Tom Vilsack. Photo: USDA

ANKENY, IOWA — Anyone who has seen the statistics understands that the future of farming in America is looking on the back-end of middle aged.

The U.S.  Department of Agriculture census indicates the average age of American farmers increased from 50.3 in 1978 to 57.1 in 2007. The majority of farm operators are between ages 45 and 64, but farmers aged 65 and older comprise the fastest growing group of farm operators.

Perhaps the most disturbing statistic is that while the number of farms owned or operated by the oldest of farmers continues to experience growth, the number of farms owned or operated by individuals under the age of 25 continues to decrease.

Stating that such statistics cause him “deep concern,” U.S. Agriculture Secretary Tom Vilsack asked a panelists of farmers at Friday’s DOJ/USDA antitrust workshop to tell him what else needs to be done to ensure the future of rural America.

Three members on the six-person panel pointed directly at farm subsidy payments as a culprit.

“I’m not interested in my tax dollars paying for somebody to farm 10,000 acres,” said Ken Foster, an independent Missouri hog farmer on the panel. “We have to scale this whole thing down where it benefits beginners instead of eating the beginner’s lunch.”

Ken Fawcett, an eastern Iowa crop farmer on the panel, said the payments ought to be tied to the way or process by which farmers produce their products.

Throughout opening statements and discussion, views expressed by the farmer panelists varied greatly.

Pam Johnson, a farmer from Lloyd, advocated that there was room in the future of agriculture for producers of all sizes and styles.

“Farmers are in a daily battle to defend what we do,” she said. “The tone has been very devisive. People are talking about food versus fuel instead of food and fuel.”

Even her call for unity, however, was tempered by comments by Todd Wiley, a Walker pork producer with roughly 1,150 sows.

“I’m not opposed to renewable fuels, but at this time we need to let the ethanol tax credit expire,” said Wiley, who feeds corn to his hogs. “We don’t oppose competing for corn, so long as we can do it on a level playing field.”

ANKENY, IOWA — Whether they realized it or not, the roughly 250 family farmers, workers and consumers gathered in Ankeny, Iowa, Thursday night fired off their own point-by-point response to a letter from two Republican senators that urged the U.S. departments of agriculture and justice to maintain the existing status quo in the agriculture industry.

Speakers line up to comment at Thursday night's townhall. Photo: Lynda Waddington, Iowa Independent

The often rambunctious townhall event was organized by a coalition of groups concerned that everyday people do not have adequate opportunity to express their opinions on the agricultural industry at a joint U.S. Department of Justice and USDA antitrust workshop on Friday. And it had one overarching message: “Bust up big ag.”

“We are here today to make sure that the voices of everyday people are heard loud and clear and send a simple but powerful message to our government regulators and elected officials,” said Barb Kalbach, a fourth generation family farmer from Dexter and board member for Iowa Citizens for Community Improvement. “Bust up big ag, pass policies that promote sustainable agriculture and local markets, and put people first during the workshop series by prioritizing public comments and input and adding more family farmers and consumers to panels.”

On Wednesday, however, two Republicans in leadership positions on the Senate Agriculture Committee urged U.S. Attorney General Eric Holder and Secretary of Agriculture Tom Vilsack to do just the opposite.

“We urge you to ensure that these sessions are balanced and reflect the wide array of producers and business operations in modern-day agriculture,” wrote Sens. Saxby Chambliss of Georgia and Pat Roberts of Kansas.

After noting that “American agriculture is responsible for feeding the world,” that many industry “segments have become more vertically-integrated” and “other small and successful agriculture businesses have merged” to meet demands, the senators note that change is often met with frustration.

“Such change has led to better income margins for producers and processors as well as lower prices for consumers,” they wrote, adding that competition issues have been “studied extensively by several entities including the United State Congress and, specifically, the Senate Agricultural Committee.”

Although Chambliss and Roberts appear to call for a wide swath of American agriculture to have representation at the meeting, it is difficult to overlook the key point of their correspondence:

“Beyond our interest in a balanced review, we would hope that no correlation is planned between the upcoming workshops and current enforcement activity in your respective Departments. From recent news of lawsuits to undo mergers to heightened scrutiny of pre-merger activity and other investigative activities with agribusiness companies from a variety of sectors, it is readily apparent that both the Department of Agriculture and Department of Justice are already quite engaged in this area. We are concerned there is potential for your workshops to become venues for further fact-finding or public scrutiny of agricultural businesses that are already subject to existing antitrust laws and in some cases are under investigation or prosecution by the federal government.”

As of 2007, more than 45 percent of U.S. beef cattle are slaughtered by four companies (Tyson, Cargill, Swift and National.) Most U.S. Pork is also processed by just four companies (Tyson, Cargill, Swift and Smithfield). Seed corn is controlled predominately by two companies (Pioneer Dupont and Monsanto), and roughly 40 percent of the U.S. fluid milk supply is controlled by one company (Dean’s Foods).

Rhonda Perry, a Missouri livestock and grain farmer, said 30,000 cattle feed lots went out of business in the last 13 years. During the past 20 years, the nation lost 70 percent of its independent family hog farmers — but managed to keep production levels the same.

“We’ve been told that we have to have consolidation, concentration and vertical-integration in order to give consumers the cheap food they desire,” she said. “The reality is, if you look at the pork industry — a prime example because it has become really vertically-integrated in the last 25 years — that between 1985 and 2008 pork prices to consumers went up by 72 percent. At the same time the hog farmers’ share of that consumer dollar went down by 43 percent. So, somebody in this industry, in this consolidation process, is definitely getting rich. It’s working for somebody, but it is not working for producers and consumers.”

