As rural pharmacies are striving to provide more services to their communities, East Tennessee State University is working to get more pharmacists into rural communities.

For the past 20 years, ETSU’s Gatton College of Pharmacy has educated pharmacists in northeastern Tennessee. Recently, the pharmacy program received $2.5 million in funding from the Tennessee General Assembly, the first state assistance for the program since it was founded in 2005. The funding allowed the school to lower tuition for in-state and out-of-state students and offer additional scholarships. The funding also allows the school to further its primary mission — to improve lives in rural America.

Rural pharmacies are becoming a healthcare lifeline as  more than a third of all rural hospitals are facing closure, according to leaders in ETSU’s pharmacy program.

“Pharmacies are absolutely important in rural communities,” Ralph Lugo, associate dean and a professor in ETSU’s Department of Pharmacy Practice, said in an interview with the Daily Yonder.

“Ninety percent of the U.S. population is within five miles of a pharmacy. You cannot say that about all aspects of healthcare … there’s a significant shortage of primary care providers of all different types, and pharmacists play a key role in meeting the needs of the patients that are seeking healthcare.”

Located in south central Appalachia, ETSU is in the middle of a healthcare desert, according to the U.S. Department of Health and Human Services Health Resources and Services Administration.

As hospitals in rural communities close, pharmacists are changing their workflow and business models, Lugo said, to focus on providing more services. ETSU is part of that change, he said.

“We’re training pharmacies and pharmacists in the region to change a little bit of their workflow and their business model, to focus more on chronic diseases care and management, and to move away a little bit from the product and more toward the patient,” he said. “That’s a national initiative called ‘Flip the Pharmacy’ that we have been involved in over the past five years.”

Sponsored by Community Pharmacy Foundation, an organization focused on assisting community pharmacy practitioners, the Flip the Pharmacy program aims to move pharmacies away from prescription-level care processes and into patient-level care processes, the organization said.

The change in focus for rural pharmacies comes as many pharmacies, like many rural hospitals, are struggling to stay open. Many are independent small businesses, according to Jeffry Gray, associate professor of pharmacy at ETSU, and the strain of changing reimbursement systems, increased costs, and workforce challenges are adding to the difficulty of staying afloat.

“Pharmacies in general are under a great deal of assault — and that’s both financial and for the workforce, as well as other areas,” Gray said. “Rural pharmacies are carrying the burden of that much more. Pharmacies in rural environments … are escalating their non-dispensing services in ways they have not before. We often refer to that as transforming the pharmacy from what they used to be.”

Gray said pharmacists now help patients with providing essential services from testing and treating illnesses such as the flu, to providing flu and Covid-19 vaccines, to helping patients manage their chronic conditions.

But none of that is possible if there aren’t pharmacists in rural areas, they both said. To get more pharmacists into rural communities, the school looks first to rural communities to recruit students. Most of the school’s recruitment comes from within a 150-mile radius of Johnson City, Tennessee, Lugo said.

“We find that actually putting students back into the region, where pharmacists and pharmacies are most needed, is to recruit them from this region,” he said. “Our students that are from this region didn’t want to leave this region, and so it really spoke to the necessity of having a college of pharmacy placed in northeast Tennessee that serves the needs of the people in this region.”

Steve Ellis, ETSU’s assistant dean of student affairs, said that a third of its students come from rural ZIP codes. Coming from rural communities is a good indicator that they will go back to a rural community, he said.

“Certainly, our students go places nationally, but by and large, we really want to serve this region and get healthcare providers into those rural areas. We really firmly believe that starts with attracting people from those areas because that’s home for them. And they have an affinity built in to wanting to serve their community, their families, and the places and people that they know and are comfortable with.”

One Kentucky family exemplifies that.

In 2007, J.P. Ball from Somerset, Kentucky, graduated as a member of the school’s inaugural Class of 2010 and received his white coat. Upon graduation, he joined his family’s independent pharmacy, Burgess Drugs, in Sterns, Kentucky. He saw then, and sees now, his position as more than just a druggist.

“Rural community pharmacists do fill Rxs, but most folks in small rural communities trust the pharmacist’s advice and professional opinion as much if not more than any other health-care practitioner in those rural communities,” Dr. Ball said in an email interview with the Daily Yonder.

“Rural community pharmacists are respected and appreciated so much that patients will adhere to what we say even when they’re skeptical about a new medication from their provider.  We find ourselves reinforcing or backing up why they need that medication and why their doctor or the nurse practitioner started a new med, or added a new med, or changed meds.”

Last year, Ball watched as his son Kyhran walked across the stage at ETSU to receive his white coat, ETSU’s first legacy student pharmacist. Kyhran said he plans to focus on improving healthcare in rural and underserved communities as part of his career after he graduates, and to return to his home in Kentucky to work at the same pharmacy as his dad. The pharmacy has three locations now in Monticello, Whitley City, and Sterns, with plans to open a fourth near Somerset.

“Growing up in Whitley, I remember seeing the community interactions my dad had with people,” Kyhran Ball told the Daily Yonder. “Dad knows everybody and everybody knows him, and he genuinely cares for the people in his community. I’ve really looked up to him and wanted to continue caring for our communities.”

Being a community pharmacist means doing more than just selling prescriptions, he said — it’s an essential element of healthcare for those with limited access to doctors.

“Some people say a pharmacist is a more accessible healthcare provider,” Kyhran Ball said. “People come in and ask my dad for help, whether it’s for allergies or the flu or whatever, and he will treat them and send them on their way. … Calling a doctor can take so much more time. Sometimes, they’re booked up for weeks. But with a pharmacist, you can usually get in touch with them the same day.”

Ellis said helping other students find that rural connection is also key in helping pharmacies be successful in the future.

“In our rotation programs, we do have a lot of sites that are rural, based in southeast Kentucky, southwest Virginia, western North Carolina, certainly northeast Tennessee, so students are able to get exposure and see a lot of things that, quite honestly, are sort of ‘Aha!’ moments for them,” Ellis said.

“It’s eye-opening, because it’s not unusual for a student to enter pharmacy school with limited knowledge, based on a local drugstore dispensing medicine. But now, they’re really able to see a much broader role for pharmacists and pharmacies in all communities, but in particular within rural and underserved areas.”

Kyhran Ball said many of his classmates are dedicated to providing those services in small towns. While he wasn’t always keen to come back to his hometown, now that he’s seen a rural pharmacist’s impact, he’s up for the challenge.

“I know there are a lot of people in my class who are interested in rural and underserved communities,” he said. “At one point, I wanted to go to Nashville, but as I got older, I realized that wasn’t for me. When I did my 120 hours of pharmacist shadowing, I really got a sense of what a rural pharmacist does and how much they help people.”

The post Rural Pharmacies Are Transforming to Take on More Healthcare Responsibilities appeared first on The Daily Yonder.

A major storm took hold across swaths of the central and southern United States on Wednesday unleashing extreme flooding and huge tornadoes from Arkansas up to Michigan. And conditions are expected to worsen on Friday as soils become saturated and water piles up: The National Weather Service is warning of a “life-threatening, catastrophic, and potentially historic flash flood event,” along with a risk of very large hail and more twisters. Eight people are so far confirmed dead, while 33 million are under flood watches across 11 states.

While scientists will need to do proper research to suss out exactly how much climate change is contributing to these storms, what’s known as an attribution study, they can say generally how planetary warming might worsen an event like this. It’s not necessarily that climate change created this storm — it could have happened independent of all the extra carbon that humanity has pumped into the atmosphere — but there are some clear trends making rainfall worse.

