It had its jocks and its cheerleaders, its slackers and its overachievers. But by the time the group entered its final year, its members said, painkillers were nearly ubiquitous, found in classrooms, school bathrooms and at weekend parties," Dan Levin reports. "Over the next decade, Scioto County, which includes Minford, would become ground zero in the state’s fight against opioids. It would lead Ohio with its rates of fatal drug overdoses, drug-related incarcerations and babies born with neonatal abstinence syndrome."

Minford, Ohio (Wikipedia map)

NYT reporters spoke to dozens of members of the Class of 2000, and heard tragic tales of addiction, jail or prison, stints in rehab, and even deaths. "In all of the interviews, one thing was clear: Opioids have spared relatively no one in Scioto County; everyone appears to know someone whose life has been affected by addiction," Levin reports.

Since the Class of 2000 graduated from Minford High, as many as 275 people have died in Scioto County.

Academic journal Health Affairs devotes entire issue to rural health; read a summary of all the studies here

The peer-reviewed academic journal Health Affairs has dedicated its December issue to research about rural health. Here's a quick summary (with links) to the 12 articles. You will have to subscribe or pay to access the full articles (emailing the authors sometimes works too).

• U.S. health care spending increased 4.6 percent, to $3.6 trillion, in 2018, driven by accelerating Medicare and private-insurance spending. The increased spending was influenced by the reinstatement of the health-insurance tax. The total number of uninsured people increased by 1 million for the second year in a row, to reach 30.7 million in 2018. Read more here.
• Rural U.S. areas have had an overall higher death rate than urban areas since the 1980s, and the gap continues to widen. A 2016 data analysis found that rural mortality rates exceeded urban mortality rates in all but three states. The gap is mostly because of socioeconomic deprivation, physician shortages, and lack of health insurance. State laws that affect Medicaid access, health infrastructure and socioeconomic conditions can affect rural mortality rates. The study suggests state and policy efforts to lower rural mortality rates. Read more here.
• Rural mothers and their babies are at a higher risk of dying or experiencing life-threatening complications during childbirth, especially African Americans, Native Americans and Alaska Natives. Read more here. The Daily Yonder also has an excellent write-up of this study.
• Increasing staffing in rural community health centers can help improve behavioral health care, which includes treatment for mental health and substance abuse. The overall staff-to-patient ratio for behavioral health staffers in community health centers rose 66% between 2013 and 2017; staffing in urban centers grew 49%. Most of the added staff were clinical social workers and other licensed mental health providers, not psychiatrists or psychologists. Read more here.
• Rural residents have worse health outcomes; understanding why could inform policy proposals to close the rural-urban gap. A nationwide analysis of Medicare beneficiaries with one or more complex chronic conditions showed that such patients make up 61% of rural beneficiaries and 57% of urban beneficiaries. Rural residents had a 40% higher rate of preventable hospitalization and a 23% higher mortality rate than urban patients. Read more here.
• Rural counties with majority African American or Native American populations have the highest rates of premature death in the U.S., and are much higher than rural counties with majority white populations. Read more here.
• A 2017 law allowed nurse practitioners and physician assistants to get waivers to prescribe the opioid abuse treatment drug buprenorphine (brand name Suboxone), but there hasn't been much data about how many rural NPs or PAs have obtained such waivers. The researchers confirmed a sizeable jump in the numbers of rural clinicians who have obtained waivers. Read more here.
• Rural residents may pay more for private health insurance because they have smaller risk pools with more high-risk residents. However, the number of insurers competing in rural areas wasn't found to be a major factor in how much premiums cost. Read more here.
• Rural hospitals have been closing at an increasing rate over the past decade. That has not only reduced access to care, but has cut the number of rural physicians; when a rural hospital closes, the doctors who worked there may decamp to an urban hospital. Read more here.
• In 2017, President Trump halted the cost-sharing payments used to help low-income people with ACA Marketplace insurance. Researchers found that rural residents who were eligible for the tax credits were able to access Marketplace plans that were more affordable than those accessible to their urban counterparts, but rural enrollees without subsidies had some of the least affordable premiums for Marketplace plans. Read more here.
• Rural hospitals that affiliated with a group between 2008 and 2017 saw a significant decrease in on-site diagnostic imaging technologies, the availability of obstetric and primary care services and outpatient nonemergency visits, but saw a significant increase in operating margins. In short, joining groups may have kept some rural hospitals afloat, but reduced access to medical services for nearby residents. Read more here.
• Fewer rural residents apply to or get into medical school. Read more here, or read the more in-depth write-up on this study we did last week.

