Along the way, she learned about her own family’s history with such trauma.

This formed the multimedia “Silence in Sikeston” project from KFF Health News, Retro Report, and WORLD as told through a documentary film, educational videos, digital articles, and a limited-series podcast. Hear about Anthony’s journey and join this conversation about the toll of racialized violence on our health and our communities.

Explore more of the “Silence in Sikeston”project:

LISTEN: The limited-series podcast is available on PRX, Apple Podcasts, Spotify, iHeart, or wherever you get your podcasts.

• Episode 1: “Racism Can Make You Sick”
• Episode 2: “Hush, Fix Your Face”
• Episode 3: “Trauma Lives in the Body”
• Episode 4: “Is There a Cure for Racism”

WATCH: The documentary film “Silence in Sikeston,” a co-production of KFF Health News and Retro Report, is now available to stream on WORLD’s YouTube channel, WORLDchannel.org, and the PBS app.

READ: KFF Health News Midwest correspondent Cara Anthony wrote an essay about what her reporting for this project helped her learn about her own family’s hidden past.

KFF Health News is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF—an independent source of health policy research, polling, and journalism. Learn more about KFF.

USE OUR CONTENT

This story can be republished for free (details).

In the series finale of the podcast, a confident, outspoken Sikeston teenager shares her feelings in an uncommonly frank conversation with Chief James McMillen, head of Sikeston’s Department of Public Safety, which includes Sikeston police. 

Host Cara Anthony asks what kind of systemic change is possible to reduce the burden of racism on the health of Black Americans. Health equity expert Gail Christopher says it starts with institutional leaders who recognize the problem, measure it, and take concrete steps to change things. 

“It is a process, and it’s not enough to march and get a victory,” Christopher said. “We have to transform the systems of inequity in this country.” 

Host

Cara Anthony
Midwest correspondent, KFF Health News

@CaraRAnthony

Read Cara's stories

Cara is an Edward R. Murrow and National Association of Black Journalists award-winning reporter from East St. Louis, Illinois. Her work has appeared in The New York Times, Time magazine, NPR, and other outlets nationwide. Her reporting trip to the Missouri Bootheel in August 2020 launched the “Silence in Sikeston” project. She is a producer on the documentary and the podcast’s host.

In Conversation With …

Gail Christopher
Public health leader and health equity expert 

click to open the transcript

Transcript: Is There a Cure for Racism?

Editor’s note: If you are able, we encourage you to listen to the audio of “Silence in Sikeston,” which includes emotion and emphasis not found in the transcript. This transcript, generated using transcription software, has been edited for style and clarity. Please use the transcript as a tool but check the corresponding audio before quoting the podcast. 

[Ambient sounds from Sikeston, Missouri’s 2021 Juneteenth celebration — a DJ making an announcement over funky music, people chatting — begin playing.] 

Cara Anthony: It’s 2021. It’s hot and humid. We’re at a park in the heart of Sunset — Sikeston, Missouri’s historically Black neighborhood. 

Emory: Today is Juneteenth, baby. 

Cara Anthony: The basketball courts are jumping. And old-school funk is blaring from the speakers. Kids are playing. 

Cara Anthony: [Laughter] Are you enjoying the water?  

Cara Anthony: People are lining up for barbecue. 

I’ve been here reporting on the toll racism and violence can take on a community’s health. But today, I’m hoping to capture a little bit of Sikeston’s joy.  

Taneshia Pulley: When I look out to the crowd of my people, I see strength. I see power. I just see all magic. 

Cara Anthony: I drift over to a tent where people are getting their blood pressure, weight, and height checked … health screenings for free. 

Cara Anthony: I’m a journalist. 

Community Health Worker: Ooooh! Hi! Hi! 

Cara Anthony: The ladies working the booth are excited I’m there to report on the event. 

Cara Anthony: OK, and I’m a health journalist. 

Community health worker: Baby, that’s what I told them. Yeah, she healthy. [Laughter] 

[Dramatic instrumental music plays.] 

Cara Anthony: This Juneteenth gathering is happening a little over a year after Sikeston police officers shot and killed 23-year-old Denzel Taylor. 

We made a documentary about Denzel’s death and the death of another young Black man — also killed in Sikeston. 

Denzel was shot by police. Nearly 80 years earlier, Cleo Wright was lynched by a white mob. 

Both were killed before they got their day in court. 

In these years of reporting, what I’ve found is that many Black families worry that their kids don’t have an equal chance of growing up healthy and safe in Sikeston. 

[Dramatic instrumental ends.] 

Rosemary Owens: Being Black in the Bootheel can get you killed at any age. 

Cara Anthony: That’s Rosemary Owens. She raised her children here in Southeast Missouri. 

Cara Anthony: About 10 Sikeston police officers showed up to Juneteenth — for security and to connect with the community. Some are in uniform; some are in plain clothes. 

Rosemary has her doubts about why they came today. 

Cara Anthony: You see the police chief talking to people. What’s going through your mind as you see them milling about? 

Rosemary Owens: I hope they are real and wanting to close the gap between the African Americans and the white people. 

Anybody can come out and shake hands. But at the end of the day, did you mean what you said? Because things are still going on here in Sikeston, Missouri. 

Cara Anthony: For Rosemary, this brings to mind an encounter with the police from years ago. 

[Slow, minor, instrumental music plays softly.] 

When her son was maybe 16 years old, she says, she and her sister gave their boys the keys to their new cars — told them they could hang out in them. 

Rosemary had gotten her new car for Mother’s Day. 

Rosemary Owens: A brand-new red Dodge Caravan. We, we knew the boys were just going from the van to the car. You know, just showing out — they were boys. They weren’t driving. 

Cara Anthony: Someone nearby saw the boys …  

Rosemary Owens: … called and told the police that two Black men were robbing cars. 

 When the boys saw the police come up, there was three police cars. So they were like, something’s going on. So their intention, they were like, they were trying to run to us. And my brother said, stop. When they looked back, when the police got out of the car, they already had their guns drawn on my son and my nephew.  Cara Anthony: That’s what Rosemary thinks about when she sees Sikeston police at Juneteenth. 

[Slow, minor, instrumental music ends.] 

[“Silence in Sikeston” theme song plays.]  Cara Anthony: In this podcast series, we’ve talked about some of the ways racism makes Black people sick. But Juneteenth has me thinking about how we get free — how we STOP racism from making us sick. 

The public health experts say it’s going to take systemwide, institutional change. 

In this episode, we’re going to examine what that community-level change looks like — or at least what it looks like to make a start. 

From WORLD Channel and KFF Health News, distributed by PRX, this is “Silence in Sikeston.” 

Episode 4 is our final episode: “Is There a Cure for Racism?” 

[“Silence in Sikeston” theme song ends.] 

James McMillen: How you doing? 

Juneteenth celebration attendee: Good. Good.  

James McMillen: Good to see you, man.  

Juneteenth celebration attendee: What’s up? How are you?   

Cara Anthony: When I spot Sikeston’s director of public safety in his cowboy hat, sipping soda from a can, I head over to talk.  James McMillen: Well, you know, I just, I, I’m glad to be … on the inside of this. 

Cara Anthony: James McMillen leads the police department. He says he made it a point to come to Juneteenth. And he encouraged his officers to come, too. 

James McMillen: I remember as being a young officer coming to work here, not knowing anybody, driving by a park and seeing several Black people out there. And I remember feeling, you know, somewhat intimidated by that. And I don’t really know why. 

I hadn’t always been, um, that active in the community. And, um, I, I have been the last several years and I’m just wanting to teach officers to do the same thing. 

Cara Anthony: The chief told me showing up was part of his department’s efforts to repair relations with Sikeston’s Black residents. 

James McMillen: What’s important about this is, being out here and actually knowing people, I think it builds that trust that we need to have to prevent and solve crimes. 

Cara Anthony: A few minutes into our conversation, I notice a teenager and her friend nearby, listening. 

Cara Anthony: Yeah, we have two people who are watching us pretty closely. Come over here. Come over here. Tell us your names. 

Lauren: My name is Lauren. 

Michaiahes: My name is Michaiahes. 

Cara Anthony: Yeah. And what are you all … ? 

James McMillen: I saw you over there. 

Cara Anthony: So, what do you think about all of this?  

Michaiahes: Personally, I don’t even know who this is because I don’t mess with police because, because of what’s happened in the past with the police. But, um … 

Cara Anthony: As she starts to trail off, I encourage her to keep going. 

Cara Anthony: He’s right here. He’s in charge of all of those people. 

Michaiahes: Well, in my opinion, y’all should start caring about the community more. 

Cara Anthony: What are you hearing? She’s speaking from the heart here, Chief. What are you hearing? 

James McMillen: Well, you know what? I agree with everything she said there. 

Cara Anthony: She’s confident now, looking the chief in the eye. 

Michaiahes: And let’s just be honest: Some of these police officers don’t even want to be here today. They’re just here to think they’re doing something for the community. 

James McMillen: Let’s be honest. Some of these are assumptions that y’all are making about police that y’all don’t really know. 

[Subtle propulsive music begins playing.] 

Michaiahes: If we seen you protecting community, if we seen you doing what you supposed to do, then we wouldn’t have these assumptions about you. 

James McMillen: I just want to say that people are individuals. We have supervisors that try to keep them to hold a standard. And you shouldn’t judge the whole department, but, but just don’t judge the whole department off of a few. No more than I should judge the whole community off of a few. 

Cara Anthony: But here’s the thing … in our conversations over the years, Chief McMillen has been candid with me about how, as a rookie cop, he had judged Sikeston’s Black residents based on interactions with just a few. 

James McMillen: Some of, um, my first calls in the Black community were dealing with, obviously, criminals, you know? So if first impressions mean anything, that one set a bad one. I had, um, really unfairly judging the whole community based on the few interactions that I had, again, with majority of criminals. 

Cara Anthony: The chief says he’s moved past that way of thinking and he’s trying to help his officers move past their assumptions. 

And he told me about other things he wants to do …  

Hire more Black officers. Invest in racial-bias awareness education for the department. And open up more lines of communication with the community. 

James McMillen: I know that we are not going to see progress or we’re not going to see success without a little bit of pain and discomfort on our part. 

Cara Anthony: I don’t think I’ve ever heard the chief use the term institutional change, but the promises and the plans he’s making sound like steps in that direction. 

Except … here’s something else the chief says he wants …  

[Subtle propulsive music ends with a flourish.] 

James McMillen: As a police officer, I would like to hear more people talk about, um, just complying with the officer. 

Cara Anthony: That phrase is chilling to me. 

[Quiet, dark music starts playing.] 

When I hear “just comply” … a litany of names cross my mind. 

Philando Castile. 

Sonya Massey. 

Tyre Nichols. 

Cara Anthony: After Denzel Taylor was killed, people felt unsafe. I talked to a lot of residents on the record about them feeling like they didn’t know if they could be next. 

One thing that you told me was, like, well, one thing that people can do is comply with the officers, you know, if they find themselves having an interaction with law enforcement. 

James McMillen: Well, I mean, I think that’s, that’s a good idea to do. 

And if the person is not complying, that officer has got to be thinking, is this person trying to hurt me? So, asking people to comply with the officer’s command — that’s a reasonable statement. 

Cara Anthony: But, it’s well documented: Black Americans are more likely than our white peers to be perceived as dangerous by police. 

That perception increases the chances we’ll be the victim of deadly force. Whether we comply — or not. 

[Quiet, dark music ends.] 

That’s all to say … even with the promise of more Black officers in Sikeston and all the chief’s other plans, I’m not sure institutional change in policing is coming soon to Sikeston. 

[Sparse electronic music starts playing.] 

Cara Anthony: I took that worry to Gail Christopher. She has spent her long career trying to address the causes of institutional racism. 

Cara Anthony: We’ve been calling most of our guests by their first name, but what’s your preference? I don’t want to get in trouble with my mom on this, you know? [Cara laughs.] 

Gail Christopher: If you don’t mind, Dr. Christopher is good. 

Cara Anthony: OK. All right. That sounds good. I’m glad I asked. 

Cara Anthony: Dr. Christopher thinks a lot about the connections between race and health. And she’s executive director of the National Collaborative for Health Equity. Her nonprofit designs strategies for social change. 

She says the way to think about starting to fix structural racism … is to think about the future. 