“In a world without the burning of fossil fuels, this event would happen once in a lifetime — that’s kind of what the National Weather Service is saying,” said Marc Alessi, a climate science fellow at the Massachusetts-based Union of Concerned Scientists. “But with the burning of fossil fuels, with more heat-trapping emissions, with a warming planet, this event will become more frequent.”

Rainfall is changing because Earth sweats. When the sun evaporates water off Earth’s surface, that moisture rises into the atmosphere, condenses, and falls as rain. But greenhouse gases trap heat up there, so the planet sweats more in response. In other words, it strikes an energy balance.

A warmer atmosphere also gets “thirstier”: For every 1 degree Celsius of warming, the air can hold 6 to 7 percent more water. That means more moisture is available to fall as rain: This weekend, the slow-moving storm is forecasted to dump as much as 15 inches of rainfall in some areas. “The sponge, which is the atmosphere in this case, will become bigger, which allows the sponge to hold more water and carry it from oceans farther inland,” Alessi said. “That could be tied into this event here.” 

The body of water in question here is the Gulf of Mexico. An outbreak of tornadoes and heavy rain is typical for this time of year as warming waters send moisture into the southern and central United States. And at the moment, the Gulf of Mexico is exceptionally warm. “There’s a lot more fuel for these rain-producing storms to lead to more flooding,” Alessi said. (The influence of climate change on tornadoes in the U.S., though, isn’t as clear.)

So a warmer Gulf of Mexico is not only producing more moisture, but the atmosphere is also able to soak up more of that moisture than it could before human-caused climate change. Indeed, the U.S. government’s own climate assessments warn that precipitation is already getting more extreme across the country, as are the economic damages from the resulting flooding. That’s projected to get worse with every bit of additional warming.

The problem is that American cities aren’t built to withstand this new atmospheric reality. Urban planners designed them for a different climate of yesteryear, with gutters and sewers that whisk away rainwater as quickly as possible to prevent flooding. With ever more extreme rainfall, that infrastructure can’t keep up, so water builds up and floods. And with storms that last for days, like those tearing through Arkansas and Kentucky right now, soils get saturated until they can hold no more water, exacerbating flooding even more. On Thursday, rescue crews in Nashville, Tennessee were scrambling to save people trapped by surging water levels. 

Now scientists will have to pick through the data to figure out, for instance, how much additional rain the storm dropped because of the sponge effect and warming of the Gulf of Mexico. But the overall trend is abundantly clear: As the planet warms, it doesn’t always get drier, but wetter, too.

This story was originally published by Grist with the headline Did climate change supercharge the ‘once-in-a-lifetime’ storm pummeling the central US? on Apr 4, 2025.

Whitleyville, Tenn. (RNS) — On a sunny morning in mid-February, Josh Abbotoy, who describes himself as a “conservative Christian who does land deals,” drove a 20-year-old Lexus LX470 around a former farm, crossing a creek, squeezing by a run-down barn and driving along one of the farm’s roads in hopes of showing off the view from one of the ridgetops.

But there had been too much rain and the road was muddy, so he parked and hopped out for a 10-minute walk up to the ridgetop, admiring the red cedars and Bois d’Arc trees that line the hillsides.

At the top of the ridge, Abbotoy surveyed the view of the green fields and rolling hills while painting a picture of a community filled with lovely homes and families, looking down over wide fields and a stately church.

A month earlier, RidgeRunner, a real estate company Abbotoy runs, announced it had bought the 448-acre farm, with hopes of developing it into an “agrihood” — with about 30 estate-style homes dotting the farm’s hillsides.

“The fields will be filled with livestock as God intended and as Jackson County remembers,” the RidgeRunner website read in announcing the purchase. “Our goal will be to preserve the sweeping views for those who build and live on the farm’s ridgetops.”

Abbotoy said it’s too early to tell how much lots on the farm will cost but said there will be a premium for ridgetop views. A similar RidgeRunner project in Kentucky, where land prices are lower, has lots priced from $35,000 to $329,000. While the Whitleyville farm has access to city water, high-speed internet and electricity, there’s still a lot of work to do on the property’s infrastructure.

But if all goes to plan, within a few years the former farm property will be filled with conservative Christians who have moved from blue states to this rural corner of the Bible Belt.

It’s the Big Sort as a business opportunity.

A former corporate lawyer turned entrepreneur and Christian publisher, Abbotoy is fond of quoting journalist Bill Bishop’s influential 2009 book about how Americans increasingly live in like-minded clusters.

That trend has accelerated in recent years, fueled by the work-from-anywhere revolution set off by the COVID-19 pandemic and the country’s political polarization.

“It’s happening on all sides,” Abbotoy told Religion News Service during a recent visit to the farm in Whitleyville. “People want to live in communities where they have a better shot of having alignment on some really basic political issues.”

Rural Tennessee communities like Jackson County have begun to attract newcomers in recent years, according to data from the Boyd Center for Business & Economic Research at the University of Tennessee in Knoxville, part of an overall pattern of population growth.

“We’ve seen more migration to rural counties so far this decade than in the entire previous decade,” said Matthew Harris, a professor of health economics who does population projection for the state of Tennessee. For example, in Jackson County, more people left than moved in from 2010 to 2020. That trend has begun to reverse.

“A couple hundred people have moved there this decade,” he said.

Abbotoy, who grew up on a small farm in Hartsville about 40 miles west of Whitleyville, sees RidgeRunner as a chance to become part of a conservative gentrification of central Appalachia, where economic decline and brain drain have left communities just waiting to be revitalized.

“If you’re considering a move out here — maybe you live in Silicon Valley and you want to move out to the country,” Ab0atoy said, “we’ll be your Sherpa.”

RELATED: How a bucolic Tennessee suburb became a hotbed of ‘Christian Nashville-ism’

A graduate of Catholic University and Harvard Law School, Abb0toy lived for a few years in Boston before practicing corporate law in Houston and Dallas — then returning home. He’s now managing director of New Founding, which invests in “American ideals and a positive national vision” — of which RidgeRunner is a project — and the executive director of American Reformer, a digital publication that seeks to “promote a vigorous Christian approach to the cultural challenges of our day.”

As Forbes recently put it, New Founding is part of a growing movement of “anti-woke” venture capitalists hoping “to remake society with a largely MAGA, tech-driven, Christian worldview.”

Standing on one of the farm’s ridgetops, Abbotoy said he’s not a Christian nationalist, adding, “that’s not my project.” He also said he is not going to let anyone tell him who his friends or his customers ought to be.

“I’ve got customers that are more right-wing than me. I’m not going to talk bad about them,” he said. “I like them. They’re my friends. And I don’t screen their religious or political views any more than I would anybody else.”

Federal fair housing law prohibits that anyway, Abbotoy noted, but the presence of a church on the property will be a signal as to the kind of close-knit community he hopes to build here. Folks are also drawn to Jackson County, he said, because of its Bible Belt culture.

“Even if they’re not Christians, they like being in a community that feels like it’s culturally Christian,” he said.

The proposed church — or at least its pastor, Andrew Isker — has been a source of controversy among locals. Isker, a podcaster and author, relocated from Minnesota to Tennessee to start Whitleyville Reformation Church, which currently is meeting on an invite-only basis during its start-up phase. The congregation plans to build on the RidgeRunner property.

Isker, co-author of “Christian Nationalism: A Biblical Guide For Taking Dominion and Discipling Nations,” with Gab founder Andrew Torba, as well as the author of “The Boniface Option: A Strategy For Christian Counteroffensive in a Post-Christian Nation,” is known for promoting the idea that Christians should dominate American culture and for his criticism of Jews and other non-Christians.

