Publications

Delores McQuinn knew her city of Richmond, Va., had challenges with access to healthy foods well before she was elected to Virginia’s House of Delegates in 2008. “This little kid … would come to my house almost every other day to see if we had food for (him) and his siblings," she said. I realized … that there were some serious issues of people having access to food.” The U.S. Department of Agriculture defines a food desert as a census tract with a substantial share of residents who live in low-income areas that have few grocery stores or healthy, affordable food retail outlets.

Sixteen states have passed laws explicitly authorizing needle exchange programs, and there are a number of states with statutes that either decrease barriers to the distribution of clean needles or altogether remove syringes from the list of drug paraphernalia. Additionally, a recent HIV outbreak in the small town of Austin, Ind., has led more states to consider authorizing such programs.

Forty-eight rural hospitals have closed their doors since 2010, according to data recorded by the North Carolina Rural Health Research Program at the University of North Carolina, Chapel Hill. The typical rural hospital has 25 to 50 beds. It is more dependent on Medicare and Medicaid, which generally pay less than other insurers, and it has lower patient volume than urban hospitals. “The implication of lower volume is that the hospital is spreading fixed costs over less people and there is less certainty about the numbers of services that will be provided on any given day,” said Mark Holmes, director of the North Carolina Rural Health Research Program. “This uncertainty makes it hard to staff the hospital and hard to plan.”

To paraphrase Mark Twain, “the reports of Rural America’s death are greatly exaggerated.” In fact, at least four major trends are helping improve the future of rural America: broadband, telemedicine, job training and new methods to attract young people to farming all offer hope.

Forty-five states levy a general statewide sales tax, with rates ranging from 2.9 to 7.5 cents $1 as of Jan. 1, 2015. Over the past decade, sales tax rates have remained relatively stable, with few states making significant changes. Among the states that levy a sales tax, the average rate was 5.64 percent in 2015, up from 5.35 percent in 2005.

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