Dollar General plans to open 1,000 stores in 2020; some worry they contribute to poor nutrition in rural areas

Dollar General Markets, with produce and meats, have hurt traditional groceries that have wider fare. (SupermarketNews.com)

Dollar General Corp., one of the fastest-growing retailers in the country, has announced it will open 1,000 new stores in 2020, just as it did last year. That's on top of the more than 16,000 stores it already has. "Dollar General's growth is nearly unrivaled in the industry at a time in which many brick-and-mortar retailers are closing stores or folding," Nathaniel Meyersohn reports for CNN. "Walmart, which swept into new towns for decades with massive superstores, has essentially stopped opening new ones. By contrast, Dollar General is entering new cities and towns with small stores and opening up in areas where it has already gained hold."

One reason dollar stores are so popular: despite the low unemployment rate, "wages for a vast number of Americans have grown only modestly," Meyersohn reports. "Americans living paycheck-to-paycheck have been a boon to Dollar General, and wages for a vast number of them have grown only modestly. The chains have also reached higher-income shoppers seeking discounts." And Dollar General appeals to convenience, offering many of the same goods as Walmart with a shorter drive.

The chain's growing presence has hurt some small-town retailers. Small, full-service groceries in some towns have been put out of business by Dollar General Markets, which sell fresh produce and meat, though usually not with as wide a selection as the grocery they dislodged.

Most Dollar Generals sell only prepackaged food, which worries nutritionists concerned about rural health. Barry Popkin, a nutrition professor at the University of North Carolina at Chapel Hill, has been a long-time critic of dollar stores. "At a time when poor diets are linked to nearly 900 deaths a day in this country, Popkin says to look at what Dollar Stores sell: rows and rows of sugary drinks, candies, and processed foods high in salt and fat," Allison Aubrey of NPR reports for CBS News. Dollar Generals are frequently located in "food deserts," where residents have little access to fresh food and are often obliged to buy the pre-packaged food Popkin warns against.

For example: in Dekalb County, Georgia, which includes part of Atlanta, there are 68 dollar stores (a mix of Dollar General, Family Dollar, and Dollar Tree, the latter two with the same owner). County Commissioner Lorraine Cochran-Johnson told Aubrey that a quarter of the county's residents live in food deserts, and that dollar stores target such areas. "When you look at the trends and you look at the pattern of growth of the dollar store as well as the areas that have the highest levels of obesity, hypertension, high blood pressure, there is a direct correlation," Cochran-Johnson said.

Food-desert concerns have led some cities and towns to pass laws limiting dollar-store expansion. "Advocates of tighter controls on dollar stores claim the big chains intentionally cluster multiple stores in low-income areas, a strategy that strategy discourages supermarkets from opening and threatens existing mom-and-pop grocers, critics say," Meyersohn reports. "Opponents also express concerns that most dollar stores don't offer fresh produce."

Dollar General spokesperson Crystal Ghassemi objected to the perception that dollar stores contribute to poor eating habits, and told Aubrey that even their regular stores have plain vegetables and chicken in the frozen-foods section. Only about 3 percent of Dollar General outlets sell fresh produce.

FCC to scrap 4G LTE rural program, create $9 billion subsidy to bring fifth-generation wireless to rural areas

"The Federal Communications Commission said Wednesday that it plans to ditch a $4.5 billion subsidy program for 4G LTE in rural areas and instead launch a $9 billion fund to bring 5G wireless to hard-to-reach parts of the country," Marguerite Reardon reports for Cnet. "FCC Chairman Ajit Pai said the new fund will help carriers pay for 5G deployments in sparsely populated, hard-to-reach areas of the US, or areas in the states with rugged terrain."

One reason the 4G LTE plan, called the Mobility Fund II program, was scrapped: a recently released FCC investigation found that the self-reported carrier data, meant to help the agency figure out where to send funding, was inaccurate.

Rural areas would benefit greatly from improved wireless speed. "One of the key applications for 5G in rural parts of the country is to provide connectivity for precision agriculture or technologies that improve the accuracy and control involved in growing crops and raising livestock," Reardon reports. "The FCC said it'll set aside at least $1 billion from the fund specifically for 5G deployments focused on precision agriculture needs."