In a podcast earlier this year with Texas pastor Joel Webbon, Isker rejected the idea of “Judeo-Christian religion” and blamed Jews for the rise of secularism.

“We have to be wary of them,” he said. “We have to not allow them to have power in our culture and destroy Christian culture.”

Isker, who did not respond to repeated requests for an interview, has described his move to Tennessee as a chance to live near friends and “laugh at each other’s jokes on our front porch.” But he has also characterized the move in political terms.

“If you were able to take even a few hundred people that all think the same way and have all the same ideas about common good and politics and so forth, and you can consolidate them in the same place, you can exercise far more political power, even with a few hundred or a few thousand people, than you can on your own, widely dispersed across the entire country,” he said in a video posted on social media by RidgeRunner.

C. Jay Engel, who co-hosts the “Contra Mundum” podcast with Isker, is a recent transplant to Tennessee from California who hopes to buy property from RidgeRunner.

“We love their understanding of how young American conservative families are finding new opportunities to live peaceably and productively among themselves, and I want to involve my family in this meta-trend,” said Engel, who has described the Civil Rights Act as government overreach.

Engel, who calls himself a “Heritage American” — which he has defined as affirming “the domination and pre-eminence of the European derived peoples, their institutions, and their way of life” —  declined a request to discuss his political or social views with RNS.

When Nashville’s News Channel 5 reporter Phil Williams reported on Isker’s and Engel’s political views and their ties to the RidgeRunner project, some residents were outraged — rejecting the prospect of these outsiders taking over their community.

Sean Zearfoss is among those concerned about the RidgeRunner project. Zearfoss, a traveling musician, lives in a house he renovated just off the town square in nearby Gainesboro.

“I like the rural community,” said Zearfoss, who also has a place outside Atlanta. “It’s tight-knit. It’s a nice quiet town, right at the Cumberland River in a really beautiful area.”

Zearfoss, who grew up in a conservative evangelical home, said he is fine with the community’s Bible Belt culture, even though his politics lean more progressive.

But the type of Christian nationalism he sees Isker and Engel promoting is a different thing, said Zearfoss.

“I see it like a steamroller trying to roll into town and roll over these people who want to live quiet conservative lives,” he said.

After the backlash to the Channel 5 report, Travis Thomas, a local Church of Christ preacher, decided to host Engel on his call-in YouTube show, “Truth with Proof.” There Engel got an earful from residents who were upset by what they’d heard.

One caller in particular cited Engel’s call to repeal the Civil Rights Act, which brought an end to Jim Crow laws in the South, and asked if he wanted to return to segregation. Engel said matters of race should have been resolved by the states.

“But I’m not for segregation, and I think it’s very harmful to the soul of a nation to participate in those things,” Engel said.

Thomas, a bi-vocational pastor, said Jackson County is still shaped by the Bible Belt, though folks don’t go to church as much as they used to.

“I think it’s a good thing when people move in, especially if they are going to hold to more biblical principles and morals,” he said. “And from what I’ve seen of the individuals that are buying the land, at least they do hold to some kind of moral principles.”

That’s different, he said, than if a group of extremists were building a compound in the area. It’s not like David Koresh is moving to the community, he said.

Thomas said he has also invited Isker to appear on his YouTube channel to talk about religion — and he had some advice for the newcomer.

“He says some of the craziest stuff on his podcast,” Thomas said. “I’ve even told him, you can’t just get on here and say anything on a podcast, because people are watching you. It sounds ridiculous.”

While he appreciates Christian values, Thomas said you can’t force religion on people. And as far as politics goes, Thomas said it’s good to vote, but the church isn’t going to gain power by politics.

“Even in local politics, you can only do so much,” he said. “It’s not like they can come in and take away your freedom of religion.”

Abbotoy, for his part, worries about the decline of American civil religion. What will bind Americans together, he wonders, in the way that Protestant religion did?

“I think every society, if it’s going to stay together, needs to have one,” he said.

That has led some of his friends — and potential customers — to wonder if America was better off when Christianity was more prominent. There are trade-offs and downsides to that kind of arrangement, he said. But those trade-offs are better than what we have now, he added.

“I think you’re seeing a lot of people who are not personally Christian,” he said, “saying, the arrangement we had where Christianity was dominant public orthodoxy was better than what we have now.”

Abbotoy seems to let most of the criticism roll off his back. RidgeRunner, he said, hopes to sell property to people who want to be good neighbors and not try to impose outside views on the local culture. At the same time, new people will be coming, and that will bring change.

“Change is coming,” he said. “The question is, how do you want to direct that?”

RELATED: Decline in American Christian observance has slowed, Pew study finds

(This story was reported with support from the Stiefel Freethought Foundation.

Kristina Reser-Jaynes can still recall a time when she’d never heard of school vouchers. Then, a few years ago, the Kickapoo school district in Southwestern Wisconsin that her daughters attend confronted a challenge all too common in small rural communities these days: a declining number of kids.

“I started looking into the causes of our declining enrollment and just trying to get better informed,” says Resar-Jaynes, 57, who grew up in this scenic corner of Wisconsin. “And this talk about vouchers kept coming up.”

Wisconsin is home to the oldest private school voucher program in the country—an experiment in which the state, starting in 1990, paid the private school tuition for 1,000 low-income children in Milwaukee. Today, the state spends more than $700 million toward the cost of private school education across the state, and communities like Resar-Jaynes’s are beginning to feel the effect.

During the 2023-24 school year, 11 students in the Kickapoo school district received a voucher to attend a religious school at a cost of $113,811 to local taxpayers, an increase of more than 400% from the previous year. Those numbers might not seem eye-popping, but in a pint-sized district with limited resources, the loss of a handful of students translates into program cuts for the remaining student body. And with vouchers in the state set to expand again next year, Resar-Jaynes says she fears for the viability of small rural districts like hers.

“In a little community like ours, the school is one of the few places we have left where we come together as a community,” says Resar-Jaynes. “We set aside our differences and we cheer on all our children in sports and in the arts. How can we allow that to be put in danger of being lost?”

Growing pains

That’s a question a growing number of rural communities face as private school voucher programs expand across the country. Sixteen states, beginning with Arizona in 2022, have now adopted so-called universal vouchers that allow virtually all families, no matter how wealthy, to use public tax dollars to pay for alternatives to public schools. In February, Tennessee and Idaho became the latest to join the voucher club. Texas, where Republican Governor Greg Abbott has made enacting vouchers his signature political cause, is the likely next member.

The programs go by different names and embody different approaches. Tax credit scholarships reward wealthy donors and corporations for contributing to private school “scholarship” groups. Traditional voucher programs allow parents to spend public funds on private schooling. Education savings accounts, meanwhile, function more like an education debit card loaded with tax dollars, which parents can use on a variety of education-related expenses. Whatever the specifics of the program, the goal is the same: to move students away from public schools and into private religious schools and to subsidize parents whose kids already attend them.

The project comes with the backing of some of the richest people in the country, including former Secretary of Education Betsy DeVos and hedge fund billionaire Jeff Yass, who together have devoted tens of millions to the cause of voucher expansion. It’s also a top priority of Trump officials, including Secretary of Defense Pete Hegseth, who has urged parents to pull their children from public schools in favor of religious homeschooling or explicitly Christian education.