Fred Dowered, a Minnesota farmer, told the audience that when he began farming 34 years ago his state had 50 seed companies. Now, however, there are only four.

“When there were 50 seed companies, the price of seed corn was held to its own. Now they just let it go rampant,” he said.

That’s a situation that Jim Kalbach, an Adair Couty grain farmer, knows all too well.

“Monsanto soybean seed was $31 a bag last year. Now they jumped it up one third to $41 a bag — in one year,” he said. “That’s highway robbery.”

Many of the men and women in the audience also took exception to the belief that the U.S. food supply boasts the most healthy and inexpensive food in the world.

“The two things we are going to hear over and over on Friday is that we’ve got the cheapest and safest food supply in the world. Both of these statements are damn lies” said Gary Klicker, a southern Iowa producer that can trace his family’s agricultural roots to 1666.

Klicker believes that taxpayers will be out “billions if not trillions” of dollars cleaning up rivers, nourishing soil and dealing with abandoned animal confinement facilities.

“Have you ever heard of 19 million pound beef recall in Sweden or Germany or Russia or Cuba or anywhere else? The food isn’t safe. We are eating garbage off the floors of our packing houses. It’s being fed to our kids in schools, and it goes into our grocery stores. Most of the people have no idea what they are getting, and wouldn’t know what real food tastes like if they had it. This is a serious, serious situation — one that we will be paying for 100 years from now. It isn’t safe. It isn’t even cheap.”

Although U.S. Sens. Tom Harkin and Chuck Grassley are on the schedule for Friday, along with U.S. Rep. Leonard Boswell, no federal elected officials attended the townhall meeting in person. A handful of audience members used their very limited comment period to note their disappointment that the officials themselves did not attend, and at least two were openly hostile toward lawmakers who had long-served without providing notable solutions to the competition issues in their industry.

“This was a huge crowd,” Dave Campbell, district representative for Boswell, said following the meeting. “What I’m going to pass on to the Congressman is the fact that were a whole lot of people here who are hurting. He will have an opportunity to hear from both sides, and will hopefully make the best decisions possible.”

John Moreland, staff assistant for Harkin, also said that he would be taking his reflections on the “passion” expressed at the meeting back to his boss.

A notable appearance at the townhall was made by members of the United Food and Commercial Workers International Union. After the meeting Mark Lauritsen, vice president and director of the UFCW Meatpacking Division, explained that his members understand how closely their livelihood is tied to that of the farmer.

“We should have been getting together back in the 1980s and having these discussions. … Our lives are connected with farmers. Our members’ lives are connected to farmers. Our success rises and falls with the American farmer,” he said.

Producers from at least 10 states traveled to Ankeny for the townhall. Many also plan to attend the workshop, and would like opportunity to speak. Since only one hour at the end of the day has been allotted for public comment, however, it isn’t likely that there will be time for them all. That being said, it also isn’t likely that these motivated individuals are going to go away. Wisconsin Dairy producer Joel Greeno said several groups are already gearing up for the June meeting planned in their state, and that other producers are organizing in relation to the workshops planned for Colorado and Alabama later this year.

“The situation in agriculture these days, even though it has been coming on for a long time, is reaching critical mass,” said Frank Jones, a Missouri owner and producer. “I’m afraid that if we don’t have some type of meaningful change in the way business is done that agriculture will be lost forever.”

John McCain and Sarah Palin visit flood-damaged areas of Northwest Cedar Rapids on Sept. 18, 2008 (Pool Photo/The Gazette, Liz Martin).

But none of that is what former Alaska Gov. Sarah Palin remembers about her visit.

On Sept. 18 — two weeks exactly from the close of the 2008 Republican National Convention — the McCain-Palin campaign planned their first joint stop in the Hawkeye State. The event was initially planned as a rally at the local airport; however, public outcry forced the campaign to make time for a trip into the city for a short walking tour of flood damage.

In her book, “Going Rogue,” Palin briefly discusses the visit to Cedar Rapids as follows: “… Jason, Jeannie and Bexie were there at one of our first campaign stops after the convention, a stop I’ll never forget. It was at a rally in Cedar Rapids, Iowa. The town was a slice of Americana, with its quaint town square with mom-and-pop stores; red, white and blue bunting; moms and dads; kids in strollers; seniors; and people of every color. …”

Green Square Park, located in downtown Cedar Rapids, is likely the only place  in the city that could be mistaken for a traditional town square. Located on 4th Avenue SE, it is bordered by a large parking ramp, the Cedar Rapids Museum of Art, the True North building, the First Presbyterian Church and Waypoint Services. None of the facilities that surround Green Square Park could be misidentified as mom-and-pop businesses, and those larger businesses in the area, like the museum, were open but still renovating and restoring at the time of the McCain-Palin visit.

More importantly, though, the downtown area was not a portion of the city that McCain and Palin visited during their flood tour. According to several reporters and local officials who participated in the tour, the campaign drove from the rally at the airport directly to a predominately residential section on the northwest side of town, known locally as the Time Check neighborhood.

After walking roughly four blocks of residential streets flanked by flooded-out homes and curbside debris, McCain and Palin paused in front of a completely gutted structure on which someone had hung an American flag to make brief remarks for the accompanying press pool. American flags were a commonplace feature in the flood zones of the city, and perhaps those are what Palin mistook for “red, white and blue bunting.”

While it may be easy to excuse a politician for confusing towns along a long campaign trail, this error happens against the backdrop of numerous concerns about facts in Palin’s book. The Associated Press dedicated a team of reporters to the book and found numerous discrepancies, ranging from her contention that President Barack Obama pushed the through a bailout package that actually was achieved by his Republican predecessor to her statements with regard to travel expenses.

