The Rural Monitor, Volume 11, No. 1, Summer 2004
In this issue:
- Cover Story
Putting Rural Services on the Map by Thomas D. Rowley
- Rethinking Human Services
Human Services in Rural
Communities -
The launch of a new column
by Tom Corbett, professor
emeritus at the University of
Wisconsin-Madison and an affiliate
of the Institute for Research
on Poverty.
- Look What's Coming
Rural Tail Wags Dog
by Wayne Myers, M.D.
- Around the Country
New state-of-the-art CAH in Nebraska;
Milagros migrant health
education center in Texas
by Deanna Durrett
- Spotlight on Rural Research
New Ideas for Rural Development
by Thomas D. Rowley
This issue is also available in PDF.
Putting Rural Services on the Map
By Thomas D. Rowley
Presentation matters.
With people increasingly glued to televisions, computers
and video games, a picture is worth not just a thousand words, it’s
worth a whole spreadsheet of numbers.
In the health and social
sciences arenas, maps can make population numbers and other data
easier to comprehend.
“When you can take a map and throw it
down there and somebody can see it, it’s very impressive,” said
Ray Stowers, D.O., Director of the Oklahoma Rural Health Policy
and Research Center. “You
can talk all day, but when you lay that map down it makes a
difference.”
What’s the difference?
By some estimates, 80 percent of all
data has a spatial component. In other words, the data are tied
to a particular place—address,
census tract, neighborhood, zip code, city, county, state
or country, to name a few. A map, because it shows the data’s
connection to place, helps immensely in visualizing and understanding
what the data have to say.
On the health care front, a map can
show what areas have the highest rates of diabetes, whether those
areas have high rates of obesity and what health care services
are available.
On the human services front, a map can show, for
example, poverty rates, alongside educational attainment rates,
unemployment rates and child care facilities.
Best of all, a map can
link all of that information together to help make the connections
between poverty, disease and their various causes (as well as the
services to address them). In short, mapping can not only show
how various measurements play out in space, it can also show how
they interrelate. Think list of ingredients (flour, eggs, sugar)
versus a picture of a cake.
“With mapping, we have something
worth its weight in gold as a tool,” said Hartzell Cobbs,
Executive Director of Mountain States Group Inc., an Idaho-based
non-profit organization working in rural health and human services. “The
tool is not a program, however. It is just a tool. It can inform
policy and allow for better decision making.”
Mapping for
Rural Communities
So how many communities are using mapping technologies
to inform policy and improve their decision making? According
to a recent survey of local governments, many are, but far
fewer than would like to—especially
among small and rural communities.
The 2003 Survey on the Use of GIS Technology
in Local Governments, conducted by Public Technology,
Inc., the International City/County Management
Association, the National League of Cities and
the National Association of Counties, asked questions
of more than 10,000 local governments—counties, cities, towns, townships,
villages and boroughs. Answers from the just over 10 percent that responded
show that 64 percent are interested in Geographic
Information Systems (GIS) but lack the resources to effectively utilize
mapping; 42 percent said they do not have the necessary technical
expertise.
Helping Overcome Those Obstacles
To help smaller, rural communities and those
who make decisions on their behalf gain access
to GIS, the Rural Policy Research Institute (RUPRI)
created the Community Information Resources Center
(CIRC) in 2001. Among other things, CIRC provides
an interactive Internet mapping tool that allows
users to build their own maps using a wide range
of datasets.
“As the federal government continues to push responsibilities
down to the states, and states push these
responsibilities down to localities, those places with inadequate infrastructure
become increasingly disadvantaged,” RUPRI Director Charles Fluharty
said. “In
our continually devolving federal system,
this is one of the greatest disadvantages rural America faces. We created
CIRC to try to level this playing field.”
The idea was to make sure
rural wasn’t left out of the picture.
“We take the technology,
which, out-of-the-box, is cumbersome and challenging to use, and modify
it so it’s more practical
in its application to the realities
of issues at the community level,” said
Ann Peton, CIRC Director and former
state GIS coordinator in both Missouri and Iowa.
