Monday, February 20, 2017

Child abuse prevention: one size may not fit all rural communities

Child Welfare Services' work preventing child abuse has a long, complex, and sometimes ugly history.  Constitutional legal issues arise when a state actor intervenes in family matters, and state involvement in such personal matters has sparked heavy debate over the years. 

Child Welfare Services did not begin as a state agency. In the mid 1800s, a man named Charles Brace founded the Children's Aid Society in New York. By the 1900s, this society was established in many cities on the East Coast. Brace believed that poor children living in urban areas should be 'saved' by placing them in christian homes out in rural "country" areas.  Trainloads of poor urban children were removed from their families and shipped to the Midwest and upstate New York in order to learn "morality" and "good work habits." Before long, similar organizations began to crop up, creating a network of "free" foster homes in which children were expected to pay for room and board through their labor. During this time, arrangements for children who were moved "for their safety" and those moved because they were deemed "delinquent" were not differentiated. 

Throughout the 1900s, more formalized institutions began to appear, and the goals and policies continued to evolve and change.

In 1958, congress amended the Social Securities Act, mandating that states provide funds to child abuse prevention. In the 1980s, Congress passed the Child Abuse Prevention and Treatment Act as well as the Adoption Assistance and Child Welfare Act. These laws required the nation's child welfare organizations to prevent child abuse by offering family support services and reunification services to families who are struggling. Both urban and rural families face stressors that can impact the wellness of children, including: addiction, mental health challenges, alcohol dependency, and family violence. Rural families are more likely to experience one or more of these stressors. If the harm or threat to the child is deemed too severe for the child to remain in the home,  reunification service, designed to support families as they cope with these stressors, are offered.  The goal is to allow children to grow up in the care of their parents, if possible.

Child Protective Services' (CPS) involvement with a family begins with a report, generally from a community member, or someone who is required by law to report any suspicion of child abuse. Then, a social worker investigates that report to see if the harm or abuse is substantiated. If substantiated (the meaning of "substantiated" could vary depending on state law or county practice), CPS will intervene. This means that they will ask the caregiver(s) to get involved in community services (such as parenting classes, substance abuse meetings, etc). Sometimes CPS will remove the child and place him or her in foster care.  

Today, child welfare organizations exist in every state, with services in every county. The majority of families involved with CPS continue to be poor, and rural families are affected differently than urban ones. In rural areas, wealthier families (those with incomes at 200% of the poverty level and above) are much more likely to have a report substantiated than urban families of the same income level. Families in rural areas who have caregivers that are experiencing domestic violence or have cognitive impairments are more likely to have a report substantiated than similarly situated urban children. Perhaps this is because rural families are more likely to experience the pressures of poverty and other stressors. Indeed, 10% more rural caregivers than urban caregivers involved in CPS report experiencingn some kind of family stress. Further, more rural parents report trouble paying for basic necessities rural areas than urban parents do.  The Carsey Institute attributes these numbers to the chronic stressors that many rural families face, paired with isolation and a lack of services in rural areas. It is also important to note that the implementation of family support services and guidelines for what  "substantiation" means vary between child welfare organizations. It is certainly not clear that these statistics reflect more abuse and neglect occurring in rural areas. What is clear, is that rural families face difficult stressors, namely poverty, which can greatly impact children.

This leaves us with an open question: are child welfare organizations catering their services to the unique needs of rural communities? Stay tuned.

Saturday, February 18, 2017

School choice without choices

After much opposition, Betsy DeVos was confirmed as education secretary on Tuesday, February 7, 2017. Chris Loss, an education-policy professor at Vanderbilt, points to the nation-wide reaction to DeVos as "evidence of just how mainstream education has become--unlike more arcane policy issues like housing and energy, issues that seem kind of abstract to the average voter. Education is pretty immediate, it's pretty visceral."

As education policy becomes more mainstream, so too does attention to parts of public education that have been often overlooked--including rural schools. (For previous blog posts on this issue, see this, this, and this.) While DeVos's appointment concerns a number of Americans throughout all settings in the country, advocates are especially worried about what her appointment will mean for rural schools. DeVos is notoriously a proponent of "school choice," which, as this blog hopes to further develop, may not amount to much of a choice for rural students.

Rural schools serve over 40% of U.S. students, but only receive 22% of federal funding. Further, rural schools have a critical shortage of teachers and often employ teachers who are not licensed in the subjects they teach. It is difficult to recruit and retain teachers because the pay is low, housing is sparse, and working conditions are difficult. Rural students are "likelier than their peers to live in poverty" and only 27% go on to college. Yet when students do go on to college, rural schools have been called "engines of exodus." The "brain drain" phenomenon leads not only to educated students leaving rural areas (see other posts here), but also exhausts rural resources. "If high school graduates or college graduates leave the local community to work and pay taxes elsewhere, then the community does not derive a benefit from its investment."

During DeVos's confirmation hearing, two Republican Senators questioned how changes would affect rural states where there are "distance issues students in frontier areas combat to physically get to non-public schools," concerns about when there is no way to get to an alternate option, and the issues that there are "simply fewer students to populate new schools" resulting in an "unequal demand for charter schools." DeVos responded vaguely, saying that individual states would design polices for the rural communities, but she envisions more distance learning and online courses. However, the National Education Policy Center has referenced the outcomes of online learning as negative "across the board" (See the full policy report here.) Further, rural areas often struggle with access to the internet, making this proposal impossible to introduce.

In rural settings, there are few charter or private school alternatives. Karen Eppley, editor of the Journal in Rural Research and Educationexplains that a large portion of rural charter schools were formed by community members in responds to school closures and consolidations. This is a very different set-up than the urban and suburban charters that are run by large-scale management companies, such as KIPP. Accordingly, it seems that rural charter schools are generally created out of necessity, not because of competition or to offer an alternative "choice" to the public schools in the area. The private schools in rural areas are often deeply religious, which, according to the Rural School and Community Trust, means they aren't an option for everyone.