But the Cedar Rapids stop should have been memorable because of the one thing that Palin appears to have forgotten: The flood-ravaged neighborhood she toured.

Long before she joined the campaign, McCain appeared to have made the Iowa floods a priority. Despite calls by Gov. Chet Culver for both McCain and Barack Obama to not tie up precious state resources in the immediate aftermath of the flood by visiting the state, McCain toured flood-damaged sites in Iowa on June 20, 2008.

When local Republican officials complained that McCain and Palin were not making time to see the devastation in Cedar Rapids first-hand at the time of the September airport rally, the campaign made time concessions so that the short walking tour could take place. A month later, in October 2008, both the McCain-Palin campaign and the Republican National Committee targeted Iowans with mailing pieces and robocalls that indicated Democrats “went on vacation” instead of helping flood victims.

The stop described in Palin’s book might very well be one she’ll “never forget,” but it did not take place in Cedar Rapids.

The Iowa Independent requested comment from Palin’s political action committee. There has been no response as of publication.

80 of Minnesota’s 87 counties are considered to be mental health shortage areas (iStockphoto)

SIOUX FALLS, S.D. — One of the most difficult challenges rural communities face is not only how to attract health care professionals to their traditionally under-served areas, but also specifically how to train them for their unique local needs, and keep them from leaving for often better opportunities in urban areas. The situation, which has been extensively detailed during a conference here last week, is especially dire in the field of mental health due to the combination of increased need, long work hours, lack of professional networks and typically low pay.

In northern Minnesota, however, a small group of local behavioral health specialists have created a post-doctorate program that has not only established one of the nation’s first pipelines of providers, but has enhanced the way existing agencies and providers interact for the betterment of an entire rural region.

Dr. Jeffrey Leichter, one of five founding members of the Minnesota Consortium for Advanced Rural Psychology Training, told conference attendees on Tuesday that one of the major challenges associated with bringing behavioral health care providers into rural areas is that few are adequately prepared for the realities of practicing there.

Jeffrey Leichter

“In a rural community, you can’t just say, ‘I treat eating disorders, and that’s all I do.’ You just can’t do that in a smaller community,” Leichter explained.

A mental health provider in a smaller community not only needs to be able to see a wide variety of clients at all life stages, often referred from various community agencies, but needs to understand when his or her scope of practice has been exceeded and a referral has to be made.

“That’s a very difficult thing to decide,” he said. “Do I keep a client even when I know that there is a provider several hours away with more knowledge about a specific condition? Since many clients won’t travel that far due to transportation or financial issues, are such clients actually better off with the care I can provide even when it will be more generalized? It becomes a question of whether some care is better than no care at all.”

There is also the aspect of running a “fishbowl medical practice,” in that clients and providers are thrust into the same day-to-day routines. The situation, he said, makes it difficult, if not impossible, for a provider to ever really leave the office.

“There are a lot of ethical boundary issues,” he said. “If you live in a small town, your client is pumping your gas. Your client is on the church committee with you. Your client is across the table at a supper you were both invited to attend. … Those are ethical issues that you don’t learn about in school.”

In addition to lower pay through a client-base that is primarily covered by either Medicare or Medicaid, the scrutiny and other unique demands that make it difficult for smaller communities to attract and retain providers, there is also the added burden of the inherent risk factors and cultural differences of working with a rural population.

“Most rural residents face triple jeopardy,” he said. “That is, they are poor, uninsured and live in isolated areas.”

Another way to describe the problem, he said, is by the “four As”: accessibility, availability, acceptability and affordability. Rural residents seeking even the most basic health care are impacted by each.

For all of these reasons and more, Leichter and four other local providers accepted a $23,000 Minnesota state grant and began writing a curriculum that would specifically provide post-doctorate psychologists with first-hand experiences of practicing in a rural setting. Since accepting its first psychology resident in 2006, MCARPT has graduated three students, all of whom have gone on to provide services in under-served areas of Minnesota. Two more residents are anticipated to complete the program this fall, and there is a possibility that the new section that begins in October will expand to three residents.

Those who developed and planned the Detroit Lakes–based training program, did so with a specific goal in mind: “Reduce the shortage of psychologists practicing in rural communities due to poor retention of mental health professionals in under-served parts of the state and thereby enhance access for rural residents to quality mental health services in their communities.” In short, it really was about creating a pipeline of professionals that could stem an existing and problematic shortage. The results of providing the service, however, have also had a local, positive impact.

“There are multiple benefits,” Leitcher said. “There is direct benefit to the community in the sense that we are populating the number of mental health professionals over the course of time that are going to be in the community. This particular project — and I don’t think I’m being overly boastful — has created cohesion among these 11 agencies that previously often times never talked with each other. There’s a connection … [and] now they all speak to one another in the interest of making sure the fellowship program works smoothly.”

Existing professionals within the community have also been able to combat feelings of isolation due to interactions, like group supervision meetings, that are built into the program.

“There aren’t a lot of psychologists in our area, but of those that are, many are involved in the program by doing supervision or teaching or some other type of training element,” he said. “I think it is very fair to say that a lot of folks who kind of felt like they were out there by themselves are now being brought into the fold of this project, and are feeling like they are a part of something that is very cutting edge and innovative.”

Since 80 of Minnesota’s 87 counties are considered to be mental health shortage areas, Leichter laughed when asked how long it would take MCARPT to provide psychologists to all under-served areas of the state.

“A lifetime at least,” he said and laughed some more. “But we are making a dent.”

Lynda Waddington is a reporter at the Iowa Independent.

