September 26, 2016; Washington Post

Created in the mid-19th century when the economy of the United States was largely agrarian, the U.S. Department of Agriculture today devotes approximately 80 percent of its $140 billion budget to the Food and Nutrition Service (FNS). The largest component of the FNS budget is the Supplemental Nutrition Assistance Program (formerly known as the Food Stamp program). But that’s not what drives the daily agenda for Agriculture Secretary Tom Vilsack. His priority these days is fighting the drug use and deepening poverty in rural America.

The Norman Rockwell idyll of white-picket fences and unlocked front doors long ago gave way to small farms vanishing, the ebbing-away of jobs, and finally the opioid epidemic.

“People use drugs, legal and illegal, because their lives are intolerably painful or dull. They hate their work and find no rest in their leisure. They are estranged from their families and their neighbors. It should tell us something that in healthy societies drug use is celebrative, convivial, and occasional, whereas among us it is lonely, shameful, and addictive. We need drugs, apparently, because we have lost each other.”

― Wendell Berry, The Art of the Commonplace: The Agrarian Essays

Opioids have seeped their way into rural America, and the crisis is challenging the limits of healthcare delivery systems. Vilsack and his staff are concerned that more physicians need to be trained on the risks of opioid addiction, more communities need to be supplied with the overdose reversal drug naloxone, and struggling communities need more federal grants.

Rural counties contend with social determinants of health that lead to substance abuse. Poor housing, poverty, and unemployment can increase the likelihood of substance use. Rural occupations cause physical injury, which introduces people to opioids by prescription. Rural emergency services lack the resources to respond quickly and rely heavily on volunteers.

Late last year, Vilsack told President Obama that he wanted to resign. Having served the administration for nearly eight years, he was highly regarded throughout the White House and Congress, even though he’d garnered a reputation as the “cranky” cabinet member. However, the president “asked him to oversee the administration’s response to the opioid crisis that was ravaging rural America.”

That challenge changed the course of Vilsack’s personal life. Touring the nation’s hard-struck communities, here’s some of what Vilsack was told.

“The last time I was on ER call at one of our local hospitals I delivered three mothers who were opioid-addicted and had no prenatal care whatsoever,” one doctor said.

“We have no resources here,” the health director for St. Charles County said. “We see a ton of overdoses,” said the next doctor from a hospital just south of St. Louis. “This Fourth of July we had three firework injuries and 23 overdoses.”

Vilsack feels that the needs of rural America are ignored despite the many contributions these communities make to the nation, such as producing most of the country’s food and disproportionately filling the ranks of its military. Seventy-two percent of United States’ land area belongs to rural counties, but in 2014, just 15 percent of the population of the country lived in rural America.

“I just sometimes think rural America is a forgotten place,” Vilsack often said. His mission now is to make sure rural America is not lost.—James Schaffer