Thursday, May 22, 2008

How We Spent Our Economic Stimulus Package

This is what we bought with our Economic Stimulus Package--a handsome pile of gravel. It probably wasn't what George Bush intended, but it didn't go for interest on a debt or gasoline, and we bought local gravel, not multinational corporate gravel.

If you look closely, you can see the gravel at the bottom of our Large Hole in the Ground as we pump out the rainwater.

Wednesday, May 21, 2008

We Purchase a Large Hole In the Ground

While the Job That Devoured My Brain continues, interesting things are happening here on our ridge. A couple of weeks ago, we purchased two holes in the ground--the larger a future basement, and the smaller to fit a septic tank.

While I was revisiting the horrors of middle school, others were having a pleasant day outdoors with large and interesting earth-moving machines.

We have a photo so that someday we may recall the days when our septic system was new.

Unlike most Droop Mountain ridges, ours is remarkably free of large rocks. There is, however, this thin layer of shale.

Monday, May 05, 2008

The Rural South--Epidemiological Reality

Recently, our local TV news has been reporting a new study indicating that life expectancies for rural Appalachian women have decreased in the last twenty years. They have accompanied this with the usual admonitions to eat healthful foods, exercise, and quit smoking. I was interested to read this newspaper story, Southwest Va.'s Mortality Mystery--More Than Diet Behind Women's Sharp Life Expectancy Drop by Theresa Vargas,Washington Post, April 26, 2008, and to follow its link to the original story, Eight Americas: Investigating Mortality Disparities across Races, Counties, and Race-Counties in the United States.

The Washington Post article features a discussion of the usual "lifestyle-related" mortality risks but also notes:

Residents will tell you little distinguishes the city of Radford and neighboring Pulaski County from elsewhere in rural America. That is what troubles health-care workers here most about a new study that found a sharp drop in life expectancy for women in the two communities.

According to the study, life expectancy for women dropped in nearly 1,000 counties but fell most in Radford and Pulaski. In 1983, life expectancy for women in the two jurisdictions was about 84 years. By 1999, it had dropped 5.8 years, to 78. No other jurisdiction in the nation had a decrease of more than 3.3 years.

This begins to get at what is surprising about the "Eight Americas" study. It looks at mortality data county by county over 20 years, for the entire United States, and identifies eight economic-geographic-racial clusterings. Since the article is in the open-source journal PLoS Medicine, you can look at a detailed data summary, the entire article, and all the figures and maps.

The eight Americas classification reveals that within the white population there is a wide variation in health experience that cannot be explained by differences in average income: low-income white rural populations in Minnesota, the Dakotas, Iowa, Montana, and Nebraska (America 2), with a life expectancy of 76.2 and 81.8 y for males and females, respectively, have a substantial advantage over the rest of white America, despite a large income disadvantage. Low-income whites in Appalachia and the Mississippi Valley (America 4), with an average income level similar to that of America 2, have a life expectancy equal to those of Mexico and Panama. The life expectancy gap between whites in America 2 and America 4 was 4.2 and 3.8 y in 2001 for males and females, respectively, comparable to the 6.4- and 4.6-y gaps between whites and blacks as a whole. The gap between whites in America 2 and America 4 has in fact increased since 1982, when it was 3.0 and 2.4 y for males and females respectively; between 1982 and 2001 life expectancy among females in America 4 declined from 78.2 y to 78.1 y.

Both white and black low-income rural Southern populations have a shorter life expectancy than their more affluent counterparts ("White Middle America" and "Black Middle America") in other areas of the US, but there is one white, rural, low-income population that has a longer life expectancy than "White Middle America." Low income, chemical exposure, and inconvenient access to health care are not the only reasons America 4 fares worse than America 2. To my mind, the study identifies rural white Southerners and rural black Southerners, as epidemiologically distinct groups, separate and unequal from their counterparts in other parts of the United States. Where Lillian Smith and W.J. Cash critiqued Southern cultural identity, this study identifies a biological definition for the region distinct from income and population density.

The traditional emphasis of the US health system has been on children and the elderly, as, for example, illustrated by the low levels of resources devoted to injury prevention and tobacco control compared with immunization. This emphasis may have partly contributed to substantially lower disparities in these age groups relative to young and middle-aged adults. On the other hand, the emphasis on children and the elderly has treated many of the diseases that are important contributors to young and middle-aged adult health disparities, and their risk factors, as either the responsibilities of individuals (alcohol, tobacco, obesity, and dietary determinants of blood pressure and cholesterol, like salt) or in the domain of clinical care (blood pressure and cholesterol)....It is when the public, community and professional groups, media, and politicians focus attention on what is being achieved, and why efforts are working in some places and not others, that the culture of accountability for health outcomes will be strengthened.

The study is an interesting data-mining exercise, intended to point the way to more intensive public health research. I grew up in a county included in "America 2," and now I live in a different rural area in "America 4." I had always thought, terrain aside, that southwestern Iowa was surprisingly similar to Pocahontas County. Now I'm wondering whether I shouldn't be trying to identify the differences.

In case you're interested, here's the abstract for the article:

Eight Americas: Investigating Mortality Disparities across Races, Counties, and Race-Counties in the United States Murray CJL, Kulkarni SC, Michaud C, Tomijima N, Bulzacchelli MT, et al. PLoS Medicine Vol. 3, No. 9, e260 doi:10.1371/journal.pmed.0030260


The gap between the highest and lowest life expectancies for race-county combinations in the United States is over 35 y. We divided the race-county combinations of the US population into eight distinct groups, referred to as the "eight Americas," to explore the causes of the disparities that can inform specific public health intervention policies and programs.