Eric Steeves, a superintendent of a rural school in Maine, insists, "If you shut down schools, you destroy a town." As is common in rural schools, Steeves wears may hats. Other than superintendent, he is also the school's guidance counselor, works on the curriculum, and teachers remedial social studies. He is married to the school principal, who is also the library media specialist and the food services director. In small towns or rural areas, the public school can be the "social anchor" of the community. In addition to being a major employer, the school can provide services unavailable anywhere else, such as sports, summer lunch programs, and food pantries.

The school choice and voucher programs would "siphon away critical funding" from rural schools as parents opt out of public school take their taxpayer dollars with them. Steeves believes that DeVos's policies would be "disastrous" and "catastrophic" for schools like his. The impact is well illustrated by the nearest town's school superintendent: "Every time I lose a student somewhere it's five or six thousand dollars," and when "you lose seven students, that's a teaching position." Not only would his school lose tuition money, but Steeves fears they would have to bus students over an hour away to other schools in rough weather conditions. These changes could lead to many school closures in rural states with few options left over for the students living in rural communities.

Friday, February 17, 2017

Remembering Ram's "Farmer"

Viewers across the world remark that the Super Bowl, which is "so uniquely American," provides a rare window into American culture by combining the drama of sports, the universal appeal of music, and a healthy dose of patriotism. This blog recently featured another post focusing on American nationalism featured in Super Bowl rhetoric.

Many people annually watch the game, anxiously awaiting to see which team is named National Football League (NFL) Champion (note: I generally watch for the ads and half-time show). While the Super Bowl is known as the ultimate competition for American sports, the American Marketing Association describes the Super Bowl as "the ultimate competition for marketers."

When watching the Super Bowl this year as a law student studying ruralism, I could not help but reminisce about Ram Truck's famous 2013 Super Bowl ad, titled "Farmer."  The ad, which aired on February 3, 2013 during Super Bowl XLVII, featured a recording of Paul Harvey's speech "So God Made a Farmer."

Harvey worked as a American radio broadcaster for ABC Radio Networks for 51 years, and he was known for his segment "The Rest of the Story." Harvey, who was born in Tulsa, Oklahoma, was often referred to as "the voice of Middle America" and "the voice of the Silent Majority" by the media for his "flag-waving conservatism." According to Bruce DuMont, president of the Museum of Broadcast Communications, Harvey turned down multiple offers to broadcast on the East Coast so he could “stay in touch with his listeners and the American people.”

Harvey delivered his speech at a 1978 Future Farmers of America (FFA) convention. The speech acts as an extension of the Genesis creation narrative, referring to God's actions on the 8th day of creation.  In his speech, Harvey described the characteristics of a farmer in each phrase, ending them with the recurring "So God Made a Farmer." See Harvey's entire speech here.

The Ram commercial began with a stark photograph of a single cow in front of a snowy field, and Harvey’s voice saying, “And on the eighth day, God looked down on his planned paradise and said, I need a caretaker. So God made a farmer.” The ad depicted a simple slideshow of rural photographs, featuring imagery including: a black and white chapel in an empty field, aged and rugged farmers with split fingernails and tired faces, rustic farm houses with American flags, farmers working the land, livestock, views of virtually endless crop fields, generations of rural people, and a family praying around the dinner table.

One of the photographers that contributed to the images featured in the add, Andy Anderson, reflected on his involvement:
A transcendent project unlike any that I have worked on. 10 photographers capturing on there own terms the life of a farmer and rancher. All of us searching for meaningful images. Not any one photo rising above any others, but collectively voicing a message for folks and a vocation we have all really taken for granted. The last truly archetypical American worker. And who better else to match the images with than Paul Harvey…America’s grandfather.
The ad debuted during the Super Bowl in conjunction with Ram's "Year of the Farmer," which focused on praising the hardworking men and women who feed and clothe the nation and world.

According to NPR, the ad was part of Ram's partnership with the National FFA Organization (formerly the Future Farmers of America) aimed at "highlighting and underscoring the importance of farmers in America." Ram announced that it would donate $1 million to the National FFA Organization if it received 10 million views of the commercial on its website. The ad surpassed 10 million views in less than a week, and Ram presented the $1 million donation to Clay Sapp, the then National FAA president.

While the ad was praised as one of 2013's best Super Bowl ads for its gorgeous still images and focus on the consumer over the product, the ad was not without criticism. One critic stated:
The last farmer in the video is driving what appears to be a 9R John Deere tractor. That comes in at about $250,000-380,000. If his land is good quality. . . it’s likely to be about $5000 an acre. If he has a dairy, the family has been using artificial insemination for at least fifty years. . . . He uses computer software to manage the farm. He has a global positioning system to help him manage crops. . . . He’s a business man. He has to stay on top of the market. . . .  if we continue to accept the kind of images promoted by this ad, images of the farmer as a good hearted chap, working with the technology of the late 1930s, and thus not frightfully smart, how are we ever going to get a sensible grip on agriculture?
This criticism implies that the ad portrays farmers in a way compatible with the stereotypes of rural America and farmers, without giving credit to technological advances and modern realities in the agriculture business. Other negative feedback focused on the fact that the video featured predominately white farmers, thus failing to paint an accurate picture of the diversity of famers in America.

While Ram's visual portrayal of the farmer may not constitute a completely accurate depiction of rural America, the ad successfully brought attention to a large population of Americans on a national stage.

Thursday, February 16, 2017

The importance of difference: why we leave big cities for rural homogeneity

In my last post, I discussed "the brain drain," and what it can look like when young, educated people move away from their rural home communities, and never end up returning. In this post, I'm addressing essentially the opposite effect: when we choose to leave the larger, more urban regions for smaller, more insulated rural communities, do we do so especially because we are seeking homogeneity of beliefs and values on some level?