Mapping Rural Health and Human Services
GIS offers rural communities a way to evaluate, plan, and improve
a wide range of services: |
•
•
•
• |
Health Care
Human Services
Law Enforcement
Education
|
•
•
• |
Economic Development
Transportation
Natural Resources |
| According to Ann Peton, Director
of the Rural Policy Research Institute’s Community Information Resources
Center (CIRC), Internet mapping enables users to do all of that far more
cost effectively for reasons including: |
| • |
No GIS software is required. Users only need a browser
such as Netscape or Internet Explorer to interact with the Internet-based
GIS. |
• |
No data distribution is required.
All data and GIS functionality
is updated via a centralized server
or clustered network. |
|
CIRC does that by offering
a step-by-step tutorial, but also by doing all of the data
processing on its computer, so that people
with slower, less powerful machines can use
the mapping tools. According to Peton, other
mapping applications typically don’t allow that. CIRC
also specifically designed its
mapping application to work with 56k line speeds, since so many rural areas
are still without broadband service.
“Most applications out there are
built by kids just out of school who learned to build applications using
T1 lines,” Peton
said. “They don’t
understand how to consider our
rural stakeholders’ resource
limitations. Everything we do
is built with the limited capacity
of rural in mind.”
In addition
to offering a service that works
with limited rural capacity,
CIRC offers data that are unavailable
in other Internet mapping services—things
like the Health Professional
Shortage Area designations, which measure health care shortage areas, and the
Rural-Urban Commuting Area codes, which are census-tract based measures of rurality.
Having
built a better mouse trap, CIRC is finding that rural organizations
around the country are beating a
path to its doorstep, giving it a
long list of customers, partners
and users.
Idaho
In Idaho, efforts are underway to map the locations of a wide
range of health and human services
as part of that state’s 211 program.
The 211 program—first developed and implemented in 1997
by the United Way of Atlanta—designates
the phone number, 211, as
a place to call for information
and assistance with non-emergency
health and human service
needs. Like its cousin, 911,
it provides an easy-to-remember,
one-stop place for help.
States and communities around
the nation are working to
get the system up and running
for their jurisdictions.
Idaho is among the leaders
in the effort.
Unlike other
states, Idaho is combining its 211 efforts
with Internet mapping. Currently,
through its Idaho CareLine component,
people can call for information or check
the Internet for information on services
and volunteer opportunities by geographic
area, keyword and program name. Eventually,
decision makers and others will also be
able to map those services to see where
they are and are not. The information will
help them evaluate the data and establish priorities
for future program development.
Among the many partners behind the effort are
Mountain States Group Inc.; CIRC; Serve Idaho,
the Governor’s Commission on Service and Volunteerism, which
oversees the state’s AmeriCorps
program; United Way; the Junior League;
the Idaho Department of Health and
Welfare; and St. Alphonsus Hospital.
Initial funding came from the Murdock
Charitable Trust.
“We’re
a large and rural state that has a
lot of challenges with access,” said
Kelly Houston, Executive Director of
Serve Idaho. “Sometimes
it’s hard for communities to
know what’s
going on and for us to know where resources
are in the state.”
The program,
she said, will allow the commission
to do more things. For example, the
Commission can more clearly see what
areas have high drop-out rates, what
services are or are not available in
those areas and then determine if those
are places to develop partnerships and
place AmeriCorps mentors and tutors.
Organizers say the program will identify
areas of high need that are not getting services.
“We want
to use it for policymaking decisions and looking at where we
invest our resources,” Houston said.
While the program will
eventually cover all of the state, Houston notes
its special importance to rural Idaho.
“In the rural areas, the main
advantage will be to allow us to identify where resources do and do not exist
without having to physically travel there,” she
said.
Mountain States Director
Cobbs, who secured early funding for the
program, agreed.
“The whole rural angle is that there is isolation in
a lot of rural communities,” Cobbs
said. “This puts
them on the map. It levels
the playing field. It provides
rural communities with
a sense that others care
about them. There’s
a psychological value in
knowing what your community
does is important to others
outside the community.”
