RURAL COMMUNITIES AND MENTAL HEALTH NEEDS
Mental Health First Aid (MHFA) is an eight-hour program that teaches people with no clinical training how to respond to signs of mental illness and substance use, similar to community-based CPR training intended to reduce cardiac deaths. Begun in Australia to reduce community stigma and to assist peers in advising friends, neighbors, and co-workers to get professional help, MHFA is now widespread in rural communities in the United States. However, the program has still not undergone rigorous evaluation here, where limited behavioral health options are already stretched.
HEALTHY TAXES
The Federal Earned Income Tax Credit (EITC) is the largest anti-poverty program we have and among the most effective, especially for reproductive-age women. Recipients earn a tax credit that varies with the level of earned income, encouraging employment. For the past 30 years individual states have introduced their own EITCs, and 26 states now have programs that may affect health as well as women’s income. These researchers found that the greater the generosity of a state’s EITC, the greater the increases in overall infant birth weight, a key predictor of infant mortality and later childhood outcomes. The measured health benefit of EITCs is similar to increases in birth weight produced by the income boost of minimum wage laws.
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WHAT THE FRACK?
Hydraulic fracturing, or fracking, is the process by which natural gas and oil are extracted from underground reservoirs using specialized drilling processes. The United States’ largest source of natural gas comes from the Marcellus Formation, 104,000 square miles of underground shale rock that spans Ohio, Pennsylvania, New York, and West Virginia.
In some communities fracking is an essential boom for local economies that brings jobs, higher wages, and lower unemployment rates. But the fracking industry can also have a negative effect on boom communities.
A 2017 study conducted by Komarek and Cseh found fracking activity in boom counties to be associated with a 20% increase in new gonorrhea cases between 2003 and 2013.
The top graph provides a timeline showing boom counties experienced a rapid increase of new wells starting in 2006. The contrast with non-boom counties is stark. The second graph (figure 4) shows a divergence in the number of new gonorrhea cases per year in counties with and without fracking. The beginning of the divergence corresponds with the onset of fracking activity in 2006. Although rates decrease in the first three years of fracking, there is a dramatic 20% increase in the last four years.
The United States spent $15.6 billion in 2008 on treating sexually transmitted infections, with $162.1 million spent on gonorrhea alone. The 20% increase in gonorrhea rates in the Marcellus Shale region is much higher than the 2-3% increase observed across the country. Only diagnosed cases can be recorded by the CDC, which means the true number of people affected is under-reported. This report demonstrates another way that fracking changes communities. Young male workers arrive to perform newly available work, alcohol use increases, and sexually transmitted infections rise. — Erin Polka, PHP Fellow
Feature image: (Top graph figure 3) Growth in the average number of wells in Boom and Non-Boom counties (NY, PA, OH, WV). (Bottom graph figure 4) Gonorrhea incidence rate (per 100,000 population) in countries above the Marcellus Shale formations with and without horizontal wells (OH, PA, WV), Komarek, & Cseh, Journal of Public Health Policy (2017) 38: 464. https://doi.org/10.1057/s41271-017-0089-5
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