5 Ways COVID-19 Puts Rural North Carolina at Risk

COVID-19 will impact North Carolina’s rural communities and small towns differently than it may the bigger cities and urban areas.

On one hand, people living with more space between them can feel safer and more secure than those living in big urban centers such as New York and Los Angeles (or even Raleigh or Charlotte) where there are more people living in closer quarters. However, the same isolation that could, on one hand, offer a certain amount of protection can also become a liability as the virus hits our rural communities.

Find predictions of transmission rates for your area here.  

Five Ways Rural North Carolina is Vulnerable to COVID-19

1. Many of the low wage jobs prevalent in rural North Carolina have been declared essential but also lack basic protections.

Almost half of all Americans work in low-wage jobs, according to the Brookings Institution. The study shows that 44% of U.S. workers are employed in low-wage jobs that pay median annual wages of $18,000 and provide no benefits, such as sick leave or health insurance. In North Carolina, low wage work is sometimes the only available work in rural communities, as agriculture has rapidly consolidated and manufacturing has steadily been declining over the last thirty years. The low wages and sometimes irregular hours of these jobs leave families with little to no savings and ill-equipped to face illness or layoffs. 

Many of these workers have been deemed essential (gas station attendants, janitors, grocery store workers, nursing home assistants, etc), and are currently working with little protections on the frontlines of this pandemic. Without employer-provided health insurance, and not covered by Medicaid due to our state’s refusal to close the coverage gap for the working poor, these employees may feel they have no choice but to go to work sick spreading the virus further. 

2. Immigrant communities and farmworkers are vital to our rural economies and our local communities but are vulnerable because they have little legal or safety protections. 

Many rural North Carolina communities have been kept afloat– or even completely revitalized– socially and economically through immigration. Since the 1990s, immigrants have migrated to rural areas at unprecedented rates, accounting for 37 percent of overall rural growth from 2000 to 2018, mitigating the exodus of younger generations.

Manufacturing and farmwork in our rural areas are highly dependent on immigrant labor, especially in harvesting and meat packing prevalent in North Carolina. According to the 2014 National Agricultural Workers Survey, 73 percent of all farmworkers are foreign-born. These families are important to the health of our rural communities, and also essential workers during this crisis. 

However, immigrant communities face the same challenges as do all low-wage workers, but with have even fewer protections on the job due to their citizenship status and frequently can’t access healthcare at all. Furthermore, immigrant communities, including essential food chain workers, have been all but cut out of the recently passed federal aid package designed to help communities hard-hit by COVID19. 

3. The closing of our schools during the pandemic is hard for all families but could hurt rural children the most. 

No one disputes that schools had to close during this pandemic to help flatten the curve and to keep our children safe. However, moving to online learning from home aggravates pre-existing disparities and will dramatically widen the achievement gap for rural children. 

North Carolina is home to 568,000 rural students, the second-largest rural student population in the United States, after Texas. The majority of children attending rural schools here in North Carolina are poor or near-poor: 62 percent of rural students qualify for free or reduced lunch compared to 46 percent of urban students. Schools serve as social hubs providing food, healthcare, and other critical resources in addition to education: Closing school doors shut down this access to families, with serious consequences to our children’s health and well-being.

North Carolina’s rural districts spend over $1,000 less per student than the average rural district in the United States and also pay their teachers less– As a result, children attending these rural schools were already at a deficit compared to their urban and suburban counterparts. With education moving online, this gap will only grow especially as both school and families lack the resources to do this well: North Carolina public schools continue to operate without a budget even as the academic year nears its end, meaning they can not operate with the flexibility to rise to the challenges of this pandemic. Furthermore, families in rural areas often lack high-speed internet access at home either because their families can not afford it or because the services simply can’t reach their homes, making it difficult for students to access information and complete assignments.

4. Rural healthcare has been under attack and too many rural North Carolinians can’t go to the doctor even as the pandemic hits their communities.  

Due to economic factors including the refusal of several states–including North Carolina– to expand Medicaid, rural hospitals across the nation have not only faced dramatic funding shortages but are closing even as the curve of the COVID-19 steadily climbs. Over the past 10 years, 120 rural hospitals have closed nationally out of 1,844 (about 7%) in what has been referred to as ‘the rural hospital closure crisis’ and the problem does not seem to be letting up. In February, The Chartis Group released a study showing that more than 450 rural hospitals are vulnerable to closure– in the same places where there are high rates of elderly folks and low wage, uninsured workers. As a result, more than half of all counties in the United States have no hospital ICU beds, posing a particular risk for the more than 7 million people over the age of 60 living in those places, who are also at a high risk of severe cases of Covid-19. Just as a pandemic hits our communities, rural hospitals in North Carolina are struggling to keep their doors open and about a third are operating in the red. There have been five rural hospital closures in North Carolina since 2010

What this means for people living in small towns and rural communities is that they will have a harder time getting medical care during this pandemic. Sometimes, rural folks need to drive to the next county for care, adding an additional cost to something too many already can’t afford. It also means that as COVID-19 hits our rural communities, North Carolina health care providers, many of who were already operating short-staffed or in the red, will be overburdened and may not be able to handle the mounting need

5. Rural communities were already at risk due to a lack of healthcare.

Overall, rural communities “tend to be older, with more chronic illness, and less healthcare access. 15% of the American population lives in rural areas and the average age of rural Americans is 73.3 years old. It is well documented that these are some of the most at-risk populations during this pandemic. 

However, evidence suggests that in the South there is another population at risk: Statistics suggest that middle-aged and working-age adults in at least two southern states (Louisiana and Georgia) are at much greater risk than their counterparts elsewhere. A recent analysis from the Kaiser Family Foundation indicates at-risk populations include people who have heart disease, cancer, lung disease, or diabetes. 

In the South, and in particular the rural South, these health concerns track with race and poverty regardless of age. In turn, these disparities track with policy: North Carolina, Texas, Florida, Georgia, and Louisiana all spend less than $25 per person on public health a year, compared with $84 per person in New York. Because North Carolina did not expand Medicaid, half a million North Carolinians have been left without affordable healthcare and are uncertain of where or what they would do if experiencing symptoms of COVID-19.

But it doesn’t have to be this way.

North Carolina’s small towns and rural places are our home. We know that they can and should be strong, healthy, and vibrant places to lives– and we know that the people living here are just that. Our state has a long legacy of racist, dog-whistle politics that divide instead of bring together the poor and working-class rural communities. The result is policies that favor big business over our families.

We can change that. Down Home is organizing in rural communities to fight for the things our families need: Medicaid expansion, fair wages and dignity at our jobs, and policies that invest in and protect all of us, not just a few.

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