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It Takes a Rural Community

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Garrett County, Maryland, wins a 2017 Robert Wood Johnson Foundation Culture of Health Prize for its multidisciplinary approach to a healthier community.


Part of a series.

Garrett County is the state of Maryland’s westernmost county. It’s in Appalachia, abutting both the West Virginia and Pennsylvania borders. The population is just under 30,000. The driving forces of the economy have traditionally been mining, quarrying, oil and gas extraction and agriculture, but in the summers tourists flock to Deep Creek Lake, and along its 69 miles of shoreline stand million-dollar-plus second homes and condos. 

Then there are those at the other end of the spectrum – those who work seasonal and/or low-wage jobs, living on the margin. 

“We have million-dollar homes here and lots of homes that are really very substandard,” says Bob Stephens. As Garrett County’s health officer, he’s concerned about health equity in his community. And he’s addressing that concern.  

Stephens is part of a multidisciplinary cadre of county residents who are taking action to improve the health of everyone in their community. It’s an effort that earned Garrett County a 2017 Robert Wood Johnson Foundation Culture of Health Prize.  

An ‘Asset-based Collaborative Approach’ 

In a February report, researchers at the University of Chicago’s NORC Walsh Center write that engaging “change agents” across multiple sectors in improving a community’s health is even more critical in rural areas than in urban ones.  

The fact is, in rural communities “interdisciplinary” is the way things generally get done. People tend to wear more than one hat. “There’s also often just that tight-knit community feel,” says Aliana Havrilla, “a strong asset-based collaborative approach that they’re bringing to this work addressing complex issues.” 

Havrilla is a community coach with the County Health Rankings & Roadmaps program, a collaboration of the Robert Wood Johnson Foundation and the University of Wisconsin Population Health Institute. Each year, the program publishes its County Health Rankings. Those rankings substantiate what Garrett County’s change agents already knew – that they have some significant health issues to tackle. 

Garrett County ranks 15th among Maryland’s 24 jurisdictions (23 counties and Baltimore City) in health outcomes and 19th in quality-of-life measures, which include the percentage of days people report poor or fair health and the percentage who report physically and mentally unhealthy days within the past 30 days. 

As Havrilla can attest, having worked with Garrett County in her role as a community coach, Garrett County is going about tackling its issues in the most effective way it can – as a community, leveraging it most valuable resources. 

‘Grown up Together’ 

“There’s a long history here of collaboration, of working together,” says Shelley Argabrite, the Garrett County Health Department’s strategic health planner. “We’re families that have grown up together and raised their kids together.” 

Garrett County’s community leaders recognize that health care involves much more than what happens in doctors’ offices, clinics and hospitals. They recognize, as the Walsh Center points out, that it involves a number of factors, including access to information to better inform health choices, quality education to expand opportunities, access to transportation and improving social connectedness. 

The county created MyGarrettCounty.com to collect data and improve collaboration.

Among the county’s most significant initiatives was building an online planning tool, MyGarrettCounty.com, designed to foster community participation. 

The Garrett County Health Department developed the tool to help its community create a shared vision based on data related to current needs.  

“The tool has helped us take collaboration to a new level,” Argabrite says, “to collect some hyperlocal data on some specific programs to look at their collective impact and be more responsive to the community and better engage the community. 

“It’s about being transparent, bringing more people to the table and trying to improve equity.” 

Priorities were set based on the county’s health needs assessment, and data was collected for six months, “engaging with the community about what really mattered to them,” Argabrite says. 

The planning tool has a feature called Action Groups that helps community members mobilize. It allows them to focus on a specific issue, “to choose one strategy and begin measuring their work together on that strategy,” Argabrite explains. “We’re collecting hyperlocal data and seeing some real differences.” 

MyGarrettCounty.com has been up 18 months. It’s logged 125,000 page views and hosted 35,000 sessions, with 20,000-plus users and 1,800 planners – planners being those actively engaged.  

The tool’s software was created in house. “This was developed by Shelley and another person in the community, both of whom were born here,” Stephens says. “They could have gone elsewhere but want to stay and help improve the community. 