This NPR article certainly points towards the conclusion that in many instances, people do leave urban areas in search of people with "similar political stripes." The most oft-cited statistics about moving to, or back to, rural areas often include things like family needs, safety, and cost of living. A need for political affirmation and support from the surrounding community is certainly much harder to quantify, but perhaps that particular factor deserves our attention now more than ever.

More sinister than the search for political affirmation is something colloquially termed "white flight" wherein the white population intentionally leaves large cities for the "solace" of the suburbs, or rural communities, where they can depend on the community being largely of the same race.

As much of the nation found itself stunned after the events of November's election, there were certainly some pockets of the population that were decidedly less incredulous about the result. In communities where people of the same race and/or political creed make an active effort to band together, a certain homogeneity of opinion and voting behavior necessarily emerges, as an inherent result of so much "sameness." Rural communities generally do not reflect the larger population proportions, and once considered from that angle, something like the election outcome seems a little less "left field." To understand the direction our nation as a whole is headed in, it is important to understand the reasons for movement between big cities to ruralities, and vice versa. These patterns of migration, so to speak, deserve more than a passing glance.

Monday, February 13, 2017

Preemption: wedge in the urban-rural divide or mutually unjust imperfect legal doctrine?

Based in the supremacy clause of the Constitution, preemption is the principle that some matters are of such national concern that federal laws must preempt state laws. The doctrine is often limited to federal laws preempting things like state-mandated deportations (e.g. Arizona v. US) and allowing for interstate commerce (e.g. Hughes v. OK). Preemption is usually a pretty useful thing. It's a necessary check in the checks-and-balances of our governmental system.

However, recently, the doctrine of Preemption has become a mighty tool in high-stakes state vs. city conflicts. States can preempt any local law or regulation that is in conflict with state law, and this is a major ace-in-the-hole for lawmakers in state capitols. As our nation has become more politically polarized, state preemption of city ordinances has become more common. In his Atlantic article "Red State, Blue City," David A. Graham observes that in recent years, "[s]tate legislatures have put their oar in on issues ranging from the expansive to the eccentric." He goes on to argue that the reinvigorated preemption trump-card (heretofore rarely dusted off since the dormant-commerce-clause debates of the '70's and 80's) has arisen from a rural-urban friction that is distinct to our current historical landscape:
Rural areas are struggling, while densely packed areas with highly educated workforces and socially liberal lifestyles flourish. In turn, rural voters harbor growing resentment toward those in cities, from Austin to Atlanta, from Birmingham to Chicago.
In this context of increasing rural-urban division, people on both sides of the political aisle have warmed to positions typically associated with their adversaries.
However, my question is, while the use of preemption in localities has been most notable with regard to cities and urban centers lately, does this make state preemption of local ordinances a distinctly rural vs. urban contest? I don't know that it necessarily has to be.

According to Pertschuk and colleagues,
Preemption can halt state or local innovation, eliminate the flexibility to respond to the needs of diverse communities, undermine grassroots movements, prevent or delay changes in social norms, and concentrate the power of industry lobbyists in Washington and the state capitals.
It does seem that preemption can have myriad negative effects, and often these negative effects outweigh the positives of preemption's success as a tool for balancing local interests with state and federal ones. However, are these negative effects only on cities?

The Preemption Watch Newsletter from Grassroots Change, cites well over 25 preemptive bills that have been introduced in states across the nation in the last month. These pieces of legislation would preempt LGBTQ anti-discrimination measures, higher minimum wages, plastic bag ordinances, and more. In addition, there are preemption challenges and battles in several states regarding everything from gun control, to GMOs, to vaping. Cities, to their chagrin, have lost preemption battles over many issues, including transgender-friendly bathrooms, to fracking bans and guns in parks. The most talked-about preemption lately deals with sanctuary cities.

Are cities the only geographies to suffer (or, indeed, benefit, if you're into fewer restrictions on tobacco, gun ownership, soda, or alcohol) when preemptive measures are taken, though? The answer is no. Cities are, by far, not the only geographical spaces impacted by state and federal preemption.

For example, when the small town of DISH, TX (all capital letters), population 304, decided to take on natural gas companies in 2010, the Mayor knew that Texas preemption laws would likely bring their complaints through a slog of legal battles. The Texas Supreme Court agreed to hear the DISH appeal only a few weeks ago.

In another such battle, the towns of  Valley Park, MO and Riverside, NJ (both with populations under 8,000), joined the cities of Hazleton, PA, Farmers Branch, TX, Escondido, CA, and Fremont, NE to put ordinances into place that blocked illegal immigrants from living within their borders. According to the Washington Post, they "did so largely out of frustration, fed up with swift demographic changes and what they saw as the rising costs of caring for undocumented residents." However, all the ordinances were overruled by courts, which found them unconstitutional, including legal battles that took the cases all the way to federal courts. and cost the towns and cities exorbitant amounts in legal fees.

We've recently discussed signs in the Central Valley and on route 99 south of Sacramento, and indeed, even outdoor advertising in unincorporated areas of California has been the subject of preemption questions.

It seems to me that preemption is not necessarily a city vs. rurality issue as Atlantic's Graham, and others have argued. What's more, it is dangerous to add to the polarization of geography in this nation, particularly over an issue that might actually unify ruralities and cities.

Instead, I propose that, despite the political polarization that drives conflict, we think of preemption as a last-resort for any state to use against any locality, regardless of political leaning. The fact is, preemption battles won in state capitols tend to remove agency from rural towns and counties in addition to cities. Preemption brings the hammer down when those local areas have chosen to pass laws that locals feel reflect their values.