Gail Christopher: What do you want for your daughter? What do I want for my children? I want them not to have interactions with the police, No. 1, right? 

Uh, so I want them to have safe places to be, to play, to be educated … equal access to the opportunity to be healthy. 

Cara Anthony: But I wonder if that future is even possible. 

[Sparse electronic music ends.] 

Cara Anthony: Is there a cure for racism? And I know it’s not that simple, but is there a cure? 

Gail Christopher: I love the question, right? And my answer to you would be yes. It is a process, and it’s not enough to march and get a victory. We have to transform the systems of inequity in this country. 

Cara Anthony: And Dr. Christopher says it is possible. Because racism is a belief system. 

[Hopeful instrumental music plays.] 

Gail Christopher: There is a methodology that’s grounded in psychological research and social science for altering our beliefs and subsequently altering our behaviors that are driven by those beliefs. 

Cara Anthony: To get there, she says, institutions need a rigorous commitment to look closely at what they are doing — and the outcomes they’re creating. 

Gail Christopher: Data tracking and monitoring and being accountable for what’s going on. 

We can’t solve a problem if we don’t admit that it exists. 

Cara Anthony: One of her favorite examples of what it looks like to make a start toward systemic change comes from the health care world. 

I know we’ve been talking about policing so far, but — bear with me here — we’re going to pivot to another way institutional bias kills people. 

A few years ago, a team of researchers at the Brigham and Women’s Hospital in Boston reviewed admission records for patients with heart failure. They found that Black and Latinx people were less likely than white patients to be admitted to specialized cardiology units. 

Gail Christopher: Without calling people racist, they saw the absolute data that showed that, wait a minute, we’re sending the white people to get the specialty care and we’re not sending the people of color. 

Cara Anthony: So, Brigham and Women’s launched a pilot program. 

When a doctor requests a bed for a Black or Latinx patient with heart failure, the computer system notifies them that, historically, Black and Latinx patients haven’t had equal access to specialty care. 

The computer system then recommends the patient be admitted to the cardiology unit. It’s still up to the doctor to actually do that. 

The hard data’s not published yet, but we checked in with the hospital, and they say the program seems to be making a difference. 

Gail Christopher: It starts with leadership. Someone in that system has the authority and makes the decision to hold themselves accountable for new results. 

[Hopeful instrumental music ends.] 

Cara Anthony: OK, so it could be working at a hospital. Let’s shift back to policing now. 

Gail Christopher: There should be an accountability board in that community, a citizens’ accountability board, where they are setting measurable and achievable goals and they are holding that police department accountable for achieving those goals. 

Cara Anthony: But, like, do Black people have to participate in this? Because we’re tired. 

Gail Christopher: Listen, do I know that we’re tired! Am I tired? After 50 years? Uh, I think that there is work that all people have to do. This business of learning to see ourselves in one another, to be fully human — it’s all of our work. 

[Warm, optimistic instrumental music plays.] 

Now, does that preclude checking out at times and taking care of yourself? I can’t tell you how many people my age who are no longer alive today, who were my colleagues and friends in the movement. But they died prematurely because of this lack of permission to take care of ourselves. 

Cara Anthony: Rest when you need to, she says, but keep going. 

Gail Christopher: We have to do that because it is our injury. It is our pain. And I think we have the stamina and the desire to see it change. 

Cara Anthony: Yep. Heard. It’s all of our work. 

Dr. Christopher has me thinking about all the Black people in Sikeston who aren’t sitting around waiting for someone else to change the institutions that are hurting them. 

People protested when Denzel Taylor was killed even with all the pressure to stay quiet about it. 

Protesters: Justice for Denzel on 3. 1, 2, 3 … Justice for Denzel! Again! 1, 2, 3 …  Justice for Denzel! 

Cara Anthony: And I’m thinking about the people who were living in the Sunset neighborhood of Sikeston in 1942 when Cleo Wright was lynched. 

Harry Howard: They picked up rocks and bricks and crowbars and just anything to protect our community. 

Cara Anthony: And Sunset did not burn. 

[Warm, optimistic instrumental music begins fading out.] 

[Piano starts warming up.] 

Cara Anthony: After nearly 80 years of mostly staying quiet about Cleo’s lynching, Sikeston residents organized a service to mark what happened to him — and their community. 

Reverend: We are so honored and humbled to be the host church this evening for the remembrance and reconciliation service of Mr. Cleo Wright. 

[Piano plays along with Pershard singing.] 

Pershard Owens: [Singing] It’s been a long, long time coming, but I know a change gonna come, oh yes it will. It’s been too hard a-livin but I’m afraid to die and I don’t know what’s up next, beyond the sky … 

[Pershard singing and piano accompaniment fade out.] 

Cara Anthony: I want to introduce you to that guy who was just singing then. His name is Pershard Owens. 

Remember Rosemary Owens? The woman who told us about someone calling the police on her son and nephew when they were playing with their parents’ new cars? Pershard is Rosemary’s younger son. 

Pershard Owens: Yeah, I definitely remember that. 

Cara Anthony: Even after all this time, other people didn’t want to talk to us about it. We couldn’t find news coverage of the incident. But Pershard remembers. He was in his weekly karate practice when it happened. He was 10 or 11 years old. 

Pershard Owens: My brother and cousin were, like, they were teens. So what do you think people are going to feel about the police when they do that, no questions asked, just guns drawn? 

Cara Anthony: Pershard’s dad works as a police officer on a different police force in the Bootheel. Pershard knows police. But that didn’t make it any less scary for him. 

Pershard Owens: You know, my parents still had to sit us down and talk and be like, “Hey, this is, that’s not OK, but you can’t, you can’t be a victim. You can’t be upset.” That’s how I was taught. So we acknowledge the past. But we don’t, we don’t stay down. 

Cara Anthony: So years later, when Chief James McMillen started a program as a more formal way for people in Sikeston and the police to build better relationships, Pershard signed up. They started meeting in 2020. 

The group is called Police and Community Together, or PACT for short. 

  [Sparse, tentative music begins playing.] 

Pershard Owens: It was a little tense that first couple of meetings because nobody knew what it was going to be. 

Cara Anthony: This was only five months after Sikeston police killed Denzel Taylor. 

PACT is not a citizens’ accountability board. The police don’t have to answer to it. 

The committee met every month. For a while. But they haven’t met in over a year now. 

Pershard Owens: We would have steps forward and then we would have three steps back. 

Cara Anthony: People have different accounts for why that is. Busy schedules. Mutual suspicion. Other things police officers have done that shook the trust of Black residents in Sikeston. 

Pershard Owens: And people were like, bro, like, how can you work with these people? 

The community is like, I can’t fully get behind it because I know what you did to my little cousin and them. Like, I know what the department did back in, you know, 15 years ago, and it’s hard to get past that. 

So, I mean, I’m getting both sides, like, constantly, and listen, that is, that is tough. 

[Sparse, tentative music ends.] 

Cara Anthony: But Pershard says something important changed because he started working with PACT. 

Pershard Owens: Chief did not like me at first [Pershard laughs]. He did not. 

Chief didn’t … me and Chief did not see eye to eye. Because he had heard things about me and he — people had told him that I was, I was anti-police and hated police officers, and he came in with a defense up. 

So, it took a minute for me and him to, like, start seeing each other in a different way. But it all happened when we sat down and had a conversation. 

[Slow instrumental music begins playing.] 

Cara Anthony: Just have a conversation. It sounds so simple; you’re probably rolling your eyes right now hearing it. 

But Pershard says … it could be meaningful. 

Pershard Owens: I truly want and believe that we can be together and we can work together and we can have a positive relationship where you see police and y’all dap each other up and y’all legit mean it. I think that can happen, but a lot of people have to change their mindsets. 

Cara Anthony: That’s a challenge Pershard is offering to police AND community members: Have a conversation with someone different from you. See if that changes the way you think about the person you’re talking to. See if it changes your beliefs. 

The more people do that, the more systems can change. 

Pershard Owens: We got to look in the mirror and say, “Am I doing what I can to try and change the dynamic of Sikeston, even if it does hurt?” 

Cara Anthony: Pershard says he’s going to keep putting himself out there. He ran for City Council in 2021. And even though he lost, he says he doesn’t regret it. 

Pershard Owens: When you’re dealing with a place like Sikeston, it’s not going to change overnight. 

Cara Anthony: And he’s glad he worked with PACT. Even if the community dialogue has fizzled for now, he’s pleased with the new relationship he built with Chief McMillen. And all of this has broadened his view of what kind of change is possible. 

[Slow instrumental music ends.] 

Pershard Owens: If you want something that has never been done, you have to go places that you’ve never been. 

[“Silence in Sikeston” theme music plays.] 

Cara Anthony: Places that you’ve never been … stories that you’ve never told out loud … maybe all of that helps build a Sikeston where Black residents can feel safer. Where Black people can live healthier lives. 

A world you might not be able to imagine yet, but one that could exist for the next generation. 

[“Silence in Sikeston” theme music ends.] 

[Upbeat instrumental music plays.] 

Cara Anthony: Thanks for listening to “Silence in Sikeston.” 

Next, go watch the documentary — it’s a joint production from Retro Report and KFF Health News, presented in partnership with WORLD. 

Subscribe to WORLD Channel on YouTube. That’s where you can find the film “Silence in Sikeston,” a Local, USA special. 

If you made it this far, thank you. Let me know how you’re feeling. 

I’d love to hear more about the conversations this podcast has sparked in your life. Leave us a voicemail at (202) 654-1366. 

And thanks to everyone in Sikeston for sharing your stories with us. 

This podcast is a co-production of WORLD Channel and KFF Health News and distributed by PRX. 

It was produced with support from PRX and made possible in part by a grant from the John S. and James L. Knight Foundation. 

This audio series was reported and hosted by me, Cara Anthony. 

Audio production by me, Zach Dyer. And me, Taylor Cook. 

Editing by me, Simone Popperl. 

And me, managing editor Taunya English. 

Sound design, mixing, and original music by me, Lonnie Ro. 

Podcast art design by Colin Mahoney and Tania Castro-Daunais. 

Tarena Lofton and Hannah Norman are engagement and social media producers for the show. 

Oona Zenda and Lydia Zuraw are the landing page designers. 

Lynne Shallcross is the photo editor, with photography from Michael B. Thomas. 

Thank you to vocal coach Viki Merrick. 

And thank you to my parents for all their support over the four years of this project. 

Music in this episode is from Epidemic Sound and Blue Dot Sessions. 

Some of the audio you heard across the podcast is also in the film. 

For that, special thanks to Adam Zletz, Matt Gettemeier, Roger Herr, and Philip Geyelin. 

Kyra Darnton is executive producer at Retro Report. 

I was a producer on the film. 

Jill Rosenbaum directed the documentary. 

Kytja Weir is national editor at KFF Health News. 

WORLD Channel’s editor-in-chief and executive producer is Chris Hastings. 

Help us get the word out about “Silence in Sikeston.” Write a review or give us a quick rating wherever you listen to this podcast. 

Thank you! It makes a difference. 

Oh yeah! And tell your friends in real life too!  

[Upbeat instrumental music ends.] 

Credits

Taunya English
Managing editor

@TaunyaEnglish

Taunya is deputy managing editor for broadcast at KFF Health News, where she leads enterprise audio projects.

Simone Popperl
Line editor

@simoneppprl

Simone is broadcast editor at KFF Health News, where she shapes stories that air on Marketplace, NPR, and CBS News Radio, and she co-manages a national reporting collaborative.

Zach Dyer
Senior producer

@zkdyer

Zach is senior producer for audio with KFF Health News, where he supervises all levels of podcast production.

Taylor Cook
Associate producer

@taylormcook7

Taylor is an independent producer who does research, books guests, contributes writing, and fact-checks episodes for several KFF Health News podcasts.

Lonnie Ro
Sound designer

@lonnielibrary

Lonnie Ro is an audio engineer and a composer who brings audio stories to life through original music and expert sound design for platforms like Spotify, Audible, and KFF Health News.

