Share Public Health Transcript: Rural Health, Community Pride

Season 2 Episode 8

Hannah Shultz: Welcome to Share Public Health, the Midwestern Public Health Training Center’s podcast connecting you to public health topics, issues, and colleagues throughout our region and the country, highlighting that we all share in public health. Thank you for tuning into this series which focuses on rural health in the Midwest. Over 10 episodes, we talk with people in a variety of communities about their experiences and perspectives on rural life, employment and health. Our aim is to deepen understanding of the complexity of rural life and celebrate rural areas. We’re so happy you’re listening and learning along with us.

Hello, my name is Hannah Shultz and I work with the Midwestern Public Health Training Center at the University of Iowa College of Public Health. I am your host and producer for this series discussing rural health in the Midwest. Today we’re going to talk with Emily Wornell and Bill Menner about what makes rural communities successful. Thanks for joining me. Dr. Emily Wornell is a researcher at Ball State University and studies demographics and population change in rural communities. She is affiliated with the Rural Policy Research Institute, also called RUPRI. The director of RUPRI, Keith Mueller, is here at the University of Iowa and is part of the planning group for this series. Emily tells us a bit about the rural wealth framework and the work RUPRI does. Some of which she says goes against commonly held understandings. She has so much good stuff to share. I’m just going to let her talk.