The National Neighborhood Indicators Partnership
On the urban front, the National Neighborhood Indicators
Partnership (NNIP)—a collaborative effort by the
Urban Institute and local partners—is developing
and using neighborhood information systems in
local policymaking and community building to help distressed
urban neighborhoods. Like the Rural Policy Research Institute’s
Community Information Resources Center, NNIP partners
seek to “democratize
information” by facilitating the direct practical
use of data by city and community leaders, rather
than preparing independent research reports on their own.
In a 1998 Working Paper, Neighborhood
Indicators: Taking Advantage of the New Potential, G. Thomas Kingsley
highlights lessons learned over the course of NNIP’s
eight-year history.
- Design indicator systems for the explicit
purpose of changing things—not just to monitor
trends.
- Develop a single integrated system that
can support one-stop shopping.
- Develop indicators at the neighborhood
level—not
just for the city as a whole.
- Build a data “warehouse” from which indicator
reports can be derived—not just a set of files
on indicators.
- Serve multiple users but emphasize using
information to build capacity in poor communities.
- Democratize information—help stakeholders
use information directly themselves.
- Help stakeholders
use data to tackle individual issues, but do
so in a way that leads toward more comprehensive
strategies.
- Use information as a bridge to promote local
collaboration.
- Use available indicators but
recognize their inadequacies—particularly
the lack of sufficient data on community assets.
- Assure integrity in the data and the institution
that provides them.
For more information, see http://www.urban.org/nnip/.
|
Nebraska
Denny Berens is both the
Director of the Nebraska
State Office of Rural Health
and the President of the
National Organization of
State Offices of Rural Health
(NOSORH). He is excited about
mapping’s potential for helping rural areas
get better health care.
Consequently,
the Nebraska office is beginning a partnership
with the University of Nebraska
Medical Center to tie GIS to
a health professions tracking
system. When it’s finished, health and
human services researchers
and policymakers will be able to click on any place in
Nebraska and see,
for example, what, if any, doctors are practicing there,
how many hours they
work in that area, how many hospital beds are there, the
demographic profile
of its residents, incidence of disease and a whole host
of other important
variables. The purpose: to find areas with service gaps and help
fill them.
“It’s
going to be very
helpful to us,” said
Berens, who, as President
of NOSORH, has asked
all state offices
of rural health to
evaluate this new
tool. “It will
basically build the
case for what needs
to be done. From
a policy standpoint,
this is a wonderful
tool, whether at
the local, state
or regional level.
It makes a whole
bundle of information
readily understandable
to local residents
and to policymakers.”
Oklahoma
Further south in
Oklahoma, the technology
was instrumental
in getting funding
recently from Congress
for the Oklahoma
Telemedicine and
Distance Learning
Center at Oklahoma State University.
According to Dr. Stowers, maps
proved invaluable in showing
policymakers what services
are in their districts, the
demographics and health care needs of constituents
and how telemedicine would help meet those
needs.
Stowers and his colleagues also have used maps to show state
legislators the need
for a statewide telemedicine network.
“We would have two sets of maps,” Stowers
said. “One showing
the existing
network and a second showing what the state would look like if we get
funding. [The network] really would put us as one of the tops in telemedicine
in the country.”
Nation
At the national level, maps are being used
to show the success of the Rural Hospital Flexibility
Grant Program. The program strengthens rural
health care through the support of Critical Access
Hospitals (CAH), among other things. Rural health
leaders—with help from the Technical Assistance Service Center of
the Rural Health Resource Center (TASC) and CIRC—have
been circulating
maps showing how the Flex program has impacted the countryside.
Specifically,
maps showing
the location
of CAHs, their
service areas
and how many
people they served
were generated for
key policymakers.
“Mapping really can help people who are not involved
in the program see…what
the
actual impact is, how much of their state is covered,” says Tami
Lichtenberg, TASC
Program Manager. “It really
helps
them see (for example) that three-quarters of their state is covered.”