The swift expansion of vouchers through red states reflects a major shift in direction by the school choice movement, which for decades has sought to build bipartisan support for the cause using the language of civil rights. Sensing an opportunity during the Covid-19 pandemic, voucher proponents embraced a sharply partisan strategy. In the name of “parents rights,” and with the aid of well-funded conservative groups including Moms for Liberty and Parents Defending Education, they leaned into explosive school culture war issues. Support for vouchers was now redefined as a “litmus test” for Republicans. Their first targets: deep red states where rural Republicans have long cast deciding “no” votes against voucher expansion.

That strategic shift has proven wildly successful. In one state after another, anti-voucher Republicans, almost all rural, have been defeated in GOP primary elections, swept out of office by a tidal wave of money from deep-pocketed pro-voucher groups. But knocking out rural legislators in states like Iowa, Texas and Wyoming, is not the same as eliminating long-standing rural opposition to vouchers.

In 2024, rural voters in three states—Nebraska, Kentucky and Colorado—sent a loud reminder that when it comes to spending tax dollars on private religious schools, they remain deeply opposed, despite Donald Trump’s embrace of the issue. In Kentucky, for example, opponents of a proposed constitutional amendment that would have allowed the state to fund “non-public” school options, warned rural Kentuckians that vouchers could force public schools in rural communities to close. One hard-hitting ad reminded voters of the lifesaving role played by their schools in the aftermath of the floods that ravaged the state in 2022. “Public schools saved us. It’s where everyone could find food and shelter.”

Rural voters responded, as voters in the state rejected the amendment by more than 60%.

Such lopsided results reveal a major weakness in the voucher movement’s strategy of targeting rural legislators. Knocking out GOP holdouts is one thing; convincing rural voters to walk away from their local public schools, even in our era of hyper-partisanship, is something altogether different.

Fighting rural decline

Lance Groves, 34, is a fifth-generation Texan on his father’s side. He grew up in the west Central part of the state near Possum Kingdom Lake, and today runs the family’s mechanical contracting business with his brother. Groves is also a passionate advocate for economic redevelopment in a part of the state that has long suffered from population decline and “brain drain,” as young people leave these small rural communities for more opportunities elsewhere. Now, those efforts are imperiled.

“The consequences of a voucher system in Texas would just completely wreck everything we’re trying to accomplish out here,” says Groves, who, with his brother Corey, started a documentary series called Rural Route Revival that chronicles the duo’s work to bring struggling Texas towns back to life.

Groves’s concerns extend beyond the state’s proposal to provide families—no matter their income—with $10,000 in order to pay for private religious education. His former state representative, Glenn Rogers, a large animal veterinarian who initially ran for office in 2019 out of concern that rural Texas was underrepresented in the state legislature, was one of nine Republicans to get primaried last year for opposing school vouchers.

Rogers ended up losing his seat in a rematch with Mike Olcott in a wildly expensive campaign that often had nothing to do with vouchers but instead focused on Rogers’s alleged failure to support Gov. Abbott’s border policy. “The other thing he said about me was that I consistently voted with Democrats,” recalls Rogers. “That was a 100 percent lie.”

Two years previously Rogers narrowly defeated Olcott, thanks in part to support from Gov. Abbott. This time Rogers opposition to Abbott’s education savings account plan made him a target. Olcott—who firmly supports Abbott’s so-called parental bill of rights amendment to the Texas Constitution—racked up endorsements not only from the governor but from Donald Trump, Sen. Ted Cruz and Texas Attorney General Ken Paxton.

As a result, this part of rural Texas no longer has an advocate for the public schools that serve as its anchor, says Groves.

“We lost a solid guy, a great rancher from a great family,” says Groves. “And for what?”

On the far western edge of the state, in the Panhandle community of Spearman, newspaper editor Suzanne Bellsnyder has been making the case to anyone who will listen that vouchers represent the latest round of disinvestment from rural Texas that has now been playing out for decades. In the competition for scarce resources, communities like Spearman (population 3,000) will inevitably come up short against their more powerful metro counterparts.

“The state of Texas already cannot fund public schools appropriately. Now we’re going to try to find a completely second system of public schools that only certain students are going to have access to,” says Bellsnyder. “You can see what happens next. There are not going to be enough resources to go around and our communities are going to be defunded.”

The Spearman schools are currently considering moving to a four-day school week, in part to save money, a shift that many other school districts in the Panhandle have already made. Bellsnyder fears that the loss of further state funds to vouchers will mean program cuts, staff layoffs and, ultimately, the closure of schools.

Recent evidence from other states that have enacted universal school vouchers shows that she is right to worry. In Iowa and West Virginia expansive new voucher programs are exacerbating the fragile math of funding rural education.

In West Virginia, the education savings account program known as the Hope Scholarship provides $4,900 per student to be used for private schooling, homeschooling, microschools and a broad range of education-related expenses. But West Virginia’s shrinking population also means declining student enrollment. Now a policy that essentially incentivizes students to leave public schools is exacerbating the numbers problem, resulting in multiple rounds of school closures.

“Most towns die after a closure of a high school,” said Charles Goff, mayor of Hundred, a town of 242 in Wetzel County, West Virginia, in an emotional speech to state school board members last year. “[Towns] lose incorporated status, lose elected officials in town, and it leads to fire departments closing and town charters being revoked. That includes losing EMS. We are an hour away from the hospital, and fire and EMS are crucial in our community.”

It’s not hyperbole. In their massive, first-of-its-kind survey of rural political attitudes, scholars Nicholas Jacobs and Daniel Shea found that rural schools play an outsized role in helping define the sense of place that is at the heart of contemporary rural identity. And decaying rural schools, trapped in the cycle of rising costs and diminishing revenues, can create a community death spiral. “A town’s demise can come in fits and starts over a long period,” they write, “but when the local school is boarded up, the death bells chime with a deafening resonance.”

Iowa Citizens for Community Improvement is A 50-year-old advocacy organization that rose to prominence during the farm crisis that rocked the state in the 1990s. These days, the group is sounding the alarm that threats to rural public schools are a threat to rural communities.

“Family farms and strong public schools were once the life blood of our rural communities in Iowa,” says Tim Glaza, special projects director for the group. But the state’s political leaders no longer seem to share that view.

Nearly 30,000 students in Iowa now receive state funding to attend private schools, thanks to a two-year old state voucher program. According to state data, 16 public schools, many of them rural, have closed since the voucher program began, while 36 new private schools have opened. While the overwhelming majority of students in the program never attended public school, even the loss of a few students can quickly translate into agonizing budget choices for shrinking rural districts, especially those for whom raising property taxes is a political non-starter.

The full impact of Iowa’s program, meanwhile, has yet to be felt. In its first two years, participation was limited by income. This year, those limits come off, meaning that the state will soon pick up the private school tuition bill for even the wealthiest families.

“The refusal to adequately fund schools combined with a voucher program that funnels public money to private schools is going to mean more school consolidation and closures, and more flight from our small towns,” says Glaza.

Backlash brewing?

The first two months of the second Trump administration has considerably darkened the prognosis for the nation’s rural schools. In addition to the state-run universal voucher programs reshaping education in red states, Trump and his allies are pushing for a federal voucher plan. The Educational Choice for Children Act (H.R. 833), introduced into Congress in January, would incentivize wealthy donors and corporations to donate to so-called scholarship-granting organizations in exchange for unprecedented tax breaks. Education secretary Linda McMahon has indicated that expanding private school choice is among her top priorities.

The federal approach would move vouchers into blue states as well as circumventing opposition among Trump’s own base. The lead sponsor of the legislation that would create a federal voucher program, for example, represents rural Nebraska, where his own constituents voted overwhelmingly last November to repeal a similar program. As one voucher proponent put it, “Rural voters have ‘emotional’ connections to their local public schools that are difficult to dislodge.”

