Hospital monopoly in Appalachia doesn't meet benchmarks; some residents say they're scared to seek care

Ballad Health's Indian Path Community Hospital has an
average ER wait time of 43 minutes. (Ballad Health photo)

The lack of choices for hospitals in parts of northeastern Tennessee and southwestern Virginia has left some residents fearful of getting care at its facilities, but hospital officials deny many patient complaints and tie their quality of care troubles to Covid-19 and nursing shortages, reports Brett Kelman of KFF Health News. "Ballad Health is the only option for hospital care in a large swath of Appalachia. . . .Lawmakers in both states "waived federal antitrust laws so two rival health systems could merge," which made Ballad Health the "largest state-sanctioned hospital monopoly in the nation."

Six years ago, lawmakers allowed the merger to prevent more hospital closures. To than end, Ballad Health has kept most of its facilities open; however, the system has "fallen short of about three-fourths of the quality-of-care goals set by the states over the last three fiscal years," Kelman explains. Those shortcomings include "failing to meet state benchmarks on infections, mortality, emergency room speed, and patient satisfaction."

Ballad's lack of consistent care has left "residents wary, afraid, or unwilling to seek care at Ballad hospitals. . according to written complaints to the Tennessee government and state lawmakers, public hearing testimony, and KFF Health News interviews," Kelman reports. "Many of those who submitted complaints or were interviewed allege that paper-thin staffing at Ballad hospitals and ERs is the root cause of the monopoly’s quality-of-care woes."

Ballad Health CEO Alan Levine defended the system's record and "said the hospitals are rapidly recovering from a quality-of-care slump caused by Covid-19 and a subsequent rise in nursing turnover and staff shortages," Kelman adds. "These issues affected hospitals nationwide, Levine said, and were not related to the Ballad merger or the monopoly it created."

Local government officials from Tennessee joined Levine during his KFF Health News interview. "As Levine spoke in a boardroom at Ballad’s hilltop headquarters, he was flanked by three local mayors who voiced support for the hospitals and said complaints came from a vocal minority of their constituents," Kelman reports.

But not every government entity echoes that support. Kelman explains, "The Tennessee Department of Health, which has the most direct oversight over Ballad Health. . . has attempted to hold Ballad more accountable for its quality of care in closed-door negotiations." The TDH declined all of KFF's requests to discuss Ballad's record.

Given the system's long list of woes, some residents wish the merger had been rejected. "Joe Macione, who for years was on the board of Wellmont Health System, one of the rival companies that became Ballad, once publicly advocated for the merger. . . . Macione said state leaders should have admitted years ago that the monopoly was a mistake," Kelman reports. Macione told him, "It has not worked."

Flora & Fauna: Joyrides for rats; feral pigs forage through Hawaii; serviceberry tree history; a unique "comeback" bird

Rats learned to love driving and would opt to take longer routes to get to their destination.
(Photo by Kelly Lambert, CC BY-ND)

People aren't the only ones who love to go for a drive. Rats do, too. "I’m a neuroscientist who taught rats to drive − their joy suggests how anticipating fun can enrich human life," writes Kelly Lambert for The Conversation. "My colleagues and I found that rats could learn to drive forward by grasping a small wire that acted like a gas pedal. Before long, they were steering with surprising precision to reach a Froot Loop treat. . . . Unexpectedly, we found that the rats had an intense motivation for their driving training, often jumping into the car and revving the 'lever engine' before their vehicle hit the road. Why was that?" Read the research here.

In the lowlands of Hawaii, things are going to pigs. Feral pigs have invaded six of the state's islands with shocking efficiency and left a path of overwhelmed ecosystems in their wake. "Their impact is profound on Kaua‘i. Its mountains are home to 255 unique native plant species and 208 native birds, including 11 found nowhere else on Earth," reports Brendan Borrell of Hakai magazine. "Their wallows breed mosquitoes that spread avian malaria, contributing to 10 of Kaua‘i’s 16 native honeycreepers [birds] going extinct. . . . Despite the damage that feral pigs are causing, you can’t just shoot them on sight . . ."

Serviceberry trees are smaller trees native to North
America. (The Spruce graphic)

Like humans, a tree species has a history. The serviceberry tree was once common in the United States, particularly in colonial New England, where its bloom cycle indicated when the soil was soft enough to begin digging graves for the many settlers who didn't make it through the winter. "Preachers then went from settlement to settlement to perform funeral services," writes Jessica Damiano of The Associated Press. "Because it’s one of the earliest spring bloomers, the serviceberry is an important food source for bees, butterflies and other pollinators. Later, its berries sustain dozens of bird species and mammals. . . .There are more than 20 species of the North American native tree, which is sadly underused." Here are four favorites.

Whether it's that hefty frozen turkey, a delectable ham or ground lamb ready to be transformed into meatballs, the holidays can be a special time to be thankful for the meat on our tables. As an act of gratefulness for farm animals, a donation to an animal charity that works to make the lives of factory animals better may be in order. "Animal Charity Evaluators, a California-based nonprofit, puts out an annual guide for recommended animal charities," report Sigal Samuel and Kenny Torrella of Vox. "ACE researches and promotes the most high-impact, effective ways to help animals." Find this year's list here.

Red-cockaded woodpeckers nest in family units.
(Adobe Stock photo)

Americans love a comeback, especially when the returning member is cute, social and unique. "The red-cockaded woodpecker, an iconic bird in southeastern forests, has recovered enough of its population to be downlisted from an endangered species to a threatened one," reports Christina Larson of The Associated Press. Will Harlan of the nonprofit Center for Biological Diversity, told Larson, "It’s an amazing bird that has an unusual communal nesting structure. All nests usually cluster in the same tree, and the birds stick together as a family unit.”