Additional Newsroom Support

Lynne Shallcross, photo editorOona Zenda, illustrator and web producerLydia Zuraw, web producerTarena Lofton, audience engagement producer Hannah Norman, video producer and visual reporter Chaseedaw Giles, audience engagement editor and digital strategistKytja Weir, national editor Mary Agnes Carey, managing editor Alex Wayne, executive editorDavid Rousseau, publisher Terry Byrne, copy chief Gabe Brison-Trezise, deputy copy chief Tammie Smith, communications officer 

The “Silence in Sikeston” podcast is a production of KFF Health News and WORLD. Distributed by PRX. Subscribe and listen on Apple Podcasts, Spotify, Amazon Music, iHeart, or wherever you get your podcasts.

Watch the accompanying documentary from WORLD, Retro Report, and KFF here.

To hear other KFF Health News podcasts, click here.

KFF Health News is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF—an independent source of health policy research, polling, and journalism. Learn more about KFF.

USE OUR CONTENT

This story can be republished for free (details).

SIKESTON, Mo. — In 1942, Mable Cook was a teenager. She was standing on her front porch when she witnessed the lynching of Cleo Wright.

In the aftermath, Cook received advice from her father that was intended to keep her safe.

“He didn’t want us talking about it,” Cook said. “He told us to forget it.”

More than 80 years later, residents of Sikeston still find it difficult to talk about the lynching.

Conversations with Cook, one of the few remaining witnesses of the lynching, launch a discussion of the health consequences of racism and violence in the United States. Host Cara Anthony speaks with historian Eddie R. Cole and racial equity scholar Keisha Bentley-Edwards about the physical, mental, and emotional burdens on Sikeston residents and Black Americans in general.

“Oftentimes, people who experience racial trauma are forced to not acknowledge it,” Bentley-Edwards said. “They’re forced to question whether or not it happened in the first place.”

Host

Cara Anthony
Midwest correspondent, KFF Health News

@CaraRAnthony

Read Cara's stories

Cara is an Edward R. Murrow and National Association of Black Journalists award-winning reporter from East St. Louis, Illinois. Her work has appeared in The New York Times, Time magazine, NPR, and other outlets nationwide. Her reporting trip to the Missouri Bootheel in August 2020 launched the “Silence in Sikeston” project. She is a producer on the documentary and the podcast’s host.

In Conversation With …

Eddie R. Cole
Professor of education and history, UCLA

Keisha Bentley-Edwards
Associate professor of medicine, Division of General Internal Medicine at Duke University

Carol Anderson
Professor of African American studies, Emory University

click to open the transcript

Transcript: Racism Can Make You Sick

“Silence in Sikeston,” Episode 1: “Racism Can Make You Sick” Transcript 

Editor’s note: If you are able, we encourage you to listen to the audio of “Silence in Sikeston,” which includes emotion and emphasis not found in the transcript. This transcript, generated using transcription software, has been edited for style and clarity. Please use the transcript as a tool but check the corresponding audio before quoting the podcast. 

Cara Anthony: Sikeston sits in the Missouri Bootheel. That’s the lower corner of the state, with the Mississippi River on one side, Arkansas on the other. Lots of people say it’s where the South meets the Midwest. 

Picture cotton, soybeans, rice. It’s hot, green, and flat. If you’ve ever heard of Sikeston before, it’s probably because of this: 

Ryan Skinner: Hot rolls! 

Cara Anthony: Lambert’s Café. Home of the “Throwed Rolls.” 

Server: Yeah, they’ll say, uh, “Hot rolls!” And people will hold their hands up and they’ll toss it to you. 

Cara Anthony: The servers walk around with carts and throw these big dinner rolls at diners. 

Ryan Skinner: Oh, it’s fun. You get to nail people in the head and not get in trouble for it. 

Cara Anthony: There’s the rodeo. The cotton carnival. 

But I came to see Rhonda Council. 

Rhonda Council: My name is Rhonda Council. I was born and raised here in Sikeston. 

Cara Anthony: Rhonda is the town’s first Black city clerk. 

She became my guide. I met her when I came here to make a film about the little-known history of racial violence in Sikeston. 

I’m Cara Anthony. I’m a health reporter. I cover the ways racism — including violence — affects health. 

Rhonda grew up in the shadow of that violence — in a part of town where nearly everyone was Black. It’s called Sunset. 

Rhonda Council: Sunset was a happy place. I remember just being, as a kid, we could walk down to the store, we could just go get candy. 

Cara Anthony: There were churches and a school there. 

Rhonda Council: We knew everybody in the community. If we did something wrong, you can best believe your parents was going to find out about it before you got home. 

Cara Anthony: Back in the day, these were dirt roads. 

Cara Anthony: OK, so we’re getting ready to go on a tour of Sunset, which used to be known as the Sunset Addition, right? 

Rhonda Council: Mm-hmm, yes. Mm-hmm. 

Cara Anthony: We got into her car, along with Rhonda’s mother and her grandmother, Mable Cook. 

Rhonda Council: This street was known as The Bottom. Everything Black-owned. They had clubs, they had stores, they even had houses that people stayed in. I think it was shotgun houses back then? 

Mable Cook: Uh-huh. 

Cara Anthony: That’s Rhonda’s grandmother, Ms. Mable, right there. She was a teenager here in the 1940s. Her memory of the place seems to get stronger with each uh-huh and mm-hmm. 

Rhonda Council: And this was just the place where people went on the weekend to, you know, have a good time and party. … And this area was kind of known as “the corner” because they used to have a club here. And they would … they would gamble a lot down here. They would throw dice. Everything down here on the corner. 

Mable Cook: That’s right. Sure did. Mm-hmm. 

Rhonda Council: You remember this street, Grandma? 

Mable Cook: Yeah, I’m trying to see where the store used to be. 

Rhonda Council: OK. 

Mable Cook: I think it was close to Smith Chapel. 

Rhonda Council: OK. 

Cara Anthony: Rhonda’s grandmother, Ms. Mable, was 97 then. 

Rhonda Council: She is a petite lady, to me, thin-framed. I describe her eyes as like a grayish-color eyes. And I don’t know if it’s because of old age, but I think they’re so beautiful. And she just has a pretty smile, and she’s just a fantastic lady. 

Cara Anthony: Ms. Mable was born in Indianola, Mississippi. When she was 14, her father moved to Sikeston looking for work. 

Rhonda Council: And so she came up here to, um, to be with her father. But she said when she came to Sikeston, she said it was an unusual experience because they were not allowed to go to stores. They were not allowed to, basically, be with the white people. And that’s not what she knew down in Mississippi. And in her mind, she couldn’t understand why Missouri, why Sikeston was like that in treating Black people that way. 

And not too long after that, the lynching of Cleo Wright occurred. 

[BEAT]  

Cara Anthony: It was 1942. While the United States was at war marching to stop fascism, a white mob here went unchecked and lynched a man named Cleo Wright. 

The lynching of a Black man in America was not uncommon. And often barely documented. 

But in the case of Cleo Wright — perhaps because the death challenged what the nation said it was fighting for — the killing in this small town made national news. 

The case generated enough attention that the FBI conducted the first federal investigation into a lynching. That investigation ultimately amounted to nothing. 

Meanwhile — here in Sikeston — the response to the brutal death was mostly silence. 

Eight decades later, another Black man was killed in Sikeston. This time by police. 

Local media outlets, like KFVS, covered it as a crime story: 

KFVS report: The Missouri State Highway Patrol says troopers must piece together exactly what led to the shooting death of 22-year-old Denzel Marshall Taylor. 

Cara Anthony: I think the killings of Denzel Taylor and Cleo Wright are a public health story. 

Our film “Silence in Sikeston” is grounded in my reporting about Cleo and Denzel. Part of the record of the community’s trauma and silence is captured in the film. This podcast extends that conversation. 

We’re exploring what it means to live with that stress — of racism, of violence. And we’re going to talk about the toll that it takes on our health as Black Americans, especially as we try to stay safe. 

In each episode, we’ll hear a story from my reporting. Then, a guest and I will talk about it. 

The history … 

Carol Anderson: The power of lynching is to terrorize the Black community, and one of the ways the community deals with that terror is the silence of it. […] And when you don’t deal with the wound, it creates all kinds of damage. 

Cara Anthony: And health … 

Aiesha Lee: It’s almost like every time we’re silent, it’s like a little pinprick. […] And after so long, those little pinpricks turn up as heart disease, as cancer, as all these other ailments. 

Cara Anthony: I’m hoping this journalism, and these stories, will spark a conversation that you’ve been meaning to have. 

This is an invitation. 

From WORLD Channel and KFF Health News and distributed by PRX, this is “Silence in Sikeston,” the podcast.  

Episode 1: “Racism Can Make You Sick” 

[BEAT] 

Cara Anthony: Ms. Mable was a witness to the lynching of Cleo Wright. The 25-year-old was about to become a father. 

Rhonda’s uncle says Cleo was … 

Harry Howard: Young, handsome, an athlete, and very well known in the community. 

Cara Anthony: That’s Harry Howard. He didn’t know Cleo. Harry wasn’t even born yet. But his uncle knew Cleo. 

Harry Howard: They were friends. They would shoot pool together and were known to be at the little corner store, the Scott’s Grocery. 

Cara Anthony: Harry’s family passed down the story of what happened. 

Harry Howard: So everything I’m reporting is the way it was told by people I trust. 

Cara Anthony: Black families mostly talked about it in whispers. 

Eddie R. Cole: And that sounds like this is one of those situations where that community would rather just leave this alone and try to move on with the life that you do have instead of losing more life. 

Cara Anthony: That’s my friend Eddie Cole. He’s a professor of history and education at UCLA. 

We were in college together at Tennessee State and worked on the school newspaper.  

I called up Eddie because I wanted to get his take as a historian. What happens when we keep quiet about a story like Cleo’s? 

Eddie R. Cole: Yeah, I’m Eddie Cole. … So here we go. 

Cara Anthony: Thousands of Black people were lynched before Cleo Wright was. But this was the first time the feds said, “Hey, we should go to Sikeston and investigate lynching as a federal crime.” 

This story though, seriously, like it just disappeared off the face of the map. Like, it’s, it’s scary to me. So many of the witnesses that I interviewed, they’ve passed away, Eddie, since we started this journey. And it’s frightening to me to think that their stories … that these stories can literally just go away. 

[BEAT]  

Eddie R. Cole: Lynching stories disappear but don’t disappear, right? So, the people who committed the crime, they committed it and went on with their day, which is twisted within itself, even to think about that. 

But on the other side, when you think about Black Americans, there was no need to talk a lot about it, right? Because you talk too much about some things and that same sort of militia justice might come to your front door in the middle of the night, right? Stories like this are known but not recorded. 

Cara Anthony: The hush that surrounded Cleo’s story back then was for Black people’s safety. But I’m conflicted. Should Cleo’s story be off the table? Or … could we be missing an opportunity for healing? 

On the phone with Eddie, I could feel this anxiety building up in me. I was almost afraid to bring it up, even though it was the reason why I called. 

[BEAT]  

Cara Anthony: And I will be honest with you, I think of you the same way I think of my brother, my father, like, I’ve almost wanted to protect the Black men in my life from that story because I know how hard it is to hear. 

Cara Anthony: It was January 1942. Cleo was accused of assaulting a white woman. A police officer arrested him; there was a fight. Cleo was beaten and shot. Covered in blood, he was eventually taken to jail. White residents of Sikeston mobbed the jail to get to Cleo. 

Cara Anthony: I do want to play a clip for you, just so you can hear a little bit, if you are up for that, because it’s a lot. How are you feeling about that today? 

Eddie R. Cole: No, I want to hear. I mean, I gotta know more now. You just told me there’s a story that just disappeared, but now you’re bringing it back to life. So let’s play the clip. 

Cara Anthony: All right. Let’s do it. 

Harry Howard: They took him out of the jail and drug him from downtown on Center Street through the Black area of Sunset. 

Obviously, it was a big commotion, and they were saying, “What’s going on?” And the man driving the station wagon told them, “Get out of the street,” and, of course, used the N-word. “There’s a lynching coming.” 

Cara Anthony: Historian Carol Anderson is a professor of African American studies at Emory University. She takes it from there. 

Carol Anderson: They hook him to the bumper of the car and decide to make an example of him in the Black community. 

The mob douses his body with five gallons of gasoline and set it on fire. People are going, “Oh my God, they are burning a Black man. They are burning a Black man. They have lynched a Black man.” 

Cara Anthony: I always need to take a deep breath after hearing that story. So, I check in with Eddie. 