Though he is the Mayor of the city of Tallahassee, Andrew Gillum's campaign called "Defend Local Solutions" isn't only for cities. The campaign is instead meant to bolster the "say" of all local folks - people who live in towns, cities, and counties. Gillum posits that "shadowy special interests and unaccountable lobbyists" are lurking behind legislators' preemption efforts in state capitols, and that these political opportunists and operatives prevent local people from controlling where their own tax dollars go. I can't say I disagree with this position. At first, it seems like Defend Local Solutions is looking out for both the geographical "little guy" as well as the "big guy." Despite this ostensibly geographic neutrality, Gillum's campaign (by its left-leaning nature) is a campaign more in lock-step with "city values." However, this isn't how Defend Local sees it, and it isn't how they're trying to sell the movement, either. The promotional language on the Defend Local website keeps cities out of the limelight. As Henry Grabar from Slate notes:
 Instead, [Defend Local] invokes taxpayers, part-time politicians, and Little League coaches. It focuses not on the successes of the old Volvo-sushi-latte nexus, like Boston or Seattle, but on the injustice that has left citizens in Tallahassee and Chattanooga unable to make basic civic decisions.
Whether Defend Local and similar movements in opposition to preemption succeed in bridging the city-rural gap, its arguably true that they are trying to find common ground and common issues. This is a page we can all take from the anti-preemption debate. Perhaps there are additional challenges that localities have in common, regardless of their differing demographics, population densities, and infrastructures. Perhaps we should be looking for issues like this to band differing spaces together on, as opposed to the polarization that's driving us apart.

Rural children and guns part two: Suicides

"A gun doesn't cause the suicidality, but a suicidal person with access to a gun is far more likely to die from an attempt than someone using another method...It's the combination of accessibility, familiarity, lethality, and really short time frame that's offered by a firearm." - Elaine Frank, director of Counseling on Access to Lethal Means. 

As I stated in my first post on this subject, guns kill rural children at a rate almost equal to urban youths. However, while most urban children die from gun homicides, rural youths tend to die from gun accidents and suicides. This post will focus on rural youths who use firearms to commit suicide. 

The Numbers
In 2011, suicide was the third leading cause of death among individuals aged 1-19 and the second leading cause of death among individuals ages 10-19, with 2,089 youths dying by suicide that year. Of these deaths, 41 percent (850 individuals) used a firearm.

Studies have shown that many teenage suicide attempts are impulsive, as can be seen by the fact that of teens who survived an attempt to kill themselves, one quarter of them said they had only thought of attempting suicide approximately five minutes before making the attempt. This impulsivity can be particularly lethal in cases in which the individual uses a firearm in their suicide attempt. According to a report by Madeline Drexler, the editor of Harvard Public Health, approximately 85 percent of suicide attempts that use a firearm end in death. This is in contrast to a drug overdose, the most widely used method for attempting suicide, which only proves to be fatal less than 3 percent of the time. 

According to a study by JAMA Pediatrics which looked at the "Widening Rural-Urban Disparities in Youth Suicides" from 1996 to 2010, rural suicides were almost double the rate in urban areas, regardless of the method used. Additionally, the study showed suicide by firearm and hanging/suffocation were "disproportionately higher in rural areas compared with urban areas." 

The (Potential) Reasons
One possible explanation for the higher rate of suicides in rural communities generally may be a lack of available and accessible mental health services in these areas.  Indeed, of the 1,669 areas that have been federally designated as having a shortage of mental health professionals, over 85 percent are in rural areas. Additionally, this lack of mental health care is even more pronounced in pediatric mental health services as, due to the shortage of specialized mental health care professionals, often primary care physicians are the ones providing mental health services to rural communities. Additionally, rural families often have lower incomes and are less likely to have mental health benefits included in their health insurance coverage.

This lack of easily accessible mental health care often means that rural individuals must travel longer distances to reach these services and/or face longer waiting times. Both of these factors may mean that individuals living in rural communities "may enter care later, with more serious symptoms, and require more expensive and intensive treatments than do their urban peers." Finally, there are the cultural barriers to consider in rural people receiving mental health care. There is often still a stigma surrounding mental health care in these communities that often pride themselves on their self-reliance, which compounded with the lack of anonymity in rural places, can lead to individuals not seeking mental health services when they may need them. 

Another explanation for the higher rates of suicides in rural communities may be due to geographic and social isolation, which may mean that rural individuals lack adequate support systems. Additionally, for younger people living in rural communities, their feelings of isolation may be heightened by the fact that many of their peers may have left the area for education and employment opportunities in more urban areas.
The final factor I will mention, though there are almost surely many more, in regards to the higher rates of suicides in rural communities is the often greater access to firearms in these areas. Gun ownership tends to be more common in rural areas (according to a 2014 study, 51 percent of rural people had guns in their home compared to 25 percent of people in urban areas and 36 percent in suburban areas). While drug overdose may be the most common form of attempted suicide in the US, guns are the most common mode of suicide in America, which is unsurprising given their lethality. Indeed, a "gun in the home raises the suicide risk for everyone: gun owner, spouse and children alike."

So, like the quote at the beginning of this post says, it does not appear as if owning a gun actually increasing the risk of attempting suicide. However, statistically it is much more likely that a person attempting suicide with a gun will succeed in their attempt. For rural children and youth that have easy access to guns and who often impulsively attempt to commit suicide with a firearm, this particularly lethal means can be devastating. 

Therefore, while factors like lack of mental health care and feelings of isolation may contribute to the higher rates of attempted and successful suicides in rural communities, guns (which don't not allow for a change of heart or mind) do have a large role in ensuring the "success" of a suicide attempt.  

Small states' outsized political power (Part II-B: Measuring the efffects in the House and Electoral College)

This post continues examination of the reality of small states' outsized political power. (For historical context, see Part I.)

Part II-A examined these effects in the U.S. Senate. This post concludes by analyzing the House of Representatives and the Electoral College.

