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Rural America

‘Cities v. Country’: Focus on Divide Means Rural Voices Go Unheard



Sarah Smarsh, left, was the keynote speaker at the Robert Wood Johnson Foundation's Life in Rural symposium in Charleston, West Virginia. Photo: Shawn Poynter/Courtesy of the Robert Wood Johnson Foundation

You probably wouldn’t suspect it, but journalist Sarah Smarsh’s dad’s favorite politician is Maxine Waters.

Nick Smarsh is a fourth-generation wheat farmer and lifelong construction worker from rural Kansas, Waters a decidedly liberal congresswoman from southern California.

Granted, Nick Smarsh isn’t likely among the majority of rural Americans in his unabashed admiration for Waters. But he’s certainly not alone.

Debunking stereotypes of rural America – as monolithic, as “Trump Country” – was a primary topic of conversation at the Life in Rural America Symposium held last month in Charleston, West Virginia, in conjunction with the release of the “Life in Rural America: Part II” report by NPR, the Robert Wood Johnson Foundation and the Harvard T.H. Chan School of Public Health from surveys of 1,405 adults living in the rural U.S.

The message emanating from Charleston was clear: Rural America is politically, racially and economically diverse. It’s the mountains of Appalachia, Midwest farmland, the Mississippi Delta, the Great Plains, Hispanic and Native-American communities scattered throughout the country, Mormon communities in the west. Out of that diversity come a myriad of narratives.

Sarah Smarsh, left, was the keynote speaker at the Robert Wood Johnson Foundation’s Life in Rural symposium in Charleston, West Virginia. Photo: Shawn Poynter/Courtesy of the Robert Wood Johnson Foundation

As keynote speaker at the symposium, Smarsh, author of the bestselling Heartland: A Memoir of Working Hard and Being Broke in the Richest Country on Earth, shared her father’s affinity for Rep. Waters. And she joined a chorus of speakers and other attendees in emphasizing the importance of hearing the many voices of rural America.

“A problem well-stated is half-solved,” Smarsh said of the issues rural Americans face today, quoting inventor Charles Kettering. But it must be articulated from within.

Narratives, if genuine, matter, she said. “Because the hell of it is, you can start believing in the lie about yourself.”

Debunking the Mainstream View

Certainly, symposium panelists acknowledged, there are issues common to the whole of rural America. Among the “Life in Rural America” report’s findings are that 64 percent of rural residents believe that better long-term job creation would be most helpful to their local economy, 61 percent believe that improving the quality of local schools would be most beneficial and 55 percent point to improved access to health care.

The report also suggests that the solutions lie within rural communities. While a majority of those interviewed in the survey acknowledged that assistance from the federal and state governments is required, more than half said they’re active in solving problems in their community – with younger adults reporting higher levels of participation – and two-thirds said their neighbors have helped them in times of need.

Ed Sivak, executive vice president of policy and communications for the Hope Enterprise Corporation, presented data that could help move rural communities toward equity. Photo: Shawn Poynter/Courtesy of the Robert Wood Johnson Foundation

“The way I look at it,” said Ed Sivak of the Mississippi-based Hope Enterprise Corporation, a nonprofit community development financial institution, “there ain’t nothing wrong in rural America that can’t be fixed by what’s going right.”

Smarsh spoke of the “promising picture” of rural America that she encounters in her travels – of people coming together as communities across political boundaries and “working in a space of what I would call localism, of, ‘How do we solve these problems locally, when we’re feeling sort of not only misunderstood but perhaps even scorned and scapegoated on a national level?’”

The story that’s told in the media about rural America, she asserted, is largely a false narrative. “There’s a great dissonance between the prevailing stereotypes and tropes about rural America and what’s actually happening on the ground,” she said.

“If you’re a cable news network, and you like conflict, and you want to whip up the idea of cities versus country – which drives up ratings and enforces some sort of unfortunate tribal identities – then you put up a map of the United States where each state is colored either red or blue, as though that monochromatic color would represent everyone in that state.”

In fact, Smarsh pointed out, in the 2016 election around 40 percent of voters in a majority of states selected the candidate who lost that state in the presidential election. “So we’re sort of rendering invisible millions of people when we use terms like ‘Trump Country’ and reduce regions to political monoliths.”

Local Talent   

Rural communities are staking claim to their future.