Images like Iowa artist Grant Wood's idyllic farm scene sometimes obscure the real stresses that make up the daily lives of rural residents. (Photo courtesy Deere Art Collection)

The Farm and Ranch Stress Assistance Network, authorized (but not funded) by the 2008 farm bill, would create a national crisis hotline for rural workers and also mandates additional behavioral health services in geographically rural regions. While some states have hotlines and some capacity to provide behavioral health services designed for agricultural workers, others have nothing in place.

Statistics show that the presence of such services can reduce rural violence and suicides, which are currently on the rise.

“How many deaths will it take?” asked Mike Rosmann, executive director of AgriWellness, an Iowa-based nonprofit that promotes accessible behavioral health services for underserved rural populations. “[This] leaves farm people with fewer options to deal with mounting stress. It is especially true for livestock and dairy producers, although the picture is much bigger than just those industries because grain prices are declining and costs of production are rising above the value of products in the marketplace.”

U.S. Sens. Tom Harkin and Chuck Grassley of Iowa pushed for the creation of the stress assistance network as a part of the farm bill. Harkin, a Democrat who chairs the Senate Agricultural Committee, had requested $5 million be provided to the program during appropriations debate. Grassley, a Republican, and Democratic Sen. Tim Johnson of South Dakota also argued for “appropriating the maximum amount possible” in a letter sent to the agriculture appropriations subcommittee in May.

“Farming is one of the most stressful and dangerous occupations in the United States,” Grassley said in December 2007, while urging members of his own political party to stop their attempts to block inclusion of the network in the farm bill. “There are environmental, cultural and economic factors that put farmers and ranchers at a higher risk for mental health problems. Stress is agriculture contributes to rates of depression and suicide that are double the national average. This is true even in good times for farmers.”

Indeed, as senators who opposed creation of the network were quick to point out, the agriculture community at the time of the farm bill debate was flourishing. That is unfortunately not the case today as farmers brace against overall economic decline, suffer massive product price reductions and battle against misinformation about disease. Under these circumstances, and without a safety net, health care professionals are worried that the nation will once again witness breakdowns within agricultural communities similar to those seen during the 1980s farm crisis.

“The consequence of all of this is that there will be mounting frustration,” Rosmann said. “There is also a greater likelihood that more and more people will be frustrated to the point that they are going to do something because they feel like government isn’t listening. We have to have parity of behavioral health care for rural and urban people.”

The appropriations bills will now be taken into a conference committee where the differences between them will be reconciled. During the appropriations conference process, according to a spokeswoman in Grassley’s office, congressional rules do not permit funding for an item that was not previously contained in either the House or Senate versions of the bill. If the conference committee did attempt to include the funding, any member could object — and, given the debate during this item’s authorization in the farm bill, some lawmaker probably would.

“I worked very hard to put the Farm Stress Assistance Network in the farm bill,” Harkin said during a conference call Thursday morning with reporters. “It was attacked … during the farm bill debate, but we persisted and got it in. I just haven’t been able to get funding for it yet. The Republicans would not sign off on my efforts on this.”

There is also some speculation that funding could be included in overall health care reform, but such inclusion would likely be left to a newly created health care committee through recommendations from the U.S. Department of Health and Human Services.

In that type of scenario, the U.S. Department of Agriculture would have much less influence in terms of ensuring urban-rural parity. Further, if health care reform does not include a public option and/or if preventive behavioral health services like the stress assistance network aren’t considered essential services, already cash-strapped rural families would be more likely to have to pay additional premiums to access insurance coverage for such services.

“I’m disappointed that the agriculture appropriations committee failed to see the positive benefits of this program,” Grassley said in a statement to The Iowa Independent. “Farmers continue to see drastic market swings and difficult weather patterns. The assistance of the Farm and Ranch Stress Assistance Network would be a tremendous help to many feeling the impact of problems out of their control.”

The fiscal 2010 Agriculture, Rural Development and FDA Appropriations approved by the Senate includes nearly $101 billion in mandatory spending, an increase of roughly $13 billion from what was enacted in 2009, and just over $24 billion in discretionary spending, an increase of roughly $2.5 billion from 2009. The House bill calls for nearly $23 billion in spending, an increase of roughly $2.3 billion from 2009. The appropriations bill funds nutritional programs, food and drug safety initiatives, international food aid, USDA research and rural development programs.

Lynda Waddington is a reporter at the Iowa Independent.

SIOUX FALLS, S.D. — Although only about four million of the estimated 44.3 million people of Latino descent in America live in Midwestern states, cultural differences and economic realities associated with those populations have created additional challenges for rural health care delivery systems that are already stretched thin. Experts warn, however, that society will have a high price to pay if access to medical and behavioral health care isn’t provided to immigrants regardless of their resident status.

“I believe the people who are here, whether they are documented or undocumented, if they pose significant public health challenges, we need to pay attention,” said Dr. Sergio Aguilar-Gaxiola, founding director of the Center for Reducing Health Disparities at the University of California-Davis Health System. “One example of why that is the case is the H1N1 epidemic. That virus does not recognize borders. HIV is another virus that has portability, as does substance abuse. None of them recognize or stop at a country’s border.”

Aguilar-Gaxiola, who is also a professor of clinical internal medicine at UC-Davis and just completed a four-year term on the National Institute of Mental Health’s advisory council, informed a group of primarily Midwestern mental health professionals gathered for a conference on Monday that immigrants are often caught in a vicious cycle of poverty and mental illness. After his keynote address at the conference, Aguilar-Gaxiola told the Iowa Independent that this is especially true for most immigrants who come into Iowa or other regional states to take jobs at factories and meatpacking plants.