“We’re really using our local human capital in order to do this.” 

Approximately $175,000 of competitive grant funding has been awarded to the health department by the Public Health National Center for Innovations, a division of the Public Health Accreditation Board, to replicate the tool and offer it to other communities along with technical assistance. 

Noah Manges stands outside Garrett College, a two-year public college in McHenry, Maryland. He benefited from scholarships offered to Garrett County students. For more than 10 years, county residents have been able to attend Garrett College tuition-free. Initiated to build the local workforce, the tax-funded scholarship program enables students to obtain an associate degree or certificate for trades such as welding, nursing assistant, apartment maintenance, truck driving, and mining. “We get letters all the time from people who say, ‘Thank you so much. It’s made a big difference in my life,’” says County Commissioner Jim Hinebaugh. (Photo via Robert Wood Johnson Foundation, rwjf.org)

Getting Ahead 

Across this rural community, people are mobilizing. 

Under the administration of the Garrett County Community Action Committee, and with support from the Annie E. Casey Foundation, the community has a 2-Generation initiative, taking a holistic approach to families’ needs. Among the services offered are early-childhood education, health insurance assistance, adult-education classes and career coaching – “helping them with whatever is preventing them from getting ahead,” Stephens says. 

The county also has a tax-funded scholarship program that allows all residents to attend Garrett College, a community college in McHenry, tuition-free.  

Then there’s the Learning Beyond the Classroom Bus, which visits the county’s more impoverished communities offering a library and learning games for kids and Wi-Fi and computers for adults.

Garrett Regional Medical Center’s affiliation with West Virginia University Healthcare has boosted health care. The medical center has reduced readmission rates through its Well Patient Program, which assigns a team of professionals to make sure patients have the resources they need to manage their illnesses at home. Last year, the community raised $4.9 million to open a cancer wing at the medical center. Previously, residents had to travel to West Virginia or Pennsylvania for cancer care. (Photo via rwjf.org)

Opting for Rec 

The Garrett Regional Medical Center has played a central role in this community-wide effort. Its Well Patient Program assigns a team of health care providers to make certain their patients have the resources needed to care for themselves at home – an initiative that’s reduced readmissions. 

Last year, the community raised $4.9 million to open a cancer wing at the medical center. Cancer patients previously had to travel to West Virginia or Pennsylvania for care. “It was an issue our community felt very strongly about,” Argabrite says. 

And when a debate arose over whether to fund a jail expansion or a recreation center, the rec center won out. Membership in the Garrett College Community Aquatic and Recreation Complex is available to everyone for a sliding-scale fee. It offers a free “I Can Swim!” program to every Garrett County kindergartner.  

“There again,” Stephens says, “it was a lot of groups coming together and collaborating, which again speaks to the nature of the community.”  

Though, like most rural communities, Garrett County has traditionally found it hard to keep its talented youth from moving away in pursuit of more and better opportunities, that trend may be turning. “People want to stay part of this community,” Stephens asserts, “and they know they need to work together for the betterment of the community.” 

‘Always Been Doing’ 

The authors of the Walsh Center report write that while rural culture is often characterized as an asset that can be leveraged to improve rural communities, sometimes the opposite is true.  

Sometimes, they write, “negative stereotypes and narratives of rural communities have made it difficult for some places to recover from economic downturns because those perceptions are internalized into feelings of hopelessness and worthlessness at the community level.” 

Not so in Garrett County.  

“Honestly, we look at one another and say, ‘Hey, this is what we’ve always been doing,’” Shelley Argabrite says. “I think there’s so much to the notion of belonging to a community, and all the positive health impacts that brings.” 

Bob Stephens says that when he looks at his county’s health rankings data – at rates of obesity and physical inactivity, for example – he recognizes there’s much work yet to do. 

“We look at the data and what resources we have, and the opinions of the folks in the community, and we try to rally around that. We want to systematically approach some of these things that have been so tough to deal with.” 