Cara Anthony: OK. How you doing? You OK? 

Eddie R. Cole: Yeah, yeah, um, that was tough. 

Cara Anthony: I’ve grappled a lot with the question of why, like, why now? Why this story? Am I crazy for doing this? 

Eddie R. Cole: Yeah, I mean, this story is really an entry point to talk about society at large. Imagine the people who like the world that we’re in. A world where Black people are oppressed. Right? And so not telling stories like what happens in Sikeston is an easier way to just keep the status quo. And what you’re doing is pushing back on it and saying, ah, we must remember, because the remnants of this period still shape this town today. 

[BEAT]  

Cara Anthony: On the tour of Sikeston with Rhonda, I see that. 

Rhonda Council: We’re going to go in front of the church where Cleo Wright was burned. 

When we get down here to the right, you’ll see Smith Chapel Church. And wasn’t it over here in this way where he got burnt, Grandma? 

Mable Cook: Uh-huh, yep. 

Rhonda Council: OK. From what I hear, it happened right along in this area right here. 

Cara Anthony: It’s a small brick church with a steeple on top. The road is paved now, not gravel as before. It all looks so … normal. 

You’d think that kind of violence, so much hate, would leave a mark on the Earth. But on the day we visited, there was nothing to see. Just the church and the road. 

Ms. Mable is quiet. I wonder what she’s thinking. 

Mable Cook: I just remember them dragging him. They drove him from, uh, the police station out to Sunset Addition. But they took him around all the streets so everybody could see. 

Cara Anthony: Back at Rhonda’s home, we talked more about what Ms. Mable remembered. 

Rhonda Council: Did that affect you in any way when you saw that happening? 

Mable Cook: Yeah, it hurt because I never had seen anything like that. Mm-hmm. And it kind of got me. I was just surprised or something. I don’t know. Mm-hmm. 

Cara Anthony: Remember Ms. Mable had been a child in Mississippi in the ’30s — and it wasn’t until she moved north to Sikeston that she came face to face with a lynching. 

Rhonda Council: Did it stick in your mind after that for a long time? 

Mable Cook: Yeah, it did. It did stick because I just wondered why they wanted to do that to him. You know, they could have just taken him and put him in jail or something and not do all that to him. 

I just never had seen anything like it. I had heard people talking about it, but I had never seen anything like that. 

Cara Anthony: When it happened, a lot of Black families in Sikeston scattered, fled town to places that felt safer. Mable’s family returned to Mississippi for a week. 

But when they got back, she says, Sikeston went on like nothing had ever happened.  

Here’s Rhonda with Ms. Mable again. 

Rhonda Council: After you all saw the lynching that happened, did you and your friends talk about that? 

Mable Cook: No, we didn’t have none … we didn’t talk about it. My daddy told us not to have nothing be said about it, uh-uh. 

Rhonda Council: Oh, because your dad said that. 

Mable Cook: That’s right. He told us not to worry about it, not talk about it. Uh-huh. And he said it’ll go away if you not talk about it, you know, uh-huh. 

Rhonda Council: So over the years, did you ever want to get it out? Did you ever want to talk about it? 

Mable Cook: Yeah, I did want to. Uh-huh. I wanted to. Uh-huh. 

Rhonda Council: But you just couldn’t do it. 

Mable Cook: No. No. Uh-uh. No, he didn’t want us talking about it. He told us to forget it. 

Cara Anthony: Forget it. Don’t talk about it. It’ll go away. 

And, in a way, it did. 

No one was charged. No one went to prison. Cleo’s name faded from the news. 

[BEAT]   

Cara Anthony: But decades later, Ms. Mable, the witness; Rhonda, her granddaughter; and me, the journalist, we talked about it a lot. 

We turned the story over and over, and as I listened to Ms. Mable, there was a distance between the almost matter-of-fact way she described the lynching and what I expected her feelings would be. 

I asked her if she was ever depressed … or if she had sleepless nights, anxiety. As a health reporter, I was on the lookout for symptoms of post-traumatic stress disorder. 

But Ms. Mable said no. 

That surprised me. And Rhonda, too. 

Cara Anthony: If we were to roll back the clock, go in a time machine, it’s 1942. All of a sudden, you see Cleo Wright’s body on the back of a car. How do you, can you even imagine that? 

Rhonda Council: I could not imagine. And even when talking to her about it, and she had such a vivid memory of it. And you ask her, did it haunt her, and she said no, she, it didn’t bother her, but I know deep down inside it had to because there’s no way that you could see something like that — someone dragged through the streets, basically naked going over rocks and the body just being dragged. 

I, I don’t know how I could have handled it because that’s just very, you just can’t treat a human being like that. 

Cara Anthony: That’s what’s so hard about these stories. And the research shows that seeing that kind of brutal, racial violence has health effects. But how do we recognize them? And what happens if we don’t? 

Those are some of the questions I asked Keisha Bentley-Edwards. 

Keisha Bentley-Edwards: Oftentimes, people who experience racial trauma are forced to not acknowledge it as such, or they’re forced to question whether or not it happened in the first place. 

Cara Anthony: Keisha is an associate professor in medicine at Duke University. She studies structural racism and chronic health conditions and knows a lot about what happens after a lynching. 

Keisha Bentley-Edwards: It’s difficult to talk about racism. And part of it is that you’re talking about power, who has it, who doesn’t have it. 

It’s not fun to talk about constantly being in a state where someone else can control your life with little recourse. 

Cara Anthony: That’s even more complicated in a place like Sikeston. 

Keisha Bentley-Edwards: When you’re in a smaller city, there is no way to turn away from the people who were the perpetrators of a race-based crime. And that, in and of itself, is a trauma. To know that someone has victimized your family member and you still have to say hello, you still have to say, “Good morning, ma’am.” And you have to just swallow your trauma in order to make the person who committed that trauma comfortable so that you don’t put your own family members at risk. 

Cara Anthony: Keisha says part of the stress comes from being Black and always being aware — alert — that the everyday ways you move through the world can be perceived as a threat to other people. 

Keisha Bentley-Edwards: Your life as a Black person is precarious. And I think that is what’s so hard about lynchings and these types of racist incidents is that so much of it is about, “I turned left when I could have turned right.” 

You know, “If I had just turned right or if I had stayed at home for another 10 minutes, this wouldn’t have happened.” 

Cara Anthony: That’s as true today as it was when Cleo Wright was alive. 

Keisha Bentley-Edwards: So, you don’t have to know the history of lynching to be affected by it. And so if you want to dismantle the legacy of the histories, you actually have to know it. So that you can address it and actually have some type of reconciliation and to move forward. 

Cara Anthony: I don’t know how you move on from something like the lynching of Cleo Wright. But breaking the silence is a step. 

And at 97, Ms. Mable did just that. 

She spoke to me. She trusted me enough to talk about it. Afterward, she said she felt lighter. 

Mable Cook: That’s right. Mm-hmm. So, it makes me feel much better after getting it out. 

[BEAT]  

Cara Anthony: A couple of years after we took the tour of Sikeston together, Ms. Mable died. 

When they lowered her casket into the ground, Ms. Mable’s family played a hymn she loved. 

It was a song she had sung for me … the day she invited me to visit her church. We sat in the pews. It was the middle of the week, but she was in her Sunday best. 

As we talked about Cleo Wright and Ms. Mable’s life in Sikeston, she told me she came back to that hymn over and over. 

Mable Cook: “Glory, Glory.” That’s what it was. [SINGING] Glory, glory, hallelujah. Since I laid my burden down. Glory, glory, hallelujah. Since I laid my burdens down […] 

Cara Anthony: I grew up singing that song. But before that moment, it was just another hymn in church. When Ms. Mable sang, it became something else. It sounded more like … an anthem. A call to acknowledge what we’ve been carrying with us in our bodies and minds. And to know it’s possible to talk about it … and maybe feel lighter. 

Mable Cook: [SINGING] … Every route go high and higher since I laid my burden down. Every route go high and higher since I laid my burden down […] 

Cara Anthony: Racism is heavy and it’s making Black people sick. Hives, high blood pressure, heart disease, inflammation, and struggles with mental health. 

To lay those burdens down, we have to name them first. 

That’s what I want this series to be: a podcast about finding the words to say the things that go unsaid. 

Across four episodes, we’re exploring the silence around violence and racism. And, maybe, we’ll get some redemption, too. 

I’m glad you’re here. There’s a lot more to talk about. 

Next time on “Silence in Sikeston,” the podcast … 

Meet my Aunt B and hear about our family’s hidden history. 

Cara Anthony: I told you what the three R’s of history are, right? 

Aunt B: No, tell me. 

Cara Anthony: So the three R’s of history are, you have to recognize something in order to repair it, in order to have days of redemption. So, Recognize, Repair, Redeem. And that’s what we’re doing. 

Aunt B: Man, how deep is that? 

Cara Anthony: That’s what we’re doing. 

Aunt B: Wow. 

CREDITS 

Cara Anthony: Thanks for listening to “Silence in Sikeston.” 

Next, go watch the documentary — it’s a joint production from Retro Report and KFF Health News, presented in partnership with WORLD. 

Subscribe to WORLD Channel on YouTube. That’s where you can find the film “Silence in Sikeston,” a Local, USA special. 

This podcast is a co-production of WORLD Channel and KFF Health News and distributed by PRX. 

It was produced with support from PRX and made possible in part by a grant from the John S. and James L. Knight Foundation. 

The audio series was reported and hosted by me, Cara Anthony. 

Zach Dyer and Taylor Cook are the producers. 

Editing by Simone Popperl. 

Taunya English is managing editor of the podcast. 

Sound design, mixing, and original music by Lonnie Ro. 

Podcast art design by Colin Mahoney and Tania Castro-Daunais. 

Oona Zenda was the lead on the landing page design. 

Julio Ricardo Varela consulted on the script. 

Sending a shoutout to my vocal coach, Viki Merrick, for helping me tap into my voice. 

Music in this episode is from BlueDot Sessions and Epidemic Sound. 

Additional audio from KFVS News in Sikeston, Missouri. 

Some of the audio you’ll hear across the podcast is also in the film. 

For that, special thanks to Adam Zletz, Matt Gettemeier, Roger Herr, and Philip Geyelin, who worked with us and colleagues from Retro Report. 

Kyra Darnton is executive producer at Retro Report. 

I was a producer on the film. 

Jill Rosenbaum directed the documentary. 

Kytja Weir is national editor at KFF Health News. 

WORLD Channel’s editor-in-chief and executive producer is Chris Hastings. 

If “Silence in Sikeston” has been meaningful to you, help us get the word out! 

Write a review or give us a quick rating on Apple, Spotify, Amazon Music, iHeart, or wherever you listen to this podcast. It shows the powers that be that this is the kind of journalism you want. 

Thank you. It makes a difference. 

Oh yeah … and tell your friends in real life, too! 

Credits

Taunya English
Managing editor

@TaunyaEnglish

Taunya is deputy managing editor for broadcast at KFF Health News, where she leads enterprise audio projects.

Simone Popperl
Line editor

@simoneppprl

Simone is broadcast editor at KFF Health News, where she shapes and edits stories that air on Marketplace and NPR, manages a reporting collaborative with local NPR member stations across the country, and edits the KFF Health News Minute.

Zach Dyer
Senior producer

@zkdyer

Zach is senior producer for audio with KFF Health News, where he supervises all levels of podcast production.

Taylor Cook
Associate producer

@taylormcook7

Taylor is an independent producer who does research, books guests, contributes writing, and fact-checks episodes for several KFF Health News podcasts.

Additional Newsroom Support

Lynne Shallcross, photo editorOona Zenda, illustrator and web producerLydia Zuraw, web producerTarena Lofton, audience engagement producer Hannah Norman, visual producer and visual reporter Chaseedaw Giles, audience engagement editor and digital strategistKytja Weir, national editor Mary Agnes Carey, managing editor Alex Wayne, executive editorDavid Rousseau, publisher Terry Byrne, copy chief Gabe Brison-Trezise, deputy copy chief Tammie Smith, communications officer 

The “Silence in Sikeston” podcast is a production of KFF Health News and WORLD. Distributed by PRX. Subscribe and listen on Apple Podcasts, Spotify, Amazon Music, iHeart, or wherever you get your podcasts.