Ines Polonius, CEO of Communities Unlimited, Inc, a not-for-profit that provides economic-development assistance in southeastern states, said that community development should begin with a focus on assets, not deficits. This approach “begins to shift mindsets, and it begins to create hope.”

Polonius spoke of structuring “entrepreneurial ecosystems” that allow communities “to build their economies from the inside.”

“A lot of times what we find is that as we identify leaders that have really creative ideas and we bring them to the table, they’ve never been in a position where they’ve had the opportunity to lead,” Polonius said. “They’ve never had an opportunity to be in a room with other leaders and actually work together and work through implementation.”

Lisa Mensah, president and CEO of Opportunity Finance Network, a national association of community development financial institutions, or CDFIs, joined Polonius in a panel discussion of capacity building and advancing economic opportunity.

In a recent op-ed piece for The Daily Yonder, Mensah reported that 85 percent of the nation’s 353 persistently poor counties are rural. CDFIs, Mensah wrote, play a critical role in lifting rural economies. They have “proven experience and the conviction that decent housing, clean drinking water and life enriching community facilities and opportunities can happen in even the remotest and poorest areas.”

“We know how to solve problems in rural infrastructure, housing, banking, small business and healthcare,” Mensah wrote, and underscored in Charleston. “The solution is capital, resources and perseverance.”

Jen Giovannitii, left, president of the Claude Worthington Benedum Foundation, joined a panel at the Life in Rural symposium to discuss how rural communities can move toward solutions. Photo: Shawn Poynter/Courtesy of the Robert Wood Johnson Foundation

Jen Giovannitti, president of the Claude Worthington Benedum Foundation, which provides grant assistance throughout southwestern Pennsylvania and West Virginia, spoke of the importance of making disruptive investments in rural communities – by investing, for example, in CDFIs.

“Banks are not providing all of the services that we need for small businesses, housing and health care,” Giovannitti said in a post-symposium interview. CDFIs are making that investment.

She cited as an example investing in young family-practice physicians, dentists and pharmacists who want to settle in a rural community. They’ve accumulated enormous debt from their education and the cost of starting out on one’s own can be prohibitive. Banks consider them a poor risk.

Investing in those practices, Giovannitti said, is an investment in both the health and economy of that community.

“So this, for us, disrupts the system,” she said. These young health care professionals “might not be able to make that happen in a traditional setting. But these intermediaries,” the CDFIs, “can make it happen.”

A Seat at the Table

The well-stated consensus in Charleston was that the foundation for development in rural communities is capacity building and leadership training. But there then must be a seat at the larger table.

“One of the reasons why rural America doesn’t get the resources it needs is because it is not really at any of the tables where those decisions about rural America are made,” Brian Dabson, a research fellow at the University of North Carolina School of Government, said.

“We go through the motions of putting our arms around and saying we care for each other,” Dabson offered, “but that’s not the reality in the way the large-scale resources are allocated. It’s who’s got the power. And until we redistribute that power, then we’ve got to put a Band Aid over it and deal with it at the local level and take care of ourselves within that unfair context.”

Demanding “equal voice, equal power,” he said, is of the essence.

“We don’t want to be in denial,” Dee Davis, founder and president of the Whitesburg, Kentucky-based Center for Rural Strategies, said, “but we also know that you really can’t build a way forward unless you’re working with an understanding of your assets and lifting them up.”

He’d made a list of assets discussed throughout the day that he felt are “worth hanging onto.” Among them: diversity, family, heritage, humor, entrepreneurial spirit, common purpose, striving for a better world for one another’s children … that “the mountains are our grandfathers” (“I want to be a mountain for someone,” Davis avowed.) … “that we aren’t supplicants, that we have standing to negotiate” … “our connections in systems and connection in story.”

Davis was encouraged by what he’d heard and experienced this day.

“People are very certain of who’s going to make it and who’s not,” he said. “But we should be a little careful in making these projections, because there are a lot of balls in the air, and we’re not sure how they’re going to fall.”

Editor’s Note: The Center for Rural Strategies produces The Daily Yonder, a publishing partner of 100 Days in Appalachia.

Rural America

New Research Challenges Idea Behind ‘Deaths of Despair’



Photo: Pexels

Low-income Americans are dying at a higher rate than high-income Americans. In fact, the life span of low-income Americans is becoming shorter – a trend largely attributed to drug and alcohol-related deaths, which has been called deaths of despair.