Key recommendations from the Walsh Center “Supporting Change Agents across Sectors to Improve Health and Equity in Rural Communities” report:  

  • Engagement of local conveners, organizations and networks.  
  • Forums for learning across rural communities to facilitate new ideas, dissemination of promising practices and networking.
  • Development of cross-sector advisory panels to inform rural implementation efforts.
  • Support for economic-development efforts to have upstream impacts on health and well-being.
  • Further study of formal and informal cross-sector networks and partnerships to understand how they can be mobilized for change.  

This article was originally published by Ohio Valley Resource.

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Rural’s Connection to Environment Means Bigger Climate-Change Impact

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Mainstays of rural American culture and economy – such as timber, agriculture, tourism, ranching, hunting, fishing, winter sports – could see major disruptions from climate change. The impact will be big enough to disrupt the national economy, a federal report says.

Rural communities face clear economic and environmental risks from a changing climate, according to the 2018 National Climate Assessment.  

The report documents changes in the timing of seasons, temperature fluctuations, increased incidence of extreme weather and change in rainfall – all patterns with the potential disrupt rural economic activities.  

Climate change in rural communities poses an outsized risk to the national economy, the report says. 

Although the majority of the U.S. population lives in urban areas, most of the country is still classified as rural. In this map, counties are classified as rural if they do not include any cities with populations of 50,000 or more. (Figure source: USDA Economic Research Service).

“Rural America’s importance to the country’s economic and social well-being is disproportionate to its population, as rural areas provide natural resources that much of the rest of the United States depends on for food, energy, water, forests, recreation, national character, and quality of life,” the report stated.  

While not all regions face the same impacts due to increased greenhouse gasses in the atmosphere, the assessment explains how increased volumes of carbon, methane and other greenhouse gasses in the atmosphere will lead to changing climatic patterns. The report’s authors predict that changes will likely increase volatility in agricultural commodity markets, shift plant and animal ranges, increase the number and intensity of droughts and floods, and increase the number and size of wildfires throughout the rural landscape.  

Tourism is often climate-dependent as well as seasonally dependent. Increasing heat and humidity – projected for summers in the Midwest, Southeast, and parts of the Southwest by mid-century (compared to the period 1961-1990) – is likely to create unfavorable conditions for summertime outdoor recreation and tourism activity. The figures illustrate projected changes in climatic attractiveness (based on maximum daily temperature and minimum daily relative humidity, average daily temperature and relative humidity, precipitation, sunshine, and wind speed) in July for much of North America. In the coming century, the distribution of these conditions is projected to shift from acceptable to unfavorable across most of the southern Midwest and a portion of the Southeast, and from very good or good to acceptable conditions in northern portions of the Midwest, under a high emissions scenario. (Source: National Climate Assessment).

For portions of rural America with an economy based on agriculture, climate scientists are most worried about shifting geographic suitability of particular crops and abnormal timing for planting and harvest. These changes may result in additional use of herbicides and pesticides, which could create additional health risks from chemical applications. Crop and pasture yields and profitability could also be affected by changes in rainfall, temperature and extreme weather events. Increased flooding could increase soil erosion and water pollution from agricultural runoff, according to the report.  

Rural communities with an economy based on recreation and tourism also face significant challenges due to climate change, according to the report. Rising seas could damage rural Florida’s multi-billion dollar recreational fishing sector and cause further ecological damage to the Everglades region.  

Coastal erosion and rising oceans throughout the nation could affect wildlife habitat, disrupting hunting, fishing, bird watching, and other wildlife-related activities. 

Rural places with significant winter recreation activities could face risks as snow-pack is expected to decrease.  

Forest-dependent rural communities are likely to face significant change as well. Forest geographies and species composition are likely to shift as the climate changes. The number of pests and disease will increase. These factors could decrease timber and pulp harvests in some places. Forest fires are also expected to continue to increase in number, intensity and cost.  

The report identifies certain demographic trends in rural communities that make climate change adaptation more difficult.  