Dr. Sergio Aguilar-Gaxiola

“There are different migratory trajectories,” he explained. “The Mexican-origin immigrants that you have here in the Midwest come from certain regions in Mexico, primarily from the more rural areas. I think there are nuances and differences that one has to look at in terms of whether the immigrants come from rural or urban areas, and whether they take skilled or unskilled jobs.”

Immigrants who originate from rural regions in Mexico, he said, are far more apt to be without an adequate education and to have little or no job skill set. In contrast, immigrants who choose to pursue skilled jobs in larger cities come primarily from Puebla or other metropolitan areas that have better access to educational and vocational opportunities.

Lack of opportunity, dead-end jobs, low wages and a general feelings of helplessness have contributed to an increased instance of substance abuse among second and long-term first generation people of Latino descent living in the U.S.

According to research Aguilar-Gaxiola helped compile, roughly 20 percent of Mexican immigrants report having either alcohol abuse or dependence issues. In addition, roughly 18 percent report drug abuse or dependence. In each case the abusive disorders reported by the Mexican population are several percentage points higher than national averages. And, unfortunately, the cultural differences between immigrants from rural and urban areas don’t appear to signify any significant substance abuse disparities following migration to the U.S.

“The differences in prevalence rates between first-, second- and third-generation immigrants are very consistent and replicated findings across the U.S. and specifically in regions of the U.S. that include Midwestern states,” Aguilar-Gaxiola said.

Cultural differences do, however, create challenges for physicians who wish to deliver behavioral health services to immigrant populations.

According to Aguilar-Gaxiola, Latinos are more likely than non-Hispanic whites to terminate treatment prematurely, with as many as 60 to 75 percent of Latinos drop out after a single session. Much of this, he believes, is due to language barriers between behavioral health professionals and those they seek to serve. This can be especially true for immigrant populations who are already concerned that requesting help could lead to discrimination or deportation.

“We have many reports that have helped us to become more aware about these raids and how they separate and impact families,” he said. “Even if parents might be undocumented, and subsequently deported, often their children are born in the U.S. and are citizens.”

Although there has been speculation regarding the mental and physical health consequences faced by the children of deported parents, Aguilar-Gaxiola said that there are currently no good studies documenting the challeges the young people face in the wake of such an event.

North Carolina, a state that is experiencing one of the nation’s largest population growth from Latino immigrants, was the subject of a University of North Carolina study that looked at whether or not such populations were a burden on state services. The study authors surmised, according to Aguilar-Gaxiola, that the immigrants gave more than what they took.

“I happen to believe that if we were to pay attention to access to health care and access to education for these populations that the return would be much greater than the cost,” he said. “Unfortunately, I think that as a part of the national debate on immigration that there is an idea or a sentiment that immigrant populations are a burden, and that they are taking other people’s jobs. This is especially true in the current economy when jobs are scarce and people are really scrambling to get good jobs. But the jobs that [immigrants] take for the most part are the jobs that not many other populations are reading and willing to do — very taxing and very high-risk jobs, very low-paying and without many benefits.

“So I see this from the public health perspective that it is better to tend to the populations, especially when they are contributing in one way or another to the economic region.”

Lynda Waddington is a reporter for the Iowa Independent.

(iStockphoto)

SIOUX FALLS, S.D. — Agricultural populations have problems accessing health care services for a number of reasons: rural areas lack qualified health care professionals, and residents face financial constraints and even local stigmas that serve as barriers to getting treatment. These challenges are even more pronounced when residents need to access behavioral or mental health services, experts said here Monday during a conference on rural health care.

As a result, America’s rural populations have become more susceptible to depression, anxiety, substance abuse and suicide. In fact, rural men are not only much more likely to have suicidal thoughts, but also much more likely to act on such thoughts successfully. Just more than 40 percent of rural women in a University of Maryland study were depressed, compared to less than 20 percent of urban women. Child psychiatrists are only available in roughly 5 percent of the nation’s rural counties that have populations ranging from 2,500 to 20,000 — and general practice psychiatrists are only available in 25 percent of those same counties.

As a result, the precious few behavioral health professionals serving rural populations are testing and utilizing more technological tools for outreach. From peer-to-peer support groups to privacy-ensured educational seminars, rural residents with Internet access are being provided more opportunities to escape the isolation and unique cultural dogmas that often a part of rural living.

Most importantly, existing pilot programs are proving that support and reassurance need only be a click away.

Making a Difference Despite Distance

“It’s a group of extremely rural women in several different states who come together over the Internet to talk about life, shared experiences, challenges and simply support one another,” said Clarann Weinert, a professor at the Montana State University College of Nursing and a Sister of Charity of Cincinnati, while explaining the Women To Women program. “What we’ve learned is that by allowing these women, most of whom were suffering from severe depression, to come together in this way, we’ve been able to significantly reduce their depression. We know this because of the measures we are taking, and also because the women are telling us how much being a part of the group has helped them.”

The program, which began in the mid-1990s, is open to women between the ages of 35 and 65 who have a chronic illness. Those accepted into the program must either live in a town with a population under 12,500 or live further than 25 miles from a town with a population in excess of 12,500.

To date more than 700 women from Montana, North Dakota, South Dakota, Nebraska, Iowa, Wyoming, Idaho, Oregon and Washington have participated in the program, which includes a 22-month computer-based support group that is moderated by a health care professional. The computer-based support has been so successful that most women who participate form some sort of social network of their own once the 22-month program ends so that they can continue to be in contact with one another.

“One woman may be in Wyoming. Another may be in Washington. Still another might be in North Dakota. But where you are sitting doesn’t make any difference when you are on the computer,” Weinert said.

Although the women all face chronic illnesses, no attempt was made to segregate or group based on specific diseases such as cancer, lupus, spinal injuries or diabetes.

