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Rural communities like this one face many unique health challenges, but often lack representation in medical research. HHRA hopes to change that.

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  • A man spraying pesticides California’s Bold Plan to Transform Pest Management Systems is Long on Ambition and Light on Details

    By: Chuck Benbrook, HHRA ED By: Mark Lipson, HHRA Director of Policy and Regulatory Engagement We welcomed the invitation from California’s Department of Pesticide Regulation for members of the public to offer comments and guidance as the State begins to take concrete actions needed to achieve the goals set forth in the new report Sustainable Pest Management: A Roadmap for California. Reviewing the 94-page Roadmap report reminded us how many constituencies, forces, and factors are pushing and pulling farmers, pest managers, and government agencies in multiple directions that are rarely aligned. This Roadmap document describes a very different pest management future that will hopefully become the “de facto” way pests are managed on and off the farm by 2050. If successful by 2050, prevention-based biointensive Integrated Pest Management (bioIPM) will be the norm and there will be minimal if any use of high-risk “Priority Pesticides”. Some thirty-two years ago, DPR hired Chuck Benbrook to carry out a comprehensive evaluation of DPR’s programs and policies to assist in the integration of DPR into the newly-formed Cal-EPA. The resulting report, Challenge and Change: A Progressive Approach to Pesticide Regulation in California, came out in March of 1993. It provides dozens of recommendations intended to do many of the same things that the 2023 Roadmap report hopes to bring within reach. The fact that most pest management systems in California have become more, not less reliant on pesticides over the last 30 years suggests that DPR’s and CDFA’s efforts to achieve Roadmap goals are going to entail heavy lifting, mostly uphill. For this reason in HHRA’s comments, Mark and Chuck describe the nature and substantial scope of changes in laws and policy that will be required to track progress toward Roadmap goals and hopefully, someday, achieve them.

  • Europe is Growing Organic Production, Will the US Follow Suit?