“The least well-off Americans have seen their wages become stagnant, their jobs become obsolete, their neighborhoods crumbling in various ways. And so there’s a thought that that leads to despair for less-educated Americans and they turn to drugs or suicide,” explained University of Michigan professor Arline Geronimus.

Geronimus was the lead on a new study that argues higher rates of death among low-income Americans are due to inequity, not despair. She talked about her research in a conversation with West Virginia Public Broadcasting’s health reporter Kara Lofton.

Lofton: But your research actually challenges that theory [of despair], correct?

Geronimus: That’s correct. My theory doesn’t necessarily challenge that the increase is due in some way to the fact that life has gotten much harder. I mean, resources have gotten fewer, for the working class and for the least-educated Americans. But it challenges whether their response to it is despair, as opposed to working that much harder to make ends meet, to support their families, to overcome the obstacles in their way. 

There’s a rich literature suggesting that when you work so tenaciously against barriers or difficulties or trying to make ends meet or working multiple jobs, that [in] itself can lead to chronic physiological stress reactions in your body that over time cause wear and tear in your body and can lead to sort of accelerated aging, the early onset of a variety of chronic diseases, cardiovascular diseases, cancers. And so you might also see this increasing inequity in life expectancy if what was happening was people are working so hard and under uncertainty and hard conditions that it wears away at their bodies.

Lofton: So you’re basically pointing to research that shows that chronic stress can impact the body’s health responses. So how healthy somebody is, is impacted by their stress in their lives.

Geronimus: Right and also how chronic it is, or unremitting, the different kinds of stress people think of stress is sort of just a feeling. But it’s more than a feeling. It’s a biological reaction and it can be triggered by feelings. But it can also be triggered by environmental factors, toxins in your environment, by sleeplessness, by working night shift jobs, from anxiety about how you’re going to make ends meet, how you’re going to get food on the table, how you’re going to pay the expensive hospital bill. You know, people have this vague notion of stress, but the stressors I’m talking about, include that idea of stress, but so much more.

Lofton: So I mean, but let’s tease this out a little bit. If you are chronically stressed about how you’re going to get to work, and how you are going to put food on the table for your family. I mean, doesn’t that contribute to a sense of despair?

Geronimus: It can, but the distinction that I’m making is despair, first of all, is entirely a feeling. And especially if you talk about deaths of despair, and look to suicide and opiate overdose, and put those together, it kind of paints this picture of people who just give up and tune out – just unproductive and depressed – and either literally kill themselves or kill themselves over time – or take risks that could have killed themselves very quickly.

That’s a very different thing than what I’m talking about, which is engaging with tenacity and even kind of hopefulness, the difficult obstacles –  going to the two jobs, waiting for the bus, you know, not just going off and getting a drink. But that’s kind of what, in jargon is called “high-effort coping.” [It] itself can harm your body if it’s chronic. When the going gets as tough as it’s gotten for the least educated Americans over the last 25-30 years, if they choose to try to engage and support their families and themselves anyway, it’s sort of like batting their head against the wall.

Lofton: So you actually do talk about this quite a bit this idea of educational inequity and the role that educational inequity plays in sort of health disparities. Can you talk to me a little bit about that?

Geronimus: In our study, we looked at the least-educated Americans at any given time. So it’s not just [having] less than say, than [a] high school [education]. Because if [it] were, if you didn’t graduate high school 50 years ago, that might not be a big deal. But if you don’t graduate high school now, it certainly is, in terms of your opportunities. And over this period of time, because we’ve moved so much to a high-tech economy and an automated economy and a globalized economy, people with the least education are having the hardest time now finding jobs in our current economy. And even those who have them, and have had them even consistently, their real wages have stayed stagnant for 30 years, while prices of housing, food, health care, everything’s skyrocketed. So if your wages have stayed the same, your life is harder, even if you are employed.

Lofton: So what is the takeaway? What do you hope the study will contribute to the general conversation around the data that shows that Americans are not living as long as they used to?