Rural 5G networks could help ameliorate some of the pain from lack of broadband access. Despite billions in private and public investment for decades, about 39 percent of rural Americans lack access to high-speed broadband. Low population density, difficult terrain, and higher expenses make rural broadband buildout a daunting prospect.

How rural and urban opioid deaths differ; one group of rural areas' overdoses are driven by many different drugs

A recently published study provides a comprehensive picture of the changing geography of the opioid epidemic. Researchers from Syracuse University, the University of Iowa, and Iowa State University tracked opioid deaths in the 48 contiguous states and cross-referenced that info with data from the Centers for Disease Control and Prevention to break down deaths not just by geography, but by the type of opioid that caused the death.

"The study finds that the opioid crisis takes different forms in urban and rural America," Richard Florida reports for CityLab. "While the urban opioid crisis is a crisis of heroin and illegal drugs, the rural opioid crisis of prescription drugs is largely a story of growing spatial inequality and of places left behind, most often occurring, as the authors note, in places that tend to have a declining industrial base."

Opioid overdose deaths have increased more than 700 percent in the most rural areas, compared to a less than 400% jump in urban areas. The epidemic can be characterized by three "waves." The first wave, in the early 1990s, involved mostly prescription opioids, mainly in rural areas. During the second wave, heroin deaths began increasing, largely in urban areas. The third wave is synthetic opioids, and is also disproportionately urban. "Such deaths are expected to soon eclipse deaths from opioid overdose in rural, non-metro areas," Florida reports.

Some areas, both rural and urban, fall into a fourth category: their overdose deaths come from many different sources, including prescriptions, heroin, synthetics, and sometimes more than one. The study calls this a "syndemic" crisis, and 4% of U.S. counties (129) fall into this category. "This syndemic opioid epidemic is concentrated in the eastern third of the nation: in Maryland, Massachusetts, rural Appalachia, stretching into Indiana, and in Michigan," Florida reports. "A third cluster is located around Santa Fe, New Mexico. Nearly two-thirds (64 percent, or 82 counties) of syndemic counties are in metropolitan areas, with 36 percent (47 counties) in rural or non-metro areas."

Many believe the opioid crisis developed from over-prescription and abuse of legal opioids, but the study found that was only true in rural areas, Florida reports.

Presidential candidate Cory Booker unveils rural plan

U.S. Sen. Cory Booker, D-N.J.

Democratic presidential candidate Cory Booker, a New Jersey senator, unveiled a plan Friday to build "wealth and opportunity" in rural America. Here are some of the highlights:

• Ensure affordable housing by increasing the supply of affordable housing units and capping rental costs.
• Guarantee access to broadband internet service.
• Invest $2 trillion in infrastructure.
• Support rural public schools, including free pre-kindergarten for 3- and 4-year-olds, more funding for special-needs students, and better pay for teachers.
• Launch the "City 2030 Project" to boost the economies of rural areas near cities.
• Help rural businesses and small family farms compete better with large businesses by blocking mergers and other practices that discourage competition.
• Expand access to credit and venture capital for rural businesses.
• Reform the "opportunity zones" tax incentives to better help rural areas.
• Develop a trade policy that holds China accountable but helps American farmers.
• Encourage rural entrepreneurship with a seed-money grant program.
• Invest in rural cooperatives.
• Expand local food systems and farmers markets.
• Reform commodity checkoff programs. 
• End abuse of small-refinery waivers for the Renewable Fuel Standard program.
• Invest over $100 billion by 2030 in existing conservation programs.
• Substantially increase funding for the Rural Energy for America program to aid in the transition to renewable energy.
• Increase the numbers of minority farmers and help farmers of color in danger of losing their land because of informal property deeds.
• Reduce the numbers of concentrated animal feeding operations. 

Read the entire plan here.

The Rural Blog reports major statements by presidential candidates about rural policy.

Sign up for Dec. 12 webinar that will discuss USDA's latest 'America's Diverse Family Farms 2019' report

The U.S. Department of Agriculture's Economic Research Service will host a free, one-hour webinar at 4 p.m. ET Dec. 12 to go over the 2019 edition of "America's Diverse Family Farms." The report, which hasn't been published yet, is an annually updated brochure that describes in detail the different types of farms in the United States. You'll find the report here when it's published. For comparison, here's the 2018 edition.

If you're not able to attend the webinar, USDA generally posts recordings of its webinars later here. Click here for more information, or to register for the webinar.