“They actually spend very little time talking about the specifics of their diseases,” she explained. “They talk about life, living life and what has to be done despite the fact that we have whatever it is that we have.”

Weinert said many of the women express themselves on the group through poetry or original drawings. By encouraging each other, she said, they renew their own strengths. And, because everyone in the group can relate to the over-riding issues surrounding chronic illness — fatigue, stress, sadness — there is no shortage of compassion for those who feel overwhelmed as well as no shortage of joy for moments of success.

“This has a lot of potential,” Weinert admitted, saying she’s contemplating adding new applications for computer-based support and health information groups. “It was expensive because we had all the research bells and whistles. Now that we have proven that it works, however, it could be pared down to a very simple option where groups of women come together with one moderating professional who only visits with them once a month. The rest of the time they are supporting each other.”

Stigma-Free Information

In the coming weeks, Minnesota rural health advocates will launch free web-based, stress-oriented seminars. Although the webinars have not yet been made available to the public, organizers from Minnesota’s Sowing the Seeds of Hope hotline provided an overview and live demonstration Monday to participants at the rural health care conference. The “webinars” are a pilot project of the Sowing the Seeds of Hope hotline, and are made possible by a grant by the Otto Bremer Foundation.

“We were really looking at the end users and their needs,” said Dr. Karen Shirer, an associate dean and capacity area leader for the Extension Center for Family Development at the University of Minnesota. “So, we were really looking at ag producers, workers and their family members. We wanted them to be able to access stress education from their own homes, where they would not experience the stigma and other embarrassment that can accompany taking that first step.”

Many rural people are concerned about perceived or real stigma that is associated with seeking behavioral health services. It was that concern that prompted the Minnesota group to partner with Minnesota State University Extension to distribute the webinars through their “Families in Tough Times” initiative.

In order to create a program that would be both helpful and used by rural people, developers first contacted and surveyed 130 health care professionals who had worked with nearly 25,000 rural Minnesotans during the previous year. When the results were tabulated, developers had a very good idea of what types of stresses rural residents were most reporting to health care professionals as well as a better picture of what percentage of that population would be most likely to utilize a webinar.

“Nineteen percent of these professionals through that agricultural people would view webinars. One in five. We thought that wasn’t too bad,” she said.

“We also thought — because of the way technology is changing and how more people are using those services — that it might be one-in-five today, but it could be three-in-five two years from now. What we also know is that ag producers use the Internet and technology.”

In Minnesota, SSoH partners with Crisis Connection in Richfield to provide hotline services. Each year the Minnesota group receives about 4,000 calls from rural areas. If the one-in-five estimate holds true, however, the organization will reach roughly 18,000 Minnesotans with the webinars.

Across the seven-state program, most callers report stress due to financial difficulties and daily living as the primary reason for their call. Others phone due to personal mental health issues, depressed family members, marital and family conflicts or addictions. In specific times of crisis, callers may seek help with particular farm-related problems, such as how to stop a livestock disease outbreak or how to access weather-related emergency services.

Although the services reported by the surveyed providers varied slightly from this list — for instance, family conflicts were the number one reason individuals sought help — there were many more similarities than differences.

Another Access Issue

One of the key challenges facing behavioral health professionals who wish to reach rural populations through technology is one that they can’t control: Rural Internet access. Broadband typically isn’t an option in more rural areas and, in the few areas in which it is available, high-speed access remains fairly cost-prohibitive.

“It was a real issue when we first began recruiting women for the Women To Women program,” Weinert said. “When women who were accepted to the program didn’t have equipment or access, we provided it to them. Now, however, we rarely encounter a woman who doesn’t already have what she needs to participate.”

Dial-up access, the rural standard for access, varies greatly by region and even by phone line. Some may be able to launch interactive scripts and programs, but others may have to wait several minutes for basic photograph to load.

“Honestly, we just don’t really know how accessible the webinars are going to be,” Shirer said. “There are no strong numbers to tell us what type of access rural families have to the Internet.”

Dr. Kay Slama, principal of Slama Consulting in Spicer, Minn., and a professional helping with the webinar project, knows all too well that, despite the fact that developers didn’t utilize all existing interative elements to create the webinars, there will still be some individuals who cannot access it due to their Internet connection.

“I have dial-up at home,” she said during the conference breakout session. “I am able to access and use the webinar. But, I have a friend who also has dial-up, and she can’t use it at all.”

Lynda Waddington is a reporter for the Iowa Independent.

Images like Iowa artist Grant Wood's idyllic farm scene sometimes obscure the real stresses that make up the daily lives of rural residents. (Photo courtesy Deere Art Collection)

Seven months ago, Jelle Hans Reitsma, a 37-year-old Dutch immigrant who owned and operated two large California dairies, succumbed to the financial strain of low milk prices. Under pressure from banks to repay millions of dollars in loans, and believing the only foreseeable way to raise money was to either sell his dairy herds or have them slaughtered, he took a handgun, drove to a nearby walnut orchard and committed suicide.

Reitsma wrote two notes before shooting himself. One was to his family. The other was a four-word note to the bank’s local branch manager: “Welcome to the kill.”

Stories like Reitsma’s are becoming more frequent in states like California, Maine and Colorado. Experts say Midwestern states like Iowa are better prepared to deal with rural mental health problems, but the risks are still high.

“To farmers there is a real kinship with the land and livestock,” explained Dr. Mike Rosmann, executive director of AgriWellness. “Ownership of a family farm — sometimes a farm that has been in the family for generations — is the triumphant result of a multitude of struggles. Losing the farm or the livestock is viewed as an ultimate loss, one that brings shame to the generation that has let down its forebearers and has dashed the hopes of successors.”