The House of Representatives

As discussed in the first part of this series, the size of the House of Representatives has remained at 435 since 1913. In the intervening century, the U.S. population has ballooned from 97M in 1913 to 316M, an increase of more than triple. The average number of people represented by each member of the House in 1913 was 223,000 compared to 737,000 people per seat today. But this is not the whole story, for several reasons.

First, each state receives one House seat no matter its population. As described above, the average House district contains almost three-quarters of a million people, but there is significant variation around this mean. Wyoming's at-large district includes just 586,000 people, while Montana's at-large member represents more than 1M. On the whole, the average people-per-seat figure does not differ significantly between large states and small ones (1.7 percent) or between urban states and rural ones (0.2 percent). But of the fifteen states with the fewest people per seat (average 662,808), nine are among the fifteen least-populous states. Conversely, among the fifteen states with the most people per seat (average 811,444), only five are among the most-populous states.

Second, House seats are only reapportioned once a decade, following the decennial census. But population change is constant, and within a decade significant change can occur. The United States has been urbanizing steadily since the Industrial Revolution, becoming a majority-urban country sometime by 1920. This trend has continued, with rural areas' share of the national population falling from 21.0 percent to 19.3 percent between the years of 2000 and 2010. Although practical concerns favor the current system of once-a-decade reapportionment, this rhythm preserves rural areas' relative political power (despite persistent urbanization) through five election cycles.

Third, the 2.2M incarcerated persons in this country are counted in the Census (usually) like any other residents. Less than 10 percent of this total represents federal prisoners, so any state-to-state differences in where these individuals are held are small. But as some researchers have found, there can be major differences within states because prisons tend to be located in rural areas. Critics argue that the presence of these "phantom constituents" wrongly shifts the center of gravity for funding decisions outward. Proponents argue that incarcerated people have needs like any others and resources should be allocated based on reality. Arguably the issues of resources and political representation are distinct, but the stalemate leads to stasis, and this phenomenon exists in a number of states large and small.

Finally, Republicans have proven especially adept at manipulating district boundaries to maximize their political power. In his book "Ratf**ked," David Daley describes the GOP's REDMAP strategy, which included massive influxes of campaign cash, late in the 2010 election cycle, into strategically chosen state-legislative races. If Daley is to be believed, this effort succeeded in flipping just enough seats to turn statehouses "red" in advance of decennial redistricting that locked in Republican advantage for a decade. Recent elections suggest Daley is not just blowing smoke: Democrats won more than 50 percent of House votes in 2012 yet secured only 46 percent of House seats. Further, Republican electoral wins in 2010, 2014, and 2016 yielded "bonus" seats to the victors. (Note: during the four decades of Democratic control of the House, Democrats often enjoyed bonus seats, as well.)

Two tactics for manipulating districts maps -- also known as "gerrymandering" -- involve rural districts. By "packing" Democratic-leaning urban areas into dense districts, one can ensure that a small number of seats are dominated by Democrats but a larger number of seats overall are captured by Republicans. Another approach, "cracking," siphons off significant numbers of these same Democratic-leaning voters into otherwise sprawling, rural districts. The result is districts that favor Republicans only slightly, making it possible for them to "run the table." Both techniques test the limits of the Voting Rights Act, and in recent years courts have struck down redistricting plans put forth by Republicans in Alabama, North Carolina, Virginia, and Wisconsin.

Thus, in a number of ways the outsized power of small states, and of the sparsely populated parts of states, reinforces and is reinforced by partisan politics.

The Electoral College

As described in the first part of this series, the Electoral College essentially combines the small-state-empowering distortions engineered by the Senate and House individually. A California senator represents almost 70 times as many people as her Wyoming colleague. A California member of the House has nearly twice as many constituents as does Wyoming's at-large member. And in the Electoral College, California has 55 votes (one for every 714,545 people) while Wyoming has three (one for every 195,000 people), a ratio of 3.6 to 1.

Another feature of the Electoral College are the "gimme" votes of the two parties. All but two states assign their electoral votes on a winner-take-all basis. Examining the states that have voted for the same party for president in each election since 2000, it emerges that Democrats can count on 192 electoral votes from 16 states (12 votes per state). (This discounts the three votes from the District of Columbia.) 

By comparison, Republicans "start" each presidential election with 179 electoral votes from 23 states (fewer than 8 votes per state). Democrats' safe votes reflect the stable preferences of 119M people compared to 102M people locked-in for the Republicans. While Democrats start the presidential election with 7 percent more electoral votes than Republicans, they do so by controlling states whose populations are 17 percent greater than those of Republican strongholds. 

According to some electors in the 2016 contest, this is a feature rather than a bug. "I feel like the Electoral College gives a very fair perspective, so that those who are in the rural areas are able to have an equal voice with those who are in the urban areas," said Oklahoma elector Lauree Elizabeth Marshall.

While the Republican nominee for president has only commanded a popular-vote majority in only one of the last seven presidential elections, Republicans have won the White House in three of these contests. As will be discussed in the next part of this series, this one-sided partisan advantage makes it less likely that these distortions will be reformed.

Next: Part III - Proposals for reform

Sunday, February 12, 2017

The opioid epidemic reaches the most vulnerable - newborn infants

I recently caught up with my mother, a long-time dietitian who works with low-income women and children at a health department in "The Thumb" of Michigan. "The Thumb" is a region aptly named for its resemblance to the "thumb" of Michigan's mitten-like shape. It is littered with rural communities that are mostly dependent on agriculture.

In our conversation, I asked how her work was going and if there were any new updates. She casually mentioned that she was seeing more and more women and infants who are or were previously addicted to opiates. This comment spurred my interest and this blog post. I wondered, how has the opioid crisis affected women and infants, and how will the Trump administration address these issues?