    Advocates calling for change in US Ag Inc often struggle to point to successful models through which farming and food chains have evolved toward safer and more sustainable production systems. The surest way to largely eliminate the impacts of prenatal pesticide exposure on birth outcomes and children’s development – HHRA’s foundational goals – is converting US farmland to organic production. We are often asked how such change can come about. Convincing answers to this key and important question are few and far between in the US, but some key lessons are emerging from efforts in Europe to expand organic farming and food supply chains. The Cilento organic food bio-district in Italy was established in 2009 and is thought to be the first-ever in the world. Overcoming challenges faced by organic farmers in marketing their produce was a primary driver. Municipal actions expanded demand for organic food and ingredients via public food-purchasing programs. The lure of scenic rural landscapes and strong support from the agrotourism industry for organic food and farming created new market demand. Today, organic farming is thriving in the Cilento district, profit margins have expanded, and enhanced soil health is supporting higher yields at lower costs on many farms. An action by a city council led to the formation of the Södertälje organic food system in east-central Sweden, some 35 kilometers from Stockholm. The goal was to expand the supply of organic products for public food-procurement programs as a way to advance health and environmental quality. The municipality’s Diet Union developed new food products and recipes in the context of a “Diet for a clean Baltic” to promote health and reduce food waste. Restaurants and cafeterias began using smaller plates to cut down on waste, an intervention that has proven to be surprisingly effective. In south-eastern France the mad cow disease outbreak across Europe was the trigger of action leading to the Mouans-Sartoux organic food system. The initial focus was on supplying organic beef to school canteens, coupled with municipal government support for regional sustainable farm research and food education programs. A multi-faceted effort to provide organic food to children led to greater awareness of the diversity of benefits arising from organic farming. New efforts emerged to reach other vulnerable segments of the population with organic food (e.g. the elderly, pregnant women). These three region-based organic food systems in Europe are case studies in a just-published paper by Lilliana Stefanovic (2020), a scientist in the Department of Organic Food Quality and Food Culture at the University of Kessel in Germany. Imagine that. An academic department focused on organic food quality and culture. How long might it take for such a department to take hold at Iowa State University, in the heart of American farm country? The Stefanovic paper addresses how local organic food systems in Europe can contribute in achieving the Sustainable Development Goals (SDG) set forth by the United Nations, and especially SDG 12, “responsible consumption and production.” Her analysis concludes that local and place-based organic food and farming districts can make important contributions in transforming food and farming systems to promote human and animal health, and soil health and environmental quality. Two drivers played key roles in all three case studies: relatively short distances to population centers, and significant support for organic supply chains from public food-procurement programs, and especially those feeding children. And just a few months ago, the Italian government pledged to invest 3 billion euros (about $3 billion US) to convert at least 25% of the country’s farmland to organic systems by 2027. The funds will come from Common Agricultural Policy payments supported in part by a tax on pesticide sales. There are about 16.6 million acres of arable land in Italy. Reaching the 25% organic goal would entail the transition of around 2 million more acres to organic, given that a little over 15% of Italian farmland is already managed organically. If $3 billion in transition payments were spread over 2 million acres, average payments would be around $1,500 per acre. A multi-pronged effort in Italy is planned to simultaneously grow the supply of organic foods and demand for them. Investments will be made in the infrastructure needed to support profitable regional organic food supply chains, while increasing the supply of value-added, premium foods for sale throughout Italy, Europe, and for a few commodities (especially olive oil), the world. Such bold pledges and audacious goals have come and gone in many countries with little concrete and sustained change to show for the resources invested. But perhaps the time is right in Italy for acceleration in the transition to organic farming in light of the many scientific studies showing that organic farming can both slow global warming and render farms more resilient in the face of drought and flooding. What about here in the USA? The USDA has recently pledged to invest $300 million in a new Organic Transition Initiative. This program will provide new funding via many USDA-program channels to encourage the transition of farms to organic production. While a major increase in USDA funding dedicated to expanding organic production, $300 million over several years is a small share of the approximate $20 billion in annual federal spending on farm commodity and crop insurance programs. It is also instructive to compare the $3 billion investment in Italy to reach their goal of 25% of farmland in organic by 2027 to the $300 million investment just announced by USDA. The Italian program, if it actually happens, would provide about $1,500 per acre transitioned to organic. The USDA’s investment of $300 million translates into about $4.30 per acre across the approximate 70 million newly transitioned acres necessary for 25% of the US cropland base to be managed organically. Current disparity in public support for and investment in the transition to organic farming in the US versus Europe arises from vastly different public awareness of the benefits likely to stem from the transition of more farmland to organic production. Many public and private institutions […]

Side Effects of Rural Living: Health Disparities in the Heartland

by Grace Koch | Nov 17th, 2021
by Grace Koch | Nov 17th, 2021
Rural communities like this one face many unique health challenges, but often lack representation in medical research. HHRA hopes to change that.

Thursday November 18th, 2021 is National Rural Health Day. This year the National Organization of State Offices of Rural Health (NOSORH) is specifically highlighting health equity in rural communities. One of the goals of HHRA’s flagship project, The Heartland Study, is to analyze the impact of pesticide exposures on human health, especially on reproductive impacts, healthy pregnancies and children’s development. Our research is already documenting rising levels of herbicide use and exposures across all citizens in the Midwest and rural communities in particular.

Factors impacting the health of rural populations are often underexplored in large scale clinical research projects carried out in large urban centers. According to the U.S. Census Bureau, 97% of land in America is considered rural. Recognition of rural health disparities, and the factors driving them, is an important part of HHRA’s current and future research.

Rural Health Disparity

A whole host of compounding factors have created significant health disparities for rural communities. Rurality is generally classified as any area outside of an urban area. The Census Bureau defines rural as any population, housing, or territory NOT in an urban area. In 2020, there were approximately 57.23 million people living in rural areas in the United States, about 17% of the overall population (Source).