Hazelnut trees are poised to flourish where they once died by the thousands. "Bullied by blight, the filbert has long failed to find a home on farms in the eastern U.S.," reports Ben Seal of Ambrook Research. "All across the eastern United States, hazelnuts had been cut down by Eastern filbert blight, or EFB, an endemic disease that chokes life from a tree. . . .But now, after nearly three decades of developing a way for farmers to overcome EFB. . . . A collection of four cultivars, [was] released in 2020, that can withstand even the intense pressure on [a] New Jersey research farm, where numerous strains of the blight are present."

AI is helping wolf trackers without using radio collars.
(Photo by ML, Unsplash)

New AI tracking technology is making it easier for wolves and ranchers near Yellowstone Park to coexist. "After 30 years of using traditional boots-on-the-ground observations, researchers are collecting wolf calls in hopes of honing population estimates, tracking wolves without using radio collars, and reducing conflict between the animals and ranchers," reports Devin Farmiloe of The Washington Post. "Learning more about how wolves communicate from a young age can shed light on pack dynamics that wildlife managers can use to better track and protect the species."

Vilsack says legacy of his 12 years at USDA is new revenue sources that will help smaller farmers and small towns

Rural voters strongly rejected President Biden, but his administration has started programs that are already reversing the decline of rural America, says Agriculture Secretary Tom Vilsack, a longtime politician who has given 12 years of his life to the job, more than anyone.

Vilsack summoned Jonathan Martin of Politico for an exit interview, and his frustration came through. “I think the challenge that we have in rural America is that we talk a lot about programs and not about vision,” he said when Martin asked what went wrong for Democrats in rural America.

“The vision is, you don’t have to get big or get out,” which has been a basis of federal agriculture policy since Richard Nixon was re-elected president in 1972, Vilsack said. “You can actually have diversity within your agriculture and in your national resource base in your rural economy and that can create enormous opportunity. And we’re investing in it.”

Vilsack cited “carbon market” payments for preventing greenhouse-gas emissions and other programs designed to help small and medium-sized farmers and boost local and regional food systems. But he said rural voters have yet to feel the impact of changes made under Biden.

“After 50 years of one approach, you can’t do this in a matter of a couple of years. You have to build the foundation. Now, the foundation has been built. The economic model is changed by virtue of the investments we’ve made in this administration. At least 10,000, probably more than that, investments have been made just in this department, in creating a different model so that small and mid-sized farming operations have an opportunity to stay in business.”

Vilsack served eight years under Barack Obama and four
under President Biden. (Associated Press photo by Carolyn Kaster)

Vilsack voiced frustration that the news media and others in Washington haven’t recognized the importance of those changes.

“Change is occurring,” he said. “It just hasn’t resonated with people like you. Or people in this city. You gotta understand the economics of this. You don’t. Nobody in your business understands it, which is the frustrating part for me. When you have a ‘get big or get out’ mentality, when you have an economy that is commodity-based, the big guys do really, really well,” but smaller producers may not.

He said 2022 was the best year ever for farm income, “but if you went out and talked to folks in rural places about that . . . that’s not how they would have seen it. It was a record year for a relatively small number of folks. So what happens, these folks are on knife’s edge, bad year comes, they have a hard time. Who is in a position to buy their farm? The larger farm or investment banks. . . . So you’ve got this model that we’ve had for 50 years that has slowly eroded economic opportunity in rural places.”

While debate about the Farm Bill is “all about reference prices” for crops, “The reference prices are about half a dozen commodities out of 100 some commodities,” Vilsack said. “We’ve created an opportunity in all 50 states, over 100 commodities. We’re paying farmers to do this. We’re giving premiums for what they’re growing and raising. It’s a brand-new concept. It’s really innovative. And it creates not only a better value for the farmer, it creates the ability to get that ecosystem market credit, to transform their waste into something more valuable.”

He added, “People out there are beginning to get it. I’ve had people come up and say, you know, for the first time, I see my kind of operation at USDA. For the first time, I see some change. I see some investment in small and mid-sized farming operations. You want to ask about legacy? That, to me, is the most important legacy.”

Vilsack said USDA “doesn’t get anywhere near the attention it deserves. Not for lack of trying, man. We tried.”

When Martin noted “the collapse of local and regional press, which would be a way to get your story out,” and cited a newspaper Vilsack knows well, the two-term Iowa governor interjected, “That’s bullshit. . . . The Des Moines Register is a shadow of what it was. But it doesn’t necessarily mean that it can’t cover what it should cover.”

The majority of Americans agree that media scrutiny acts as a check on politicians

Pew Research Center graph, from Pew's American trends panel and center phone survey data.

Despite the somewhat contentious relationship many Americans have with news outlets, most citizens still agree that "media scrutiny keeps politicians from doing things they shouldn’t," reports Sarah Naseer on a Pew Research Center survey conducted and released this year. This opinion has remained a constant over the past 40 years, even as the government's majority party affiliations have changed.

The Pew Research Center began "asking Americans about the news media’s role in investigating and reporting on public officials to hold them accountable since the mid-1980s," Naseer explains. "That was about a decade after The Washington Post’s coverage of the Watergate scandal contributed to President Richard Nixon’s resignation in 1974."