The psychological attachment farm families feel for their land and livestock is one of the lessons of the 1980s farm crisis — a time when farmer suicides and rural violence made front page news across the nation. Back then, Iowa and Nebraska, two states severely impacted by the farm crisis, developed crisis hotlines designed specifically to serve the needs of agricultural workers. Today, in the wake of natural disasters and in the midst of economic uncertainty, the hotlines are experiencing a spike in activity, likely helping to prevent more tragedies.

Sowing the Seeds of Hope provides behavioral health services to uninsured, underinsured and other at-risk farm families and ag workers in seven states. Despite droughts, floods and economic challenges to family-sized farm operations, the suicide rate has not increased in states that have these services.

AgriWellness and Iowa State University Extension jointly sponsor the Iowa-based Sowing the Seeds of Hope hotline, which serves rural people in seven Midwestern states, including Minnesota. It is the nation’s largest crisis help line for agricultural workers, and the calls are coming more often than they did even a year ago.

Though many of the calls the hotline has received from Iowa have been related to the impact of last year’s floods, Rosmann noted, “More recently, we have seen an uptick in calls that are related to market prices for swine and dairy.”

“In addition to the 20-percent increase in calls [when comparing the first four months of 2008 with the first four months of 2009], the content of the calls is changing,” Rosmann said. “The callers are reporting much more severe economic turmoil, more mental health symptoms and significant increases in mental stress.”

In times of inclement weather — for instance, severe storms, floods or droughts — the hotlines experience increased activity. The callers in these situations, according to Rosmann, are distraught but do not have the “intensity” of the callers during tough economic times.

“You probably aren’t seeing as many [suicides] in the states, like Iowa, where we have hotlines,” he said. “The hotlines have the effect of reducing the isolation and they create a vehicle people can use to contact someone. We don’t have quite as many suicides in any of the states where we have the hotlines and have other additional support services. [We have heard] that there were two suicides reported out of North Carolina, where there is no hotline. The same is true of California — there is no hotline there — or in Colorado.”

The statistical evidence of suicide reduction creates a good argument, he said, for why Congress should approve funding for the Farm and Ranch Stress Assistance Network that was authorized as part of the 2008 farm bill. The network creates a national crisis hotline for rural workers and also mandates additional behavioral health services in geographically rural regions.

There is insufficient data that examines suicide by occupational group, but several studies have demonostrated that suicide by farmers differs somewhat from suicide patterns by urban residents. The table above illustrates how farmers, if they decide to take their own lives, often align themselves with the cycles of farming. (Source: AgriWellness)

Federal officials, including U.S. Secretary of Agriculture Tom Vilsack, have signaled their awareness of the ongoing problem, but additional solutions may be hard to come by. “I’ve talked to farmers whose loved ones have committed suicide over this. I do understand,” Vilsack said during a rural community forum this week in Wisconsin.

Despite Vilsack’s recognition of what’s happening in rural communities, he said that he does not see many opportunities for additional federal intervention to turn things around. The U.S. Department of Agriculture, which recently approved $760 million in new farm loans, is considering restructuring loans and providing temporarily higher support payments, but ongoing discussions in the halls of Washington, D.C., will provide little comfort for agricultural families who field daily calls from creditors. Even if the idea is implemented, it is unlikely to be enough on its own.

Iowa has not yet seen the brunt of the burgeoning mental health crisis, largely because it remains ahead of the curve on rural mental health issues. The Hawkeye State not only provides an outlet for stress with its hotline, but it also offers follow-up care to agricultural workers who need it. The Iowa hotline has about 37 or 38 providers who have been contracted to give follow-up support to callers, Rosmann said. That means that Iowa residents need only travel 30 to 40 miles to access additional services.

“For many people that sort of distance is actually preferable because some don’t want to see a provider in their own town,” he said. “This usually has nothing to do with quality of care at local mental health centers, but has to do with the perceptions of what others might say if a family is seen going to the local facility or provider. So there is a perception of stigma attached to accessing behavioral health services, but that varies from person-to-person.”

In other states, rural residents tend to have more difficulty accessing mental health care.

“It’s a very complex picture,” Rosmann warned before beginning to explain the problems surrounding behavioral health services in rural America. “We have seen in Iowa the loss of psychiatrists and psychologists in rural areas. There just aren’t enough. But, we are better off than some other states. South Dakota is just terrible, and in Montana there just aren’t any psychologists and psychiatrists in rural areas. Residents there might have to travel 150 or more miles to get a court-ordered neuro-psychological evaluation because of lack of access.

“The numbers of appropriately-trained providers of psychology, psychiatry and substance abuse counseling in rural areas is half that of the same professionals in urban areas — and it is worsening.”

Further complicating the access issue for rural Americans is that there are very few medical educational tracks currently available that train health care professionals about the specific concerns that are often seen in more rural settings. And, outside of the rudimentary knowledge provided within those few agricultural medicine courses, there is no national curriculum in place for behavioral health professionals who intend to service rural areas.

“You simply can’t provide the information these professionals will need during a two-hour lecture,” Rosmann said. “We need a whole textbook and curriculum on agricultural behavioral health, and that is one of the things that we are now undertaking at AgriWellness.”

The organization plans to offer a six-hour course to professionals as a part of its upcoming biennial convention next month in South Dakota. Rosmann said that while recent discussions regarding mental health parity in conjunction with national discussions of health care reform are “a noble goal,” they don’t necessarily translate to actual access in rural areas.

“Having it on the books doesn’t mean that it is going to be adequately implemented,” he said. “I don’t know if it is a goal we are going to be able to achieve easily because parity requires the distribution of professional providers in ways that are quite different then where we are at currently. So, we are going to have to somehow get providers into the rural areas, and we’re going to have to change the reimbursement structure. Both of those are hard to change, but they are proper goals in my opinion.”