And
More
The list
of applications
for GIS goes on and on—from refining Medicare
reimbursement for rural ambulance service to building a better early childhood
development system. As Dr. Cathy Grace, Director of the National Center
for Rural Early Childhood Learning Initiatives, put it, “The
questions and the answers are limitless.”
As
with
all tools,
however,
a word of caution
is in order.
As one of the pioneers in using maps to further rural
health policy, Dr. Tom Ricketts, Professor
of Health Policy and Administration at the University of
North Carolina-Chapel Hill, knows how valuable they can
be.
“Everybody’s doing it and should,” he said.
Still, he and other GIS experts say it is important to also understand
mapping’s
limitations.
“A map doesn’t solve your problems,” Ricketts
said. “It’s
just a picture. To do real analysis, you have to do more than
just make a map.”
He also warns that maps, like all graphic
representations, can distort reality—intentionally
or unintentionally.
“What you see,” Ricketts said, “may
not be what you get.”
That caution noted, Denny Berens is still high
on the possibilities.
“You
can begin to dream,” he said.
Get Connected
For more information on the people and sources described in the
previous article, see the following web sites:
|
Rethinking Human Services
by Tom Corbett, Ph.D.
Human Services in
Rural Communities: Envisioning the Future
Almost two generations ago, the specter of want and isolation in places
like rural Appalachia and the Mississippi Delta motivated John Kennedy
and Lyndon Johnson to call for an unconditional War-On-Poverty. But
attention soon wandered to urban areas where key media outlets vividly
documented the consequences of economic and social inequality as well as
racial anger.
Though long neglected, the need for effective systems of social
supports for rural America remains a pressing challenge. Persistent,
high-poverty counties (i.e., those with aggregate poverty rates in excess
of 20 percent in each decennial census since 1960) are disproportionately
likely to be rural.
Given this, issues touching on the availability of
public services and how they are delivered in rural communities
are of great concern to the policy community. What is the best way to design
and deliver high quality human services in areas where the need is so great
and where both the institutional infrastructure and financing are
likely to be deficient?
I, and a number of colleagues, have been studying
the challenge of how best to design and deliver human services,
particularly to families with multiple needs. As we see it, social programs
too often are delivered through a confusing array of categorical
programs organized around specific target groups (at-risk children) or
narrowly defined service technologies (e.g., in-kind benefits like Food
Stamps or substance abuse counseling). Disadvantaged families in the real
world, on the other hand, often experience multiple challenges at the same
time.
A group of senior welfare officials, in a 2002 report from the Welfare
Peer Assistance Network, put it this way:
"Arguably,
the Federal government thinks about policy in terms of specific programs
and categorical funding streams (each as it were, an independent 'silo').
States, on the other hand, increasingly think about how a
coherent and seamless service delivery system might better assist
disadvantaged families."
In the 1930s, when the federal government became a major player in the
delivery of services during the Great Depression, there were few public
programs dedicated to poor families. Over time, new social challenges were
identified. New groups were designated as worthy of public help. And new
strategies were suggested for solving this growing list of societal issues.
While each new public program was defensible in its own right, the array
of separate programs grew unabated, each developing its own congressional
supporters and advocacy groups. With separate oversight committees,
with different rules for spending money and determining success, it became
increasingly difficult at the local level to help families in ways that
made sense to them. As early as the 1970s, then Secretary of Health and
Human Services Elliot Richardson noted that services in the United States
suffered from a "hardening of the categories."
A medical analogy is often
used to describe why this is a problem. A given patient has five
medical issues, but the hospital has expertise in only four of them. They
treat those four very well, and assert that each procedure was a complete
success. And the patient dies of the fifth condition, which, of course,
is someone else's responsibility.
When the welfare reform act (the Personal Responsibilities and Work Opportunities
Act of 1996) was up for renewal in 2002, the Bush administration
proposed a so-called "superwaiver" provision. This would have allowed states and local
governments to seek waivers of federal rules across a broad set of programs
and executive agencies for the purpose of better aligning programs and more
effectively delivering integrated services. Though the welfare re-authorization
bill has not been enacted to date, interest in service integration remains
high nevertheless.