In Pew's 2024 survey, about "three-quarters of Americans (74%) said criticism from news organizations keeps political leaders from doing things that shouldn’t be done, while far fewer (24%) said this type of scrutiny keeps leaders from doing their job," Naseer reports. "The last time such a large share of Americans expressed the view that media criticism helps hold political leaders accountable was in 2016, just before (Donald) Trump was elected the first time."

The survey also asked respondents if "they see the news media as generally fair to all sides when reporting on politics and social issues, or if they think the media tend to favor one side," Naseer adds.
"About three-quarters of U.S. adults (77%) say news organizations tend to favor one side when presenting the news on political and social issues. Far fewer (22%) believe news organizations deal fairly with all sides. In surveys going back almost 40 years, most Americans have viewed news coverage as biased toward one side."

Throughout the survey's 40-year history, political parties have consistently held separate beliefs about media fairness, with Republicans more likely to see media as favoring one side more than Democrats. Naseer reports, "In this year's survey, about nine-in-ten Republicans (88%) say news organizations tend to favor one side when presenting the news on political and social issues, compared with 67% of Democrats."

Construction and agriculture industries 'brace' for potential changes to U.S. immigration and tariff policies

Several U.S. sectors are preparing for imminent changes the transition to a Republican president and Congress promise to bring. Stories focused on upcoming changes are excerpted below.

Undocumented workers make up roughly 13%
of the construction industry. (Adobe Stock photo)

President-elect Donald Trump's planned immigration crackdown and tariffs on Mexican and Canadian goods will hit the housing market with a "one-two punch," report Elizabeth Findell and Gina Heeb of The Wall Street Journal. "In Texas, California, New Jersey and the District of Columbia, immigrants make up more than half of construction trade workers. . . Undocumented workers make up an estimated 13% of the construction industry." Beyond the possible loss of skilled trade workers, "the president-elect’s proposed tariffs of 25% on Canada and Mexico could increase the cost of construction materials."

Once Trump and a solidly Republican Congress are back at work, health officials anticipate the Affordable Care Act’s Medicaid expansion will be "back on the chopping block," reports Phil Galewitz of KFF Health News. "More than 3 million adults in nine states would be at immediate risk of losing their health coverage should the GOP reduce the extra federal Medicaid funding that’s enabled states to widen eligibility." Arizona, Arkansas, Illinois, Indiana, Montana, New Hampshire, North Carolina, Utah and Virginia all have trigger laws that would swiftly end their Medicaid expansions if federal funding changes.

In 2023, the United States exported 17.83 metric tons
of wheat, worth $6.08 billion. (Adobe Stock photo)

Farmers and meat plants are "bracing" for immigration changes, including possible mass deportations of some current workers, reports Patick Thomas of The Wall Street Journal. "America’s food-supply chain relies on a predominantly immigrant workforce for some of its most challenging jobs. . . . About two-thirds of U.S. crop-farm workers are foreign-born, and 42% aren’t legally authorized to work in the country, according to a Labor Department report. . . . Having a smaller pool of workers would likely prompt companies to raise wages, but that could result in higher food prices."

If the Trump administration makes good on its promise to levy tariffs on Mexico, Canada and China, a trade war is likely; however, the administration may no longer have free rein to tap into the Agriculture Department's discretionary spending to buffer farm losses. "A bipartisan cohort of lawmakers want to rein in a pot of money Trump’s first administration used to compensate farmers decimated by the then-president’s trade confrontation with China," reports Skye Witley of Bloomberg News. "A farm bill package that would require congressional approval of certain Agriculture Department discretionary spending supporting the farm economy" was championed by Senate Agriculture Committee Chair Debbie Stabenow (D-Mich.) and House Agriculture Chair GT Thompson (R-Pa.)

Brooke Rollins in 2021
(Wikipedia photo)

While many of the incoming administration's actions were anticipated, Trump surprised some lawmakers and agriculture groups when he nominated Brooke Rollins as his Agriculture secretary. "Trump’s decision to tap her came amid bitter infighting over the role among his advisers, family members and powerful agriculture groups, report Grace Yarrow and Meredith Lee Hill of Politico. "Rollins, who grew up on a farm, has less experience in agriculture policy than those on Trump’s shortlist. Rollins is from Texas and has a degree in agricultural development. While some GOP lawmakers on Capitol Hill were surprised by the pick, she’s expected to have a fairly smooth Senate confirmation."

Making sense of bird flu virus H5N1, from its risks to why there's reason to be hopeful

Bird flu H5N1 can kill chickens in 48 hours, but the
infection is less severe in humans. (J. Whitt photo, Unsplash)

As avian flu spreads among birds, cows, and people, understanding the virus can help lessen unnecessary worry and build support for virus containment, testing and possible vaccination efforts.

David Leonhardt of The New York Times demystifies the bird flu virus through questions and answers. The answers have been lightly edited.

1. What is bird flu?
It’s an influenza virus officially known as H5N1 (and sometimes called avian flu). It attracted global attention in the late 1990s after an outbreak among chickens in southern China. . . . That outbreak was especially worrisome because it included the first documented human cases of the virus. At least 18 people were infected, six of whom died.

2. Why the recent concerns?
The virus has recently expanded in two ways: across regions and across species. Rather than being concentrated in Asia, bird flu has moved across much of the planet. And it has infected a wider variety of animals, including mammals. Dairy cows in many parts of the United States have tested positive.

Most concerning, at least four people have tested positive without evidently having had contact with a sick animal. . . . These infections raise the possibility that the virus can move from one human being to another, rather than only from an animal to a person. Human-to-human transmission can lead to a much more rapid spread of a disease.