“Modern rural populations are generally older, less affluent, and less educated than their urban counterparts. Rural areas are characterized by higher unemployment, more dependence on government transfer payments, less diversified economies, and fewer social and economic resources needed for resilience in the face of major changes,” the report states. That combination of an aging population with higher poverty rates increases vulnerability of rural people and places to changes in climate.  

“Emergency management, energy use and distribution systems, transportation and infrastructure planning, and public health will all be affected,” the study states. State, regional, local and tribal governments in rural communities tend to be under-funded and rely heavily on volunteers.  

“Even in communities where there is increasing awareness of climate change and interest in comprehensive adaptation planning, lack of funding, human resources, access to information, training, and expertise provide significant barriers for many rural communities,” the report concludes. 

This report is the fourth National Climate Assessment, and summarizes the impacts of climate change on the United States. The report process was established by the Global Change Research Act of 1990 and mandates that the U.S. Global Change Research Program (USGCRP) deliver a report to Congress and the president no less than every four years.  

A team of more than 300 experts guided by a 60-member Federal Advisory Committee developed the report. Scientists and researchers from federal, state and local governments, tribes and Indigenous communities, national laboratories, universities, and the private sector volunteered their time to produce the assessment. Information was gathered through a series of regional engagement workshops that reached more than 1,000 individuals in over 40 cities. Listening sessions, webinars and public comment periods also provided valuable input.  

This article was originally published by Daily Yonder.

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When Losing 14 to 1 is a Win — Sort Of

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Matthew Ferrence is a writer and college professor who ran a 14-day write-in campaign against an unopposed Pennsylvania state legislator. He got clobbered but finds something positive in the results. Photo: submitted by the author
A last-minute write-in campaign against an unopposed Pennsylvania state representative yielded 900 official votes. It wasn’t nearly enough to win, but it was enough to show that there’s more to Appalachia than the average TV pundit claims.
Well, I didn’t win. Let’s get that out of the way.But on the night of November 6th, 2018, after launching a last-minute zero-budget Green Party write-in campaign against an unopposed Republican incumbent, in a Pennsylvania district that perpetually votes at about a 70 percent clip for even Republicans who get absolutely blasted in statewide races (see: gubernatorial candidate Scott Wagner, soundly defeated by Tom Wolfe), I wound up making a nearly 5 percent dent.

The how isn’t quite as important as they why, I think, but in brief: exactly two weeks before the election, I announced on Facebook my intention to mount a write-in campaign for the Pennsylvania House of Representatives, disgusted that for the fourth time in seven elections, the local incumbent — Brad Roae — faced literally no competition. Nobody squared off against him in the Republican primary and nobody ran on the Democratic ticket. In fact, only twice in his tenure has he faced opposition from Democrats, each of them throttled to the tune of 60-40 or thereabouts in the general election.

As an even sorrier indication of the state of political engagement in the rural part of Northwestern Pennsylvania where I live, only once has a Republican ever challenged him in a primary. It’s smooth sailing every two years, which leads to a tepid, basic and uninspiring legislative track record. Taxes are bad, he says. And, oh, let’s have some laws to weaken environmental protections for gas well drilling. He has made public media posts that appear to equate school boards to Hitler, and he has argued that state funding shouldn’t support students who major in “poetry or some other pre-Walmart major.”

Yeah, that’s who I lost to, my 900 votes or so to his 13,000. And that’s the guy who has gone to Harrisburg for more than a decade representing my home. Among the many things that gall me about his incumbency is the way that, outside of Appalachia, a lot of people would probably nod their heads and say, yup. Brad Roae is the kind of representative people think Appalachia embraces, is the kind of person so many non-Appalachians see as purely representative of who we are and what we stand for.

But here’s the thing. I’m finding hope in my two weeks as a candidate, and in the sudden flurry of interest and support. I ran because there had to be some opposition for democracy to have any chance at all, and when I did so I hoped I’d get 1 or 2 percent, not embarrass myself, shoot for the bar of 300 votes. That would be the same number of votes I would have needed as signatures to get on the ballot had I, say, planned ahead.