Emily Wornell: So one of the biggest frameworks that we use is called the comprehensive rural wealth framework. And it is essentially kind of a theory of health, a theory of wealth in rural communities that looks at communities in a more comprehensive way. So there’s eight different capitals, essentially that’s looking at eight different types of wealth that it’s looking at. So it includes human, which is we’re all fairly familiar with that. It’s the capabilities of a population, education, skills, talents, health status, things like that. Social capital, social wealth is a stock of trust and relationships. Political is the influence, power and goodwill. Cultural wealth is things like arts and architecture, religious beliefs, cultural traditions, things like that. Physical capital or built capital are roads, infrastructure, things like that. Natural capital, what you would think of, forest, air, water. Financial capital, I think we all know what financial capital is, money. And then intellectual capital is kind of human knowledge and innovation that’s in a society. And so often when you’re thinking about a community, particularly a rural community, just a couple of those things get thought about. So we generally think about financial capital, sometimes we think about built capital, we often think about natural capital. But this framework is really saying we need to understand communities in a more comprehensive way. It’s a very assets-based approach to understanding community wealth and community health rather than a deficit. So a lot of rural communities, most rural communities, one might even argue, are going to have lower financial capital, they’re going to have worse infrastructure, older infrastructure. And so if you look at it just in kind of those traditional ways, you see a big deficit in rural communities. But if you look at it more comprehensively, the human capital, the social capital, the cultural capital within rural communities that people utilize to help make their communities good places to live but also can utilize in their own household or family wellbeing, then you understand rural communities much better. You can see the assets that you’re able to build off of in rural communities to help them be more successful and sustainable longterm. So that’s the general kind of structure of the framework. And then we have the Center for State and Local Policy. We’ve adapted that broader structure of the comprehensive rural wealth framework to actually apply it in communities. So it’s great to have this framework and this theory, but then what does that actually mean in practice for communities? And so that’s what we’re calling the comprehensive community wealth approach. And that’s more of a community-based approach to community and economic development. So right now, I mean, we’re still kind of test piloting this here in Indiana. So we have almost two dozen different counties in the state that are interested in working with us to try to build up a comprehensive approach to community and economic development. And really the way that we talk about it is the kind of typical economic development strategies are very business attraction, retention, and expansion types of activities. That’s what communities all over the country have been doing for decades, because they say if you have jobs, people are going to move there in order to fill those jobs. So it’s a very people following jobs orientation. So the first thing that we really talk about using the comprehensive community wealth approach is just looking at the data that people don’t actually follow jobs and they haven’t since the 80’s at least, but jobs follow people. So people decide where they want to live based on the quality of life, that they choose their individual community based on the assets of the community, the aspect of the community that’s important to them. And then they’re willing to commute to a job. So they might move to the Midwest. So for example, I’m from Oregon and I’ve lived all over the country. I moved to the Midwest, I moved to Indiana because of my job. I chose the actual community that I live in based on the community characteristics that I was looking for and then I would be willing to commute to my job. For me, that just happened to mean that I get to live in the community where I work, which is great. But if you’re a community where you don’t have that quality of life, where you don’t have those characteristics that people are looking for, it doesn’t matter how many businesses you open, people are going to commute there, they’re not going to live there. So that’s really kind of the first part of this, it’s flipping that script in terms of looking at the types of places that people want to live. And that really means that creating the quality of life in your community is economic development because you have more people willing to live there. Once you have more people living there, you also have more jobs coming into those communities because that’s where the people are. So that’s the first part of it. And then we really look at these eight different types of capital are really important to be thinking about when we’re thinking about quality of life, it is essentially quality of life. It’s not just about financial and built capital, but it is about natural capital and human capital and cultural capital and creating that quality of life that people are really interested in, being invested in in their communities. So we have almost two dozen counties who are going through the process of figuring out what their assets are, kind of what their level of capital is and their level of health is in their community, who needs to be at the table to be having those conversations. That’s an incredibly important part of what we do, is that you can have those leaders in that community who’ve always been there, who are going to have one certain perspective on their community. And the comprehensive community welfare approach says that we need to have all areas of our community involved in these conversations, particularly those who have been disenfranchised from these conversations in the past. The difficult thing with this is that it is not prescriptive, it is not a silver bullet solution. It’s different in every single community that you go to because every single community that you go to is different. So the assets that you have to build off are different, the challenges the communities are experiencing are different. But the application of it in communities really started the very end of 2018. And so we are definitely still on the front end, we are still evaluating all of the projects that we’re going through. But the places that we have worked so far… so there’s kind of two different pieces to this. The first is what we call the community development course. And that basically kind of lets people know what this alternative script is. It introduces them to the framework, it introduces them to the different types of capital. It really asks them to get other folks involved in the conversation who aren’t typically involved in the conversation, those sorts of things. It really lays the groundwork for doing the next level, which is what we’re just starting now. And that is, I hesitate to call it strategic planning because everybody does strategic planning and those suckers just go in a bookshelf, is in a room and nobody ever looks at them again. And so what we’re doing it’s called community based action planning. So it is kind of strategic planning, but it really is… the focus is on action. So it’s, we’ve got these great plans that we really want to get to, what are the actual steps that we’re going to be taking to get there, and breaking them down into really manageable pieces so that we can actually get to this goal. So it’s not just the big document that somebody puts on a shelf, but people have responsibilities and roles, they have tasks and deadlines so that they can actually be meeting those goals and moving towards their bigger goals for the community. And it involves the community-visioning kind of process that includes what does it mean to be a great community for the people who live there today, for everybody who lives there today? So what does it mean to be a good community for people who are experiencing financial insecurity and housing insecurity, right? Those are people who are often not at the table of trying to decide what the goal of the community is going to be. What does it mean to be a good community if you are a new immigrant to the country? Because a lot of rural communities are experiencing really dramatic increases in immigration. What does it mean to be a good community if you’re a business owner, one of those kind of traditional things that we think about, or if you are a single mom or if you are a retired teacher, right? So all of these people are part of the fabric of our communities that really make a community what it is, but are also looking for a certain kind of quality of life. They need to be involved in those conversations. So like I said, we’re really at the starting point of this, we’re really excited about where it’s going. We’ve gotten great feedback from the communities who have gone through that first phase already, the community development force. And even just… there’s a county here in Indiana that has a really long history of tension between the county and the cities. And there’s been legal action against each other and they just don’t like each other, they don’t get along, they haven’t for a really long time. And going through this process has helped people be able to talk to each other again, has helped people be more willing to be involved in leadership to where before they were just really wary of being involved in leadership. They’re really excited to go onto this next level, the community-based action planning, and they haven’t been excited about anything in their county or their community for quite some time. So some of the early things that we’re seeing have been really successful and we’re excited about them, but it is definitely an ongoing learning process that we’re in right now. One of the questions that we always have is how are you defining rural? I mean, that’s literally a question on my comprehensive exams, was how do you define rural? In all quantitative sense, Muncie, which is where Ball State is, is not a rural community. We’ve got close to 70,000 people. It’s declining, but certainly we are above that rural threshold. But it is rural in a couple of important ways as well. One, it has kind of a lot of the economic characteristics that a lot of rural communities are going through. It’s a former industrial town. Its population is decreasing very, very quickly. It has a fairly narrow labor market. There’s not a lot of diversity in the labor market. And then I think really importantly, when you ask people, they identify as rural. And I think that that’s an important aspect that we often miss when we’re just looking at quantitative measures of what rural is, is that people do identify themselves as rural in this area where we might not ever do that. So like with health, it depends on how you’re going to define it, whether or not it’s a real place.