Watch the accompanying documentary from WORLD, Retro Report, and KFF starting Sept. 16, here.

To hear other KFF Health News podcasts, click here.

KFF Health News is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF—an independent source of health policy research, polling, and journalism. Learn more about KFF.

USE OUR CONTENT

This story can be republished for free (details).

Letters to the Editor is a periodic feature. We welcome all comments and will publish a selection. We edit for length and clarity and require full names.

Debunking Abortion Myths

I want to send a big THANK YOU to Matt Volz for writing a fact-checking article on the nonsense rhetoric around “abortion up until and after birth” that has run wild and unchallenged in the media (“GOP’s Tim Sheehy Revives Discredited Abortion Claims in Pivotal Senate Race,” July 9). Thanks for putting abortion later in pregnancy in context and debunking false assumptions.

I am a near-third-trimester abortion patient (nonviable pregnancy, terminated at 26 weeks), and I am so sick of hearing politicians like Tim Sheehy talk about something they have never experienced or bothered to learn about. It is as though I am watching the entire nation maliciously gossip about me and other parents like me. Those of us in the termination for medical reasons (TFMR) community have walked through hell only to have our voices, at best, be ignored or, more commonly, be insulted and threatened.

And I imagine watching this political circus is just as hurtful for parents who lost an infant shortly after birth and had to provide palliative care. That is who they are talking about with “abortion after birth”; they are talking about comfort care for infants who will not survive.

Thank you again for bringing a dose of reality to a conversation that never should have become political. These are impossible decisions that only parents should make. It was really refreshing to read Volz’s article and know that some journalists are still willing to fact-check the absurd claims floating around. It was encouraging to know that someone does see us.

— Anne Angus, Bozeman, Montana

A physician and Yale professor of radiology and biomedical imaging took to the social platform X to share feedback:

.@SenatorTester is a great Senator. And his opponent is a great liar. Both the GOP presidential candidate and Tim Sheehy have perpetuated this lie. Please push back every time you hear it. https://t.co/1LBGPgOA2u

— (((Howard Forman))) (@thehowie) July 9, 2024

— Howard Forman, New Haven, Connecticut

I just read your article at PolitiFact on Republican Senate candidate Tim Sheehy’s statement about abortion, and I would like to point out (what I believe) are a couple of errors.

1. In paragraph 10, you quote KFF’s Alina Salganicoff saying that “in the good-faith medical judgment of the treating health care provider, continuation of the pregnancy would pose a risk to the pregnant patient’s life or health.” Now, you may know that almost at the same time that the Roe v. Wade decision was released, there was a decision called Doe v. Bolton that interpreted “health” to mean almost anything. That broad interpretation of health is found in your article in paragraph 24: “Women have abortions later in pregnancy either because they find out new information or because of economic or political barriers,” [Katrina] Kimport said.

When a woman can have an abortion after viability because she offers any reason that can be interpreted as “health,” then abortion would be legal throughout all nine months of pregnancy. I believe that you are wrong in your interpretation. Democrats do not want to name any restriction on abortion during all nine months, and every mention of “health” is a fig leaf that does not restrict abortion at all. Every abortion advocate knows that.

2. Whether late-term abortions are rare or not is logically irrelevant to whether late-term abortions should be restricted.

Why don’t you know these things?

— Darryl A. Linde, Tahlequah, Oklahoma

An Air Force veteran added his two cents on X:

Dems have the facts. Republicans spread fear and lies.https://t.co/6CWfKhqxJZ

— James Knight (@jamesUSAF_vet) July 12, 2024

— James Knight, Reno, Nevada

Making a Healthy Difference for the Homeless

Thank you for printing this story (“A California Medical Group Treats Only Homeless Patients — And Makes Money Doing It,” July 19). It really piqued my interest and portrayed a positive solution for getting care to the people.

Up here in the Bay Area, I believe there are a couple of groups who go out and find what needs doing instead of waiting for people to come to them — but nothing like this. Makes me curious about what we actually have going on here.

— Laurie Lippe, El Cerrito, California

A self-described “nurse turned health tech nerd” commended the effort on X:

"They distribute GPS devices so they can track their homeless patients. They keep company credit cards on hand in case a patient needs emergency food or water, or an Uber ride to the doctor"This is healthcare at its best 💕https://t.co/UhM1dgTPH7

— Rik Renard (@rikrenard) July 22, 2024

— Rik Renard, New York City

A senior policy director at the National Health Care for the Homeless Council shared the post on X — while stressing that her tweets reflected her own opinions and not those of her organization:

I’m with ⁦@DrJimWithers: “I do worry about the corporatization of street medicine and capitalism invading what we’ve been building, largely as a social justice mission outside of the traditional health care system.” https://t.co/IOjazvrvqP

— Barbara DiPietro (@BarbaraDiPietro) July 19, 2024

— Barbara DiPietro, Baltimore

On X, a physician who says she champions “physicians, patients, public health, and the patient-physician relationship” reacted to our coverage surrounding the Federal Trade Commission’s rule banning the use of noncompete agreements in employment contracts: 

FTC #noncompete crackdown may not protect doctors and nurses at ~64% of US community hospitals that are tax-exempt nonprofits or government-owned.But, ⁦@FTC⁩ said some nonprofits could be bound by the rule if they do not operate as true charities. https://t.co/9fDbfVflTH

— Marilyn Heine (@MarilynHeineMD) May 28, 2024

— Marilyn Heine, Langhorne, Pennsylvania

Without a Noncompete Ban on All Employers, Rural Access to Care Suffers

When news broke that the Federal Trade Commission would be banning noncompete agreements in employment contracts, many of us in the medical profession celebrated. However, until nonprofit hospitals and health care facilities benefit from the same ban, access to care — particularly in rural regions — will suffer.

As reported in “Health Worker for a Nonprofit? The New Ban on Noncompete Contracts May Not Help You” (June 5), about two-thirds of U.S. community hospitals are nonprofit or government-owned. This means that most hospitals nationwide may continue to enforce noncompete agreements among their employees, a practice that will have an outsize impact on rural medical professionals.

As a rheumatologist in a rural area, I’ve seen how detrimental limited access to care is for patients. Noncompete agreements serve only to further limit access to much-needed care. Due to the physician shortage being particularly acute in rural America, there are oftentimes only a few specialty physicians servicing a large region. Suppose one of these specialists is employed by a large health system and wants to transition to a private practice. It reduces the number of accessible specialists in the area when their noncompete agreement prohibits them from practicing near any of the health care facilities associated with the system. And increasing consolidation across health care means many rural regions may have only a single health system that operates across the entire state and surrounding areas. A geographically limiting noncompete agreement essentially stops a physician or medical professional from practicing entirely in the area, or they must uproot their life and move away from the major health system.

I hope the FTC takes further action to include nonprofit health care employers in its noncompete ban. I also urge nonprofit employers to consider their rural patients’ access to care when requiring providers to sign noncompete agreements. It’s in the best interest of our patient’s health to get rid of these agreements entirely.

— Chris Phillips, chair of the American College of Rheumatology’s Committee on Rheumatologic Care, Paducah, Kentucky

The president of the Texas Medical Board also posted on X with feedback:

Is it a coincidence that this affects everyone, except those who work for nonprofit hospitals and health care facilities, which employs the largest number of medical professionals?The FTC and it's selective enforcement and rules is blatantly obvious! https://t.co/RzXInqiJ8D

— Sherif Zaafran, MD (@szaafran) June 16, 2024

— Sherif Zaafran, Houston

Repurposing Newspaper Boxes for Public Health

I recently read your article by Mara Silvers regarding the state’s intended use of public health vending machines (PHVMs) to help fight the opioid overdose epidemic (“Montana’s Plan To Curb Opioid Overdoses Includes Vending Machines,” July 18). Working on the covid-19 response for almost four years now, and with our American Rescue Plan Act funding coming to an end, we recently used a byline in our equipment budget to purchase and place “resource kiosks” in the community.

In 2022, after researching the use of vending machines for test distribution, we discovered vending machines have high barrier-to-entry costs and high maintenance costs. And even if purchasing isn’t possible, rental contracts come with high fees. We decided it was better to use a lower-cost resource that could be purchased in greater quantity, easily placed with community partners, and required no maintenance: the refurbished newspaper kiosk.

We decided to purchase double-decker boxes, which have a secondary door, creating another shelf, for roughly $410 apiece and stocked them with covid tests, nasal naloxone, injectable naloxone, fentanyl test strips, xylazine test strips, various types of condoms, and lubrication packets. We are in the process of securing a supply of gun locks and adding links to our pilot landing page for individual free gun lock deliveries, as well as links for free sexually transmitted infection test kits. We have investigated providing dental supplies and other items, but long-term funding is a constant concern. Grant money for most programs (likely all ARPA dollars) is running out, so the viability of these types of pilot programs is tentative without a buy-in from state or federal agencies.

Mara’s article hinted at criteria for possible placements and, similarly, we didn’t use locational overdose data, which can be “othering” to communities, but instead placed these kiosks with community partners that have been accomplished supporters of their at-risk populations throughout the covid response. Each community partner helped protect the communities they served through increased access to resources and provided information as trusted messengers. Truly meeting people where they are.

While money quickly appeared to fight the covid pandemic, and states spirited away dollars for pet projects, that sea of funding has dried up, and there doesn’t seem to be a plan for any continued funding. Covid-related functions have all been folded back into communicable disease epidemiology programs, which were already underfunded; in our state, the money funding the naloxone bulk fund is also drying up. Covid deaths might be down, but there is always a new bug (H5N1), STI infections are up, and gun-related deaths grow year over year. Funding population-level health interventions is our next pandemic.

With enough funding, kiosk-sized PHVMs could be swiftly added to any public health agency’s or community program’s quiver of tools to help increase access to resources and information for the most vulnerable residents.

Thank you for publishing a great article about the emerging opportunities to respond to changing public health needs!

— Christopher Howk, Arapahoe County Public Health’s covid-19 testing and logistics coordinator, Greenwood Village, Colorado

A retiree with a PhD in quantum chemistry tweeted his surprise over the news:

Montana’s Plan To Curb Opioid Overdoses Includes Vending Machineshttps://t.co/kNxYjnIOEO(What???!! Vending machines for opioids?)

— John Lounsbury (@jlounsbury59) July 18, 2024

— John Lounsbury, Lake Frederick, Virginia

Misappropriation of Opioid Settlement Funds

OK, so I see how all these states got all these lump sums of money for people like us who became addicted and whose lives were devastated by Purdue Pharma, Vicodin, and all the pharmacies (“Lifesaving Drugs and Police Projects Mark First Use of Opioid Settlement Cash in California,” July 12). How come all these states got all the money but those of us who have suffered have to wait, hire lawyers, and wait years for the money that was just handed over to these states? We’re the ones whose lives were devastated. My son was hooked, I was hooked, and my wife, and yet we must sit here penniless after the addiction, while all these states take the money — and they don’t do what they’re supposed to with it, and everyone knows it.

— Michael Stewart, Des Moines, Iowa

KFF Health News is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF—an independent source of health policy research, polling, and journalism. Learn more about KFF.

USE OUR CONTENT

This story can be republished for free (details).

Not so long ago, Bonner General Health, the hospital in Sandpoint, Idaho, had four OB/GYNs on staff, who treated patients from multiple rural counties.

That was before Idaho’s near-total abortion ban went into effect almost two years ago, criminalizing most abortions. All four of Bonner’s OB/GYNs left by last summer, some citing fears that the state’s ban exposed them to legal peril for doing their jobs.

The exodus forced Bonner General to shutter its labor and delivery unit and sent patients scrambling to seek new providers more than 40 miles away in Coeur d’Alene or Post Falls, or across the state border to Spokane, Wash. It has made Sandpoint a “double desert,” meaning it lacks access to both maternity care and abortion services.

One patient, Jonell Anderson, was referred to an OB-GYN in Coeur d’Alene, roughly an hour’s drive from Sandpoint, after an ultrasound showed a mass growing in her uterus. Anderson made multiple trips to the out-of-town provider. Previously, she would have found that care close to home.

The experience isn’t limited to this small Idaho town.

A 2023 analysis by ABC News and Boston Children’s Hospital found that more than 1.7 million women of reproductive age in the United States live in a “double desert.” About 3.7 million women live in counties with no access to abortion and little to no maternity care.

