ANSWER: It’s about Everyone

The Question of Bridging the Rural Divide

We are a nation adamantly divided.  Partisans on both sides have dug in their heels and stubbornly hold onto their ideological and political positions for nothing less than full victory.

The divide is most clearly represented by the results of the presidential election where the significant factor was college education – those who have it and those who do not, which is reflected in an urban versus rural split, as significantly more urban dwellers tend to have a college education.

So how do leaders bridge this divide?  (Despite the rural constituency’s importance, I find some Democrats refusing to acknowledge that rural denizens have unique issues that should be addressed.)

I believe the answer is simple.  It hearkens back to times when politicians were less likely to turn away from constituents who were not part of their winning coalition.  As practical and judicious, elected officials should listen to and work for the best policy solutions for everyone.  Include, do not exclude.

The recent Washington Post-Kaiser Family Foundation survey found that “the political divide between rural and urban America is more cultural than it is economic, rooted in rural residents’ deep misgivings about the nation’s rapidly changing demographics, their sense that Christianity is under siege, and their perception that the federal government caters most to the needs of people in big cities.”

As such, rural citizens are much more disaffected from urbanites than the other way around:

  • 68 percent of rural residents say their values differ from people who live in cities, while only 48 percent of urban residents make the same comparison with rural dwellers.
  • 41 percent of rural residents say their values are “very different” from city folk, but only 18 percent of urbanites say rural values are “very different” from their own.

Key, the survey shows that disagreements between rural and urban America center on the perception of fairness:  “Who wins and loses in the new American economy, who deserves the most help in society, and whether the federal government shows preferential treatment towards certain groups of people.”

As before, there is less influence found from economic distress in rural support for Trump.  Those who lament their community’s job opportunities report supporting Trump by 14 percentage points more than for Clinton.  Trump’s margin was 30 points among those who thought job prospects were excellent or good.

The largest and key fissures between Americans living in cities and those in less-dense areas are rooted in misgivings about the country’s changing demographics and resentment about perceived biases in federal assistance.  Race permeates these issues.

Agree with statement that blacks and Hispanics losing out because of preferences for Caucasians is the larger problem than the reverse.

  • 56 percent – urban
  • 37 percent – suburban
  • 34 percent – rural

Agree with statement that Caucasians losing out because of preferences for blacks and Hispanics is the larger problem than the reverse.

  • 34 percent – rural
  • 27 percent – suburban
  • 23 percent – urban

Agree with statement that immigrants are a burden on the nation.

  • 42 percent – rural
  • 31 percent – suburban
  • 16 percent – urban


In this context, rural Americans are skeptical that the federal government is fair or effective at improving people’s economic situations.

  • A total of 64 percent say federal efforts to improve living standards either have little impact or make things worse.
    • 31 percent – do not have much impact
    • 33 percent – make things worse
  • 56 percent of rural residents say the federal government does more to help people living in and around large cities.
  • 37 percent feel the federal government treat both urban and rural areas equally.

Policies for improving the employment situation in their areas that rural Americans support:

  • 68 percent – decreasing regulations on businesses
  • 79 percent – lowering taxes on businesses
  • 93 percent – infrastructure projects
    • 74 percent – “very important”


An analysis of the conditions that may have lead to the anger of rural and blue collar America.  Republicans and Democrats should seek constructive solutions.  Success in doing so could shape the balance of political power in this country.

A Wall Street Journal analysis shows that since the 1990s, sparsely populated counties have replaced large cities as America’s most troubled areas by key measures of socioeconomic well-being – a decline that is accelerating.

  • With many of these measures – poverty, teenage births, divorce, death rates from heart disease and cancer, reliance on federal disability insurance, and male labor-force participation, rural counties now rank the worst among the four major U.S. population groupings (the others are big cities, suburbs, and medium/small metro areas).
  • Previously, for more than a century, rural towns sustained themselves, and often thrived, through a mix of agriculture and light manufacturing.  Until recently, programs funded by counties and townships, combined with the charitable efforts of churches and community groups, provided a viable social safety net in lean times.
  • In the 1980s and for years afterwards, the nation’s basket cases were its urban areas – where a toxic stew of crime, drugs, and suburban flight conspired to make large cities the slowest-growing and most troubled places.
  • By 2013, in the majority of sparsely populated U.S. counties, more people died than were born – the first time that has happened since universal birth registration began in the 1930s.  In fact, the total rural population – accounting for births, deaths, and migration – had declined for five straight years.

From Breadbasket to Basket Case

  • As jobs in manufacturing and agriculture continue to vanish, America’s heartland faces a larger, more existential crisis.
  • Just two decades ago, the onset of new technologies, in particular the internet, offered the potential to boost the fortunes of rural areas by allowing more people to work from anywhere and freeing companies to expand and invest outside metropolitan areas.  Unfortunately, those gains never materialized.  (For example, while President Barack Obama’s administration pushed expanded broadband access, Obama found that service providers were reluctant to enter sparsely populated towns.)
  • In medical health, even after adjusting for age, rural areas have become markedly less healthy than America’s cities.  In 1980, rural areas had lower rates of heart disease and cancer.  By 2014, those positions have flipped.
  • Also, in the 1980s, rural Americans had lower teen birth and lower divorce rates than their urban counterparts.  Now, those positions also have flipped.

