People in rural America are five times as likely to live in so-called "ambulance deserts," areas far from an ambulance service or station, than those in urban areas.

In rural Iowa, ambulance service has declined as the population dwindles. The study, from the Maine Rural Health Research Center, said half of those living in ambulance deserts are in rural areas, more than 25 minutes from an ambulance station.

Keokuk, along the banks of the Mississippi in eastern Iowa, has seen its population shrink to fewer than 10,000, with a sharp decline in ambulance service.

Cole O'Donnell, city administrator, said the situation got worse when officials were forced to close the local hospital.

"It frightened a lot of people," O'Donnell recounted. "I know that we have older people that moved out of Keokuk to someplace closer to a hospital. You know, they had health problems and if something happened, they couldn't wait those extra minutes, or even the extra minutes of getting them from Keokuk to a hospital."

In addition to trying to bolster county ambulance service, O'Donnell noted Keokuk is working to help reopen the local hospital as a federally designated Rural Emergency Hospital, which requires the facility to provide emergency services and outpatient care 24 hours a day, 7 days a week.

Emergency medical service is not considered essential in rural America, and the federal government does not fund it. Volunteers form the backbone of E-M-S operations in many areas, including Iowa. But O'Donnell acknowledged in Keokuk, times have changed. It is hard to find paramedics and emergency medical technicians, let alone people who do not get paid to do those jobs.

"When I was growing up in the '70s and the '80s, my mom was even part of the first responders," O'Donnell explained. "You can't even get first responders now to set up a service where they respond before the ambulance gets there, because nobody wants to volunteer anymore."

While about 14% of Americans live in rural areas, the report shows they make up more than half the population living in ambulance deserts.

Young farmers in New York and across the country want Congress to help them deal with the effects of climate change.

Bayer's Farmer Voice Survey showed 71% of farmers said climate change has affected their farm. The Fifth National Climate Assessment reported drier conditions are becoming more of a detriment to agriculture in the Southeast, and the problem of drying land is increasing since New York and other Northeastern states had modest droughts in 2022.

Holly Rippon-Butler, land policy director for the National Young Farmers Coalition, described some climate-resistant practices farmers are using to combat climate change.

"One of the most popular programs that farmers in our network are using is the high tunnel program," Rippon-Butler pointed out. "One of the ways farmers are adapting is by building high tunnels on their farm, making sure that they've got some way to keep crops out of the weather or control the climate a little bit for their crops."

Conservation is becoming more important to farmers. The National Young Farmers Survey found 83% of young farmers said their farm exists primarily to engage in conservation or regeneration and 86% of young farmers utilize regenerative agriculture practices. But fewer than half of younger farmers are taking advantage of U.S. Department of Agriculture programs which could prove beneficial to handling climate change.

While farmers are determining how to handle climate change's effects, there are other barriers preventing them from leading the charge. Rippon-Butler described the challenges farmers are facing.

"Being able to afford land to purchase is the top challenge young farmers face," Rippon-Butler explained. "This kind of long-term security is really necessary for farmers to invest in climate mitigation and resilience."

She noted federal legislation could help young farmers better deal with climate change. Some bills include the Increasing Land Access, Security, and Opportunities Act, which provides funding for equitable land access, and The Farmer to Farmer Education Act, which creates investments in farmer-led climate change education could prove helpful.


get more stories like this via email

President Joe Biden was in southern Minnesota yesterday to highlight federal investments for rural America.

Biden visited a farm near Northfield to discuss funding from recent packages such as the Bipartisan Infrastructure Law and the Inflation Reduction Act, with the latter focusing on climate projects and health care assistance.

For agriculture, the administration said there is new funding for farmers to take advantage of climate-friendly practices, such as nutrient management, with other provisions designed to create market fairness.

Tom Vilsack, U.S. Secretary of Agriculture, spoke at the event and said the efforts allow rural residents to keep their communities vibrant.

"They want their families to have the opportunity to farm and to work, and to raise their families in the small communities where they come from," Vilsack explained.

While the infrastructure law received support from lawmakers on both sides, Republicans strongly opposed the Inflation Reduction Act. They've been trying to cut some elements of the law amid budget battles in Congress. Some of the proposed rollbacks would come under the Farm Bill reauthorization, with opponents of such moves arguing there would be a negative effect on rural communities.

Meanwhile, $65 billion has been set aside within the infrastructure law to boost access to high-speed internet, with the hopes of enhancing efforts to close broadband gaps in rural areas.

Josh Sumption, chief technology and information officer for the Southwest West Central Service Cooperative, said they welcome any help in putting local students in a better position to learn in the digital age.

"For schools, it's really about students being able to continue to learn and take their homework home," Sumption pointed out. "And stay connected to their educational institutions and the resources that they're using in the classroom."

Like other voices in education, he said the pandemic made worse some of the internet connection challenges rural students face. Sumption acknowledged recent federal investments might not close all broadband gaps but hoped more projects will be shovel-ready very soon, citing additional funding from the state.


get more stories like this via email

By
Tony Leys for KFF Health News.
Broadcast version by Mark Moran for Iowa News Service reporting for the KFF Health News-Public News Service Collaboration

Allison Roderick has a warning and a pledge for rural residents of her county: The water from their wells could be contaminated, but the government can help make it safe.

Roderick is the environmental health officer for Webster County in north-central Iowa, where a few thousand rural residents live among sprawling corn and soybean fields. Many draw their water from private wells, which are exempt from most federal testing and purity regulations. Roderick spreads the word that they aren't exempt from danger.