Texas, Mississippi and Kentucky have the highest numbers of women of reproductive age living in double deserts, according to the analysis.

Amelia Huntsberger, one of the OB/GYNs who chose to leave Sandpoint — despite having practiced there for a decade — did so because she felt she couldn’t provide the care her patients needed under a law as strict as Idaho’s.

The growing provider shortages in rural states affect not only pregnant and postpartum women, but all women, said Usha Ranji, an associate director for Women’s Health Policy at KFF, a health information nonprofit that includes KFF Health News.

“Pregnancy is obviously a very intense period of focus, but people need access to this care before, during and after, and outside of pregnancy,” Ranji said.

The problem is expected to worsen.

In Idaho, the number of applicants to fill spots left by departing doctors has “absolutely plummeted,” said Susie Keller, CEO of the Idaho Medical Association.

“We are witnessing the dismantling of our health system,” she said.

This article is not available for syndication due to republishing restrictions. If you have questions about the availability of this or other content for republication, please contact NewsWeb@kff.org.

KFF Health News is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF—an independent source of health policy research, polling, and journalism. Learn more about KFF.

USE OUR CONTENT

This story can be republished for free (details).

Las pruebas han detectado el virus en el ganado en nueve estados, principalmente en Texas y Nuevo México, y más recientemente en Colorado, dijo Nirav Shah, director principal adjunto de los Centros para el Control y Prevención de Enfermedades (CDC), en un evento del 1 de mayo.

Otros animales, y al menos una persona en Texas, también se infectaron con el H5N1. Pero lo que más temen los científicos es si el virus se propagara de manera eficiente de persona a persona. Eso no ha sucedido y podría no suceder. Shah dijo que los CDC consideran que el brote de H5N1 “es un riesgo bajo para el público en general en este momento”.

Los virus evolucionan y los brotes pueden cambiar rápidamente. “Como con cualquier brote importante, esto se mueve a la velocidad de un tren bala”, dijo Shah. “De lo que hablamos ahora es de un instantánea de ese tren que se mueve rápidamente”. Lo que quiere decir es que lo que hoy se sabe sobre la gripe aviar H5N1 seguramente cambiará.

Con eso en mente, KFF Health News explica lo que se necesita saber ahora.

¿Quién contrae el virus que causa la gripe aviar?

Principalmente las aves. Sin embargo, en los últimos años, el virus de la gripe aviar H5N1 ha estado saltando cada vez más de las aves a los mamíferos en todo el mundo. La creciente lista, de más de 50 especies, incluye focas, cabras, zorrinos, gatos y perros salvajes en un zoológico en el Reino Unido. Al menos 24,000 leones marinos murieron en brotes de gripe aviar H5N1 en Sudamérica el año pasado.

Lo que hace que el brote actual en el ganado sea inusual es que se está propagando rápidamente de vaca a vaca, mientras que los otros casos, excepto las infecciones de leones marinos, parecen limitados. Los investigadores saben esto porque las secuencias genéticas de los virus H5N1 extraídos de las vacas este año eran casi idénticas entre sí.

El brote de ganado también preocupa porque agarró al país desprevenido. Los investigadores que examinan los genomas del virus sugieren que originalmente se transmitió de las aves a las vacas a finales del año pasado en Texas, y desde entonces se ha propagado entre muchas más vacas de las que se han examinado.

“Nuestros análisis muestran que esto ha estado circulando en vacas durante unos cuatro meses, bajo nuestras narices”, dijo Michael Worobey, biólogo especializado en evolución de la Universidad de Arizona en Tucson.

¿Es este el comienzo de la próxima pandemia?

Aún no. Pero es algo que vale la pena considerar porque una pandemia de gripe aviar sería una pesadilla. Más de la mitad de las personas infectadas por cepas anteriores del virus de la gripe aviar H5N1 de 2003 a 2016 murieron.

Incluso si las tasas de mortalidad resultan ser menos severas para la cepa H5N1 que circula actualmente en el ganado, las repercusiones podrían implicar muchas personas enfermas y hospitales demasiado abrumados para manejar otras emergencias médicas.

Aunque al menos una persona se infectó con el H5N1 este año, el virus no puede provocar una pandemia en su estado actual.

Para alcanzar este horrible estatus, un patógeno necesita enfermar a muchas personas en varios continentes. Y para lograrlo, el virus H5N1 necesitaría infectar a toneladas de personas. Eso no sucederá a través de saltos ocasionales del virus de los animales de granja a las personas. Más bien, el virus debe adquirir mutaciones para propagarse de persona a persona, como la gripe estacional, como una infección respiratoria transmitida principalmente por el aire cuando las personas tosen, estornudan y respiran.

Como aprendimos de covid-19, los virus transmitidos por el aire son difíciles de frenar.

Eso aún no ha sucedido. Sin embargo, los virus H5N1 ahora tienen muchas oportunidades para evolucionar a medida que se replican dentro de los organismos de miles de vacas. Como todos los virus, mutan a medida que se replican, y las mutaciones que mejoran la supervivencia del virus se transmiten a la próxima generación. Y debido a que las vacas son mamíferos, los virus podrían estar mejorando en reproducirse dentro de células más cercanas a las nuestras que las de las aves.

La evolución de un virus de gripe aviar listo para una pandemia podría facilitarse por una especie de superpoder que poseen muchos virus. Es decir, a veces intercambian sus genes con otras cepas en un proceso llamado recombinación.

En un estudio publicado en 2009, Worobey y otros investigadores rastrearon el origen de la pandemia del virus de la gripe porcina H1N1 en eventos en los que diferentes virus que causaban esta gripe, la gripe aviar y la gripe humana mezclaban y combinaban sus genes dentro de cerdos que se estaban infectando simultáneamente. Los cerdos no necesitan estar involucrados esta vez, advirtió Worobey.

¿Comenzará una pandemia si una persona bebe leche contaminada con el virus?

Aún no. La leche de vaca, así como la leche en polvo y la fórmula infantil, que se venden en tiendas se consideran seguras porque la ley requiere que toda la leche vendida comercialmente sea pasteurizada. Este proceso de calentar la leche a altas temperaturas mata bacterias, virus y otros microorganismos.

Las pruebas han identificado fragmentos de virus H5N1 en la leche comercial, pero confirman que los fragmentos del virus están muertos y, por lo tanto, son inofensivos.

Sin embargo, la leche “cruda” no pasteurizada ha demostrado contener virus H5N1 vivos, por eso la Administración de Drogas y Alimentos (FDA) y otras autoridades sanitarias recomiendan firmemente a las personas que no la tomen, porque podrían enfermarse de gravedad o algo peor.

Pero, aún así, es poco probable que se desate una pandemia porque el virus, en su forma actual, no se propaga eficientemente de persona a persona, como lo hace, por ejemplo, la gripe estacional.

¿Qué se debe hacer?

¡Mucho! Debido a la falta de vigilancia, el Departamento de Agricultura (USDA) y otras agencias han permitido que la gripe aviar H5N1 se propague en el ganado, sin ser detectada. Para hacerse cargo de la situación, el USDA recientemente ordenó que se sometan a pruebas a todas las vacas lecheras en lactancia antes que los ganaderos las trasladen a otros estados, y que se informen los resultados de las pruebas.

Pero al igual que restringir las pruebas de covid a los viajeros internacionales a principios de 2020 permitió que el coronavirus se propagara sin ser detectado, testear solo a las vacas que se mueven entre estados dejaría pasar muchos casos.

Estas pruebas limitadas no revelarán cómo se está propagando el virus entre el ganado, información que los ganaderos necesitan desesperadamente para frenarlo. Una hipótesis principal es que los virus se están transfiriendo de una vaca a la siguiente a través de las máquinas utilizadas para ordeñarlas.

Para aumentar las pruebas, Fred Gingrich, director ejecutivo de la American Association of Bovine Practitioners, dijo que el gobierno debería ofrecer fondos a los ganaderos para que informen casos y así tengan un incentivo para hacer pruebas. De lo contrario, dijo, informar solo daña la reputación por encima de las pérdidas financieras.

“Estos brotes tienen un impacto económico significativo”, dijo Gingrich. “Los ganaderos pierden aproximadamente el 20% de su producción de leche en un brote porque los animales dejan de comer, producen menos leche, y parte de esa leche es anormal y no se puede vender”.

Gingrich agregó que el gobierno ha hecho gratuitas las pruebas de H5N1 para los ganaderos, pero no han presupuestado dinero para los veterinarios que deben tomar muestras de las vacas, transportar las muestras y presentar los documentos. “Las pruebas son la parte menos costosa”, explicó.

Si las pruebas en las granjas siguen siendo esquivas, los virólogos aún pueden aprender mucho analizando secuencias genómicas del virus H5N1 de muestras de ganado. Las diferencias entre las secuencias cuentan una historia sobre dónde y cuándo comenzó el brote actual, el camino que recorre y si los virus están adquiriendo mutaciones que representan una amenaza para las personas.

Sin embargo, esta investigación vital se ha visto obstaculizada porque el USDA publica los datos incompletos y con cuentagotas, dijo Worobey.

El gobierno también debería ayudar a los criadores de aves de corral a prevenir brotes de H5N1, ya que estos matan a muchas aves y representan una amenaza constante de potenciales saltos de especies, dijo Maurice Pitesky, especialista en enfermedades de aves de la Universidad de California-Davis.

Las aves acuáticas como los patos y los gansos son las fuentes habituales de brotes en granjas avícolas, y los investigadores pueden detectar su proximidad mediante el uso de sensores remotos y otras tecnologías. Eso puede significar una vigilancia rutinaria para detectar signos tempranos de infecciones en aves de corral, usar cañones de agua para ahuyentar a las bandadas migratorias, reubicar animales de granja o llevarlos temporalmente a cobertizos. “Deberíamos estar invirtiendo en prevención”, dijo Pitesky.

Bien, no es una pandemia, pero ¿qué podría pasarle a las personas que contraigan la gripe aviar H5N1 de este año?

Realmente nadie lo sabe. Solo una persona en Texas fue diagnosticada con la enfermedad este año, en abril. Esta persona trabajaba con vacas lecheras, y tuvo un caso leve con una infección en el ojo. Los CDC se enteraron de esto debido a su proceso de vigilancia. Las clínicas deben alertar a los departamentos de salud estatales cuando diagnostican a trabajadores agrícolas con gripe, utilizando pruebas que detectan virus de la influenza en general.

Los departamentos de salud estatales luego confirman la prueba y, si es positiva, envían una muestra de la persona a un laboratorio de los CDC, donde se verifica específicamente la presencia del virus H5N1. “Hasta ahora hemos recibido 23”, dijo Shah. “Todos menos uno resultaron negativos”.

Agregó que funcionarios del departamento de salud estatal también están monitoreando a alrededor de 150 personas que han pasado tiempo alrededor de ganado. Están en contacto con estos trabajadores agrícolas con llamadas telefónicas, mensajes de texto o visitas en persona para ver si desarrollan síntomas. Y si eso sucede, les harán pruebas.

Otra forma de evaluar a los trabajadores agrícolas sería testear su sangre en busca de anticuerpos contra el virus de la gripe aviar H5N1; un resultado positivo indicaría que podrían haberse infectado sin saberlo. Pero Shah dijo que los funcionarios de salud aún no están haciendo este trabajo.

“El hecho de que hayan pasado cuatro meses y aún no hayamos hecho esto no es una buena señal”, dijo Worobey. “No estoy muy preocupado por una pandemia en este momento, pero deberíamos comenzar a actuar como si no quisiéramos que sucediera”.

KFF Health News is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF—an independent source of health policy research, polling, and journalism. Learn more about KFF.

USE OUR CONTENT

This story can be republished for free (details).

Three words are commonly repeated to describe rural America and its residents: older, sicker and poorer.

Obviously, there’s a lot more going on in the nation’s towns than that tired stereotype suggests. But a new report from the Agriculture Department’s Economic Research Service gives credence to the “sicker” part of the trope.

Rural Americans ages 25 to 54 — considered the prime working-age population — are dying of natural causes such as chronic diseases and cancer at wildly higher rates than their age-group peers in urban areas, according to the report.