Over the past two years, I've worked with my colleagues
to convene a number of meetings that have brought together what I call "lighthouse" sites,
localities that have experienced some success in advancing the service integration
agenda. I've visited many of these sites and I've attended meetings where we
convene stakeholders and experts to discuss how best to advance this agenda.
This initiative has also worked with states through the National Governor's
Association Policy Academy initiative.
In future articles, I'll share some
of the insights and lessons learned about how to design and deliver integrated
and comprehensive services effectively. And I'll discuss ways to think through
how these lessons might apply to the unique and complex circumstances found
in rural America.
Tom Corbett has emeritus status at the University of Wisconsin-Madison
and is an active affiliate with the Institute for Research on Poverty where
he served as Associate Director. Over the years, he has worked on welfare
reform issues at all levels of government, including a year as senior policy
advisor at the U.S. Department of Health and Human Services. He continues
to work with a number of states through networks of senior state welfare
officials in the Midwest and West Coasts and on issues of program and systems
integration to deliver better services to challenged families.
Look What's Coming
by Wayne Myers, M.D.
Rural Tail Wags Dog
In the Spring issue of The Rural Monitor, I argued that American
health care has two great problems: (1) health care is outgrowing
our capacity to pay for it and (2) the quality of the care we get,
and give, is unreliable. In this column I’ll suggest some ways
that rural communities can help themselves and the rest of the country
out of this mess.
The National Academy of Sciences’ Institute
of Medicine (IOM) has been hard at work on the quality issues.
In the year 2000 its Committee on Quality of Health Care in America
issued the sentinel study, To Err is Human, pointing out how many
people are hurt by their health care, and recommending the development
of safeguards. The following year the Committee released a much
broader report, Crossing the Quality Chasm. This report went beyond
patient safety to tackle the whole subject of health care quality.
The
title, “…Chasm,” was selected to point out
the enormous gap between the care we are giving/getting, and
the care that people rightfully expect. The report endorses a recommendation
that care should be safe, timely, effective, efficient, equitable
and patient-centered. The mnemonic, “STEEEP,” helps
me remember the six aims. If it helps you, realize that the road
to health care with those six characteristics is going to be
steep.
Several of these six characteristics of quality care have
potential for helping with the cost problem. For example, quality
care is SAFE and EFFICIENT. One reason our health care costs
so much is that it is fragmented. Hoards of independent providers
generate duplicate management costs, redundant lab and clinical
work, scattered records and lack of information management.
In
1998 no airline passengers died in accidents. Would that impressive
safety record have been possible if every aircraft mechanic
kept his own records to himself, and worked for a separate contractor?
In Crossing the Chasm the IOM makes the point that “Trying
harder (to avoid making mistakes) won’t work.” Catching
and preventing errors requires systems we don’t have,
and can’t
have because of our fragmentation. Pulling pieces of health
care together under common management and information systems
can make care safer and reduce costs.
Quality health care is
EFFECTIVE. That means practice based on current clinical evidence
rather than personal bias, idiosyncratic experience or intuition.
It is generally more economical, and safer, to work through
a problem methodically than erratically, though the researchers
will have to scramble to keep up with the clinicians.
Quality
care is TIMELY. Saving money while improving timeliness will take
ingenuity. Certainly treating the diabetic early rather than when
his foot is ulcerating will help. Getting the lab report today
rather than next week may be very important. But some advances in
timeliness must rest on pure human decency. A woman with a breast
lump should not have to wait weeks to find out whether she has cancer.
A TIMELY, PATIENT-CENTERED system would answer that question today.
EQUITABLE care treats everyone alike regardless of race or wealth.
What has
this to do with rural care? Rural systems may be more amenable
to innovation and constructive change than cumbersome urban systems.
They are smaller and have fewer players than urban systems. Local
movers and shakers already know each other. It may be relatively
easy to spread the word about new ways of doing things. Rural clinicians
are relatively likely to know their patients’ socioeconomic
situation.