Trump’s ongoing efforts to dismantle the Department of Education will also fall heavily on rural schools and the students who attend them.

Rural schools are highly dependent on Title 1, the 50-year-old program created to ease the nation’s vast school funding disparities. As education writer and retired rural education Peter Greene observed, rural schools are likely to take a double hit if the administration repackages Title 1 funds as block grants, which states then convert into voucher funds.

“Those districts will see a loss of funding and will have limited ability to replace those funds by raising local taxes. At the same time, they are not attractive markets for any high-quality education-flavored businesses,” writes Greene. “Those communities are more likely to end up with a ‘school’ aisle in their local Dollar General.”

The slash-and-burn-style budget cutting that is a hallmark of our DOGE era is also hitting rural schools hard. The Agriculture Department recently axed two programs that gave schools and food banks money to buy food from local farms and ranchers, halting more than $1 billion in federal spending. Even Trump’s effort to unwind his predecessor’s commitment to green energy could take a toll on schools.

In Missouri, where one out of three school districts have adapted a four-day week, largely in response to economic pressures, the only rural districts that still provide five days of school rely on taxes paid by wind farms. “When Trump and his Republican allies take aim at green energy, this is what they’re talking about,” says Jessica Piper, executive director of Blue Missouri and the author of the newsletter, View from Rural Missouri.

But if the emerging policy landscape looks bleak for rural education, funding cuts and school closures are also deeply unpopular among rural voters, including Trump’s most ardent supporters. Liv Cook spent years as a special education teacher in rural southeastern Tennessee. These days she works as public education campaign organizer for SOCM (pronounced “sock-em”), the Statewide Organizing for Community eMpowerment, statewide membership group founded in 1972 to organize grassroots resistance to mining companies and in the coalfield communities of the Cumberland Mountains. The group’s organizing work has since expanded statewide, including their #PublicSchoolStrongTN campaign to counter attacks on public education.

When the Tennessee Republican-controlled legislature adopted a $447 million universal voucher program in January, it was over the opposition of many rural communities, including southeastern Tennessee, says Cook. “Vouchers are now seen as a conservative value but there’s a big disconnect with these rural folks. They love their home schools and their teachers.”

Last year, when Tennessee Republicans floated the idea of refusing more than $1 billion in federal education funding over objections to expanded student civil rights protections, Cook spent months going door to door talking to voters about what such cuts would mean for local schools.

“When people learned that their elected officials were talking about less money for local schools they were shocked,” recalls Cook. “Everyone could list off the things that their local schools and teachers desperately needed, and finding out that the plan is actually to privatize and make a few people even more money, was just infuriating to them.”

SOCM was part of a sprawling coalition that fended off vouchers in 2024; they weren’t so lucky this time around. Still, Cook remains convinced that the unique tie between rural voters and their public schools offers a vehicle for not just resisting bad policies, but demanding approaches that strengthen rural communities.

“We ask our neighbors what they want their schools and their kids and the answer is ‘everything,’ ” says Cook. “That’s a powerful place to start.”

The post In Red States, Rural Voters Are Leading the Resistance to School Vouchers appeared first on Barn Raiser.

Dozens of people were killed across multiple states this week as Hurricane Helene swept across parts of the Southeastern United States, bringing heavy rains and a 15-foot storm surge.

Coastal towns and cities in Florida were devastated when the Category 4 hurricane made landfall, but communities inland bore a similar brunt as the storm carved a path through North Carolina, South Carolina, Georgia, and Tennessee.

“Turn around, don’t drown,” North Carolina Governor Roy Cooper urged drivers in a press conference. 

At least 42 people have died from the storm. As of Friday, Florida reported seven deaths. Georgia, meanwhile, reported 15, and South Carolina, 17. In both of the latter states, most of the known fatalities were from falling trees and debris. North Carolina reported two deaths, including a car crash that killed a 4-year-old girl after a road flooded. 

Atlanta received 11.12 inches of rain in 48 hours, breaking its previous record of 9.59 inches in the same time period from 1886, according to Bill Murphey, Georgia’s state climatologist. More than 1 million Georgia residents also lost power in the storm, particularly in southern and eastern parts of the state. 

In western North Carolina, officials sounded alarms and went door-to-door evacuating residents south of the Lake Lure Dam in Rutherford County after the National Weather Service warned that a dam failure was “imminent.” Emergency crews also conducted more than 50 swift water rescues across the region, with one sheriff’s department warning it could not respond to all of the 911 calls due to flooded roads. The North Carolina Department of Transportation warned on social media that “all roads in Western NC should be considered closed” due to flooding from Helene.

In Tennessee, more than 50 people were stranded on the roof of a hospital due to heavy flooding and had to be rescued by helicopter. Residents of Cocke County in Tennessee were also asked to evacuate after reports that a separate dam could fail, although officials later said the dam failure had been a false alarm. In South Carolina, the National Weather Service said the storm was “one of the most significant weather events… in the modern era.”

The hurricane’s widespread flooding was worsened by climate change, scientists told Grist. Hurricane Helene was an unusually large storm with an expansive reach. After forming in the Caribbean, it traveled over extremely warm ocean waters in the Gulf of Mexico that enabled the storm to intensify more quickly than it may have otherwise. In fact, Helene went from a relatively weak tropical storm to a Category 4 in just two days. Warmer air also holds more moisture, supercharging the storm’s water content and leading to more rapid rainfall and intense flooding. 

“When that enhanced moisture comes up and hits terrain like the Appalachian Mountains,” said University of Hawaiʻi meteorology professor Steve Businger, “it results in very, very high rainfall rates, exceptionally high rainfall rates and that unfortunately results in a lot of flash flooding.”

Shel Winkley, a meteorologist at the scientific group Climate Central, said research has shown that the Gulf’s current extra-warm ocean temperatures were ​​made up to 500 times more likely with climate change. “One of the things that we’re seeing with these big storms, especially as they seem to become more frequent, is that they’re no longer natural disasters, but that they’re unnatural disasters,” Winkley said. “It’s not just a normal weather system anymore.” 

Hurricanes are naturally occuring, of course, but the conditions that led to Helene’s severity — its rapid intensification and heavy rainfall — were partially driven by warmer ocean and atmospheric temperatures from the burning of fossil fuels. “There is a fingerprint of climate change in that process,” Winkley said. 

“This summer was record warm globally and there was a record amount of water vapor in the global atmosphere,” said Daniel Swain, a climate scientist at the University of California, Los Angeles, or UCLA. Both factors contributed to what the Southeastern U.S. experienced this week. “This is one of the more significant flood events in the U.S. in recent memory.”  

Initial estimates for the storm’s damage to homes, businesses, and infrastructure range between $15 billion and $26 billion, the New York Times reported. Businger said he expects the enormous loss to fuel more conversations about the precarity of the existing property insurance system. “The cost to society is becoming extravagant,” he said.

Scientists noted that the fact that the storm’s winds increased by 55 miles per hour in the 24 hours before it made landfall also made it deadlier.

“It was so strong and moving so fast it just didn’t have time to weaken very much before it made it far inland,” Swain said. Rapid intensification is particularly dangerous, he said, because people often make decisions on how to prepare for storms and whether or not to evacuate based on how bad they appear to be initially. 

“It was one of the faster intensifying storms on record,” Swain said. “This is not a fluke. We should expect to see more rapidly intensifying hurricanes in a warming climate.” 

This story was originally published by Grist with the headline After battering coastal towns, Hurricane Helene causes deadly flooding across five states on Sep 27, 2024.