Rural communities are often geographically isolated from the many resources urban and suburban people take for granted. Something as simple as a yearly doctor’s appointment, or finding a healthcare specialist, can be difficult for rural families, due to long distances they may have to travel and limited transportation options. Census data of medical doctors in the US shows that rural areas only have 11 MDs per 10,000 people, compared to 31 per 10,000 in urban/metro areas. In addition, the extent and quality of healthcare services varies greatly across rural regions of the country.

Source: March of Dimes

Data from March of Dimes shows how access to hospitals in the Heartland state of Iowa are limited to only a few counties (see map). Many families in rural counties have little or no access to a nearby hospital or birth center. This distance can complicate a person’s ability to get appropriate treatment for serious health problems, especially for rural individuals who don’t have a car, money, or access to transportation.

Lack of access to healthcare resources has a direct impact on the health and quality of life of rural communities. These populations have statistically higher rates of disease and disability, pain, increased mortality, and shorter life expectancies. The top five leading causes of death (heart disease, cancer, unintentional injury, chronic lower respiratory disease, and stroke) are all higher in rural populations compared to urban populations.

In the Heartland State of Indiana, for example, cancer related deaths are far higher in rural/nonmetro counties than in urban/metro counties (see chart below).

Source: RHIhub

Food insecurity is also higher among rural populations. According to the USDA Economic Research Service report in 2020, 11.6% of rural households are food insecure, compared to 10.5% for the nation as a whole. Child poverty and food insecurity is also higher in rural areas, with 16.1% of rural households with children being food insecure, compared to 14.8% overall.

Inequality and Social Determinants of Health in Rural Populations

One rural population that is particularly vulnerable to pesticide exposure is farmworkers. HHRA hopes to translate Heartland Study materials into Spanish and other languages to promote participation by farmworker communities.

Health inequalities are often exacerbated by social determinants of health. Rural Americans are more likely to be low in socioeconomic status or be unemployed, have less post-secondary education, and are less likely to have healthcare coverage by employers or through Medicaid.  In addition, rural households have less access to community social programs, foodbanks, and SNAP program benefits.

Social inequities and health disparities go hand in hand. Social determinants of health like income, education, health literacy, environmental health, gender identity, and race/ethnicity all impact an individual’s physical and mental health.

The data backs this up – adults of racial and ethnic populations, living in rural areas, face more health disparities than white adults. A 2017 CDC report showed that Indigenous, Hispanic, and Black individuals in rural areas were more likely to have higher rates of poor health, report multiple chronic conditions, and are at most risk for obesity.

Rural communities may also face more environmental challenges that can impact health. Overall access to safe drinking water, healthy food options, and stable housing is a problem for many rural communities. Hazardous materials often end up in rural areas, contaminating local environments. In farming areas, heavy use of agricultural chemicals can expose both farmers and non-farmers to toxic pesticides in air, water and dust and soil particles. These additional routes of exposure to possibly toxic chemicals are at the crux of HHRA’s scientific research on the impacts of pesticide exposure on reproductive health, pregnancy outcomes and children’s development in the Midwest. By including rurality in our research, we hope to better understand the connections between farming practices, pesticides and other toxins unique to rural areas and public health outcomes.

HHRA is committed to taking account of the impacts of the unique risk factors and unequal access to healthcare services in specific rural areas, as well as gleaning insights from rural-based clinical research. Progress in understanding these factors will help HHRA address how access to food and farming systems impact public health outcomes in the Heartland and beyond. 

We are committed to enrolling at least 30% of participants in our flagship project, The Heartland Study, from rural areas. Most clinical research on pregnancy and reproduction takes place in urban research hospitals, and the unique health challenges faced by rural women are often not explored. We want to change that.

This is why HHRA is working to build research capacity in rural hospitals and why we will be recruiting more rural hospitals into The Heartland Study. 

We are also hoping to raise adequate funding for 2022 to translate our clinical research documents into other languages. Inclusivity starts with ensuring everyone has a seat at the table, where their voice can be heard.

This #GivingNovember please help us expand our reach to rural families and healthcare providers in the Heartland.  You can do so my making a contribution, signing up for the HHRA newsletter and following us on social media.

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