Hitting the Floor

  • Although federal and state antipoverty programs were not limited to urban areas, they often failed to address the realities of the rural poor.  The 1996 welfare overhaul put more city dwellers back to work, for example, but did not take into account the lack of public transportation and child care that made it difficult for lower-income people in small towns to hold down jobs.
  • In addition, as employers left small towns, many young residents packed up and left, too.  In 1980, the median age of people in small towns and big cities almost matched.  Today, the median age in small towns is about five years above that in big cities.
  • As other areas saw an upswing in quality of life, rural areas struggled to find ways to harness changes and maintain the levels of their own quality.
    • Health and health care have declined in rural areas.
      • Consolidation has shut down many rural hospitals, which also struggle from a shortage of patients with employer-sponsored insurance.
      • Rural residents say irregular care left them sicker, aggravated by long drives for treatment and high rates of smoking and obesity.
      • The opioid epidemic – and a lack of access to treatment for it – also has compounded the damage.
    • A third of adults in urban areas hold a college degree, almost twice the share in rural counties, census figures show.
    • Opioid abuse has contributed towards driving up crime rates.

7,000 Doctors from Travel Ban Countries Practice in Underserved U.S. Communities

Some quick big picture thoughts before the purpose of this message.

After advocating for balance and grounded decision-making after the election, I have discovered that I was wrong.  Organizations such as No Labels and shining stars such as John McCain and Lindsay Graham have worked to keep debate and action on a principled and sensible course.  And they should continue to do so.

Nevertheless, the battle lines are primarily drawn, as we saw in last year’s election, between the college-educated and worldly versus the non-college educated and more traditional.

As with the tea parties, it is clear the progressives will stand their ground and fight vigorously for their principles.  Unless the debate is based on fake news and lies, everyone should have it all out.  It is as if with a dysfunctional family or a family with a lot of problems.  Nothing gets worked out and righted unless all the ugly emotions, dirt, lies and facts are hurled out to be faced and argued.  It is going to be a long two – four years.  So have at it.


This story not only provides another important angle to the issue but assists in highlighting the myopia of many (nativist or not) Americans who have not, do not or refuse to see the international engagement and contributions that meet Americans’ basic and crucial needs and desires.  (I am avoiding the terms foreign and global because their connotations turn off many of the Americans that should hear this message.)

  • A study from Harvard and MIT researchers found 7,000 doctors practicing in the U.S. are from countries covered under President Trump’s travel ban.  Many of these doctors work in rural and impoverished parts of Michigan, Ohio, Pennsylvania and West Virginia that strongly supported Trump’s White House bid. These 7,000 doctors provide an estimated 14M medical appointments per year.
  • The ban could block thousands of immigrant medical professionals from staying in or entering the country, potentially affecting the health of millions of Americans, especially those in rural areas.
  • American health care relies substantially on foreign-born labor, especially in rural and high-risk urban areas where hospitals and clinics struggle to fill jobs amid what medical associations describe as a catastrophic shortage of doctors. The shortfall is only projected to grow worse in coming years amid the aging of the Baby Boom generation.
  • While most foreign-born doctors already in the country are unlikely to be directly affected by the order, medical groups are sounding the alarm about the danger that expiring work visas may be delayed or not renewed at all, forcing physicians to leave the country. And they also say the country’s next generation of doctors could be at risk, amid lingering questions about whether students from the affected countries will be allowed to study and work in the U.S.

Brookings Institution: Caucasian Non-College Educated Deaths Rise at Startling Rate

Reflective of the unhappiness and needs among non-college educated Caucasians:

  • The Brookings Institution has released a report documenting rising mortality since the turn of this century for a broad swath of Caucasian adults, starting at age 25, driven by troubles in the hard-hit working class.
  • The increase stems partly from ‘deaths of despair’—from drugs, alcohol-related liver diseases and suicide.  The opioid epidemic has only heightened a trend that was already under way before those drugs hit the market.
  • Death rates for non-college educated Caucasians now exceed those of blacks overall.
  • By contrast, the mortality rate has continued to decline this century for Caucasians with a college degree, albeit more slowly than before.
  • The analysis paints a portrait of a gradual “collapse of the white, high-school-educated working class after its heyday in the early 1970s,” and whose health, mental well-being, and attachment to the labor force have become successively worse for people born after 1945.
  • Taken together, these changes in life may be leading to physical and mental-health problems, the researchers calling their hypothesis “preliminary but plausible” with more research needed on several fronts.  The rising mortality of working-class white adults appears to be rooted both in worse job opportunities and increasing social dysfunction, following generations of relatively stable lives that involved job advancement and an expectation of living better than one’s parents.  Those changes have come along with trends such as a decline in marriage, more temporary relationships and children out of wedlock, and a rise in social isolation that have made life less stable.
  • The work deepens a growing body of academic and government research into the possible causes of rising mortality rates among Caucasians, whose ills among the working class are reshaping the nation’s social, political, and economic landscape.
  • The ills are so deep and complex that it could take many years and many changes in policy to reverse.