Hannah Shultz: I was curious why Emily decided to become a rural sociologist. She shared that she had an informative experience working with domestic violence and sexual assault and seeing an urban, rural divide.

Emily Wornell: You ask my 18 year-old self and I would have been horrified because I grew up in rural Oregon, about a thousand people in my community when I lived there, no stoplight, raised sheep, a tiny little place. And I swore up and down that I was a big city girl. And when I moved to the city, I really missed living in rural places. But the big switch for me happened, I was an advocate at a domestic violence and sexual assault service center in an urban place in Oregon. But a big part of our service area was rural. And through that experience I really started to understand the different challenges and concerns that the women that were in our service area, who were rural, just how different their challenges and concerns were from our urban women, and really seeing the differential impact of policy around domestic violence and sexual assault when it’s implemented in rural and urban places and the level of disenfranchisement that rural women experienced in a very different way than urban women did. And so that really started to kind of turn my mind back to looking at rural places and kind of this rural, urban difference. And so I went back to school, my master’s degrees is in public policy actually, in social policy with an emphasis in rural communities. So I was very interested in public policy implementation in rural places and how that’s different than urban places. And then from there really my PhD is in rural sociology, it made sense to continue in that direction for me. I’m still very interested in policy, that is a lot of what I do. But I wanted to do a deeper dive into some of these issues of inequality and change in rural places.

Hannah Shultz: Wow. I loved talking with Emily. I was especially interested in asking her what the strengths of rural communities are given that she initially thought she’d end up in a city. Listen to what she’s got to say.

Emily Wornell: I think that there is, and I could say this through my own experience, but also more importantly through the research that I do in rural communities, there is generally a very strong sense of pride in place that people have that I think is an asset that isn’t tapped into nearly enough. People by and large love where they live and the people are a part of that. So, so often you hear when you’re in a rural place people are just saying I love being in a place where I know all my neighbors and where my kids can walk down the streets and they’re safe. And again, certainly this is not universally true. But I think that kind of rural culture, that rural sense of self and identity is a big strength in a lot of rural places. And I think that our culture, American culture and our history, so much of it is rural. And it changes over time and it becomes urban as people migrate and as culture and art and those sorts of things migrate into urban spaces. But so much of it is really rooted in American rurality, and I think that that’s something to remember and to appreciate even as we continue to urbanize.

Hannah Shultz: So let’s flip that now and hear what Emily sees as threats to rural communities.

Emily Wornell: I think the biggest threat is a lack of recognition for the role that rural communities continue to play in our country’s security, identity, future. And this disproportionate focus on the deficits of rural rather than recognizing the assets that it brings to our country and really just a lack of recognition of how successful some rural places are. So, so much… we talk about these places that are declining in population and they’re doing really bad economically, but so much of urban population gain over the last several decades has been reclassification from rural places that are doing really well. So the kind of frustrating thing is our rural places that are doing really well are no longer considered rural for obvious reasons because the way that we quantify things, the population increase, so they have to be considered micropolitan or even metropolitan. But then that means that rural, when we look at rural as kind of a rural America, this big thing, we’re always going to be left with the “losers”, because the winners are doing so much better, that more people want to move there and they’re no longer rural. And so that interplay between urban and rural, I think is really not recognized in the way that it needs to be. There was a new study out by Ken Johnson and Dan Lichter that just came out this last month. And I believe they said it was from 1980, I could be wrong with the date, 1980 or 1990, that the entire growth of urban America is due to reclassification, not migration, which is massive if we think about it. And that is not a story that gets told. That is a story of rural America doing super well, and that’s not what we usually say.

Hannah Shultz: Isn’t that interesting about the reclassification of rural areas? The study Emily references looks at metropolitan reclassification from 1960 to 2017. Think about Waukee, North Liberty, Tiffin, some of these towns are 10 times bigger than they were just 30 years ago. We’ll link the article in the show notes if you’re interested.