The USDA researchers analyzed mortality data from the Centers for Disease Control and Prevention from two three-year periods — 1999 through 2001, and 2017 through 2019. In 1999, the natural-cause mortality rate for rural working-age adults was only 6 percent higherthan that of their city-dwelling peers. By 2019, the gap had widened to 43 percent.

The disparity was significantly worse for women — and for Native American women, in particular. The gap highlights how persistent difficulties accessing health care, and a dispassionate response from national leaders, can eat away at the fabric of rural communities.

A possible Medicaid link

USDA researchers and other experts noted that states in the South that have declined to expand Medicaid under the Affordable Care Act had some of the highest natural-cause mortality rates for rural areas. But the researchers didn’t pinpoint the causes of the overall disparity.

Seven of the 10 states that have not expanded Medicaid are in the South, though that could change soon because some lawmakers are rethinking their opposition, as KFF Health News previously reported.

The USDA’s findings were shocking but not surprising, said Alan Morgan, CEO of the National Rural Health Association. He and other health experts have maintained for years that rural America needs more attention and investment in its healthcare systems by national leaders and lawmakers.

Another recent report, from the health analytics and consulting firm Chartis, identified 418 rural hospitals that are “vulnerable to closure.” Congress, trying to slow the collapse of rural health infrastructure, enacted the Rural Emergency Hospital designation, which became available last year.

That new classification aimed to keep some facilities from shuttering in smaller towns by allowing hospitals to discontinue many inpatient services. But it has so far attracted only about 21of the hundreds of hospitals that qualify.

It’s unlikely that things have improved for rural Americans since 2019, the last year in the periods the USDA researchers examined. The coronavirus pandemic was particularly devastating in rural parts of the country. 

Morgan wondered: How wide is the gap today? Congress, Morgan said, should direct the CDC to examine life expectancy in rural America before and after the pandemic: “Covid really changed the nature of public health in rural America.”

The National Rural Health Association’s current advocacy efforts include raising support on policies before Congress, including strengthening the rural health workforce and increasing funding for various initiatives focused on rural hospitals, sustaining obstetrics services, expanding physician training and addressing the opioid response, among others. 

This article is not available for syndication due to republishing restrictions. If you have questions about the availability of this or other content for republication, please contact NewsWeb@kff.org.

KFF Health News is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF—an independent source of health policy research, polling, and journalism. Learn more about KFF.

USE OUR CONTENT

This story can be republished for free (details).

State and local governments are receiving billions of dollars in opioid settlements to address the drug crisis that has ravaged America for decades. But instead of spending the money on new addiction treatment and prevention services they couldn’t afford before, some jurisdictions are using it to replace existing funding and stretch tight budgets.

Scott County, Indiana, for example, has spent more than $250,000 of opioid settlement dollars on salaries for its health director and emergency medical services staff. The money usually budgeted for those salaries was freed to buy an ambulance and create a financial cushion for the health department.

In Blair County, Pennsylvania, about $320,000 went to a drug court the county has been operating with other sources of money for more than two decades.

And in New York, some lawmakers and treatment advocates say the governor’s proposed budget substitutes millions of opioid settlement dollars for a portion of the state addiction agency’s normal funding.

The national opioid settlements don’t prohibit the use of money for initiatives already supported by other means. But families affected by addiction, recovery advocates, and legal and public health experts say doing so squanders a rare opportunity to direct additional resources toward saving lives.

“To think that replacing what you’re already spending with settlement funds is going to make things better — it’s not,” said Robert Kent, former general counsel for the Office of National Drug Control Policy. “Certainly, the spirit of the settlements wasn’t to keep doing what you’re doing. It was to do more.”

Settlement money is a new funding stream, separate from tax dollars. It comes from more than a dozen companies that were accused of aggressively marketing and distributing prescription painkillers. States are required to spend at least 85% of the funds on addressing the opioid crisis. Now, with illicit fentanyl flooding the drug market and killing tens of thousands of Americans annually, the need for treatment and social services is more urgent.

Thirteen states and Washington, D.C., have restricted the practice of substituting opioid settlement funds for existing dollars, according to state guides created by OpioidSettlementTracker.com and the public health organization Vital Strategies. A national set of principles created by Johns Hopkins University also advises against the practice, known as supplantation.

Paying Staff Salaries

Scott County, Indiana — a small, rural place known nationally as the site of an HIV outbreak in 2015 sparked by intravenous drug use — received more than $570,000 in opioid settlement funds in 2022.

From August 2022 to July 2023, the county reported using roughly $191,000 for the salaries of its EMS director, deputy director, and training officer/clinical coordinator, as well as about $60,000 for its health administrator. The county also awarded about $151,000 total to three community organizations that address addiction and related issues.

In a public meeting discussing the settlement dollars, county attorney Zachary Stewart voiced concerns. “I don’t know whether or not we’re supposed to be using that money to add, rather than supplement, already existing resources,” he said.

But a couple of months later, the county council approved the allocations.

Council President Lyndi Hughbanks did not respond to repeated requests to explain this decision. But council members and county commissioners said in public meetings that they hoped to compensate county departments for resources expended during the HIV outbreak.

Their conversations echoed the struggles of many rural counties nationwide, which have tight budgets, in part because they poured money into addressing the opioid crisis for years. Now as they receive settlement funds, they want to recoup some of those expenses.

The Scott County Health Department did not respond to questions about how the funds typically allocated for salary were used instead. But at the public meeting, it was suggested they could be used at the department’s discretion.

EMS Chief Nick Oleck told KFF Health News the money saved on salaries was put toward loan payments for a new ambulance, purchased in spring 2023.

Unlike other departments, which are funded from local tax dollars and start each year with a full budget, the county EMS is mostly funded through insurance reimbursements for transporting patients, Oleck said. The opioid settlement funds provided enough cash flow to make payments on the new ambulance while his department waited for reimbursements.

Oleck said this use of settlement dollars will save lives. His staff needs vehicles to respond to overdose calls, and his department regularly trains area emergency responders on overdose response.

“It can be played that it was just money used to buy an ambulance, but there’s a lot more behind the scenes,” Oleck said.

Still, Jonathan White — the only council member to vote against using settlement funds for EMS salaries — said he felt the expense did not fit the money’s intended purpose.

The settlement “was written to pay for certain things: helping people get off drugs,” White told KFF Health News. “We got drug rehab facilities and stuff like that that I believe could have used that money more.”

Phil Stucky, executive director of a local nonprofit called Thrive, said his organization could have used the money too. Founded in the wake of the HIV outbreak, Thrive employs people in recovery to provide support to peers with mental health and substance use disorders.

Stucky, who is in recovery himself, asked Scott County for $300,000 in opioid settlement funds to hire three peer specialists and purchase a vehicle to transport people to treatment. He ultimately received one-sixth of that amount — enough to hire one person.

In Blair County, Pennsylvania, Marianne Sinisi was frustrated to learn her county used about $322,000 of opioid settlement funds to pay for a drug court that has existed for decades.

“This is an opioid epidemic, which is not being treated enough as it is now,” said Sinisi, who lost her 26-year-old son to an overdose in 2018. The county received extra money to help people, but instead it pulled back its own money, she said. “How do you expect that to change? Isn’t that the definition of insanity?”

Blair County Commissioner Laura Burke told KFF Health News that salaries for drug court probation officers and aides were previously covered by a state grant and parole fees. But in recent years that funding has been inadequate, and the county general fund has picked up the slack. Using opioid settlement funds provides a small reprieve since the general fund is overburdened, she said. The county’s most recent budget faces a $2 million deficit.

Forfeited Federal Dollars

Supplantation can take many forms, said Shelly Weizman, project director of the addiction and public policy initiative at Georgetown University’s O’Neill Institute. Replacing general funds with opioid settlement dollars is an obvious one, but there are subtler approaches.

The federal government pours billions of dollars into addiction-related initiatives annually. But some states forfeit federal grants or decline to expand Medicaid, which is the largest payer of mental health and addiction treatment.

If those jurisdictions then use opioid settlement funds for activities that could have been covered with federal money, Weizman considers it supplantation.

“It’s really letting down the citizens of their state,” she said.

Officials in Bucks County, Pennsylvania, forfeited more than $1 million in federal funds from September 2022 to September 2023, the bulk of which was meant to support the construction of a behavioral health crisis stabilization center.

“We were probably overly optimistic” about spending the money by the grant deadline, said Diane Rosati, executive director of the Bucks County Drug and Alcohol Commission.

Now the county plans to use $3.9 million in local and state opioid settlement funds to support the center.

Susan Ousterman finds these developments difficult to stomach. Her 24-year-old son died of an overdose in 2020, and she later joined the Bucks County Opioid Settlement Advisory Committee, which developed a plan to spend the funds.

In a September 2022 email to other committee members, she expressed disappointment in the suggested uses: “Please keep in mind, the settlement funds are not meant to fund existing programs or programs that can be funded by other sources, such as federal grants.”

But Rosati said the county is maximizing its resources. Settlement funds will create a host of services, including grief groups for families and transportation to treatment facilities.

“We’re determined to utilize every bit of funding that’s available to Bucks County, using every funding source, every stream, and frankly every grant opportunity that comes our way,” Rosati said.

The county’s guiding principles for settlement funds demand as much. They say, “Whenever possible, use existing resources in order that Opioid Settlement funds can be directed to addressing gaps in services.”

Ed Mahon of Spotlight PA contributed to this report.

KFF Health News is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF—an independent source of health policy research, polling, and journalism. Learn more about KFF.

USE OUR CONTENT

This story can be republished for free (details).

For decades, rates of the sexually transmitted infection were low. But the Hamilton County Health Department in Chattanooga — a midsize city surrounded by national forests and nestled into the Appalachian foothills of Tennessee — was seeing several syphilis patients a day, Miller said. A nurse who had worked at the clinic for decades told Miller the wave of patients was a radical change from the norm.

What Miller observed in Chattanooga is reflective of a trend that is raising alarm bells for health departments across the country.

Nationwide, syphilis rates are at a 70-year high. The Centers for Disease Control and Prevention said Jan. 30 that 207,255 cases were reported in 2022, continuing a steep increase over five years. Between 2018 and 2022, syphilis rates rose about 80%. The epidemic of sexually transmitted infections — especially syphilis — is “out of control,” said the National Coalition of STD Directors.

The surge has been even more pronounced in Tennessee, where infection rates for the first two stages of syphilis grew 86% between 2017 and 2021.

But this already difficult situation was complicated last spring by a shortage of a specific penicillin injection that is the go-to treatment for syphilis. The ongoing shortage is so severe that public health agencies have recommended that providers ration the drug — prioritizing pregnant patients, since it is the only syphilis treatment considered safe for them. Congenital syphilis, which happens when the mom spreads the disease to the fetus, can cause birth defects, miscarriages, and stillbirths.

Across the country, 3,755 cases of congenital syphilis were reported to the CDC in 2022 — that’s 10 times as high as the number a decade before, the recent data shows. Of those cases, 231 resulted in stillbirth and 51 led to infant death. The number of cases in babies swelled by 183% between 2018 and 2022.

“Lack of timely testing and adequate treatment during pregnancy contributed to 88% of cases of congenital syphilis,” said a report from the CDC released in November. “Testing and treatment gaps were present in the majority of cases across all races, ethnicities, and U.S. Census Bureau regions.”

Hamilton County’s syphilis rates have mirrored the national trend, with an increase in cases for all groups, including infants.

In November, the maternal and infant health advocacy organization March of Dimes released its annual report on states’ health outcomes. It found that, nationwide, about 15.5% of pregnant people received care beginning in the fifth month of pregnancy or later — or attended fewer than half the recommended prenatal visits. In Tennessee, the rate was even worse, 17.4%.

But Miller said even those who attend every recommended appointment can run into problems because providers are required to test for syphilis only at the beginning of a pregnancy. The idea is that if you test a few weeks before birth, there is time to treat the infection.

However, that recommendation hinges on whether the provider suspects the patient was exposed to the bacterium that causes syphilis, which may not be obvious for people who say their relationships are monogamous.

“What we found is, a lot of times their partner was not as monogamous, and they were bringing it into the relationship,” Miller said.

Even if the patient tested negative initially, they may have contracted syphilis later in pregnancy, when testing for the disease is not routine, he said.

Two antibiotics are used to treat syphilis, the injectable penicillin and an oral drug called doxycycline.