Then a funny thing happened. I started making videos introducing myself and my ideas, and put together a platform paper, and people started sharing these materials on Facebook, and I had to work through the anti-Russian Bot regulations the social media site now has so I could finally “boost” two of those posts on the morning of the election, and even before all that the organic sharing of an electorate dying for something, anything, that pushed against Appalachian political stereotypes meant 9,000 people had seen my stuff. Then, even though people had to first know I was running and then actually bother typing my name in, I fared okay. I earned about 65 votes for each day of my campaign. And I spent $50 on stickers, $20 on my Facebook ads.

Brad Roae poses in the Pennsylvania House chamber with Pennsylvania dairy princess LeeAnn Kapanick. Roae has represented the 6th House district since 2007. The district covers parts of Crawford and Erie counties in the state’s northwest corner. Photo: Pennsylvania State Legislature webpage

Official county returns compiled right before Thanksgiving gave me 851 votes. The Monday following, I reviewed the official computations and found another 60+, if I include misspellings like Matt Terrance and, Michael Ferrence, and Matthew Fetterman (for a voter who maybe confused me with our Democratic Lt. Governor candidate John Fetterman), and That Guy Whose Name Starts With F, as well as The Guy on Facebook Ask (name redacted), as well as a litany of close-but-no-cigar last names coupled with Matt or Matthew: Ferrer, Ferraro, Fetter, Farreah, Ferrenc, Ferrous, Ferris, Ferentz, Ferrick, and DeFerence. I got 14 votes in neighboring state districts, and four votes for the U.S. House Race. Among other write-ins, I beat a slew of names that received a single vote or a handful, tough competitors like Brad Roae (who a few people wrote in, even though he was on the ballot), Stephen Colbert, Anyone But Him, Anyone Else, Jesus, God, and Red Breasted Nuthatch.

Look, my day job is writing and teaching. I’m a professor at a small liberal arts college, chair of the Department of English, writer and teacher of creative nonfiction. I was born in southwestern Pennsylvania, among the played out coal fields and strip mines an hour east of Pittsburgh. I earned a Ph.D. at West Virginia University, where I specialized in Appalachian literature. I wrote a memoir about my brain tumor, and the geology of the Allegheny Plateau, and the curious exile of inhabiting the weird position of Northern Appalachian, which means you’re not quite normal American and not quite Appalachian. None of that adds up to politician, but all of it adds up to frustration. I’ve spent most of my life, other than brief adult stints in Arizona and France, living in a region that skews way right, even as that right continues to exploit and degrade the people and place. All Appalachia ever has been allowed to be is exploited. That’s it. And that’s all the rhetoric of the GOP offers, when you boil it down. Let’s Make America Great Again, like when black lung wrecked lives on the regular and, newsflash, is now roaring back to life since the unions have been busted, and the economy of the region stayed busted, so the people crawled down into mines without the protections hard fought with blood and love by the striking workers of Blair Mountain, and the striking workers of Pittsburgh steel, and the striking auto workers of the Rust Belt.

Ferrence knocked on some doors and created a Facebook page to promote his campaign. He did several short videos to explain why he ran and discuss issues. Photo: Matthew Ferrence for PA House, District 6 Facebook page

Public historian Elizabeth Catte gets it right (she’s the author of “What You’re Getting Wrong about Appalachia”) when she argues that Appalachians have been socialists all along. They just don’t know it. They gathered together. They fought the power of industrial dominion. They powered America with their coal, yes, but they also fueled the national movement for respect and dignity for labor. Then the GOP figured out how to weaponize hatred and fear, and there you go. You get Joe Manchin, alleged Democrat. And you get a region that votes more than 2/3 for Trump and Trump-esque troglodytes like Pennsylvania’s GOP gubernatorial candidate Scott Wagner, who claims that global warming is probably just accumulated body heat from a larger human population or happens because the earth is getting closer to the sun, and campaigns by saying he’ll dance on the governor’s face while wearing golf spikes.