Emily Wornell: And I knew that it was big, I knew that it was a big percentage, but I didn’t realize it was that transformative really. And that isn’t a story we talk about, and it just tears me up inside that it’s not something that we talk about. But it’s not necessarily that people are picking up and moving, they are, but maybe even moving in the other direction. Because we’ve got a lot of suburbia that people are starting to move out of. Our biggest cities, our biggest metropolitan areas in the country are starting to see population decline for the first time in decades. And that was happening even before COVID started. And there was another report that came out, a survey report that came out fairly recently earlier this year that show that over half of Americans, regardless of where they live now want to live in a rural community or a small town. So if they had their choice of where they were to live, it would not be in an urban center. And so I think that that’s kind of the second, for me, the really important piece of what you were asking about, kind of the biggest challenge for rural community, or the biggest danger to a rural [community], is a lack of infrastructure that would allow people to choose to live in rural if that’s where they wanted to live. And the big thing that I’m thinking of, particularly with COVID, is a lack of universal access to broadband. And I think a lot of folks living in urban places have no idea that there are millions of people in our country who do not have access to high-speed internet and just what a devastating impact that can have, not just on individuals, but on the broader community, which can also have an impact on our society in general. So educational opportunities, when you have something like COVID that’s shutting things down, you have to be able to rely on the internet. And there are not insignificant numbers of kids who do not have the internet infrastructure and technology available to them to actually be active participants in their education. And primary and secondary education are things that are promised to us from our government as people who live in this country. And in 2020, there were millions of kids around the country who did not have access to primary and secondary education because they didn’t have access to the internet. And that is not acceptable. It’s completely not okay. There is no family in the country who if they had a choice would say, “I’m going to move to a rural place that doesn’t have an access to the internet” if they have school-aged children, because the danger is just too high. And that doesn’t even say anything about job opportunities, which absolutely rely on reliable, high quality access to the internet. That doesn’t say anything about the ability to be civically engaged. One thing that we’ve seen with COVID and state houses being shut down is that there have been satellites in other rural communities where there’s a small group of people that they’re able to get together and provide testimony to these online virtual events with their legislators, to provide testimony and to hear what people are saying and to still be involved in the civic process in a way that they haven’t been able to before, if they live very far away from the capital. And so I can imagine we’re going to be moving more in that direction, right? That things are going to be increasingly online, virtual events so that people have more access to their government in general. But if there are people, because our infrastructure does not allow for it, who don’t have access to the internet, then they are being even more disenfranchised from civic participation, from the democratic process, because of a lack of access to the technology that’s needed to be involved in those processes. And because they’re more likely to be rural, that means that rural is more likely to be continued to be disenfranchised from the policy process, the democratic process. And because of, particularly with that education piece and the civic engagement democratic process piece, it is absolutely vital to the health and wellbeing of our rural communities and our country for there to be universal access to broadband. And because it is in the national interest, I very strongly believe that it is something that the central government needs to make happen. Because we have tried to leave that up to the market, and it has not only failed to provide universal access to broadband, but big leaders in the telecommunications industry have actually actively blocked state legislatures or who have blocked local state community cooperatives from organizing their own access to broadband through state legislatures. They have been successfully able to lobby with state legislatures to say, “No, you can’t do that.” Which makes no sense, it makes no sense at all. They say, “We can’t make money off of this, and so we don’t want anybody to make money off of this,” is essentially what it comes down to. But the big state I think needs to recognize that access to high quality, reliable internet is in the national interest and step in and help make that happen. And without it, I think rural communities are really, really going to struggle in the future.

Hannah Shultz: So we’re going to talk with Bill Menner now. Bill lives in Grinnell, Iowa. We’ll hear a bit about Bill’s background throughout the conversation, but he’s worked in a variety of rural development kinds of jobs for many years. He has a rural consulting business and he is the executive director of the Iowa Rural Health Association and of the Iowa Rural Development Council. As we were getting to know one another, I made a joke that he must know all the back roads across the state. He agreed that he indeed knows a lot of them.

Bill Menner: So I spent almost eight years as the state director of USDA Rural Development, which is an agency within the USDA that focuses on rural infrastructure. It’s like a big infrastructure bank for small towns, but also does community development and empowerment. And so I went around the state for almost eight years making awards, connecting dots, and so it’s hundreds. When people say to me, “I grew up in a small town in rural Iowa, you’ve probably never heard of it”. My response is usually, “Try me because I bet I have”. And I bet that USDA Rural Development made some sort of an investment in that town, whether it was somebody’s mortgage, whether it was a water or sewer system, a hospital, or a small business loan, or maybe a wind turbine you see outside of town powering a farm operation.

Hannah Shultz: Bill clearly knows Iowa very well, but he’s not from here. He actually grew up in Ohio, but he’s been in Iowa for quite a while.