3. What are the reasons to be hopeful?
First, it’s not yet clear whether those four recent cases stemmed from human-to-human transmission.

Second, H5N1 seems to have become less severe in human beings recently. The reasons aren’t clear. . . . As my colleague Apoorva Mandavilli says, 'Very few people known to be infected with bird flu in the United States have become seriously ill, and none have died.'

4. How can the U.S. reduce the risks?
More testing — of birds, cows and farmworkers — would help. “We know very, very little about how far this virus has spread and how many people and animals have been infected,” Mandavilli said. Testing could allow farms to isolate infected animals and people.

What about a vaccine?
A vaccine for bird flu exists, but the supply is modest. Jennifer Nuzzo, director of the Pandemic Center at Brown University, believes the government should help expand production and make the vaccine available to farmworkers who want to receive it.

The bottom line:
Caitlin Rivers, an epidemiologist at Johns Hopkins, recently published a book on preventing outbreaks called "Crisis Averted." In it, she argues that one of the most effective public health strategies is honesty: Experts should level with people, rather than telling selective truths intended to shape behavior in paternalistic ways (as happened during Covid).

A high school public health care boarding school is planned in Alabama; part of its mission is to serve rural counties

Alabama will launch a high school focused on health
care. (Adobe Stock photo)

Amid national health care provider shortages, Alabama is investing in a high school public health care boarding school "to address [the state's] health care staffing crisis, particularly in rural parts of the state, by training students for roles across the medical field," reports Alander Rocha of the Alabama Reflector. The board "overseeing the creation laid the groundwork to select a leader and prepare a curriculum."

With planning under way, the school "is scheduled to enroll its inaugural ninth-grade class in 2026," Rocha writes. "Rob Pearson, interim president of the Alabama School of Healthcare Sciences Foundation, said that the school will offer 'certification levels beyond what’s currently available in Alabama high schools for those looking to become health care professionals.'"

Health disparities between the state's rural and urban populations, which are particularly dire along the Black Belt, motivated health care leaders and stakeholders to work creatively to increase health care access in rural areas. Rocha reports, "The Black Belt experiences some of the state’s worst health outcomes, and Alabama already ranks among the lowest nationally. Life expectancy in every Black Belt county is below the state average of nearly 75 years."

Demopolis is in Marengo
County, Ala. (Wikipedia)

True to its rural service mission, the new Alabama School of Healthcare Sciences will be built in Demopolis, a small town with roughly 7,000 residents in west-central Alabama. State Superintendent Eric Mackey "said the school’s recruitment strategy will focus on drawing students from across the state to build a workforce pipeline beyond those wanting to attend medical school, like nursing," Rocha reports. The school "will join a network of specialized boarding schools, including the Alabama School of Cyber Technology and Engineering."

Through their initiative to establish high schools focused on health care, Bloomberg Philanthropies "is providing $26 million of the estimated $80 million needed," Rocha adds. "A groundbreaking expected by mid-2025. . . . The school is the only rural residential school funded by Bloomberg."

Christmas tree growers are 'overcoming historic challenges' to provide live trees to holiday buyers

Fraser firs are a holiday tree
favorite. (Photo by W. Hicks)

Picking out a live Christmas tree, even with the family haggling that often comes with it, is how many Americans officially begin their holiday season. But this year, Christmas tree farmers had to work harder and with more creativity to get those trees ready for sale, reports Valerie Bauerlein of The Wall Street Journal. "Growers are having to overcome historic challenges to get them to the lots."

The difficulties Christmas tree farmers face aren't limited to growing perfectly shaped trees. They also face tree disease, labor shortages, plastic tree competitors, and "inflation on everything from seeds to tractors," Bauerlein writes. "And that was before Hurricane Helene wreaked havoc on the western part of North Carolina, which produces more Christmas trees than any state except Oregon."

The beloved Fraser fir tree crop grows primarily in western North Carolina where flooding "left 95 people dead, washed out roads and destroyed homes," Bauerlein adds. Tree farmer Waightstill Avery III lost a barn, equipment and "60,000 trees, a third of the total at family-owned Trinity Tree Company-Avery Farms. Many of the damaged trees were partially submerged by floodwater. Others were covered in clingy silt that resists washing. . . . Avery’s staff have been recovering what they can."

Besides dealing with unpredictable weather, most tree farmers are short-staffed, with many using migrant workers to shore up labor gaps, but that solution has become more difficult and expensive. Bauerlein reports, "Tree farmer Rusty Barr said the regulations around hiring foreign workers have become increasingly cumbersome. . . . The hourly rate he pays is increasing to more than $16 next year, another cost to absorb."

The industry also faces a smaller pool of customers as "baby boomers stop putting up live trees," Bauerlein explains. "There is increasingly stiff competition from China-made artificial trees, which have become easier to assemble and more lifelike, sometimes boasting scents like 'white winter fir.' . . . Such challenges have buffeted market size: The number of trees harvested in the U.S. has declined 30% since 2002."

Even as the industry looks at this obstacle-filled season, "the North Carolina Christmas Tree Association said there should be enough supply for anyone who wants a real tree this year, though growers say that buyers might need to adjust their expectations," Bauerlein adds. "Some church groups that flock to the mountains to stock their tree lots back home have been intentionally seeking out scraggly 'Charlie Brown' trees as a show of support."

A new analysis suggests that when rural areas lack access to civic infrastruture, it contributes to health disparities

The index is based on weighted health outcomes that measure the quality and length of one's life.