Bridging Access:

Across rural America, communities of color may be facing barriers to health care, but they’re also laying the groundwork for a more equitable future. Whether it’s hospitals reopening, a community’s holistic approach to maternal care, or the grassroots work to bring comprehensive  services to immigrants, these stories offer a road map. This story is part of a collaborative reporting effort led by the Institute for Nonprofit News’ Rural News Network, with visual support from CatchLight.  Photo credits: Ariel Cobbert and Aallyah Wright.

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BROWNSVILLE, Tenn. — On a late evening in 1986, sharp pains hit Alma Jean Thomas-Carney’s stomach like lightning.

Days earlier, she’d just returned home to Brownsville, after dancing all weekend at her high school reunion hundreds of miles away in Illinois. Maybe that’s where the pain originated, she thought.

She cried profusely to her husband to take her to a hospital. But not the local Haywood Park Community Hospital, a 62-bed facility built in 1974.

“Please don’t take me up there. Don’t take me up there,” she pleaded. He rushed her to the car and drove to Jackson, Tennessee, nearly 40 miles away.

When she arrived at the hospital in Jackson, she underwent exploratory surgery. They found cysts on her ovaries, a diagnosis she says she wouldn’t have gotten at Haywood Park.

“I didn’t trust I would get the proper care or care that would help me to survive,” she told Capital B.

Years prior, she experienced an unwelcoming environment from white staffers, including doctors, at Haywood Park. Upon entry, she’d walk to the reception desk, only to be ignored or met with unpleasant looks. 

“They acted like you were invisible,” she said. “Whether they were talking or drinking coffee, they kept doing whatever they were doing and didn’t pay attention to you.”

Haywood Park’s reputation deteriorated over the years. Some residents voluntarily drove elsewhere if they could, or went without critical care, which contributed to low patient volume. Many more reasons, such as financial instability, resulted in its ultimate demise.

The hospital closed in 2014, after a long, slow decline. But, the news saddened the community, including Thomas-Carney. “Despite my ill-feelings or experiences I had in that environment … you have indigent people living in Haywood County who need to get to the closest facility available.”

From 1990 to 2020, 334 rural hospitals have closed across 47 states, which disproportionately affect areas with higher populations of Black and Hispanic people. Since 2011, hospital closures have outnumbered new hospital openings. In Brownsville, they’ve been able to do the impossible: reopen a full-service hospital. They’re not the only ones. 

Less than three hours away in the heart of the Mississippi Delta, leaders in Marks reopened their facility in 2021, after a five-year shutdown. In neighboring Georgia, county officials received millions in congressional funding to reopen their hospital in Cuthbert, which closed in 2020. Currently, they’re researching what model is feasible for their town. 

When a rural hospital closes, there’s usually no turning back. Yet, Brownsville became an outlier two years ago and is part of a growing but short list of hospitals in rural counties that have been able to fully reopen. What’s happening in this 68% Black town of 9,700 people is quite uncommon, health experts say. Usually hospitals cut back or reduce services, such as obstetric departments, to keep their doors open. The most recent alternative to prevent closures include the Rural Emergency Hospital designation, a new model established in 2020 that eliminates in-patient beds but keeps an emergency department in order to receive a boost in federal support. At least 29 rural hospitals have converted to rural emergency hospitals, according to Becker’s Hospital Review.

While this is a fix for some, it may not be the most viable for others, experts say. 

“Once you’ve seen one rural community, you’ve seen one rural community; they’re very different. We understand that not every rural hospital that is struggling will benefit or will want to convert to this rural emergency hospital,” said Shannon Wu, senior associate director of payment policy at the American Hospital Association. “We see this as a tool in a toolbox for those that fit their community needs.”

Why the distrust runs deep 

Thomas-Carney lost faith in the local health system long before the establishment of Haywood Park 50 years ago.

As a kid, she witnessed her grandmother lying in a hospital bed in the basement of the Haywood County Memorial Hospital, a 30-bed facility built in 1930 during Jim Crow. Steel pipes followed the linings of the walls. The sounds of steam echoed in her ears.

“I just remember looking around, and it didn’t look like nothin’ that I had seen in a book about a hospital,” she explained. 

Thomas-Carney’s grandmother’s experience was not uncommon, as most Southern, white-run hospitals refused to accept Black patients. The few that did placed them “on inferior Black wards, often in the basement, and usually with no separation by disease process,” writes historian Karen Kruse Thomas. 

Kruse Thomas details how prior to World War II, hospitals in the South were racially separate and Black patients mostly went to all-Black hospitals, if they had one. Few and far between, Black hospitals were unaccredited, underequipped, and struggling to remain open. 

In the 1940s, the federal government began to address hospital segregation through the Hospital Survey and Construction Act, known as the Hill-Burton Act. At the time, the South had the highest population of Black folks with the worst rates of morbidity and mortality. In 1938, the surgeon general called the South “the number one health problem in the nation.”

Today, the health disparities can be described the same. 

Black people still experience higher rates of disease, chronic illnesses, and mortality in comparison to their urban counterparts. In Tennessee, Haywood County has higher percentages of adult diabetes, obesity, and overall poor health in comparison to the state and national averages. 

Unfortunately, where you live dictates your health and the type of access you have.

Only recently did a study in the National Library of Medicine distinctly spell out that structural racism — in addition to poverty, education, and environmental conditions — is a major contributor to why such health disparities continue to persist.  

“In rural areas, especially in the South, it is important to understand how institutional policies, such as the Jim Crow laws that segregated hospitals and neighborhoods, led to differences in resource allocation between white populations and nonwhite populations, which may impact healthcare access today,” the study’s authors noted. 

Greta Sanders, a Brownsville resident, recalled how Eva Rawls, a Black registered nurse who worked at Haywood County hospital, was forced to work under the supervision of white women who were licensed practical nurses, even though she was the superior.

That hospital closed in 1974, the same year Haywood Park opened.  

“When [the new owners] found out that a registered nurse was working underneath the LPNs, they were just blown away,” said Sanders, a retired lab technician who worked at Haywood Park. “When the white LPNs had to start working under her supervision …  they did not like it.” 

Advocacy for critical and preventive care isn’t enough

Many residents in Brownsville — the birthplace of the Queen of Rock ‘n’ Roll, Tina Turner — have received life-saving care at the local hospital. 

One of those people: the wife of John Ashworth, a local civil rights activist and historian who co-runs the Dunbar Carver Museum with Thomas-Carney. Some time ago, Ashworth’s wife got stung by a bee. By the time she arrived at Haywood Park, her blood pressure was extremely high. They immediately admitted her and stabilized her.

“I have mixed emotions, but I really think it was a good hospital,” Ashworth said. “I am absolutely convinced that my wife would not be alive today if that hospital had not been there at the time.”

Ashworth believes some deaths could have been prevented had the hospital been open. 

Fed up with the poor health outcomes in his community, William “Bill” Rawls Jr. ran for office. He became the first Black mayor in Brownsville in 2014. Before he could celebrate the win, the hospital closed its doors for good. 

So, he thought.

Rawls set out on a mission to work with Michael Banks, a local attorney, and county officials to bring back the hospital. Like many small towns, the train tracks here still represent a divide, a symbol of racial segregation.

While Banks worked to find quality suitors for the hospital, Rawls started the Healthy Moves Initiative, a health education and preventive care effort. He hosted health fairs, quarterly free wellness screenings, built walking trails and a dog park, and created a farmer’s market. But, it didn’t create the impact he’d hoped for. 

It’s still a work in progress, he says, but the challenge is getting more participation.