Bill Menner: I am a trailing spouse. My wife got a job teaching at Grinnell College in 1990. We moved here with a two week-old and we’ve been here ever since. She’s still on the faculty at Grinnell. Of the 30 years here, I have worked in Grinnell for about 10 of them. The rest of the time was spent commuting either to Cedar Falls or to Des Moines and back. But we’ve always been here. When we came here and I got my first Iowa driver’s license, they asked me if I wanted the two year license or the four year. And I said, “What’s the difference?” And they said, “Well, if you want to have to come back and renew in two years or four years.” And I said, “Give me the two year license, we’re not going to be here that long.” And 30 years later we’re still here. And part of it was that when got here, I was the product of an urban environment. And I just assumed that there was nothing that was going to keep us here. And in fact, as it turned out, there was plenty. So it was a good move and we’re happy to have made it and happy to have been here the whole time.

Hannah Shultz: Once again, we’re going to hear that whether or not a town is rural, is a matter of perspective. I totally get this. When I was growing up, I would visit an aunt and uncle in Waverley, Iowa, and thought it was a huge town. There was a Walmart and a McDonald’s and a bridge with a dam. They even had some stoplights. Waverley’s population is about 10,000. So now after living in bigger cities for about half of my life, I think Waverly’s a small town.

Bill Menner: Well, coming from big cities where I grew up in suburban Cleveland, Ohio, and I spent 10 years in Columbus, Ohio, when I came to Grinnell, I thought of myself as coming to a very small town. In fact, by Iowa standards we’re a mid-sized city. Now, I work with lots of communities that are under a thousand in population and when I say, “Well, I’m from Grinnell,” they roll their eyes at me when I say it’s a rural place. It is, it’s truly a mid-sized city. When we have 850 plus small towns or towns in the state and a vast majority of them are a thousand or under, Grinnell is a big city. So I feel like I have a rural experience when compared to urban places, but by comparison, it’s very different from the couple of places where this week, it was in Brooklyn, Iowa, population, 1500 or Montezuma, population, 1100. But they’re different. Small towns, when you go from a thousand to 9,000, have different capabilities and capacities, and they’re different places. I think the biggest strengths of rural communities are the opportunities for individuals to make a difference. If you live in New York City, your ability to influence anything is minute. Whereas if you live in a town of a thousand or 500 or 9,000, where I live, you have the ability to make a difference, whether it’s running for an office or serving on a board or simply being active in your community.The cumulative impact of a single individual in a small town is exponentially greater than if you are in a big place. And if that’s important to you, if you value the ability to impact the lives of others or make a difference, why wouldn’t you want to be in a small town? There are so many ways that somebody who lives in a small town or a rural place, an unincorporated area, to just change the whole dynamic of where they live and what happens.

Hannah Shultz: Again, I’m going to fall back on my own experience here. I love Bill’s comments that people in small towns can make a big difference. I think of my friends and family in small towns, they’re on the school board, volunteer firefighters, serving on community boards, planning community festivals, driving the school bus. They have real ownership of and responsibility to their communities.

Bill Menner: I’ve been doing a lot of work in the last couple of weeks to develop a strategic plan for our county’s economic development future in a post-COVID world. One of the things we know is that a lot of businesses that are struggling right now may not survive. And then the question becomes, well, what are we going to do with all those empty storefronts on main streets? And my question is, well, somebody is going to jump at an opportunity to be entrepreneurial, to find a new opportunity, to do something in a great space that otherwise they might not have had that chance. So I think one of the challenges of being in a small town is that you wear lots of different hats. At the same time, wearing lots of different hats introduces you to lots of different people. The people who have the abilities and the desires to lead need to step up and lead. And whether that means running for office, or simply volunteering to do things, it’s all about the willingness of citizens to participate in the development of their community. There are a lot of people who think that the best thing that could happen in a small town is we’re to go back to 1955, because back then the main street was full, everyone was downtown on Friday night, things were better back then. That is true. It’s nothing we can recapture. So then the question becomes, how do we move forward? How do we create new opportunities and bring new businesses and find entrepreneurs and recruit families and create a quality of life that gets us maybe back to the point where we have vibrant downtowns but it doesn’t look like it did in 1955, it looks like it’s going to look in 2025. That’s the big challenge. And for small towns to also think about who is it coming up, what young person or young people, or people that aren’t from our town have the ability to play important roles in that too. And sometimes that means opening up the leadership circles to folks you never thought would be leaders but they bring talents and skills and insights and different perspectives. In a homogenous, small town, there’s value in that sort of diversity. So these are the sorts of things that get me excited, when people take their energy that they have about their community and invest it in new and big ways and change things. And that to me sends a message to visitors or to folks looking at coming and living there or working there that this is a really good place to be. It goes back to that question about how much impact can you have? Well, in a small town, you can make all the impact you want.