Geronimus: That it shows that the main drivers of [death among low-income Americans] are cancers and cardiovascular diseases and internal causes. And that points in different directions than if you think people are despairing and taking drugs. And you would come up with different policies to address it. And as a researcher, we would pursue different avenues in researching it. And if in fact, it’s related to keeping on keeping on, even in the face of early onset of diseases and low wages and great uncertainty and illness in your family. That certainly points in directions that are different than ‘let’s just make sure we get opioids off the streets.’

This article was originally published by West Virginia Public Broadcasting.

Appalachia Health News is a project of West Virginia Public Broadcasting, with support from Marshall Health and Charleston Area Medical Center.

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Rural America

Q&A: Why We Need Better Reporting on Rural America



Journalists Sarah Smarsh and Ken Ward Jr. discuss the state of rural journalism at Robert Wood Johnson's Life in Rural America symposium. Photo: Shawn Poynter, courtesy of the Robert Wood Johnson Foundation.

Is there room to tell more complete stories about the diverse circumstances and perspectives in rural America? We better hope so, says Kansas native Sarah Smarsh, author of the bestselling memoir “Heartland: A Memoir of Working Hard and Being Broke in the Richest Country on Earth.” Smarsh speaks with veteran coal reporter Ken Ward Jr. about the relationship between good journalism, community health and our collective future.

Journalists Sarah Smarsh and Ken Ward Jr. have made careers out of telling complicated but compelling stories.

Smarsh is up for a National Book Award for her memoir “Heartland,” which examines her rural Kansas upbringing. Ward just received a MacArthur fellowship (a.k.a. the MacArthur “genius” award) for his long career covering the coal industry from its Appalachian epicenter in West Virginia.

Ward interviewed Smarsh in May in Charleston, West Virginia, at a national rural-life summit sponsored by the Robert Wood Johnson Foundation, a national funder of health-related projects. (Disclosure: The Center for Rural Strategies, which publishes the Daily Yonder, receives funding from the foundation.)

The reporters talked about American journalism’s portrayal of rural people and the need for Americans to build a more accurate and complicated understanding of rural communities and issues.

The following question-and-answer format article is based on that interview. It has been edited for length and clarity.


Journalists Ken Ward Jr. (Shawn Poynter courtesy of the Robert Wood Johnson Foundation.)

Ken Ward Jr.: You’ve been doing a lot of traveling around and talking to people in rural America. I sense that there’s a different conversation going on there [than we hear about]. What are people in rural America talking to each other about and talking with you about that maybe the chattering class needs to listen to?

Sarah Smarsh: The story that’s told about [rural places] is largely a false narrative, and there’s great dissonance between the prevailing stereotypes and tropes about rural America and what’s actually happening on the ground. If you’re a cable news network, and you like conflict, and you want to whip up the idea of cities versus country (which drives up ratings and enforces some sort of unfortunate cultural identities), then you put up a map of the United States where each state is colored either red or blue, as though that monochromatic color would represent everyone in that state.

Actually, in 2016, in just about every state, almost 40 percent, so almost two out of five people, voted for the candidate who lost in that state. So we’re sort of rendering invisible millions of people when we use terms like “Trump country” and reduce regions to political monoliths.

So ultimately, those maps I think are very misleading. When I’m talking to people on the ground, it is a much more promising picture than you would think from CNN or MSNBC. People are coming together as communities across even political boundaries and working in a space that I would call localism, like how do we solve these problems locally when we’re feeling not only misunderstood but perhaps even scorned and scapegoated on a national level?

Ward: I’m wondering is it really even appropriate to talk about one rural America, and to assume that farmland in Kansas and the people who live there have all the same ways of doing things, and thinking, and talking as people in the coalfields of southern West Virginia, or steel country in western Pennsylvania and Ohio? Is there room in this space for what could be lots of different rural Americas?

Smarsh: There had better be room if we want to understand ourselves accurately as a country. Unfortunately, the way the power structure works is whoever gets to set the narrative often has a blind spot to the spaces with less power. Sometimes, it’s with direct malice, but sometimes it’s just for a sort of ironic ignorance at the top that the story is told in a way that is reductive to a dangerous extent.

Of course, there’s not just one rural America. I happen to be a white, fifth-generation wheat farmer. I grew up on a flat expanse in the middle of a country. I happen to have been born into a sort of stereotype, in terms of imagery. My dad has been a construction worker for decades. He wears a hard hat, and he’s got a farmer’s tan, and he struggles to get dental care. We carry with us the symbols of rural America, and yet what those symbols would represent to someone about who we are, let’s say politically, would be actually the opposite of the way that my particular family votes and believes in things. My dad’s favorite politician, by the way, is [U.S. Representative] Maxine Waters [D-California 43rd].