(Map by Sarah Melotte, The Daily Yonder, from County Health Rankings data)

When compared to their urban counterparts, rural communities continue to face health disparities for a wide range of reasons; however, a new analysis of County Health Rankings & Roadmaps data by The Daily Yonder suggests that this "disparity is driven partly by unequal access to civic infrastructure," reports Sarah Melotte. A lack of "access to resources like high-speed internet and public libraries is part of the reason rural counties aren’t as healthy as metropolitan ones."

The 2024 CHR&R National Findings Report, Creating Thriving Communities Through Civic Participation, underscored the relationship between a community's civic participation access and the health of its members. Counties with well-resourced civic infrastructure, such as local news, broadband internet and public libraries, were healthier and often more urban.

More insights from the Yonder's analysis:

• Rural counties make up 17 of the top 20 most unhealthy counties in the health outcome index, a CHR&R tool that measures the length and quality of life in a county.
• People who live in rural areas are more likely to experience unequal access to civic infrastructure, according to the report. Rural communities are more likely to lack access to broadband internet and to pay more for a subscription when they do have it.
• Health outcomes also vary by region. Both rural and metro counties in the South are the least healthy compared to other regions, while some of the healthiest counties are in New England.
• The rural South exhibits the worst index scores compared to all other regions in both nonmetropolitan and metropolitan areas.
• The states with the worst inequalities between rural and urban counties are Alaska and Hawaii.

Opinion: Bringing grocery stores back to poor and rural areas requires reviving a 1936 law that is now ignored

Adobe Stock photo

A change in federal policy during the 1980's created modern-day "food deserts" in poor and rural communities. While the revision was intended "to reward the biggest retail chains for their efficiency," writes Stacy Mitchell in her opinion for The Atlantic, it put local grocery stores out of business while increasing food costs in areas already hampered by poverty and depopulation. . . . "Food deserts will not go away until that mistake is reversed."

Historically, local grocery stores were shielded by the Robinson-Patman Act. "The law essentially bans price discrimination, making it illegal for suppliers to offer preferential deals and for retailers to demand them. It does, however, allow businesses to pass along legitimate savings," Mitchell explains. For more than four decades, the Robinson-Patman Act successfully maintained the delicate balance of U.S. grocery store competition between big chains and local stores.

In the 1980s, the Reagan administration didn't agree with the "tough antitrust enforcement" that previous administrations had provided through the Robinson-Patman Act, so "the government simply stopped enforcing it," Mitchell writes. "That move tipped the retail market in favor of the largest chains. . . .Walmart was the first to fully grasp the implications of the new legal terrain. It soon became notorious for aggressively strong-arming suppliers, a strategy that fueled its rapid expansion."

Once the Robinson-Patman Act was dismantled, independent grocers and smaller supply businesses couldn't compete on price and were squeezed out of their neighborhood markets. "Price discrimination spread beyond groceries, hobbling bookstores, pharmacies, and many other local businesses," Mitchell reports. "From 1982 to 2017, the market share of independent retailers shrank from 53% to 22%."

Meanwhile, mega-retailers such as Walmart and Safeway continue to dominate sales but still fail to meet needs in rural communities. Why? They don't have to. "Walmart can capture spending across a wide region by locating its supercenters in larger towns."

Stacy Mitchell
(Photo by Brian Fitzgerald via ILSR)

To create an economic atmosphere where smaller local grocers and retailers could succeed, the Robinson-Patman Act will need to be revived and applied. Mitchell adds,"Requiring a level pricing playing field would restore local retailers’ ability to compete. This would provide immediate relief to entrepreneurs who have recently opened grocery stores in food deserts, only to find that their inability to buy on the same terms as Walmart and Dollar General makes survival difficult."

Stacy Mitchell is a co-director of the Institute for Local Self-Reliance, where her research focuses on economic concentration and the health of local economies.

Reporting on contentious issues in rural America: An informal discussion on what journalists should consider

Nicholas Jacobs, Sarah Melotte, Natalia Alamdari

After an election year marked by national chatter about what rural Americans believe and do, the Rural Journalism Collective is offering an informal panel conversation about how rural towns manage conflict and what journalists should consider as they report on contentious issues within their community. The event is on Thursday, Dec. 12, 2 p.m. E.T. Register here.

The panel discussion features:

• Nicholas Jacobs, an assistant professor of government at Colby College and an expert on American politics and policymaking, with a focus on the rural-urban divide, federalism, and developments in the American party system.

• Sarah Melotte, a staff writer at The Daily Yonder, an independent newsroom about rural America. Mellotte has a master’s degree in applied geography and geospatial science. She analyzes data, and plans and creates most of The Daily Yonder’s data reporting maps and graphics.

• Natalia Alamdari, a greater Nebraska reporter for the Flatwater Free Press, where she covers everything from chaos on rural village boards to shady international nonprofits to election misinformation efforts straight from the heartland. She is a graduate of the University of Missouri-Columbia and a native Texan.

Another food recall? U.S. food supply diversification created 'many more points' where food can be contaminated.

The listeria outbreak in Boar's Head meat caused 10 deaths
and sickened at least 61 people this year. (Boar's Head photo)

In the past six months, the number of reported food-borne illness outbreaks and food recalls in the United States has started to feel like a daily occurrence. And as the list of tainted foods grows from deli meat to onions to ground beef, many American consumers are wondering which foods are safe. Emily Schmall of The New York Times reports on "what the data on food safety actually shows."