The opioid epidemic is not a recent development (see other posts about the opioid epidemic here, here, and here). In rural America, the number of people affected by the epidemic is still rising, and this includes the number of drug-dependent newborns who require intensive pediatric services. Doctors frequently prescribe opioids to pregnant mothers to relieve back or abdominal pain (for some startling statistics, see here). The infants of drug-addicted mothers are born with a condition known as neonatal abstinence syndrome (NAS), characterized by symptoms including seizures, breathing challenges, and difficulty feeding.

Although these symptoms can stem from a variety of drugs, a new study by JAMA Pediatrics found that the number of drug-dependent newborns is rising with the rate of maternal opioid use. The JAMA study is also the first to conclude that the number of drug-dependent newborns is accelerating at a higher rate in rural areas when compared to urban areas (increasing almost seven times for infants in rural counties as opposed to four times for infants in urban areas between 2004 and 2013).

The problem is that rural hospitals are not adequately equipped to deal with this increase. As the New York Times recently reported, "rural hospitals that deliver babies have traditionally focused on the lower-risk population in the areas they serve." Now these hospitals are faced with treating mothers with opioid addictions and infants experiencing opioid withdrawals, without enough resources to do so.

Another problem that rural communities face is a lack of access to treatment centers. Some treatment options, like Methadone, must be distributed by a clinic every day, making it difficult for rural residents who must travel long distances. Although Methadone and other similar treatments may be a viable option for pregnant women, a full detox is not, because it can result in dehydration and increase the risk of miscarriage.

In 2016, the Obama administration made some attempts to combat this issue and acknowledged the unique impact of the "opioid crisis" on rural communities.  First, the Comprehensive Addiction and Recovery Act (CARA) was passed by Congress in July of 2016, promising to prioritize funds for addiction recovery programs in rural areas and improve treatment options for rural women. But CARA did not include any secured funding for these programs. Most recently, in December, Congress approved the 21st Century Cures Act, which set aside $1 billion in grants to help states deal with opioid abuse.

Now, with the newly appointed Tom Price to the Department of Health and Human Services (DHHS) and the threat of an Obamacare repeal, discussions are turning towards how the Trump administration will address this problem.

President Trump was remarkably silent about this issue during the campaign, giving only one speech about the epidemic. In this speech, he mostly focused on reducing the supply of drugs - starting with the removal of illegal immigrants, defunding of sanctuary cities, and aggressive prosecution of drug traffickers. Although Trump did address the need for expanded treatment options, it was last on his list.

Price, the conservative surgeon from Georgia, should be familiar with the effects of the opioid epidemic. After all, he formerly represented a wealthy suburban district that is also plagued by the crisis. But while his wife Betty, a Georgia state representative, introduced a bill last year to increase the amount of state needle exchange programs, Price has voted to block U.S. funding for needle exchange programs in the past.

Price is also opposed to Obamacare and very critical of certain provisions, such as mandatory contraceptive coverage for women. If Price fails to enforce or loosens certain health regulations, like coverage for drug addiction treatment, this could make it difficult for individuals to get the care they need.

What does this mean for rural women and infants? Currently, more people have access to addiction treatment as a result of Obamacare, and the 21st Century Cures Act (discussed above) will provide more funding to treatment programs in high-need areas. But as the New York Times reports, if people lose their health insurance, they may also lose access to these treatment programs. DHHS reports that the states likely to see the biggest loss in insurance coverage are also some of those hit hardest by the epidemic, such as New Hampshire, Massachusetts, Ohio, West Virginia and Kentucky.

Finally, the Medicaid expansion offered some financial relief for rural hospitals on the verge of closing, but it is unclear whether they will be able to stay afloat if Obamacare is repealed, making it more difficult for drug-addicted mothers and infants to get the care they need.

Civil rights and the USDA in the modern era (Part 2)

In my previous post, I discussed the USDA’s history with civil rights in the modern era. This week I will discuss the results of the changes the Obama administration made, as well as what changes are likely to come under the Trump administration.

The USDA has advanced significantly in regards to civil rights in the past eight years. The processing time to new civil rights program complaints was reduced from approximately four years to eighteen months. The inventory of pending civil rights complaints was reduced to its lowest level in five years with a 97% decrease in claims filed, demonstrating the success of the USDA’s aggressive approach to reformation. The past eight years have seen the lowest level of equal opportunity employment complaints and program participant’s complaints in the USDA’s history. The Farm Service Agency, which is the agency that most frequently interacts with farmers directly, saw a 70% decrease in complaints.

The farm loan program also saw significant improvements. The amount lent to underserved producers, such as people of color or LGBT individuals, has more than doubled from 380 million in 2008 to almost 830 million in 2015.  A microloan program was launched, and although it was not intended specifically to target minority farmers, they make up a significant portion of participants. These programs, in conjunction with the other efforts by the USDA, has managed to increase the number of African-American and Hispanic farmers by 12 percent and 21 percent, respectively.

LGBT rights is another area that has seen improvements since 2008. The USDA established a Special Emphasis Program for LGBT employees in order to improve employment and advancement opportunities, identify causes of discrimination, and increase cultural sensitivity in the workplace. The USDA’s nondiscrimination clause was amended to include discrimination on the basis of gender identity or expression.  And finally, they created the LGBT Rural Summit Series and the #RuralPride Campaign.

After the results of the 2016 election Agriculture Secretary Tom Vilsack was among the many Democrats who pointed to a lack of understanding and attention to rural voters as being a significant factor in the the election loss. He left the position on January 13th, leaving the post empty. The Agriculture Secretary was the last cabinet position to be filled by the Trump administration, and there was speculation that Trump would select a woman or a person of color to add diversity to his predominantly white cabinet.

