A friend of mine recently called my attention to this excellent article in The Chronicle of Higher Education, not usually the sort of publication that one associates with societal analysis. But it’s comprehensive, it’s long, and it’s well worth the time.
The subject is the interconnection between poverty, education, and health in a rural Missouri town – Kennett, a town in the Bootheel, the seat of Dunklin County. I don’t remember much about Kennett from my childhood except that I think we drove through it once; it also had an excellent newspaper, the Daily Dunklin Democrat, locally owned, that we read and admired when I was working for the Journal-Banner. (It’s now just the Dunklin Democrat, published three days a week, and kinda-sorta locally owned.)
But Kennett is not the story here; Kennett is merely the example of a story which can be repeated a thousand times across the country. Rural poverty, rural despair, forgotten people whose sense of futility leads to addictive behaviors and self-harm.
What’s remarkable to me is that this story could have been written a hundred years ago. Read Hamlin Garland, read Sarah Orne Jewett, read Sherwood Anderson, and you’ll read these same stories from a different era, with only the superficial details changed. The intractability of rural poverty is a continuing theme in America.
In Sinclair Lewis‘ novels, the warping power of rural despair is portrayed as malevolent, and the smug inhabitants of Gopher Prairie are portrayed as co-conspirators in their own limitation. In the work of someone like Frank Norris, by contrast, the rural folk are helpless victims of larger forces, cruel fate or wicked industrialists.
I think it’s possible to be both villain and victim in one’s own story, as we see in the Chronicle article: people who know the self-destructive consequences of their actions but who do them anyway. The great dilemma of rural poverty is its self-perpetuating quality. Poor folks can’t pay much in taxes, so they are unable to finance the kinds of improvements that would attract industry or a wealthier strata of people; thus the roads grow ever more pitted, the hospitals scratch along with the barest of talent, the educational system strains for the minimum. Putting a dent in rural poverty requires outside intervention. That’s why the state legislators in Missouri (and elsewhere) who turned down the expansion of Medicaid for partisan reasons were so foolish: they were essentially condemning themselves and their own constituents to a cycle of degradation. As we watch the lights of rural hospitals blink out across the state and nation, making those impoverished areas even less desirable to live in (an inevitable consequence of the refusal to expand Medicaid), we can see the future of towns like Kennett. And it’s not pretty.
stevewiegenstein 
As I begin the monumental undertaking of writing a novel about my mother’s family, the Chronicle’s article and your comments put their story in a much larger context. That side of my family were dirt farmers in the countryside around Birmingham, Alabama, and “escaped” the brutality of that hardscrabble poverty when their father died in the 1919 flu epidemic and they were all six taken to the Masonic Home in Montgomery, where they lived until high school graduation. They did get off that dead-end and losing battle with the land, but the price they paid was very very high. There isn’t a good ending.
Dean, you put a wonderful personal touch on this issue. Best of luck with the novel!
I need to RTA (“read the article”), but I really appreciate your take on the situation, and the parallels you draw across eras. In the current situation, while it is almost a foregone conclusion that wealth continues to be redistributed upwards, some victims of regressive policy may be complicit in their own victimization (ie the Medicare example – indeed, Medicare’s fate seems increasingly dire).
But, what I really wanted to respond to is your hospital comment. Our two largest county hospitals have interesting histories. One got swallowed up by a corporate hospital based in a neighboring county. The other held out, ostensibly because it wanted to remain independent (I believe that to be true). It was drowning in debt, and eventually got bought by the NC university hospital system. I am keeping my eyes on how these hospitals fare, in terms of serving the population, and in comparison to national averages. But just thinking about it boggles my mind – healthcare is so complex!
You are certainly right that healthcare is incredibly complex! I think a lot about rural health care and the part it plays in community development. I grew up and have lived and worked in rural areas much of my life, and the two things people care about the most are medical care and the school system. If there’s a doctor, clinic, or hospital near, and if the school system seems well run, people are happy to put up with the other inconveniences of living in a rural area, and businesses feel confident establishing themselves. But if those pillars of society start to crumble, the area enters a self-fulfilling cycle of despondency. That’s why I think public officials have to do everything they can to to support these institutions if they truly want to promote rural prosperity.
My current congresswoman likes to tout how she “supports agriculture,” but if you look at her actual policy positions, it’s easy to see that she supports “agribusiness,” the multinational corporations that are rural America’s latest exploiter, and not the actual people who live in those small towns and farming communities.
Yes and yes. I would like to avoid tempting fate, but I will say that my experience of our rural county’s healthcare has been positive. I hope that we can move forward with supporting all people’s access to affordable healthcare options, and building habits that lend towards a healthy life.
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