Ward: What are the health concerns that you think rural Americans have, based on what you’ve heard in the places you’ve been or the place that you’re from?

Smarsh: I was just talking in Hutchinson, Kansas [population 42,000]. It’s only 30 miles from the farm that I grew up in [in central Kansas] They have a local health initiative called Heal Reno County. It was a beautiful evening, standing room only. One hundred people showed up to talk about this not very sexy topic of health.

Every single person in there, during the hour-long Q-and-A engagement, was saying, “Why isn’t our state expanding Medicaid?” This is so counter [to national media representations of rural]. A TV studio in New York would be stunned that that’s the line on the ground. Then I can just hear right now comments on some national news, at the bottom of the story, “Well, then why did they vote against it?” Or, “Why did they vote against their best interest?” That presumes, again, that this places a political monolith. What I try to tell people, when they want to cast an entire state or region in one particular way politically or culturally, “If you right now do not feel represented by our federal administration, then perhaps logically you can imagine that within the smaller political unit of a state, or even a county, or city, you could live there and not be represented by the people who are in office.”

Ward: How do you have a dialogue with someone who starts off with, “That’s what you get for voting that way”?

Smarsh: The first way that I come at any conversation about community progress is humility about not presuming that I know better than the person walking in his or her shoes. I come by that humility easily in the political sector because I was raised with somewhat different political views than I and my whole family hold now. I wasn’t a worse person then, and I’m not a better person now. I’m the same person with extremely different sets of information.

Journalists Sarah Smarsh and Ken Ward Jr. (Photo by Shawn Poynter courtesy of the Robert Wood Johnson Foundation.)

Ward: Where can we find information to better understand what’s happening in rural America?

Smarsh: I think that part of how we rectify this concern of different sets of information is local news, but it’s also the national news paradigm that increasingly… It’s like this perfect storm, where so much local reporting has fallen and not yet been built, even though there are great efforts going on to that in the digital era. The big dogs that were left are where people increasingly turn for all of their stories and narratives, and that is the national networks. If you’re sitting in your recliner in small-town Idaho, and somebody in New York is telling you a story about your place as though it’s the truth, this is sort of a disconnect. We have half the country watching Fox News and half the country watching MSNBC. While I’m all for increasing efforts on the local level, there is something that is so toxic in that top-level system being broken from the rest of the information sphere that that’s, I think, a bigger problem to contend with.

Ward: How does class figure into your work?

Smarsh: Actually, the first thing that I wrote that quote-unquote, went viral … was an essay called “Poor Teeth” about lack of access to dental care. It centered on my dad’s struggle. Well, my dad had a cavity turn into an infected root, and then ultimately it turned into sepsis, and almost killed him. In 2014, a lifelong construction worker has a nearly fatal bout with a rotten tooth, basically. That’s in the richest country on Earth.

So many people contacted me. Thousands of people sent me messages about that story that said that somehow that had never quite been articulated. I was thinking, “What in the world? How we are at this moment in our supposedly advanced society when people just haven’t even felt…” There is such a veil over the truth about economic inequality in this country, and the ways in which it intersects with race, gender and a whole bunch of other aspects of identity, that in 2014, all I did was articulate it, and then people were like, “I’ve never heard someone say this.”

The trick that we do socially and culturally to ensure that veil stays up has to do with shame. My dad felt ashamed to talk about his teeth and very bravely let me do so with his blessing, but when you’ve got to keep up these appearances, like, “This is bootstrap America and I’m getting by on my own,” that doesn’t leave much space for the vulnerability of, “And meanwhile there’s poison in my blood because I can’t afford a dentist.”

Ward: One thing that I struggle with is, to what extent some of these must-pull-myself-up-by-bootstraps sort of narratives are internalized and coming from us, and to what extent they are being overly reinforced by some national media portrayal?

Smarsh: I think that it is both coming from popular culture and news media, but it also arises from within the very community. That’s why I go back to why narratives matter and words matter because the hell of it is, you can start believing the lie about yourself. The way that this keeps us from progressing as a country is, again, we are dealing with things without looking right at some of the most glaring problems.