More than 43 million Americans rely on private wells, which are subject to a patchwork of state and local regulations, including standards for new construction. But in most cases, residents are free to use outdated wells without having them tested or inspected. The practice is common despite concern about runoff from farms and industrial sites, plus cancer-causing minerals that can taint groundwater.

"You're cooking with it. You're cleaning with it. You're bathing in it - and, nowadays, there are so many things that can make you sick," Roderick said.

Federal experts estimate more than a fifth of private wells have concentrations of contaminants above levels considered safe.

Like many states, Iowa offers aid to homeowners who use well water. The state provides about $50,000 a year to each of its 99 counties to cover testing and help finance well repairs or treatment. The money comes from fees paid on agricultural chemical purchases, but about half goes unused every year, according to the Iowa Department of Natural Resources.

Roderick, who started her job in 2022, aims to spend every penny allotted to her county. Last spring, she snared an extra $40,000 that other counties hadn't used. She promotes the program online and by mailing piles of postcards. Traveling the countryside in a hand-me-down SUV from the sheriff's department, she collects water samples from outdoor spigots and sends them to a lab.

When she finds contamination, she can offer up to $1,000 of state grant money to help with repairs, or up to $500 to cap an abandoned well.

Experts urge all users of private wells to have them tested at least annually. Even if wells meet modern construction standards and have tested clean in the past, they can become contaminated as the water table rises or falls and conditions change above them. A faulty septic system or overapplication of fertilizer or pesticide can quickly taint groundwater.

Too many residents assume everything is fine "as long as the water is coming out of the tap and it doesn't smell funny," said Sydney Evans, a senior science analyst for the Environmental Working Group, a national advocacy organization that studies water pollution.

The main concerns vary, depending on an area's geology and industries.

In Midwestern farming regions, for example, primary contaminants include bacteria and nitrates, which can be present in agricultural runoff. In rural Nevada and Maine, arsenic and uranium often taint water. And, throughout the country, concerns are rising about the health effects of PFAS chemicals, widely used products also known as "forever chemicals." A recent federal study estimated at least 45% of U.S. tap water contains them.

Filters can help ensure safety, but only if they're selected to address the specific problem affecting a home's water supply, Evans said. The wrong filter can give a false sense of safety.

Evans said people who wonder about possible contaminants in their area can ask to see test results from wells supplying nearby community water systems. Those systems are required to test their water regularly, and the results should be public, she said: "It's a great place to start, and it's free and easy."

She also said people who rely on private water wells should ask local health officials about eligibility for help paying for testing and possible repairs or filters. Subsidies are often available but not publicized, she said.

A study by Emory University researchers published in 2019 found that all states have standards for new well construction, and most states require permits for them. However, the researchers wrote, "even in states with standards for water quality testing, testing is typically infrequent or not conducted at all."

Some longtime rural residents live in homes that have been in their families for generations. They often know little about their water source. "They'll say, 'This is the well my grandfather dug. We've used it ever since, and no one's had an issue,'" said David Cwiertny, director of the University of Iowa's Center for Health Effects of Environmental Contamination. They might not realize impure water can harm health over time, he said.

Some states require inspection and tests of private wells when properties are sold. Iowa doesn't mandate such measures, although Webster County does. It's a good idea for homebuyers anywhere to request them, said Erik Day, who oversees the private well program for the Iowa Department of Natural Resources. He also recommends asking for a technician who can run a flexible scope down the well to visually inspect the inside.

Day estimated fewer than 10% of Iowa's private well owners have them tested annually, even though testing can be free under the state grant program.

In Webster County, Larry Jones recently took advantage of free well testing at a weathered ranch house he bought west of Fort Dodge, in a subdivision bordering a large soybean field. Jones lives next door to the 54-year-old home, and he is refurbishing it as a place for his relatives to stay.

Roderick, the county health official, sampled water from the well and found it was tainted with bacteria. She offered Jones $1,000 from the state grant to help get it fixed. He added a few thousand dollars of his own and hired a contractor.

"It's an investment for the future," he said. "You're talking about your family."

The old well was made with a 2-foot-diameter concrete casing sunk vertically in sections about 60 feet into the ground. A smaller plastic pipe ran down the middle of the casing to water at the bottom. A pump pulled water up through the smaller pipe and into the home.

Lynn Rosenquist, who owns a local well-repair business, told Jones the well probably was original to the house and likely met standards when it was built. But at least one chunk of concrete had broken off and fallen in.

Repairs took two days of heavy work by Rosenquist and his brother, Lanny, who are the third generation of their family to maintain wells. The brothers used a backhoe and small crane to remove much of the concrete casing. They replaced it with a narrower, PVC pipe, which they sealed with a cement mixture to prevent seepage from the surface. When finished, they "shocked" the system with a bleach solution, then flushed and tested again.

Such modern construction is less prone to becoming tainted, Roderick said. "If it's not sealed airtight, bacteria can get in there and it's just gross," she said.

Grossness is not the only thing Roderick considers. Besides E. coli and other bacteria, she tests for nitrates and sulfates, which can exist in farm or lawn runoff or come from natural sources, and for arsenic and manganese, which can occur in rock formations. She plans to add tests for PFAS chemicals soon.

She collects the water in small plastic bottles, which she mails to a lab. She enters information about each well into a state database. If the tests turn up contaminants, she advises homeowners of their options.

Roderick said she enjoys the routine. "I've met so many people - and I've met a lot of dogs," she said with a laugh. "I love the feeling that I'm really helping people."


Tony Leys wrote this article for KFF Health News.


get more stories like this via email