Missouri Farm Bureau conference concentrates on rural life issues

"Rural Communities Matter'

Missouri's rural residents endure challenges unique to the places they live - typically small towns abundant in farmland but sometimes lacking in certain resources needed in daily life.

Those resources - broadband, health care and transportation - headlined discussions Wednesday between rural development and state transportation officials, health care professionals, state legislators, farmers and rural residents at the Missouri Farm Bureau's first-ever "Rural Communities Matter" conference.

Blake Hurst, president of the Missouri Farm Bureau, said the three topics are important to the organization's membership base, and the information presented will be beneficial as the Farm Bureau looks to the 2016 legislative session.

He said the conference was also designed to empower rural residents to be advocates in their own areas.

Broadband

Across the nation, Missouri is ranked the 38th most connected state with 22 percent of the population under served.

Missouri's broadband coverage is at 74 percent. Towns and communities on the outskirts of more densely populated centers lack the infrastructure for Internet access. Not only is the installment expensive, but the affordability for rural consumers is another challenge, sometimes caused by little to no competition for a single Internet service provider, said Janie Dunning, state director of rural development.

Rural communities that do have Internet access, she added, struggle with its speed. The Federal Communications Commission (FCC) established benchmark speeds in 2010 at 4 megabits per second (Mbps) download speed and 1 Mbps upload speed. In January, the FCC recognized the broadband deployment, prominently in rural communities, was falling behind advancements in technology and couldn't keep up with consumer demands. It changed the benchmarks to 25 Mbps for downloads and 3 Mbps for uploads.

Of all Americans, 17 percent, or 55 million people, cannot access that benchmark, the FCC said. Nearly half of those - 22 million - live rural areas. As education trends increasingly toward technology incorporation, Dunning said rural schools suffer the most when Internet services are deficient.

She said if rural communities need greater broadband infrastructure, they must lead campaign for the service. She added electric cooperatives are partnering with their customers for broadband, and some phone companies are offering the capability.

"The main point of this is that it goes back to community," she said. "It's hard enough to build it. It's not a build it and they will come thing, you got to know they will come before you build it or they can't pay for it."

Dunning said increased state government involvement in improving broadband access would better rural communities. Christopher Collins, a general field representative with the USDA Rural Utilities Service, added the state can become progressive with new or modified legislation.

Health care

In rural communities, many people have health care but with limited access, Hurst said.

Dr. Stanley Horner, a Jefferson City-based allergy, asthma and immunology expert said patients try to save on cost by seeing a physician's assistant or a nurse practitioner during a visit to their doctors' offices rather than their physician. Family practice, he added, is on the decline due to the rate of overhead costs to run a clinic, which is currently at 65 percent. This figure is driven by insurance companies asking doctors to provide non-reimbursable services, such as approvals for medications and procedures.

In that same vein, Brooks Miller, president and CEO of the Jordan Valley Community Health Center in Marshfield, said family practices pay the least and are the most work intensive.

"If you compound that by putting a general practitioner or a family practitioner in a rural setting, there's no rest," Miller said. "Quite honestly, the rural providers I've worked with don't go to the grocery store without seeing their patients, they don't go home at night without getting the routine call."

Miller said female doctors are also affecting patient access. According to the Association of American Medical Colleges, 47 percent of medical school students are women and 46 percent of residents are women. He said because women, historically, identify with children and families, they tend to trade their professions and practices for their home life.

Horner added rural communities could see benefits from TeleHealth and TeleMedicine - telecommunication services that allow health care professionals to connect with patients via video technology.

Transportation

Missouri is in a "transportation crisis," state Highways and Transportation Commission Chairman Stephen Miller told the conference.

The Show-Me State has the seventh largest transportation system in the country - more than Kansas, Iowa and Arkansas combined - but is the 47th lowest funded, he said. While Kansas spends $71,000 per mile of road, he noted Missouri spends $14,000.

Bordered by eight states, Miller said Missouri should be the "hub of the greatest economic engine" - transportation - but it is not recognized that way statewide or nationally.

However, there is good news for the farming community, he said. In the early 1950s, Missouri improved its transportation system and expanded to 34,000 miles of road and more than 10,000 miles of bridges, improving the connectivity of rural communities. The bad news, though, is the Missouri Department of Transportation doesn't have adequate funds to maintain that.

"What we inherited from our parents and grandparents, we are in the process of squandering," Miller said.

MoDOT has prioritized its primary system, 8,000 miles worth of routes connecting the entire state, and its 26,000 miles of supplementary routes, which are utilized in smaller towns, take whatever funds are left over, he added. At this point, Miller said the state is in "preservation mode." MoDOT is also focused on replacing I-70 and enhancing its roads and bridges.

Of the 10,000 Missouri bridges, 641 are considered in critical condition, meaning they can be driven on but are susceptible to being closed. That doesn't count the 1,400 bridges with weight limits that can prevent farmers from hauling goods across.