I know of some rural innovations that move
health care toward lower costs and the six IOM aims, such as:
- Moving toward a culture of error reporting, analysis and prevention, rather
than concealment.
- Starting case management in the critical access hospital and
extending it into the community when the patient goes home,
reducing emergency visits and readmissions.
- Pulling together local care entities (e.g. hospital, clinic,
ambulance) into a single organization for purposes of administration,
billing and records.
- Reducing paper and increasing electronic clinical record keeping,
facilitating error detection and timely access to accurate
essential information.
- Supporting evidence-based care.
Would you please tell me about your examples of rural innovations
through an e-mail to me c/o the Rural Assistance Center
(
editor@raconline.org)? Have you had any success in getting
payers to share the benefits of better, more efficient
care?
How can such modest local innovations be of any national significance?
As employers and states determine that they can no longer meet their medical
bills we will enter a period of rapid and striking change. Practical experience
with better ways of organizing care will be of great interest to policymakers.
In the next issue of The Rural Monitor I’ll outline one possible scenario
for that period.
Wayne Myers, a pediatrician, founded the University of Kentucky
Center for Rural Health and served as its director. He also served
as director of the Office of Rural Health Policy in the Department
of Health and Human Services' Health Resources and Services Administration.
He is a past president of the National Rural Health Association and
currently serves on its Board of Trustees.
Around the Country
by Deanna Durrett
Nebraska: Community Assists in Creation of CAH
Folks in Crete, Nebraska, were part of their new Critical Access
Hospital long before its doors opened.
The Crete Area Medical Center
opened on June 3, 2003 with a state-of-the-art design, advanced
technology and extended services. But its creation began more
than six years before that, with input from the community.
In 1996,
Joseph Lohrman, the administrator of Crete’s previous
public-owned hospital, began discussions with the hospital’s
Board of Directors about the limitations of the old facility
and the need for expanded services. Many of Crete’s residents
were forced to travel to Lincoln to receive the care they needed.
Lohrman
arranged a partnership between the hospital and BryanLGH Health
System, a Lincoln-based nonprofit health care company, which
agreed to construct and own the facility. An oversight committee
was then established that included medical staff, members of
the chamber of commerce, county commissioners and other community
representatives. From there, it was time to engage the community.
“I
took the show on the road,” Lohrman said. “I
met with all the major service organizations and a lot of community
members.”
The change of ownership from public to private
created some initial hesitation among residents, but Lohrman
addressed this issue and other concerns at public hearings.
The architect of the new facility, Doug Elting, also attended
several public meetings and worked with residents in designing
the facility.
The new $15.8 million medical center integrated the
hospital and medical clinic and contains 25 patient rooms, two
surgery suites and an emergency department and trauma area. The
facility also touts a physical therapy and cardiac rehabilitation
area, a healing garden and a helicopter pad.
“You would
be hard pressed to find anyone who has not touched the project
in some way or form,” Lohrman said.
For more information, contact
Joe Lohrman, President of Crete Area Medical Center, at (402) 826-6800.
Texas:
New Distance Learning Program for
Migrant Health
A new center will offer specialized training to nurses
and other professionals who work with migrant and seasonal laborers.
The Milagros Center of Excellence in Migrant Health, a collaboration
between Georgetown University’s School of Nursing and Health
Studies and South Texas College’s Division of Nursing and
Allied Health, will educate nurses, early childhood specialists,
paraprofessionals and child advocates who work with migrant families
in their home-base and during the seasonal migration.
The center
was created in September of 2003 with funding from the Office
of Minority Health in the Department of Health and Human Services.
According to the National Center for Farmworker Health, there
are more than three million migrant and seasonal farmworkers in
the United States today, and this population has different health
needs and receives different care than the general public.
Mayra
Fernandez, the administrative assistant at the Center and daughter
of once-migrant farmworkers, described their unique circumstances.
“They
toil in the sun, enduring occupational dangers, environmental
health risks from pesticides and poor housing to harvest our
fruits and vegetables,” Fernandez
said.