A more in-depth look at U.S. food system data reveals a complex system with some documented safety improvements and plenty of room for improvement. Schmall explains, "By some measures, the food supply has become safer in recent years: We now have better testing systems that make it possible to detect contaminated food sooner and recall it faster, which means that outbreaks are now often smaller. It’s also easier to detect foodborne illnesses and link them to specific outbreaks. . . . Still, there has been less progress than experts had hoped to see by now."

Part of the country's food safety dilemma comes from the system's complexity and the sheer number of countries and suppliers involved. Schmall reports, "More products and ingredients are now being imported, and food is more frequently grown, manufactured, packed, and distributed by separate companies. A longer and less integrated supply chain means there are many more points at which the food can be contaminated."

The American public isn't wrong; recalls have increased. In fact, "recalls have nearly doubled between 2012 and 2024, though the Food and Drug Administration lumps food and cosmetic recalls together," Schmall writes. "Some of this increase may be because of better testing. Not all recalls involve pathogens, either." 

While the constant barrage of food recalls has left many Americans thinking U.S. regulators cannot ensure that the food supply is safe, the FDA has funding constraints that limit its ability to inspect more foreign food facilities. "The FDA physically inspects less than 1% of food imports," Schmall explains. "That gap in oversight was illuminated last year when applesauce pouches that contained lead-tainted cinnamon sourced from Ecuador sickened hundreds of children across the United States."

Susan Mayne, who served as the FDA's director of food safety during the Obama, Trump and Biden administrations, told Schmal, "The FDA functions as a food safety cop on the beat. But the ultimate responsibility for making things safer really comes from the food industry.”

Shopping rural helps small communities -- and it's a romp through one-of-a-kind gifts, practical gear and artful whimsy

Celebrating all the holidays in November and December can be more fun when shopping rural in-store or online. When gift-givers choose to buy from small-town businesses, they support local communities and get to spend their hard-earned gift-giving dollars on delightful, original items that can't be found at larger retailers. Below are just a few stops for readers to browse and hopefully, take time to enjoy the ingenuity, resourcefulness and craftsmanship rural businesses offer.

Mohr's art captures rich rural moments.

The art of Bonnie Mohr captures the beauty and spirit of life lived closer to nature. Whether it's cows, cats, old trucks, luscious landscapes or children playing in the snow, Mohr's work captures the unique perspective and warm wisdom of rural living. 

Inspired by the 1803 diary writings of midwife and tallow candle maker, Martha Ballard, 1803 Candles celebrate the nostalgia of simpler times. Like Ballard's candles, 1803 Candles are made by hand. Located in tiny, Waterman, Illinois, many of the company's employees are moms who work while their children are in school. 1803 Candles can be purchased online but can be discovered and smelled at a local shop with this handy finder.

Rural Cloth promotes rural as a lifestyle and strives to sell
high quality clothes that tout fashion and function.

Rural clothing styles are just as diverse as rural people, but for giftgivers seeking ranch, farm or outdoor life gear, the options start with flannel and go beyond. There's Rural Cloth for "those who live in small towns, like rodeos, bull riding, hunting, fishing, cold beer, backyard BBQs, and football." Duluth Trading is also a very rural pick. Headquartered in Mount Horeb, Wisconsin, the company is serious about rural Americans being comfortable and ready for anything. The company even has "Fire Hose Workwear" and heirloom gardening bib overalls. Find a local store here.

Shop Rural can supply ideas and inspiration for gift-giving budgets of all sizes. The site supports "Small Towns and Small Batches" for hand-picking gifts that are special and support local artisans. The options go from craft woodworking to whimsical gnome-shaped soaps made from goat milk. Shop Rural is for small-town businesses only, so there's no mass production and the site does not take commissions. Shop Rural is still growing and has artist listing packages from $2 to $8.

Bookshop.org makes supporting independent bookstores simple. Avid readers need books, and bookgivers can choose a favorite rural/local bookstore to receive the full profit from their Bookshop.org purchases. Many smaller bookstores also offer book purchases through their own websites, which are "powered" by Bookshop. In Hazard, Kentucky, a local bookstore called "Read Spotted Newt" has a website full of local offerings along with the option to order books directly from its site through Bookshop.

When perusing the web for outdoor adventure and nature lover gifts, Rural is Rad is a stop that offers an online database featuring local businesses in Colorado. The site has beanies, nature notebooks, hand-knitted hats and gloves, specialty ski apparel, hiking equipment and hiking guides and journals to go with it.

Shopping rural helps small communities -- and it's a romp through one-of-a-kind gifts, practical gear and artful whimsy

Celebrating all the holidays in November and December can be more fun when shopping rural in-store or online. When gift-givers choose to buy from small-town businesses, they support local communities and get to spend their hard-earned gift-giving dollars on delightful, original items that can't be found at larger retailers. Below are just a few stops for readers to browse and hopefully, take time to enjoy the ingenuity, resourcefulness and craftsmanship rural businesses offer.

When perusing the web for outdoor adventure and nature lover gifts, Rural is Rad is a stop that offers an online database featuring local businesses in Colorado. The site has beanies, nature notebooks, hand-knitted hats and gloves, specialty ski apparel, hiking equipment and hiking guides and journals to go with it.

Mohr's art captures rich rural moments.

The art of Bonnie Mohr captures the beauty and spirit of life lived closer to nature. Whether it's cows, cats, old trucks, luscious landscapes or children playing in the snow, Mohr's work captures the unique perspective and warm wisdom of rural living. 