On January 19th Donald Trump announced former Georgia Governor Sonny Purdue as his selection for Agriculture Secretary. Purdue is from the rural town Bonaire, Georgia, and is a somewhat unusual pick as in past decades the Agriculture Secretary has been from the Midwest. In a statement released by the Trump administration, he describes himself as "a simple Georgia farm boy". 

We can only speculate on what changes he is likely to make, but some predictions can be gathered from his actions as Georgia governor. As governor, one of his primary focuses was saving money for the state, so it is likely that many programs that saw their budgets increased will have them reduced to the level they were under the Bush administration. A devout Southern Baptist, Purdue once led a prayer for rain to end a drought in Georgia so his religious beliefs may have an impact on the priorities and choices of the USDA. The USDA web page with information on the LGBT Rural Summit Series has been removed, likely signaling that the program will be terminated. 

We may also see changes with regards to climate change programs. In 2014 he wrote an op-ed stating "Climate change, we’re told, is responsible for heavy rains and drought alike...It’s become a running joke among the public, and liberals have lost all credibility when it comes to climate science because their arguments have become so ridiculous and so obviously disconnected from reality." 

It has only been a month since Purdue was selected as Agriculture Secretary, so it is still uncertain what changes will be made. Perhaps the success of the civil rights reforms will mean that they are here to stay, as fewer complaints filed results in cost savings. Right now we can only wait and see. 

Saturday, February 11, 2017

The state of the opiate epidemic in rural America

The opioid epidemic in America is a widely acknowledged problem, and it disproportionately affects rural communities. Is it a public health problem, a legal issue, or both? And to what extent is the problem driven by circumstances particular to rural life?

Rural doctors acknowledge the difficulty of getting patients to physical therapy and rehabilitative care for their injuries, and often resort to prescribing opioid pain medicine instead. Their ability and their incentives changed drastically in the late 1990s as Purdue Pharmaceutical introduced OxyContin to the market, aggressively marketing it as a safe method of approaching an under-treated problem-- chronic pain. In 2001, the Joint Commission on Accreditation of Healthcare Organizations released a new set of guidelines mandating a much greater focus on treating pain than before in order for hospitals to receive accreditation. Sixteen years after the Joint Commission's revised pain guidelines, the unintended consequences for rural America are clear. Opioid overdoses, including those from users of heroin who switched from prescription pain pills, have increased the fastest in the rural states of Kentucky, West Virginia, Oklahoma, and Alaska. As the standards for prescribing opiates relaxed, rural areas suffered from an accelerating spiral of addiction, ending in many instances with the user switching from prescription pills to heroin, and ultimately incarceration or death.

The political will to enact legislative solutions has been haphazard. Politicians on the right and left cannot seem to agree whether to treat the problem as a legal issue or as one of public health. As many of the rural states hit hardest are run by Republicans, many of them have turned to well-worn tough on crime rhetoric that polices the boundary between rural and urban areas in the harshest way possible.

In rural counties, some prosecutors are turning to drug-induced homicide charges against heroin users who have provided heroin on which another person has fatally overdosed. In the far exurban orbit of St. Louis, rural prosecutors like Thomas Gibbons of Madison County, IL couch their use of the tactic in language of protection of family and place: "I fear for the existence of the county my sons grow up in.We intend to absolutely make an example of these people in public." The policy rationale of DIH charges is that prosecutors can leverage the threat of serious jail time to induce addicts to inform on their dealers. However, it is often addicts who procure drugs for a group and themselves overdose who are charged with this crime. By 'othering' addicts (see Gibbons use of the phrase "these people") and claiming that those charged are conspiring with non-locals, these charges alienate and exclude the addicts of these rural communities.

Right wing pundits and politicians are also visibly casting about for ways to characterize opioids and heroin as a problem 'imported from urbanity'. See Maine Governor Paul LePage's racist and demonstrably incorrect statement that the heroin problem in his rural state was mostly the fault of black city-dwellers.

Commentators who don't resort to the claim that opioid problems originate in the Hogarthian metropolis resort to familiar claims about personal responsibility and moral failings. See, for example, J.D. Vance's claim that heroin addiction in rural America is about misplaced priorities and a decline in community values. Or David French and Kevin Williamson's vitriolic one-two punch declaring that "The truth about these dysfunctional, downscale communities is that they deserve to die."

In contrast to these claims about the moral failings of the rural addict, public health literature provides a clearer-headed view. Recent writings on rural opioid addiction in the public health literature identifies a confluence of geographical factors that spur the phenomenon. Rural areas have high rates of opioid prescription for chronic conditions. Kinship networks can encourage diffusion of bad behavioral health practices. And opportunities are limited in rural areas, tending to produce mental health issues that coincide with addiction.

As Lisa Pruitt points out, people turning to drugs are a symptom of despair and malaise about declining prospects and downward mobility in rural areas. This theory does not locate the driver for addiction in either unsavory connections to urban spaces, like the Paul LePage characterization, or in poor personal character of some 'bad apples' who reject the traditional values of rural communities like the conservative commentators above. Viewing opiate overdoses as deaths of despair is all about structural pressures that reduce opportunity in rural places, combined with veritable spigot of easily available drugs.

Unfortunately, it's hard to tell what's likely to change in the next few years for the better. The Secretary of Agriculture for the Obama administration, Tom Vilsack, made big efforts to bring the rural opioid epidemic to the attention of Washington in the last years of his tenure. The new administration has been quiet on the issue, but if Mike Pence's foot-dragging attitude toward needle exchanges in Indiana is any indication, it might be a long time before these rural places get a public health approach that works.

Justice Without Lawyers?