Patients allergic to penicillin are often prescribed the oral antibiotic. But the World Health Organization strongly advises pregnant patients to avoid doxycycline because it can cause severe bone and teeth deformities in the infant.

As a result, pregnant syphilis patients are often given penicillin, even when they’re allergic, using a technique called desensitization, said Mark Turrentine, a Houston OB-GYN. Patients are given low doses in a hospital setting to help their bodies get used to the drug and to check for a severe reaction. The penicillin shot is a one-and-done technique, unlike an antibiotic, which requires sticking to a two-week regimen.

“It’s tough to take a medication for a long period of time,” Turrentine said. The single injection can provide patients and their clinicians peace of mind. “If they don’t come back for whatever reason, you’re not worried about it,” he said.

The Metro Public Health Department in Nashville, Tennessee, began giving all nonpregnant adults with syphilis the oral antibiotic in July, said Laura Varnier, nursing and clinical director.

Turrentine said he started seeing advisories about the injectable penicillin shortage in April, around the time the antibiotic amoxicillin became difficult to find and physicians were using penicillin as a substitute, potentially precipitating the shortage, he said.

The rise in syphilis has created demand for the injection that manufacturer Pfizer can’t keep up with, according to the American Society of Health-System Pharmacists. “There is insufficient supply for usual ordering,” the ASHP said in a memo.

Even though penicillin has been around a long time, manufacturing it is difficult, largely because so many people are allergic, said Erin Fox, associate chief pharmacy officer for the University of Utah health system and an adjunct professor at the university, who studies drug shortages.

“That means you can’t make other drugs on that manufacturing line,” she said. Only major manufacturers like Pfizer have the resources to build and operate such a specialized, cordoned-off facility. “It’s not necessarily efficient — or necessarily profitable,” Fox said.

In a statement, Pfizer confirmed the amoxicillin shortage and surge in syphilis increased demand for injectable penicillin by about 70%. Representatives said the company invested $38 million in the facility that produces this form of penicillin, hiring more staff and expanding the production line.

“This ramp up will take some time to be felt in the market, as product cycle time is 3-6 months from when product is manufactured to when it is available to be released to customers,” the statement reads. The company estimated the shortage would be significantly alleviated by spring.

In the meantime, Miller said, his clinic in Chattanooga is continuing to strategize. Each dose of injectable penicillin can cost hundreds of dollars. Plus, it has to be placed in cold storage, and it expires after 48 months.

Even with the dramatic increase in cases, syphilis is still relatively rare. More than 7 million people live in Tennessee, and in 2019, providers statewide reported 683 cases of syphilis.

Health departments like Miller’s treat the bulk of syphilis patients. Many patients are sent by their provider to the health department, which works with contact tracers to identify and notify sexual partners who might be affected and tests patients for other sexually transmitted infections, including HIV.

“When you diagnose in the office, think of it as just seeing the tip of the iceberg,” Miller said. “You need a team of individuals to be able to explore and look at the rest of the iceberg.”

This story is part of a partnership that includes WPLN, NPR, and KFF Health News.

KFF Health News is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF—an independent source of health policy research, polling, and journalism. Learn more about KFF.

USE OUR CONTENT

This story can be republished for free (details).

Kevin Stansbury, CEO del Lincoln Community Hospital de Hugo, un pueblo de 800 habitantes en Colorado, se enfrenta a un clásico dilema: podría aumentar los ingresos de su hospital rural ofreciendo prótesis de cadera y operaciones de hombro, pero el centro de salud, con 64 años de antigüedad, necesita más dinero para poder ampliar su quirófano y realizar esas intervenciones.

“Tengo un cirujano dispuesto a hacerlo; pero mis instalaciones no son lo bastante grandes”, dijo Stansbury. “Y en mi hospital no puedo hacer servicios urgentes como obstetricia porque mi instalación no cumple con el código”.

Además de asegurar ingresos adicionales para el hospital, una ampliación de este tipo podría evitar que los habitantes de la zona tengan que conducir 100 millas hasta Denver para someterse a operaciones ortopédicas o dar a luz.

Los hospitales rurales a lo largo del país se enfrentan a un dilema similar.

El aumento de los costos, en medio de reducciones de los pagos de las aseguradoras, dificulta que los pequeños hospitales obtengan financiación para grandes renovaciones. Además, la elevada inflación y el aumento de las tasas de interés, como consecuencia de la pandemia, complica la obtención de préstamos u otros tipos de financiación para modernizar las instalaciones y adaptarlas a los estándares de la atención médica en constante cambio.

“La mayoría trabajamos con márgenes muy bajos, si es que tenemos alguno”, afirmó Stansbury. “Así que nos cuesta encontrar el dinero”.

El envejecimiento de las infraestructuras hospitalarias, sobre todo en las zonas rurales, es un problema que va en aumento. Los datos sobre la edad de los hospitales son difíciles de conseguir, porque se amplían, modernizan y remodelan diferentes partes de sus instalaciones a lo largo del tiempo.

Un análisis de 2017 de la American Society for Health Care Engineering, que forma parte de la American Hospital Association, descubrió que la edad media de los hospitales en Estados Unidos aumentó de 8,6 años en 1994 a 11,5 años en 2015. Ese número probablemente ha crecido, según conocedores de la industria, ya que muchos hospitales retrasaron los proyectos de mejora, particularmente durante la pandemia.

Una investigación publicada en 2021 por la empresa de planificación de capital Facility Health Inc, ahora llamada Brightly, reportó que los centros de salud estadounidenses habían aplazado un 41% de su mantenimiento y necesitarían $243,000 millones para ponerse al día.

Los hospitales rurales no disponen de los recursos de los grandes hospitales, sobre todo los que forman parte de cadenas hospitalarias, para financiar ampliaciones multimillonarias.

La mayoría de los hospitales rurales en funciones hoy se abrieron con fondos del Hill-Burton Act, una ley aprobada por el Congreso en 1946. Este programa se integró en la Ley de Servicios de Salud Pública en la década de 1970 y, en 1997, había financiado la construcción de casi 7,000 hospitales y clínicas. Ahora, muchos de esos edificios, sobre todo los rurales, necesitan mejoras urgentes.

Stansbury, que también preside el consejo de administración de la Colorado Hospital Association, señaló que al menos media docena de hospitales rurales del estado necesitan importantes inversiones de capital.

Harold Miller, presidente y CEO del Center for Healthcare Quality and Payment Reform, un think tank de Pittsburgh, afirmó que el principal problema de los pequeños hospitales rurales es que los seguros privados ya no cubren el costo total de la asistencia. Según Miller, Medicare Advantage, un programa por el que Medicare paga a planes privados para dar cobertura a personas mayores y discapacitadas, es uno de los principales responsables del problema.

“Básicamente, apartan a los pacientes de lo que puede ser el mejor pagador que tiene un pequeño hospital, y se los llevan a un plan privado, que no paga de la misma manera que Medicare tradicional y termina utilizando una variedad de técnicas para rechazar los reclamos”, explicó Miller.

Además, los hospitales rurales deben dotar sus servicios de urgencias de médicos las 24 horas del día, pero sólo cobran si hay pacientes.

Mientras tanto, los costos laborales desde el fin de la pandemia han aumentado, y la inflación ha disparado el precio de los suministros. Es probable que estas dificultades financieras obliguen a cerrar más hospitales rurales.

Los cierres de hospitales se redujeron durante la pandemia, de un récord de 18 cierres en 2020 a un total de ocho cierres en 2021 y 2022, según el Centro Cecil G. Sheps para la Investigación de Servicios de Salud de la Universidad de Carolina del Norte-Chapel Hill, porque los fondos de ayuda de emergencia los mantuvieron abiertos. Pero ese soporte vital ha terminado, y al menos nueve más cerraron en 2023. Según Miller, los cierres han vuelto a los niveles anteriores a la pandemia.

Esto hace temer que algunos hospitales inviertan en nuevas instalaciones y acaben cerrando de todos modos. Miller aseguró que sólo una pequeña parte de los hospitales rurales conseguiría una mejora significativa en sus finanzas agregando nuevos servicios.

Legisladores han intentado ayudar. California, por ejemplo, cuenta con programas de préstamos a bajo o ningún interés en los que pueden participar los hospitales rurales, y representantes de los hospitales le han pedido a los legisladores de Colorado que aprueben ayudas similares.

A nivel federal, la legisladora Yadira Caraveo, demócrata de Colorado, ha presentado el proyecto de ley bipartidista Rural Health Care Facilities Revitalization Act, que ayudaría a los hospitales rurales a obtener más fondos a través del Departamento de Agricultura de Estados Unidos (USDA).

El USDA ha sido uno de los mayores financiadores del desarrollo rural a través de los Community Facilities Programs, proporcionando más de $3 mil millones en préstamos al año. En 2019, la mitad de los más de $10 mil millones en préstamos pendientes a través del programa ayudaron a instalaciones de salud.

“De lo contrario, los centros tendrían que recurrir a prestamistas privados”, dijo Carrie Cochran-McClain, directora de la National Rural Health Association.

Los hospitales rurales pueden no resultar muy atractivos para los prestamistas privados debido a sus limitaciones financieras, y por lo tanto tendrían que pagar tasas de interés más altas o cumplir requisitos adicionales para obtener esos préstamos, agregó.

El proyecto de ley de Caraveo también permitiría a los hospitales, que ya tienen préstamos, refinanciarlos a tipos de interés más bajos, y cubriría más categorías de equipos médicos, como los dispositivos y la tecnología utilizados para la telesalud.

“Tenemos que mantener estos centros abiertos, no sólo para urgencias, sino también para dar a luz o para una consulta de cardiología”, explicó Caraveo, que también es pediatra. “No deberías tener que conducir dos o tres horas para tener esos servicios”.

Kristin Juliar, consultora de recursos de capital de la National Organization of State Offices of Rural Health, ha estudiado los retos a los que se enfrentan los hospitales rurales a la hora de pedir dinero prestado y planificar grandes proyectos.

“Intentan hacer esto mientras realizan su trabajo habitual dirigiendo un hospital”, dijo Juliar. “Por ejemplo, muchas veces, cuando surgen oportunidades de financiación, la agenda puede ser demasiado ajustada para que puedan desarrollar un proyecto”.

Parte de la financiación depende de que el hospital consiga fondos de contrapartida, lo que puede resultar difícil en comunidades rurales de bajos recursos. Y la mayoría de los proyectos exigen que los hospitales reúnan fondos de varias fuentes, lo que suma complejidad.

Y como la elaboración de estos proyectos suele llevar mucho tiempo, los CEO o los miembros del consejo de administración de los hospitales rurales a veces dejan el cargo antes de que se finalicen.

“Te pones manos a la obra y luego desaparecen personas clave, y entonces te sientes como si empezaras de nuevo”, explicó Juliar.

El hospital de Hugo abrió sus puertas en 1959, por iniciativa de los soldados que regresaban de la Segunda Guerra Mundial al condado de Lincoln, en las llanuras del este de Colorado. Donaron dinero, materiales, terrenos y mano de obra para construirlo. El hospital ha agregado cuatro clínicas de medicina familiar, un centro de enfermería especializada y un centro de vida asistida fuera de las instalaciones. Y atrae a especialistas de Denver y Colorado Springs.

A Stansbury le gustaría construir un nuevo hospital de aproximadamente el doble de tamaño que el actual, de 45,000 pies cuadrados. Dado que la inflación está bajando y es probable que las tasas de interés bajen este año, Stansbury espera conseguir financiación en 2024 y empezar a construir en 2025.

“El problema es que cada día que me despierto es más caro”, afirmó Stansbury.

Cuando autoridades del hospital se plantearon por primera vez la construcción de un nuevo hospital hace tres años, calcularon que el costo total del proyecto rondaría los $65 millones. Pero la inflación se disparó y ahora han subido las tasas de interés, lo que ha elevado el costo total a $75 millones.

“Si tenemos que esperar un par de años más, puede que nos acerquemos a los $80 millones”, señaló Stansbury. “Pero tenemos que hacerlo. No puedo esperar cinco años y pensar que los costos de construcción van a bajar”.

KFF Health News is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF—an independent source of health policy research, polling, and journalism. Learn more about KFF.

USE OUR CONTENT

This story can be republished for free (details).