It boils down to this: I am so tired of waking up on November Wednesdays in Appalachia, seeing election results and, worse, national punditry that says this is all we are and all we’ll ever be. The election map of my state is bright red, other than around a few urban centers, just like most of Appalachia. That seems to translate to the same conclusion we get over and over and over again: dumb hillbillies voting for the worst. That conclusion seems to be supported by the simple math of our state politics, where more than half of state legislators run unopposed in their general elections, and our incumbency rate is about 90 percent. Few candidates ever put up a fight to change that.

So what’s an Appalachian creative writing professor to do? You run a last-ditch campaign. You tilt against the windmills in a manner that is both impotent (because you get crushed at the polls) and, at least for me, hopeful. Because having a choice, any choice, other than the incumbent mattered to the 2,000 people who either voted for me or tossed in a symbolic protest write-in. Because people stopped me when I walked by, and messaged me on Facebook, and were angry when they learned about the campaign only after they voted because, damn it, they couldn’t vote for the incumbent, and leaving it blank is just what the GOP has wanted for so long. The story of Appalachian politics has been about that blankness, a cultivation of the sense — and you can read this in almost every national outlet at some point in the last two years, usually with a quote from that faux-Appalachian pseudo-pundit J.D. Vance — that there’s nothing but right-wing fools in these hills and hollers. Appalachia is given up for dead again, this time just as a tarnished example of the hatred and backwardness of politics in this strange, strange land.

That’s just not how it is. That’s not the Appalachia I know nor the one I saw in my brief campaign. Heck, I ran this mini-campaign focused specifically on lefty sustainability, as in ecology and tree-hugging, as well as economies that stop repeating the boom-bust cycles of our past, and I drew a mighty good swipe of votes all at once, in the end. There are a lot of people in my county who believe in the value of the environment, and the necessity of fine educations, and the rightness of universal healthcare, and the imperative of social justice, and the glory of love in all its forms. There are progressives in these hills, you know. And a lot of them, but also a lot who hear those same old stories and worry about what the neighbors will think, so they don’t vote, or accept the inevitability of political monoculture. Thus the slam happens again. And again. And again. Unopposed Republican. Platforms of no taxes. Tacit acceptance of the Confederate Battle Flags that flutter on too many once-Union farmhouses.

Yeah, I got creamed. But I think we also won something that night. And we’ll keep coming back for more, riding a blue wave tinged with green, fighting for a change in the rural center of America that so many figure is lost forever. You know the joke, about Philadelphia and Pittsburgh and a lot of Alabama in between. Well, Alabama has a Democratic Senator, and so does Pennsylvania. We can do more, do better, push against the dogged stupidity of a right-wing cultural war that makes us all weaker and worse off. We can step into these races, and we can square off and say, hit me, and we can get hit, and eventually we can win. I know I’ll give it another shot – with my name printed on the ballot next time. I’ll need at least a couple of months next time, to get enough votes to be competitive, if history holds. But I’ll vow, and I hope others will too, that no one gets to run unopposed anymore. No one gets to spit out tired political bullshit and not get called out. This is our Appalachia too.

This article was originally published by the Daily Yonder

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There’s a Tool that Claims to Predict Potential for Criminal Behavior. Should PA Judges Use It?

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Allegheny County Courthouse in downtown Pittsburgh. Photo: Connor Mulvaney/PublicSource

The Pennsylvania Commission on Sentencing is considering a “risk assessment” tool, which, according to social justice activists, would reinforce existing bias in the criminal justice system. But the tool’s designers say it would give judges more data to base sentencing decisions on as opposed to primarily relying on uniform guidelines.

The commission is hearing public feedback about the risk assessment tool on Thursday, Dec. 13, from 10 to 11:30 a.m. at the Allegheny County Courthouse (436 Grant St., Pittsburgh).

How would the “risk assessment” tool work? Say you’re facing a criminal charge. In addition to the usual information about your present and past — as in the crime for which you are on trial and your prior record, if any — the judge also has a report trying to predict your future. On a scale from 0 to 18 points, an algorithm has indicated how likely you are to reoffend, based on data about recidivism rates.

Read more about how the risk assessment tool is used to calculate sentences from PublicSource.

This story was originally published by PublicSource based in Pittsburgh.

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