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.


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