She added that they receive too few health and social
services due to several factors, including high costs of health
insurance, lack of transportation to health facilities and the
inability to take off work to attend to their health concerns.
“Right
now, there is not enough to meet their increasing need,” she
said.
The Milagros Center has tested two online pilot courses
this year, “Mental
Health & the Migrant Family” and “Growing
Up on the Border.” The
courses will become part of a targeted program that will
use distance-learning technology. Students for the courses
will be accepted from states in the Northeastern and Midwestern
migrant streams, with Georgetown managing the former and
Texas the latter. Program administrators hope to eventually
expand the program to places like California.
The program,
which will first offer Certification in Migrant Health
or service learning credits, is projected to be completed and
available for enrollment in January of 2005.
For more information,
please contact Mayra Fernandez at (202) 687-1309 or visit http://elearn.stcc.cc.tx.us.
Spotlight on Rural Research
by Thomas D. Rowley
New Ideas for Rural Development
Over the past year, several institutions have taken a fresh look
at rural development and proposed major policy changes to promote
it.
At a March meeting convened by the international Organization
for Economic Cooperation and Development, the Federal Reserve Bank
of Kansas City, the United Kingdom’s Countryside Agency and
the Rural Policy Research Institute, some 120 senior policy officials
and experts from 15 countries gathered near Washington, D.C. to
discuss the future of rural policy. The consensus: rural policy
in developed countries must change if rural communities are to
prosper.
“Existing subsidies tie regions to the status quo….,” said
Thomas Hoenig, President of the Federal Reserve Bank of Kansas
City. “Holding
a steady course in rural policy is likely to be expensive and
less than effective.”
In his keynote address, Federal Reserve
Chairman Alan Greenspan pronounced that the key to improving
the well-being of rural people and places lies in giving them
the flexibility to innovate and adapt to changing global conditions.
He went on to warn that flexibility is stymied and rural development
hindered by the de facto rural policy of agricultural subsidies,
which distort market forces, restrain trade and trap resources
that could be better utilized in other endeavors.
According to
these and other experts, new and effective rural policies would
do three key things:
- Replace agricultural subsidies that preserve the status quo with investments
that enable innovation;
- Help rural entrepreneurs find and exploit niches in the global
market in which they already have or can build competitive
advantages; and
- Allow a wide range of individuals and institutions—public and private—from
all levels—local, regional, and national—to work together
to initiate and administer them.
In Competitiveness in Rural U.S. Regions:
Learning and Research Agenda, Harvard Business School professor and
author, Michael Porter, also makes the case for new rural policy.
Commissioned by the Department of Commerce’s Economic
Development Administration, Porter provides a useful synthesis of the
rural economic situation and some ideas for improving it.
The highlights of Porter’s report:
- The pain felt by
some rural areas notwithstanding, Porter notes that most of the
job losses have been concentrated in a few industries such as textile,
apparel and footwear that now account for a small part of rural
employment and are concentrated in a few regions. These industries,
he says, are not representative of the whole rural economy.
“The
performance of rural economies is far from dismal, and is actually
promising in many fields,” Porter writes in his article. “This
suggests that there may well be more opportunities for economic
growth in rural areas than are generally perceived.”
- The
essence of rural areas is their differences, not their similarities.
Efforts to improve rural economic performance must be region-specific.
One size does not fit all.
Furthermore, the efforts must be truly regional—encompassing
both rural and urban areas. “There is little or no structure in place to
forge the strategic linkages between rural and nearby urban areas that will be
critically important in moving to the next level of economic development,” the
author notes.
- Productivity is the key. “A region’s
standard of living,” writes
Porter, “is determined by the productivity of its economy.
Productivity is measured by the value of goods and services produced
per unit of labor, capital and the natural resources employed.
Productivity sets the wages that can be sustained and the returns
to investment in the region—the two principal
components of per capita income.”
Porter’s article argues that the way to increase productivity
is to create and commercialize innovations. And the way to promote
that is to see to it that rural areas have the research, training
and investment capital needed to support entrepreneurship.