Two years after Brownsville lost its hospital, Marks, a small town in the Mississippi Delta, did, too. The closure of the only critical access hospital in Quitman County resulted in the loss of 100 jobs. Similar to Brownsville, limited health care access resulted in longer waits to receive emergency and medical assistance.

Six months later, the Black town of 1,600 people lost its only grocery store.

During this time, Velma Benson-Wilson returned to her hometown after 20 years in Jackson, Tennessee. It started as frequent trips to conduct research to write What’s In The Water?, a tribute to her mother. She stayed a bit longer to work as a consultant on cultural tourism for the county, particularly the construction of the Amtrak project and memorializing the history of the Mule Train, which kicked off the late Martin Luther King Jr.’s Poor People’s Campaign.

But, the health crisis and food desert in Marks motivated her to dig deeper. 

Wilson became the Quitman county administrator, the first Black person and female to serve in the position. After she helped close the Amtrak deal in 2018, she turned her focus to the hospital and worked with the county supervisors to find a solution.

After working to save a hospital in Holly Springs, roughly 90 minutes from Marks, Quinten Whitwell, an attorney from Oxford, and Dr. Kenneth Williams, a Black physician, launched Progressive Health Group to keep rural hospitals from closure across the South. 

Five years after the Marks hospital closed in 2016, its Certificate of Need was set to expire. The legal document was required to reopen, establish or construct a health facility.

Whitwell, in quarantine, worked with his team on a plan to get it approved by the state.

Manuel Killebrew, president of the Quitman County Board of Supervisors, said that state Democratic Sen. Robert Jackson passed legislation to help reopen the hospital. Soon after, in 2021, the county supervisors voted to reopen the hospital in partnership with nearby Panola Medical Center in Batesville, Mississippi. The county gave Whitwell’s group a loan, and Citizen Banks of Marks gave a $1 million donation to reopen the facility as Progressive Health of Marks, a critical access hospital. The same year, a local entrepreneur opened a new grocery store across the street from the hospital.

The hospital has a walk-in clinic, emergency room, radiology department, and several other services, such as telehealth, according to Mejilda Spearman, the administrator for the Quitman hospital. They currently have four in-patient beds and are currently renovating their senior care unit. They’ve hired fewer than 50 people. While they’ve seen a steady increase in patients since, they still struggle to get community support. 

But, some residents still aren’t satisfied, Killebrew added.

“There’s still people who gripe, but the hospital here is the closest place to get medical treatment,” he said. “If one of their loved ones were shot or had a heart attack, they get here, and at least they’ll survive.”

A Georgia community gets a second chance

Despite low support in Marks and Brownsville for a hospital, residents in Cuthbert, Georgia, have prayed for more health care options in their predominantly Black community of fewer than 3,100 people.

The Southwest Georgia Regional Hospital in Cuthbert, the county’s only hospital, closed at the height of the COVID-19 pandemic due to increased costs from aging infrastructure and underinsured and uninsured patients. Officials added that the inaction of Medicaid expansion in Georgia also contributed to the closure in Randolph County, which is majority Black. 

Before the hospital closed, some uninsured residents relied on the emergency room for primary care. Now for emergencies or other care, many travel 30 minutes to Eufaula, Alabama, or nearly an hour to Albany, Georgia, said Cuthbert Mayor Bobby Jenkins. 

Minnie Lewis, a retired educator, travels to Albany and Columbus frequently for appointments and would love to eliminate the additional time it takes for roundtrips there.

“In fact, I just had a health scare, but I had to go to have a CT scan there. Then I had to go to Sylvester [Georgia] to a hospital there because they didn’t have enough space there for me for that particular thing,” she said. “I would have had that CT scan right here in Cuthbert, if it was open.”

When the hospital closed, the doctors left, too. Until about a year ago, the town had no doctors, despite Care Connect, an urgent care clinic, opening immediately after the hospital closed in 2020. Jenkins and residents hope the draw of a hospital will bring more jobs, affordable housing, and food options into the town, which is racially divided.

“With the white there and the Black here, you can’t get nothin’ done. We don’t go to church together, but at least we can have some common ground when it comes to the community and for the betterment of all the citizens,” said Cuthbert council member Sandra Willis. 

The hospital is the only issue that they’re united on, she says. The majority Black county commissioners, all-Black city council, and Randolph County Housing Authority have worked together to figure out a solution.

They’ve been able to get the attention of their state and federal officials. After four years, they have a plan.

Earlier this year, U.S. Rep. Sanford Bishop and Sens. John Ossoff and Raphael Warnock requested congressional earmarks to develop and reopen Southwest Regional. They secured more $4 million from the USDA Community Facilities Program and more than $2 million from HUD for the Randolph County Hospital Authority to move forward, according to a spokesperson in Bishop’s office.

There’s no date for when a hospital, or some version of it, will be reopened in Cuthbert. Will critical access, rural emergency hospital, or freestanding emergency department work best? County officials contracted with a third-party to conduct a feasibility study to decide what route to go with the hospital.

“What we hope is to have an emergency room so we can get ‘em stabilized,” State Rep. Gerald Greene said in a phone call. “We’re hoping this is going to work, but we’ll have some [inpatient] rooms. That’s our plan.” 

‘True systemic change is a grassroots effort’

In Brownsville, it took six years to find a solution. In attorney Banks’ eyes, it was all “pure luck.”

On a recent tour of the hospital, Banks — who is now CEO of Haywood County Community Hospital — pointed out a bed that displayed colorful LED lights with symbols, advanced technology that checks oxygen levels, weight, and heart rates.

“If a [patient] gets too close to the edge, the alarm goes off. So, the nurse at night – rather than waking someone up – they can come out and look at those lights.”

He credits Braden Health, the hospital management group that took over the hospital. As counsel for Haywood County, Banks would take prospective buyers on “a tour with a flashlight” because the building was boarded up. None of the deals panned out — until 2020 when they met Dr. Beau Braden, an emergency medicine specialist and co-founder of Braden Health. The county officials agreed that Braden Health could take if they improved the property and ran the facility as a full service hospital. 

Two years later, they reopened Haywood Park Community Hospital, under a new name: Haywood County Community Hospital. They downsized to nine in-patient rooms and have a staff of 80 employees, all from Brownsville or neighboring communities.

In addition to an emergency room, they have an urgent care walk-in clinic, pharmacy, mammography, ultrasound, and radiology department. Despite the new infrastructure and quality, Banks averages about five patients a day, and about 25 patients in the ER. But, there have been times when they’ve had to send patients to other facilities because they are full, he said.

Residents stop by often for the handprint ceramic tile wall in the main entrance of the hospital. In the 1990s and early 2000s, kids in Brownsville painted these tiles. Many people come back to find their handprint. They built a conference room so local organizations can meet. They also eat at Annie Mae’s Cafe, a soul food restaurant in the hospital named after Tina Turner and run by two local cooks who lost their restaurant during the pandemic. 

Banks, the mayor and residents, are optimistic about the hospital’s future. In fact, they’re planning to expand, adding things like a physical therapy section. They expect more traffic, especially with the opening of Ford’s Blue Oval mega facility.

“Ever since we opened the inpatient side, we’re breaking even. We’re profitable and growing more every month,” Banks said. “Even if Brownsville stayed the size it was, we’d be fine.”

Staying on top of the accounting, rural health-related policies and regulations, and making sure insurance providers pay is the key to being sustainable, Banks says. 

Beyond federal dollars, there’s a need to expand Medicaid, increase Medicare payments, and incentivize health care professionals to work in rural areas, rural health experts say. They also advocate for health equity, specifically on better pay systems for rural hospitals and ensuring those investments focus on communities that have “faced historical and contemporary challenges of racism.”