Lynda Waddington is a reporter for the Iowa Independent.

(Wikipedia)

Four years ago when Andy and Erin Nagel started their dairy farm in Allerton, Iowa, they thought they were embarking on the life they always wanted.

“We wanted to live on a farm, to be close to home, to raise children in this lifestyle,” Erin Nagel said. “This was exactly what we wanted.”

Due to low milk prices, however, the Nagels and other midwestern dairy farmers are hurting.

“We didn’t know it would be this bad or that it would stay this bad for so long,” Erin added.

The couple, who 18 months ago became parents to twins, a boy and a girl, had begun construction of a milking facility next to their home and were making plans for a house addition. The barn, which got as far as a frame and a concrete pad, now sits mostly idle except for the work that Andy does himself.

“I’m not sure what we are going to do if things don’t turn around,” Erin said. “We won’t keep milking if we can’t make money doing it, but I don’t know exactly what we will do.”

The Nagels aren’t alone. Throughout the region and the nation, dairy farms are feeling the crunch of low milk prices, earning the lowest prices for their products since the 1970s.

Jerry Harvey and his two sons milk 70 cows twice a day on their farm in Iowa’s Wayne County. His family is also feeling the squeeze and worry that they will not be able to remain in business. Last year the farm garnered a monthly milk check of about $6,500 per month. Now they receive just over $2,100.

“We aren’t making a living anymore,” Harvey said. “We aren’t even bringing in enough to pay our feed costs. Every month we are borrowing money just to stay afloat, and I don’t know how much longer we can continue.”

Milk checks paid to farmers are primarily based on three components: Protein, butter fat and other solids. The value of those components, according to Wisconsin dairy farmer Joel Greeno, are determined by formulas from the U.S. Department of Agriculture.

“For the past few months, the value for other solids has been assigned a negative value,” Greeno said. “That means that although the milk processor is taking that component and using it, I’m actually having money taken from my milk check for it. It’s worse than zero. It’s now a liability.”

U.S. Sens. Arlen Specter and Robert Casey Jr., both Democrats from Pennsylvania, have introduced a bill that dairy farmers believe would help ease decreased prices. The bill, dubbed the Federal Milk Marketing Improvement Act of 2009, would strengthen the price of milk paid to dairy farmers by requiring that all milk produced in the United States be priced using a national average cost of production. The USDA would reassess milk prices each year, ensuring that extreme price volatility is mitigated.

Tom Harkin and Chuck Grassley, Iowa’s two U.S. senators known nationally for their work on agricultural policy, are aware of the legislation proposed by Specter and Casey, but neither one is optimistic that the proposal will garner precious floor debate time in a Senate currently busy with health care and energy reform.

“We have some things already in place that can help,” Grassley said in a telephone interview with our sister site, The Iowa Independent. “But I’ve got to be candid with you: It’s not going to be enough to make up the cost difference that farmers are now experiencing.”

Grassley said that for the first time in history, dairy farmers do have feed incentives based on production costs written into the farm bill.

“But, you know, it’s kinda like a pimple on an elephant, compared to what the problem is,” he added. “It is, however, the first time Congress has ever recognized that a formula for price supports ought to be adjusted because of increased costs of production.”

Harkin, who briefly addressed the dairy crisis on his weekly conference call with reporters, is as skeptical as Grassley about the Specter-Casey bill’s chances of emerging from committee and getting a vote on the floor of the Senate.  But Grassley said there may still be other opportunities for reform on the federal level.

“I’ve been in Congress long enough to see, on three or four occasions, between Specter and [Vermont Sen. Patrick] Leahy, things that have gotten things done — especially to help dairy farmers — in addition to the farm program,” Grassley said. “They’ve done it through the annual agriculture appropriations bill. So the chances of doing something that way, I would guess could happen. But I doubt if it would be along the lines of the Specter-Casey bill.”

Harkin also thinks there are opportunities for Congress to help dairy farmers in lieu of the Specter-Casey bill.  He is hoping that the government can increase demand for dairy products (thereby raising prices) simply by leveraging its massive purchasing power.

“I’ve called upon the government to do more in terms of purchasing dry non-fat milk solids and non-fat dry milk and to use that in our foreign feeding programs,” Harkin said. “It is a pretty good bargain right now for the government to purchase that, and it is a good, usable commodity for people in other parts of the world who are suffering from malnutrition. That’s basically about all we can do.”

In the meantime, dairy farmers from Iowa and a host of other states are making efforts to raise awareness of the economic realities they face.  A group of farmers has planned a Saturday rally at the Manchester (Iowa) Livestock Exchange to call for passage of the Specter-Casey bill or similar federal legislation that could alleviate the problem.

“People believe that this is just one other unfortunate incident because of the existing economy,” Greeno said. “That is just absolutely false. The major three in each of the dairy categories — Kraft Foods being one — are turning major profits. How can that be possible when they are saying that consumption is down, production is up and product can’t be moved?”

A study, quoted by Greeno and released in March, indicates that over-production and decreased consumption are a myth.

“This is just absolutely demoralizing,” Greeno concluded. “No matter what you do, even if you give 110 percent every day on your farm from sun up to sun down, at the end of that day you will not have earned enough to pay your bills. It doesn’t get any more demoralizing than knowing that you did your job and you did it well, but someone tells you that what you just did isn’t valued enough to earn you a living. That’s just wrong when you are producing food for your country.”

Lynda Waddington is a reporter for the Iowa Independent. ]]> http://minnesotaindependent.com/35740/cash-strapped-dairy-farmers-pin-hopes-to-legislative-action/feed 0