Inspired by the 1803 diary writings of midwife and tallow candle maker, Martha Ballard, 1803 Candles celebrate the nostalgia of simpler times. Like Ballard's candles, 1803 Candles are made by hand. Located in tiny, Waterman, Illinois, many of the company's employees are moms who work while their children are in school. 1803 Candles can be purchased online but can be discovered and smelled at a local shop with this handy finder.

Rural Cloth promotes rural as a lifestyle and strives to sell
high quality clothes that tout fashion and function.

Rural clothing styles are just as diverse as rural people, but for giftgivers seeking ranch, farm or outdoor life gear, the options start with flannel and go beyond. There's Rural Cloth for "those who live in small towns, like rodeos, bull riding, hunting, fishing, cold beer, backyard BBQs, and football." Duluth Trading is also a very rural pick. Headquartered in Mount Horeb, Wisconsin, the company is serious about rural Americans being comfortable and ready for anything. The company even has "Fire Hose Workwear" and heirloom gardening bib overalls. Find a local store here.

Bookshop.org makes supporting independent bookstores simple. Avid readers need books, and bookgivers can choose a favorite rural/local bookstore to receive the full profit from their Bookshop.org purchases. Many smaller bookstores also offer book purchases through their own websites, which are "powered" by Bookshop. In Hazard, Kentucky, a local bookstore called "Read Spotted Newt" has a website full of local offerings along with the option to order books directly from its site through Bookshop.

Shop Rural can supply ideas and inspiration for gift-giving budgets of all sizes. The site supports "Small Towns and Small Batches" for hand-picking gifts that are special and support local artisans. The options go from craft woodworking to whimsical gnome-shaped soaps made from goat milk. Shop Rural is for small-town businesses only, so there's no mass production and the site does not take commissions. Shop Rural is still growing and has artist listing packages from $2 to $8.

Thanksgiving dinner is less expensive this year, but the small decline doesn't make up for 2022's dramatic increases

Serving up this year's Thanksgiving dinner will cost 5% less than it did in 2023. The average price of this year's turkey dinner with all the trimmings rings in at $58.08, compared to 2023's, $61.17, and 2022's painful $64.05. And while the decrease is welcomed news, this year's Thanksgiving meal is still 19% higher than it was in 2019, according to the American Farm Bureau Federation's 39th annual survey.

To tally this year's Thanksgiving dinner costs, the AFBF sent out volunteer shoppers who checked prices Nov. 1-7, which is notably before most grocery store chains began featuring deep discounts on whole frozen turkeys. U.S. turkey prices declined in 2024, with the average price for a 16-pound turkey at $25.67 or $1.60 per pound, down 6% from 2023.

Several other ingredient prices declined, including the cost of whole milk, which dropped more than 14%, and the price of fresh vegetables decreased by 6.4%. Those decreases helped offset the price hikes on dinner rolls and stuffing cubes, which increased by around 8%.

Individual Prices:

• 16-pound turkey: $25.67 or $1.60 per pound (down 6.1%)
• 14 ounces of cubed stuffing mix: $4.08 (up 8.2%)
• 2 frozen pie crusts: $3.40 (down 2.9%)
• Half pint of whipping cream: $1.81 (up 4.7%)
• 1 pound of frozen peas: $1.73 (down 8.1%)
• 1 dozen dinner rolls: $4.16 (up 8.4%)
• Misc. ingredients to prepare the meal: $3.75 (down 5.1%)
• 30-ounce can of pumpkin pie mix: $4.15 (down 6.5%)
• 1 gallon of whole milk: $3.21 (down 14.3%)
• 3 pounds of sweet potatoes: $2.93 (down 26.2%)
• 1-pound veggie tray (carrots & celery): $.84 (down 6.4%)
• 12-ounce bag of fresh cranberries: $2.35 (up 11.8%)

Can social awkwardness at holiday functions be avoided? No, but preparation can help manage it.

Holiday get-togethers can be
awkward. (Adobe Stock photo)

The holidays can be the best time of the year, but it can also be the most awkward. As we reconnect with family, friends and coworkers, conversations can veer into uncomfortable stories or political views that lead to dead silence or arguments. In her opinion for The Conversation, philosopher Alexandra Plakias "offers a few strategies people can use to minimize awkwardness and deal with it when it does, inevitably, happen." A condensed version of her tips is shared below.

Know your goals, know your roles. Uncertainty is the oxygen of awkwardness. Before you engage in a potentially awkward or contentious interaction, ask yourself: What do I  want to get out of this? . . . I’m not suggesting that some forethought will make things go smoothly or guarantee that no one’s feelings will be hurt. But it will help you feel more confident in your ability to navigate toward your desired outcome.
 
There’s no ‘I’ in awkward. Awkward situations breed intense self-consciousness. This is both uncomfortable and counterproductive. By focusing on yourself, you’re not attuned to the people around you or the signals they’re sending – signals that could offer you a pathway out of the awkward situation. So make sure you’re paying attention to the other players in the drama, not just your own discomfort.

Plan, coordinate and be explicit. People do so much planning in other areas of their lives, yet they expect social interactions to just flow effortlessly. . . . Have some go-to topics or questions at hand. . . .If you expect to see someone with whom you have an unresolved relationship – an estranged family member, or an old friend you ghosted – try to do some prep work in advance. Emails or letters can give people a chance to process reactions without putting them on the spot.

Laugh it off. Despite your best efforts, awkwardness does strike, offer people a way out – they’ll probably grab it. This doesn’t need to be momentous; it could be a little joke, a small-talk topic, or even – and only if things get very desperate – knocking a spoon off the table to break the silence.