Ward: How is the way we tell stories important for matters of health?

Smarsh: I think when we talk about health, it’s easy to think of this as a wholly physical concern, but health and wellness, of course, as you all know, goes beyond that. There is something that I would call just a… I hesitate to use the word spiritual because I don’t necessarily mean that in any context that remotely involves God or religion. But if you just think of your being, your sense of your relationship to the world, the universe. If every story being told about you is that you’re backwards, ignorant, your community is dying, why don’t you just leave, and meanwhile, you’re doing the work of picking the lettuce in California or raising the wheat in Kansas that’s on the plate of the people who are carelessly levying those condescending comments, that is a bitter pill to swallow spiritually and psychologically.

I don’t know how to back this up other than my own lived experience. That has reverberations in the way of wellness and health, whether it’s that shame or a sense of not being validated somehow. It’s related to a general malaise and a need to self-medicate. The stories that we tell about ourselves and about specific populations within our country, they affect the wellness of those communities.

This article was originally published by the Daily Yonder.

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Rural America

Survey Report Reveals Disparities In Appalachian Subregions



This article was originally published by Ohio Valley ReSource.

A new report from the Appalachian Regional Commission shows that Central Appalachia lags behind other parts of the region in employment, household income and other key measures.

The data come from the American Community Survey, which is similar to the census and tracks county-level data over five-year periods. Researchers often use the survey to understand trends over time.

The Appalachian Regional Commission, which analyzed the ACS data, separated Appalachia into five subregions. In many key metrics, Central Appalachia, which includes parts of Kentucky and West Virginia, lagged behind other subregions.

Population, Income, Poverty

Appalachia as a whole has grown in population by 1.4 percent since 2008-2012, the last survey period, well below the national rate, but Central and South Central Appalachia lost population.  

Although the region’s poverty rate declined 3 percentage points since the last survey period, Central Appalachia’s poverty rate went up in the same time frame.

And Central Appalachia had by far the lowest median household income at about $35,862, while the region as a whole was nearly $48,000.

Central and South Central Appalachia lag behind other subregions in change in poverty rate. Courtesy of Appalachian Regional Commission

The trends will resonate with residents of Central Appalachia, who have long worried about working-age adults pursuing careers elsewhere, leaving a poorer, aging population behind.

Wendy Wasserman, a spokesperson for the Appalachian Regional Commission, said the survey did not analyze the causes or consequences of the data.

“What the report does show is a couple things,” Wasserman said. “As we know, Appalachia is not an entire region having the same experience from Northern Mississippi to Southern New York. There are variations across the region itself, and every region has its own challenges, its own opportunities, and its own way of being.”

New Data

The ARC analysis includes for the first time information on access to transportation, Internet and digital devices down to the county level. Because this is the first survey period to include that information, it is more difficult to draw conclusions about trends over time, but the data still reveals disparities across Appalachia that can help ARC and other grant-making organizations more closely target grant funding and other resources.

In Central Appalachia, where Kentucky’s failure to deliver high-speed internet access through the KentuckyWired project has drawn national attention, access to broadband internet stands at 64.3 percent, compared to the Appalachian average of 72.3 percent and a national average of 78.1 percent. A full 25 percent of Central Appalachian households had no access to any computer device, including a smartphone, well above the Appalachian average and more than double the national average, 12.8 percent.

In transportation, Central Appalachia was generally in line with the rest of the region in access to a vehicle, commute times, and percent of workers who drive to work alone.

Wasserman said ARC was hopeful the new data points on tech and transportation would serve as a baseline for future improvements.

Some Upsides

The report is not entirely negative. Although in many cases Central Appalachia lagged behind other subregions, Appalachia as a whole saw improvements in income and poverty metrics. Appalachian Kentucky saw the largest decrease of all Appalachian states in poverty among residents over the age of 65.

Education showed positive signs in new American Community Survey data. Courtesy of Appalachian Regional Commission

Wasserman said even though unemployment in Appalachia remains higher than the national average, it still went down across the region.

“High school [graduation] rates have been stronger, rates of degrees from community college are higher, graduation rates from Bachelors are better,” Wasserman said. “And that to me is exciting because that’s an indicator of optimism, as it were.”

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