Hannah Shultz: And the flip side of this argument is simply that there are fewer people to do the work.

Bill Menner: The biggest threat to rural communities is a lack of capacity. When you have a smaller number of individuals helping to make change, to drive innovation, to make things happen, whether for age or health or other reasons, when they leave, that leaves huge gaps. Or you have places that don’t have those sorts of people who are willing or able to step up and there’s a void there in the ability to do things.
What happens in a lot of very small towns is when ideas get developed they often look to the city clerk to make it happen because that city clerk is often the only paid person or one of a few paid people at the city level to actually make policies reality. There’s a volunteer mayor and a volunteer city council and a volunteer chamber of commerce maybe, but it always seems to land in the lap of that city clerk to drive some of these changes. And some city clerks are able to do that, some are not. And the capacity that exists in these places can be limiting. At the same time, there are really small towns doing amazing things, and it’s because they have a core of people, old, young, male, female, otherwise, who are doing things because they want them to happen.
So the biggest challenges you see from small town to small town is the existing leadership base and their ability to get things done. That’s the biggest challenge is these places that don’t have the leaders, don’t have the capacity, they could be sunk unless somebody steps in and says, “I’m going to make this happen.”

Hannah Shultz: We often hear about brain drain, this idea that kids grow up, get degrees and leave. I asked Bill what his thoughts are on keeping young people in small towns.

Bill Menner: First off, I’m the father of four. None of my kids live in Iowa currently, none of them live in a rural place. But I don’t think that precludes them from coming back. I think want and have the opportunity are two different things. I think there’s nothing… I think young people who grow up in rural Iowa make choices on where they choose to go for a lot of different reasons. Some feel like they need to get away to a big city for a while just to experience a big city. But when it comes time to have a family or to settle down, they’re more comfortable in a rural place. For young people who have a job choice where the only options for that sort of a career are in an urban area, that can be a limiting factor on their ability to stay in a small town. If they really want a Starbucks on every corner, they’re not going to find one in a small town. And if that’s driving what they want to do, or if they want to go to live theater every night, or do any number of things that you associate with living in an urban area, then they’re probably ready to go to those big cities. But I’m not convinced that every young person is ready to flee. I do know that when you grow up in a small town you’re ready to see different things and experience different things, and that’s okay. My hope is that if my kids want to come home to Iowa and live in a small town someday, that they can do that and that there are jobs that they will find fulfilling and that their career paths take them toward that they can find. Or if that job, for example, is in Des Moines or Iowa City or Cedar Rapids, that they have great opportunities or confined places and fulfilling places to live nearby. I mean, when you draw those geographic circles around some of our major metropolitan areas, there are folks who choose to live within 20 miles in a suburb or in the city itself, and some who are choosing to live in the more rural areas, they call it a micropolitan. In my mind, they’re small towns. If you want to live in Williamsburg, Iowa and commute to Iowa City, it’s a piece of cake. If you want to live in Oxford, Iowa, or Hills, Iowa, and commute to Iowa City, that’s great. You’ll have a different life experience and you’re still within 20 minutes of the big city. This is something that in economic development circles, this comes up all the time. Oh, we’re [inaudible 00:43:19], we’re losing our young people. What are we going to do? We got to keep our young people. I don’t want to keep anybody who doesn’t want to be here and I also want them to go have some great life experiences. And if that means moving to Chicago for a few years and experiencing new things and making new friends and meeting your life partner there and then coming back, so much the better. I think it enriches our small towns.

Hannah Shultz: A few minutes ago Emily talked about challenges with internet access. I asked almost everyone I talked with for this series what the biggest threat to their communities are. Almost every person had reliable access to internet, including Bill. And it was related to this question about people leaving and job opportunities for people who want to live in small communities.

Bill Menner: If you’re a small town with a big pipe, and that’s what they call your connectivity, a big stinking internet connection, a gigabit or more, you can work from anywhere. And if you’re a small town that has that asset, you ought to be out waving flags right now telling people “we’re a gigabit city, come live in our community because we have high speed broadband, we have low housing prices, great quality of life, and you can make a difference here”.