Consider the alternatives. These strategies might help you avoid awkwardness. But take a moment to consider whether you really want to. Awkwardness is the result of social uncertainty; it slows things down and curbs your confidence. . . . If things are awkward, it’s worth looking around to see what role that awkwardness is playing, and what might take its place if it’s gone.

Alexandra Plakias

Alexandra Plakias is an associate professor of Philosophy at Hamilton College in New York. She's a moral psychology expert who studies social awkwardness as a way to explore how it "it stops people from engaging with difficult topics and challenging conversations." For more of her insights on social awkwardness, read her full article here.

Yelloh, once known as Schwan's Home Delivery, closes due to 'insurmountable business challenges'

Yelloh started out as Schwan’s home delivery business
in 1952. (Yelloh photo via Twin Cities Business)

After years of decline, the frozen food delivery icon formerly called Schwan's closed its doors after 72 years of service. The company's direct-to-consumer delivery model increased its popularity among rural communities, where its signature yellow trucks became synonymous with good people and food. "At its peak, the company delivered meals and ice cream across 48 states," reports Aimee Ortiz of The New York Times. "But critics and experts said the company became frozen in time, ceding ground to competitors and modernity."

The company's setbacks began in the late 1980s, "with fewer people home as drivers came, the relationships between drivers and customers that had been built over decades began to diminish," Ortiz explains. "Then came membership stores like Costco, which could compete on frozen food price and quality, and on top of that regulatory changes added restrictions to their truck operations."

In 2019, Schwan's sold a group of its frozen food grocery store brands in a deal that forced the company to relinquish the "Schwan's" name and suppliers. The company renamed its service "Yelloh," but many loyal consumers were put off by the new name. "The 2022 rebranding was a failure on multiple levels, said Ken Moskowitz, who is the founder of Ad Zombies and has been a marketer for 40 years," Ortiz reports. "By changing the company’s name, decision-makers 'threw away all that history,' Mr. Moskowtiz said."

The loss of Yelloh's food suppliers also cut into its customer base. "The home delivery service carried Schwan’s items until early 2024, but soon enough customers lost access to many of their favorite entrees, snacks and desserts, including the Schwan’s ice cream that had made the company famous," Ortiz explains. Ed Johnson, a retail and consumer products expert, said "that he could not speak directly to what exactly caused Yelloh’s demise, but that it’s 'very hard to sustain that business in a world where there’s more choice.'"

Yelloh released a statement that explained the closure was due to “'multiple insurmountable business challenges,” including “economic and market forces, as well as changing consumer lifestyles,'” Ortiz reports. "The closure means that about 1,100 people across 13 states are out of a job."

The debate over fluoride in public water may just be getting started: Local stories and knowledge can help

Fluoride is a mineral that helps prevent
tooth decay. (Photo by G. Rosenke, Unsplash)

The decades-long practice of adding fluoride to public water supplies to prevent tooth decay is under fire from anti-fluoride activists, including "fluoride foe Robert F. Kennedy Jr., who was tapped for a top spot overseeing public health as head of the Department of Health and Human Services," reports Joseph A. Davies for the Society for Environmental Journalists. Kennedy wants "to remove fluoride from drinking water, and President-elect Trump has said he supports the idea."

Adding fluoride to public water sources began in the 1940s; however, the decision to add fluoride is not made at the federal level. Davis explains, "The federal government has no legal authority to require fluoride in drinking water — not the EPA or any other agency. But some 13 states (plus Washington, D.C., and Puerto Rico) do — they currently have laws requiring utilities to add fluoride to drinking water. Hawaii is the only state to prohibit it. . . . Not only that, but laws in 37 states allow local governments and utilities to choose for themselves."

Davis writes, "The public should know the facts. For environmental journalists, that means local stories."

A recent court case won by anti-fluoride activists "ordered the EPA to reevaluate its rule on fluoride in drinking water, using the Toxic Substances Control Act rather than the SDWA (Safe Drinking Water Act)," Davis explains. "The suit came after controversial research by the Department of Health and Human Services’ National Toxicology Program suggested fluoride could harm the IQ of growing kids."

The political atmosphere and anti-fluoride sentiment by some citizens is pushing the fluoride debate into more local community spaces. Davis shares these story ideas and sources.

Story ideas:

• Does your state require fluoride to be added to public drinking water systems? Talk to your state regulators.
• What are the main drinking water utilities in your audience area? Do they add fluoride? Talk to local managers about the issue.
• Does fluoride occur naturally in the source water(s) of your local utilities? How much? Is it below or above the maximum contaminant level (MCL)?
• Does your utility fully inform customers about fluoride in water (as they are legally required to under the SDWA)?
• What does your local or state health department think about fluoride in drinking water?
• Talk to your dentist and other local dentists about their views on fluoride.
  

Reporting resources:

• U.S. Environmental Protection Agency: The EPA oversees implementation of the Safe Drinking Water Act, with most enforcement carried out by the states.
• Centers for Disease Control: The main U.S. public health agency.
• National Institutes of Health: This scientific research agency has studied fluoride in water.
• World Health Organization: This international public health agency has recommended a level for fluoride in drinking water.
• American Dental Association: The main professional association for general dentists in the United States.
• Fluoride Action Network: A nongovernmental organization that opposes addition of fluoride to drinking water.
• Food & Water Watch: A nonprofit NGO opposed to fluoride in drinking water.