Ultimately, everyone has to work together — government officials, local agencies and the residents.

“People are dying. Not because the hospital is there or not there. It’s because we’ve not taken control. We’re accepting a lesser quality of life and a shorter life expectancy,” Rawls said. “True systemic change is a grassroots effort, but you will need people from the top pushing legislation that’s going to allow rural hospitals to survive or reopen.”

The post Healing a Dark Past: The Long Road to Reopening Hospitals in the Rural South appeared first on Capital B News.

“Blue Oval City” sounds like some kind of fantastic, utopian megalopolis of the  future. In reality, it’s a massive automotive manufacturing complex that will provide several links in the EV supply chain. The joint venture, between Ford and Korean company SK Innovation, promises 6,000 good-paying jobs for residents of the small, rural communities around Stanton, Tennessee. Many expect it to benefit surrounding towns like Covington, Brownsville, and Jackson as well, while reaching south into Mississippi and north into Kentucky, too.

But the multibillion-dollar project raises complicated feelings for many in the working-class, largely Black communities that dot the farm country and marshy bottoms of west Tennessee. They pride themselves on a slower way of life, and feel lucky to have good drinking water from a reliable aquifer. Development on such a large scale will, they fear, change the community, suck up water and electricity, and prompt an influx of newcomers and development.

They are only the latest to face uncertainties with energy transition projects, which, from solar fields to wind farms, have prompted reservations about their size, industrial activity, and environmental impacts. But rather than accept their fate, the constellation of towns orbiting Stanton are sitting down with Ford and SK to negotiate a binding agreement that will ensure they benefit from Blue Oval City as much as the companies do.

During a series of community meetings held over the past few months, the coalition has drafted a list of stipulations, called a community benefits agreement, that it wants Ford/Blue Oval SK to abide by. It is asking for community resources like youth facilities, support for road maintenance, and apprenticeship pathways run by local union chapters. It also seeks a binding assurance that the joint venture will dispose of its waste properly. And although Ford has announced many community programs, local residents want the automaker to give them some say in such things.

“They didn’t really reach out,” Michael Adriaanse, who serves on the committee drafting the agreement, said of Ford’s efforts. “I know a lot of people who feel like it happened overnight.”

So how does such a process begin? Generally with meetings that bring stakeholders together to draw up a list of demands in a broad public conversation the company cannot ignore.

“The argument a community can make is, ‘If you want our resources, you have to contribute back to the health and welfare of the community you’re gonna be a part of now,’” said Kathleen Mulltigan, who leads the National Labor Leadership Initiative at Cornell University. “What we’re really trying to do is bring real democracy into the economic realm, because a lot of the work of shaping the economy happens without workers having any voice in it.”

Ultimately, community benefits agreements, or CBAs, are a contract between a corporation and coalition of local organizations that gives the community, through binding arbitration, leverage to ensure the commitments are kept.

Historically, CBAs have been used by those impacted by the entertainment and sports industries, which tend to get big municipal tax breaks and public funding. Some of the first were negotiated in Los Angeles in the early 2000s to address, separately, a sports arena and an entertainment district. After exhaustive negotiations, residents achieved many of their goals, including higher wages, guaranteed affordable housing, and revolving loans for local business. CBAs have since spread nationwide, with folks in Nashville negotiating a high wage floor, onsite childcare, and other provisions at Geodis Park, a $275 million stadium being built for the Nashville SC soccer team.

Now, CBAs are increasingly being used to address clean energy developments. According to the Sabine Climate Change Law Center at Columbia University, more than a dozen have been signed since 2015, many of them in the last three years. The contracts resulted in projects agreeing to give preference to local hires, and in companies sharing revenue with the county in which they operate. An offshore wind facility in Maine even underwrote rural broadband access.

Vonda McDaniel, the president of the Central Labor Council of Nashville and Middle Tennessee, is helping to formulate Blue Oval agreement and plan town halls. The process has been lively. “We haven’t had a whole lot of wilting flowers that have showed up at our meetings, to be honest,” she said.

One reason for that is that locals already see changes. “The community is feeling a bit squeezed; there’s heavy equipment up and down the road every day,” said McDaniel.

Farmland counties in the region known as Middle Tennessee endured rapid urbanization when automakers arrived in Spring Hill, south of Nashville. As investment increased and people began moving in, housing costs skyrocketed. They’re beginning to creep up around Stanton, too. McDaniel says a CBA could forestall that.

“Community benefits agreements are based on the power and leverage that communities build within themselves,” she said. “They’re not just gonna give you a list of things you say you want.” In her mind, these agreements help ensure a measure of democracy in a part of the country where voter disenfranchisement, especially in rural, Black communities, is high and private interests have the ear of state government.

The Blue Oval project received a $9.2 billion loan from the Department of Energy. As clean energy funding and incentives have proliferated under the Inflation Reduction Act and Bipartisan Infrastructure Law, much investment has gone to the Southeast and America’s vaunted EV “Battery Belt.” The region’s famously climate-unfriendly governors have opened their doors wide, with Tennessee Governor Bill Lee seemingly keen on snatching the automaking mantle from the Great Lakes. With $900 million in public incentives approved by the Tennessee legislature, it’s the largest single manufacturing investment in the state’s history.

Amidst the green boom, many have speculated that a part of the South’s draw is its generally lax environmental and safety regulations. Tennessee is a  “right-to-work” state; such locales typically support lower average wages. Tennessee’s preemption ordinance also prevents municipalities from enacting worker standards beyond what state law requires.

This does not mean publicly supported clean energy projects in the South are doomed to a lower standard than those in other places. The president of the Nashville chapter of the United Auto Workers Union has promised that Blue Oval City will be a “union facility.” The Inflation Reduction Act and bipartisan infrastructure law require those seeking federal funding to submit a “community benefits plan” outlining how they will invest in domestic labor, local communities, and diversity, equity, and inclusion initiatives. Although similar to CBAs, they’re not the same. Advocates of such arrangements say CBAs are needed to secure accountability and transparency, and to give communities direct input into projects that impact them.

Will Tucker works as the Southern Programs Manager with Jobs to Move America, a national labor advocacy nonprofit. It recently negotiated a CBA with New Flyer, an electric bus manufacturer in Anniston, Alabama, and Tucker feels confident this approach to the transition can work in the South.

“What sets a real community benefits agreement apart from a dressed up community outreach program by another name is the element of negotiations with the company,” he said. Though many companies will set aside funding for local sports leagues, schools, and the like, Tucker considers such moves more of a PR strategy than a way of giving the community power.

If community organizations can present a united front, that pressure usually pushes the company to negotiate, though in some cases, protests and demonstrations heighten the stakes. Michael Adriaanse hopes such pressure will send the Blue Oval City CBA over the finish line.

Ultimately, for a CBA to work, the company in question must sit down with the community. Adriaanse said the coalition invited Ford representatives to a town hall to discuss preliminary demands, but it didn’t work out. McDaniel speculated that the company’s ongoing negotiations with United Auto Workers, which recently concluded a strike, may have slowed some things down. There’s a long road ahead, but Adriaanse and McDaniel are hopeful that with a strong enough coalition, the company won’t be able to dodge any longer.

The coalition still plans to go to the table with Ford, with a complete draft of the agreement in hand, early in the new year. Even if the effort is not immediately successful, community members say, the relationships they’ve built with one another will only get stronger, leaving possibilities for further organizing open down the road.

This story was originally published by Grist with the headline A huge EV factory is coming to west Tennessee. Here’s how locals are ensuring they benefit. on Dec 18, 2023.