Hannah Shultz: The challenge of internet speed isn’t only for people who live 10 miles outside of town.

Bill Menner: We were in a DSL system, everybody in our neighborhood was also using that DSL. And our speed was under one megabit per second, which is horrific and it would be impossible to do a Zoom meeting, let alone two or three in the same household. And I basically had to call the phone company and say, “Get rid of it. I can’t use this. It’s not worth it.” And their response was “we just put a brand new fiber optic node in the alley behind your house, can we run fiber optics to your house?” And the answer was, “Well, sure.” And now suddenly I go from one megabit per second to 300. And the transformation was unbelievable. I mean, when we talk about haves and have nots when it comes to rural economies and urban economies or the US versus other countries, the biggest have and have not moving forward from a global economy perspective is going to be that you have high-speed broadband. And really that means you have a fiber optic line that comes to your home because everything else pales to that. In small towns… there are 135 rural telephone cooperatives in Iowa, a remarkable number, the most in any state by at least two times. And they have been investing in fiber optics for decades now. So they’ve been building out their networks and now they’re starting to go places where the incumbent providers, the investor owned companies don’t want to go. And it’s making a huge difference for those individuals in those places that they choose to serve. That’s why this whole question about broadband and who’s going to pay for it, and should there be a level playing field? The answer is yes. And it was during the New Deal that the federal government stepped up and said, “If the electric companies aren’t going to serve rural communities, we’re going to pay for someone to do it because everybody should have electricity.” Then they said the same thing about telephone and the same thing should apply to broadband today. We had someone speak at our rural health association meeting this week, a futurist from the New York Times, and he said that the one thing COVID has done has been to demonstrate to everyone that high-speed broadband is as essential as electricity and clean water. So a basic necessity of life for people, regardless of where they live, regardless of what they make, they have to have electricity, clean water, I would say, clean air, place to live, but it’s an essential. And I don’t know that we are treating it in many places like what it is, which is an essential public utility.

Hannah Shultz: If you listened to last week’s episode and heard Art Cohen talked about how valuable local ownership of business is, Bill’s comments here make a lot of sense. The local co-ops have been investing in the needs of their communities for years in a way that large companies are still not. In 2020, we’ve seen just how important internet access is. Many of us are going on 10 months of working from home, kids have been in and out of virtual schooling. Whether or not someone can get high-speed internet is directly tied to whether they can do their job. Bill says workforce is the number one issue in many small towns. And just as our other guests are bringing in all sorts of connections to the conversation, Bill does as well. In public health, we talk about health in all policies. Just about everything impacts our health and our health impacts just about everything. We know everything is connected. We can’t pull out one issue and solve it without understanding what’s going on around it.

Bill Menner: And that issue of how do we recruit or retain our workforce is one of the number one challenges in small towns right now. Everybody will tell you workforce is their problem, how do we keep them, how do we get them? And then that takes us back to the conversation about broadband and housing and the arts and childcare and quality of life. These are all factors that influence the livability of a place. So if I’m an employer, I have to be thinking about those other things that impact the workforce. And that’s why we’re sort of reaching an all-hands-on-deck situation, where everybody has to be involved in conversations about housing development and childcare and healthcare and education. I mean, these are all amenities that small towns need to be successful. And if they don’t have them, they will pay in lost workers or a smaller workforce. Health and healthcare are big deals. And if you’re in a community where people don’t have a place to live, where they don’t have access to food, where they’re not making a living wage, where the environment or the transportation network is substandard, that’s going to impact their overall health. And then the next question is, well, if their overall health is affected, do they even have access to health care? So that intersect, it’s an interesting intersection of health, healthcare. And then coming from the top are all these social determinants. These economic development factors that I think most economic developers don’t realize that everything they do has a health outcome attached to it. But in fact, when they’re working on housing or creating new job opportunities or a downtown arts center, everything’s related. I always like to tell hospital CEOs that they’re an anchor industry in their community and they should act like it, which means they have to be a leader when it comes to economic development and community development issues. They can’t just lock themselves in the C-suite and worry only about their hospital. They have to get involved with the entire community because of the health implications that are involved in that.

Hannah Shultz: Bill says hospitals are economic drivers and major employers and communities. So I asked what other employers are out there.