Do you want to be a justice of the peace in Montana with the ability to send defendants to jail for up to six months? If so, all you just need to be elected and to complete a four-day “certification” course consisting of approximately 28 hours of study. In contrast to become a cosmetologist in Montana you must complete 2,000 hours of study or the equivalent of 71 times as much training as it takes to become a justice of the peace. Don’t worry, a law degree or even a bachelor’s degree are not required. For example, the justice who presided over both trials at issue in the recent Supreme Court case Davis v. Montana, Linda Budeski, spent 24 years as a cashier and meat wrapper at a grocery store and six years as a prevention specialist for a chemical dependency program before becoming Park County’s elected Justice of the Peace.

Last July, Kelly Davis and Shane Sherman petitioned the Supreme Court of the United States for certiorari in the case Davis v. Montana. Both were separately arrested and charged with driving under the influence in Park County, Montana and unsuccessfully moved for dismissal at trial. They argued that the proceedings violated their Constitutional rights to be tried by a lawyer-judge. Justice Budeski sentenced Davis to 30 days in jail and Sherman to 10 days. Davis and Sherman both appealed their sentences.

In their appeal Davis and Sherman argued that being tried by a non-lawyer judge was a violation of due process when incarceration is a possible penalty. The fundamental guarantee of the Due Process Clause is “a meaningful opportunity to be heard.” In North v. Russell, the Court recognized that once imprisonment is an available penalty, the process commands scrutiny under the Due Process Clause. This distinction is analogous to that drawn for the right to counsel, which attaches when a defendant may be imprisoned. Misdemeanor trials, where imprisonment is a possible penalty, require a legally trained judge. Similar to felony trials, they can involve evidentiary issues and constitutional questions that are difficult and complex. So the judge conducting the trial must be able to understand what the defendant’s legal counsel is talking about.

But in May 2016, the Montana Supreme Court upheld their convictions and the U.S. Supreme Court denied certiorari on January 17, 2017 leaving the practice of non-lawyer judges in place. This decision is consistent with the 1976 U.S. Supreme Court decision in North v. Russell, that the due process clause isn’t violated when “a criminal defendant is tried by a nonlawyer judge and the defendant has a right to a new trial before a judge who is a lawyer.” However, this case left open the question whether a defendant’s due process rights are violated when their only trial option is before a non-lawyer, like in Montana. Unfortunately, the Supreme Court did not take the opportunity to answer this in Davis v. Montana.

Residents of Montana are not the only citizens at risk of being tried by a non-lawyer judge. 22 states in America do not require judges presiding over misdemeanor cases to be lawyers. But in 14 of those states if a defendant receives a jail sentence from a non-lawyer judge, they have a right to a new trial before a lawyer-judge. In the remaining eight states—Montana, Arizona, Colorado, Nevada, New York, Texas, South Carolina, and Wyoming—defendants sentenced to jail for misdemeanors are not guaranteed a new trial before a lawyer judge. Montana removed that right in 2003 due to budgetary concerns. However, some of these states--Montana, New York, Colorado, Nevada, and Texas--only allow the use of non-lawyer judges in rural counties.

The tradition of justices of the peace dates back to United States independence from England. In England, members of the gentry, who were not usually lawyers, conducted criminal trials. Even though the U.S. lacked a gentry their justices were similar, “an enlightened citizen” who is “not necessarily versed in the knowledge of the law.” Critics argue that this tradition could be justified historically when lawyers and law schools were scarce, but today it raises issues with due process and the Sixth Amendment right to a fair trial. Non-lawyer judges gradually became less capable and necessary as legal education became more rigorous and standardized, technological changes allowed each courthouse to serve a larger geographic area, and criminal trials became substantially more complex. But have these problems really been solved in rural areas?

Today, rural America still has an egregious lawyer shortage. A 2013 New York Times article featured data indicative of the rural lawyer shortage. Only 2% of small law practices are located in rural areas, but almost one fifth of the population lives in these areas. As of 2013:
  • 65% of South Dakota’s lawyers live in four urban areas.
  • 70% of Georgia’s lawyers live in the Atlanta area.
  • 94% of Arizona’s lawyers are in Maricopa and Pima counties.
  • 83% of Texas lawyers are in Houston, Dallas, Austin, and San Antonio.
Unfortunately, this data has not improved since 2013. Very similar statistics were quoted for South Dakota, Georgia, and Arizona in a 2016 PBS interview. In 2016, nearly 70% of all American counties were considered small but only 2% of American lawyers practice in them. In Nebraska, 11 out of 93 counties still have no lawyers.

The lawyers who do live in rural areas must cover large geographic areas. For instance, Tim Brouillette, a rural Nebraskan lawyer, drives 40-100 miles at least twice a week to see clients.[1] He also travels to McPherson county once a month to serve as the county prosecutor. Brouillette attributed the shortage of rural Nebraskan lawyers to brain drain in rural America. As discussed in a recent blog post, young people often leave rural areas to achieve higher education and do not return. As a result, rural areas often have a shortage of doctors, dentists, and lawyers.

However, several states have implemented programs to attract rural lawyers. Nebraska is offering 15 rural high school students a year a full tuition scholarship and future admission to the University of Nebraska Law School. South Dakota created a Rural Attorney Recruitment Program which promises young attorneys $12,000 per year for five years if they move to a qualifying county with less than 10,000 people. These programs help young lawyers lessen their student debt, which may be a big inhibitor to moving to rural areas since they don’t necessarily get paid as well as urban lawyers. Texas has chosen to forgo incentivizing lawyers to move to rural areas and is instead connecting rural self-represented litigants with volunteer attorneys through videoconferencing.

I hope that these programs flourish and continue to spread across rural America. However, until the shortage of rural lawyers is solved, it is hard to see an end to non-lawyer judges. If rural areas cannot attract enough lawyers now, how can they have enough lawyers to replace all of the non-lawyer judges? Solving this shortage may mean utilizing technology like in Texas to give rural areas access to lawyers without lawyers moving there. Or it may mean more incentive programs like in Nebraska and South Dakota which strive to attract young lawyers worried about student debt.