Methods and Findings

The eight Americas were defined based on race, location of the county of residence, population density, race-specific county-level per capita income, and cumulative homicide rate. Data sources for population and mortality figures were the Bureau of the Census and the National Center for Health Statistics. We estimated life expectancy, the risk of mortality from specific diseases, health insurance, and health-care utilization for the eight Americas. The life expectancy gap between the 3.4 million high-risk urban black males and the 5.6 million Asian females was 20.7 y in 2001. Within the sexes, the life expectancy gap between the best-off and the worst-off groups was 15.4 y for males (Asians versus high-risk urban blacks) and 12.8 y for females (Asians versus low-income southern rural blacks). Mortality disparities among the eight Americas were largest for young (15-44 y) and middle-aged (45-59 y) adults, especially for men. The disparities were caused primarily by a number of chronic diseases and injuries with well-established risk factors. Between 1982 and 2001, the ordering of life expectancy among the eight Americas and the absolute difference between the advantaged and disadvantaged groups remained largely unchanged. Self-reported health plan coverage was lowest for western Native Americans and low-income southern rural blacks. Crude self-reported health-care utilization, however, was slightly higher for the more disadvantaged populations.


Disparities in mortality across the eight Americas, each consisting of millions or tens of millions of Americans, are enormous by all international standards. The observed disparities in life expectancy cannot be explained by race, income, or basic health-care access and utilization alone. Because policies aimed at reducing fundamental socioeconomic inequalities are currently practically absent in the US, health disparities will have to be at least partly addressed through public health strategies that reduce risk factors for chronic diseases and injuries.

Sunday, May 04, 2008

Wooly Mullein

From African violets to wooly mullein, I've always been fascinated by fuzzy leaves. Whether you consider common mullein a noxious weed, a useful herb, or a handsome ornamental probably depends on how many plants you have in a given area. We have just a few, and so we find it charming and useful.

Saturday, May 03, 2008

Sympathy For the Urban Trees

Earth Day spawned a host of articles on "environmental issues." I'm still sifting through my RSS feed results from that day, which is how I came upon The Greening of America--Ambitious Tree-Planting Programs Are Sprouting Up Nationwide by William Booth, Washington Post, Friday, April 25, 2008. It's not easy making those small changes:

Urban tree farming can be a time-consuming, expensive and exasperating experience -- like children, trees require years of maintenance. Businesses complain about the cost, neighbors about the sap. Their roots are murder on sidewalks; their limbs tangle with power lines.

"The city sidewalk can be one of the most hostile environments for a young tree," a cramped cell of garbage soil surrounded by smothering asphalt, says Gregory McPherson, a scientist with the federal Center for Urban Forest Research. "A virtual conflict zone," as one arborist put it, beset by disease, pollution, drought, insects -- not to mention drunk drivers and staple guns and trip-and-fall lawsuits. "It's a tough life," sighs Marcia Bansley, executive director of Trees Atlanta. It's hard out there for a poplar....

Nationwide, three dozen cities have lost a quarter of their tree canopy since 1972, according to the group American Forests, which discovered that America is missing 600 million trees, as our major metropolitan areas fade from green to gray. But here's the problem: The increased density of American cities means there is less room for trees to replace the missing. The same is true in the suburbs: All those new mini-mansions built to the edge of the property line don't have big yards.

When Los Angeles launched its "Million Trees LA" project, it was assumed there would be plenty of room, but as it turns out, "the space is actually quite tight," says McPherson, the scientist with the Forest Service who surveyed the city's bio-inventory with the help of aerial reconnaissance and computer algorithms. McPherson found just 1.3 million spots to "realistically" plant in Los Angeles, most in the yards of private homes....

Treewise, "Washington is in pretty good shape," says Mark Buscaino, executive director of Casey Trees, a community group that helped plant 1,500 trees in the city last year. Canopy cover in Washington is a nice, leafy, green 35 percent, he says, and per capita the city spends more than New York or Los Angeles on its forest, which includes about 120,000 street trees....

But everybody likes trees, right? Apparently, no. According to the community tree planters toiling on the streets, businesses don't like trees (when foliage blocks signage). Bureaucrats don't like trees (because they're a hassle). And despite what they say now, politicians have not been tree huggers. The first item cut in any tight budget year is usually tree maintenance. "When you say, 'What's the cost of a tree?' it is more than buying a tree and putting it in the ground. It's also taking care of it," says Ray Tretheway, executive director of the Sacramento Tree Foundation, who explains it takes two or three years for a tree to establish a home....

Especially, when cities give away small, vulnerable six-inch seedlings in bags or tubes -- the kind of tree offered today, on Arbor Day, around the country. Many arborists now urge cities not to distribute free seedlings for fear the green swag just ends up in the trash. Los Angeles recently stopped the practice.

Planting street trees often requires both a city permit and the permission of neighbors, who give many reasons for not wanting a tree at the curb. They don't like dogs, who do like trees. Tree activists have heard people complain about sap, birds, squirrels, spiders, leaves and shade. Oh, and they don't want their views blocked.

Burry explains that neighborhoods with the fewest trees are the toughest places to plant. "These are often the harshest environments, communities on the bad side of environmental justice issues -- lots of renters, working class, two-job individuals. For us it is much more costly." Burry says it takes intense community outreach -- many meetings, much door knocking, to get neighbors to agree to plant and care for new trees. Then: "Sometimes there has been no organic life on the street in 20 years. The soil is extremely dry, nutrient-poor, compacted. We have to pour gallons and gallons of water and just let it sit, and still sometimes you dig and it's like concrete. This loud clang." Other challenges? "They don't have water hoses," Burry says....