Bill Menner: There are jobs in rural communities. In fact, there are more jobs than we have people for right now. They’re not all low wage. And more importantly, I mean, manufacturing is the state’s biggest industry. Some of that manufacturing is related to agricultural and agricultural implements, but for the most part, it’s not. So while agriculture is a really important industry in our state, many of the jobs in rural Iowa have nothing to do with agriculture, even though many of the people who are working there or who are living there may have come from families that were from family farms or grew up in small towns and walk beams and did the stuff that you do when you grow up in a rural state like this. But I think the misconception is that if you come to Iowa you’re going to be shucking corn. And that clearly is not the case. And there’s also an assumption that everything is blue collar when this is a state that’s driven by technology, the service industry, finances and we need people with those sorts of skill sets to fill those jobs.

Hannah Shultz: And then of course we have the ag adjacent industries.

Bill Menner: That’s agriculture related, but it’s value added. Now that’s a whole different story is, what sort of innovation happens in our state because of the proximity of the crops, the livestock that drives future processing opportunities and adds value to those products beyond what you would get simply by growing them? Now, that’s an exciting opportunity and it’s constantly changing. And whether it’s a processing plant or a plant that extrudes tiny pieces of a corn kernel and does amazing new things like the things that that Kemin does in Des Moines with their research. I mean, there are elements of this in our state, but again, we’re a state that although we are a farm state, everything that is driven in rural Iowa is not necessarily ag related. I mean, when we talk about the impact of agriculture on our state’s economy, there is a growing number of people who have no clue. Even if you grow up in Mount Vernon… you would think, at least by osmosis, you’d figure out corn and beans and what stover is and there are lots of people who don’t, lots of young people who don’t. And frankly, it’s farmers who need to be telling those stories because it’s in their best interests.

Hannah Shultz: We’re going to wrap up today’s conversation talking about Manning, an impressive town in Western Iowa.

Bill Menner: I always talk about Manning, Iowa, which is a town of about 1500 people in the middle of Carroll County, not far from the city of Carroll, which is one of those cities of 10,000 that’s more of a regional hub, but you’ve got little Manning there. Not far away also is Templeton, the home of Templeton Rye. And the leadership in Manning started to change maybe 10 years ago or so. And folks started to do things and they started to reinvent their main street and they built a new hospital and developed a spirit of entrepreneurship, refurbished a historical German barn. And a few years ago, they were named the Small Business Administration’s Small Business City of the Year beating out Sioux City, Dubuque and Cedar Rapids. Manning, Iowa did this. And it was because it was some elected officials, they developed a main street program and people rallied around what they were going to become. And they are a remarkable small town, again, 1500 people. And when I look at what Manning has done driven by local leadership and a local vision, I’m convinced anybody can do it with the right pieces in place and with the capacity to make those things happen. So you can’t just say, “Oh, well, small towns don’t have the capacity, they don’t have enough people.” They can, as long as they have the right people doing the right things and working together. Again, I just get back to the fact that the future of many small towns is going to be determined by the people who live there or the people that come there. And the idea that you can make a difference in your community is absolutely true, more so in small towns than in big cities. But it takes a little bit of courage, it takes the willingness to step out and put yourself at risk by actually being active and by stepping forward and saying, “I’ll volunteer, I’ll lead.” For some people that’s not something they’re comfortable with, but if they can get over that discomfort knowing that there are these great assets they’re bringing to the table, then the impact they’re going to have on the community, on their families’ lives, on the lives of their neighbors and their friends really will be impactful.

Hannah Shultz: I’m Hannah Shultz. Thank you so much for joining me for another episode of Share Public Health. Please join us again next week as we talk about food systems.

Thank you for tuning into this episode of Share Public Health. Thank you to the Injury Prevention Research Center, Iowa Center for Agricultural Safety and Health, the Healthier Workforce Center of the Midwest, the Heartland Center for Occupational Health and Safety, the Great Plains Center for Agricultural Health, the Midwestern Public Health Training Center, the Prevention Research Center for Rural Health and the Rural Policy Research Institute. The theme song for this series is Walk Along John. It’s performed by Al Murphy on fiddle, Mark Janssen on mandolin, Brandy Janssen on banjo, Warren Hamlin on guitar and Aletta Murphy on bass. Al learned these songs from a Fiddler named Albert Spray, who is from Kahoka, Missouri. A transcript, evaluation and discussion guide for this episode are available at and in the podcast notes.

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