Porter believes a rural policy framework is needed
that recognizes and addresses the differences in rural regions and
focuses on building their competitive advantages rather than simply
reducing their disadvantages.
In Reversing Rural America’s
Economic Decline: The Case for a National Balanced Growth Strategy,
the Progressive Policy Institute’s Robert Atkinson
lays out his plan for revitalizing the rural economy. In
it, he writes “our
de-facto federal rural policy—providing massive subsidies
to a shrinking number of farmers—does little to help
develop competitive rural economies or boost opportunity
for rural residents.”
Atkinson’s three-pronged
approach:
1. Convert farm subsidies to investments in place-based
rural economic development. Citing the billions of dollars that
the U.S. (and Japan and the European Union) spend propping up agricultural
producers, Atkinson calls for a multi-lateral disarmament in
agricultural subsidies over a 15-year period by developed nations.
The money saved would be used to help rural communities plan
and gear up to compete in the New Economy. (In 2001, rural
development programs in the U.S. got only $1.2 billion, a fraction
of the sum given to farm payments.)
2. Move rural programs out of the
federal bureaucracy and consolidate them in a single quasi-governmental
agency. Hundreds of federal programs exist to help rural America.
Clearly, that bewildering array isn’t getting the job done
and, in fact, gives community leaders fits trying to
figure out where to go for help and how to get it. Atkinson wants
Congress to create a new Rural Prosperity Corporation—directed
by folks from business, labor, state and local government, and
by rural experts—and
give it the flexibility and entrepreneurial drive to make things
happen.
Specifically, he wants the corporation to manage grants
to states (with financial contributions by the states)
that enlist them in helping communities develop. He also
wants funds targeted to so-called growth poles, rather
than spread all over the map.
“In order to effectively
create the most jobs in rural areas,” Atkinson
writes, “efforts should be targeted to a small
number of centers with the potential to be the regional
anchors for growth that surrounding rural residents can
commute to for employment.”
3. Move government facilities
and jobs out of congested, high-cost urban areas that
don’t need them and into un-congested, low-cost
rural areas that do. He cites Social Security Administration
claims processing centers and teleservice centers as
prime candidates of “routine back office government
functions” that
could be relocated to rural growth poles—reducing
costs, maintaining service and helping rural areas.
Whither
Farming?
In all these ideas, agricultural subsidies are
reduced drastically, if not eliminated. What, then, will be done
for farmers?
While agriculture can no longer be the driving force behind
rural policy, farmers and ranchers cannot be forgotten.
Rural development policies must be crafted to enhance their well-being
too. Indeed, the link between the two is obvious, if sometimes
ignored or presented cart before horse.
Most U.S. farm households
rely on non-farm employment for the majority of their income. Rural development
provides jobs, income and benefits (32 percent of the country’s farmers
have no health insurance) for farmers and their families. And just
like everyone else, farmers need the hospitals, schools
and other services that rural development helps provide. Farmers today
depend more upon the rural economy for economic survival
than vice versa.
As Secretary-General of the Organization for Economic
Cooperation and Development Donald Johnston put it, “Agriculture must
find itself within a new, broader, synergistic policy,
not outside of it.”
Reports are available at:
New Approaches to Rural Policy: Lessons from Around the World
http://www.kansascityfed.org/RuralCenter/mainstreet/MSE_0604.pdf
Competitiveness in Rural U.S. Regions: Learning and Research Agenda
http://www.eda.gov/PDF/EDA_Rural_Regions_Final.pdf
Reversing Rural America’s Economic Decline:
The Case for a National Balanced Growth Strategy
http://www.ppionline.org/documents/rural_economy_0204.pdf
The Rural Monitor is published by the Rural
Assistance Center.
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© 2006. Rural Assistance Center. All Rights Reserved
Reprint Policy: Articles, photos, and charts appearing in the Rural Monitor may be reprinted with the permission of the Rural Assistance Center and proper citation. For permission, please contact ksande@raconline.org
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