Social Services & Public Health in Rural America, 2017

As the recent presidential election demonstrated to those of us concentrated around urban areas and city centers, we are living in a country made up of two different Americas: the ‘haves’ and the ‘have-nots’; the urban and the rural; the educated and the uneducated. Although urban centers have, in the past, been held up as examples of crime-ridden, poverty-stricken areas, rural America is becoming more and more known for its high levels of unemployment, poverty, and opioid abuse.

The Atlantic Monthly recently called this divide “the grand divergence,” citing the earnings gap in small town America as being largely the result of educational differences that create huge economic and cultural rifts. In the article, Alana Semuels juxtaposes two residents of Connersville, Indiana—both white and in their thirties—with dramatically different lives: one works the night shift at a manufacturing plant for automotive parts; the other runs a creative consultancy business and lives a comfortable existence characterized by flexible working hours and plenty of time to travel and cook with friends. One attended high school but doesn’t have a bachelor’s degree; the other is a college graduate. This comparison is held up as typical of the increasing divide between those with higher education and those without.

Typically, cities come with built-in infrastructure: public transportation, health care services, social services, and a wide variety of people to provide community for whatever walk of life and social demographic you happen to inhabit or seek out. In rural towns, however, these resources are few and far between, simply due to the lack of population and tax base necessary to fund them. The University of Southern California’s Public Health program cites a report titled Global Health 2035 that argues, “If we make the right investments in the health sector today, we could achieve universally low rates of infectious, maternal and child deaths by 2015. In other words, we could shift directions to achieve a ‘grand convergence’ in global health within just one generation.” Some possible investments include subsidies on fossil fuels and tobacco tax.

This increase in global health would also translate to economic and productivity growth. What does this have to do with economic inequality, in general? According to Healthline, Americans living in rural areas face a higher risk of dying from the five leading causes of death in the United States (heart disease, cancer, respiratory disease, stroke, and unintentional injuries) than do their urban counterparts. In other words, rural Americans are sicker than those who live in cities and more populous areas. Why is this, you ask? It seems to be a combination of economic factors and a general lack of access to healthcare resources. For example, older people without a mode of transportation may have more trouble getting to a doctor, due to a lack of infrastructure and public transportation—something that is virtually nonexistent in many more rural areas.

Because of this lack of access to healthcare, it would particularly benefit many rural areas to retain as many young people with professional talent as possible—especially those specializing in health care and social services. Access to information and resources via Internet is one element that seems to be helping many more sparsely populated areas. In addition to utilizing healthcare resources remotely in the form of telemedicine, many rural college students interested in health and social services are increasingly able to remain in their hometowns because of remote online graduate-level programs that allow them to develop competence in more general subject knowledge—as opposed to specializing in pediatrics, for example.

One group greatly in need of specialized care is the elderly population, since there is both a projected surge in aging Baby Boomers and a shortage of qualified geriatric health providers, in rural areas. Health Journalism recently interviewed Dr. Stephen Bartels, who said, “We have to develop a new type of health outreach worker who knows about older adults and who’s specialized in older adult concerns: direct care service workers who actually can do many of the things required without the nurse or physician intervention.” Luckily, there is the Geriatric Workforce Enhancement Program (GWEP), which helps pick up the slack by training and supporting primary care practices in rural areas to offer better care management.

There are also programs like FARM CAMP, which stands for Frontier Area Rural Mental Health Camp and Mentorship Program, a way to plant the idea of a behavioral health career with hometown students and encourage them to stick around and become local professionals. In this way, these young people would provide a partial solution to the ‘brain drain’ so prevalent in many small towns in the U.S. Currently, there is a chronic shortage of psychologists, social workers, and substance abuse counselors—2,700, to be exact, across the country. There are also concepts like MERGE, a new downtown co-working space in Iowa City that aims to reverse brain drain by attracting local students, young professionals, and recent graduates to live and work in town and collaborate with other on projects and business ideas.

Some small towns like Fergus Falls, Minnesota, are actually experiencing a reverse “brain gain” trend because, although students leave for college, many 30-50 year-olds come to the area because they are drawn to a slower, more family-friendly pace of life. Part of what will help rural America recover from its long, slow descent into abandonment is just this kind of element, but it will require enough interest from younger people willing to invest in communities and make life work for them, outside the comforts of the big city.

What do you think? What elements will be most helpful for small-town America? Do you live in a rural community? What works for the benefit of both younger and older people, in your town?


Image Source: Nicholas A. Tonelli

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