My friend Jo Kline, who writes and speaks about the difficulties of health care in Iowa, sent an email recently titled: “Every Iowan recognizes the odor of fertilizer.”

The subject was Gov. Kim Reynolds’ proclamation of Nov. 21 as “Rural Health Day.” I’ll get to the specifics of what Kline said in a bit, but first a little background.

The topic of health care in Iowa has generated a lot of discussion in recent years, but little in the way of real accomplishments.

One example is the refusal of state officials to investigate possible links between water pollution and Iowa’s rising cancer rates. Instead, they point to alcohol consumption, which may be a factor, but far from the sole cause, or even main cause, of Iowa’s growing health problems.

Most Iowans intuitively know that the reason state officials won’t undertake a proper study of our polluted waters is because they are afraid of what they will find. Namely, that Iowa’s unhealthy water is the result of an unregulated ag industry.

Too many farmers apply too much fertilizer and dangerous pesticides to their fields; also, there is too much leaking and spillage of animal waste from confined feeding operations into our streams and rivers.

Earlier this fall, I received an email from a reader questioning Iowa’s Healthiest State Initiative, which had just given an award to Bayer Corp.

Although the award was based on health initiatives Bayer provides for employees, my reader noted the high-dollar, cancer-related legal awards Bayer has made to users of Roundup, the glyphosate-based herbicide made by Monsanto, which Bayer acquired a few years ago.

Why, the reader asked, do state officials honor a company that makes a product that is clearly controversial and has harmed farmers and farm workers in the past?

It’s a fair question, but a better question might be why does the state continue promoting its “healthiest state” contest years after it failed to achieve its original goal. When Gov. Terry Branstad launched the Healthiest State Initiative in 2011, he set a five-year goal of moving Iowa from No. 19 to No.1 on a Gallup Healthways ranking of healthy states.

That never happened. The best Iowa did was No.14 in 2016.

Gallup discontinued its rankings several years ago, although BarBend, a promoter of fitness and nutrition products, picked up the idea and now produces annual “healthiest states” rankings.

This year, Iowa placed 30th overall, with particularly low scores for “healthy environment,” “healthy nutrition” and “healthy activity,” according to BarBend’s September news release.

Barbend’s measurements are different from Gallup’s. Still, ranking 30th on anyone’s “healthiest state” list has to be embarrassing for Gov. Reynolds and all of the people who have worked since 2011 to make “Iowa the healthiest state.”

Which brings me back to Kline’s email, in which she listed “some brutal truths not included in the governor’s proclamation” for Rural Health Day.

Kline’s brutal truths about health care in rural Iowa were:

 Nearly 4 of every 10 Iowans live in rural Iowa.

Three quarters of Iowa’s rural hospitals are operating in the red.

One-third of our 99 counties no longer offer maternity services.

Among the six Upper Midwest states, Iowa has the lowest number of physicians per 100,000 residents.

Iowa lawmakers have barred the opening of new nursing homes since June 2023.

One-third of Iowa’s doctors are already aged 60 or older.

We will need 25,000-plus additional health care workers by 2032, because 23% of all job growth will be in health care.

Iowa’s workforce will shrink by 33,300 over this decade, a decline that began in 2016 and will continue until 2031.

It will be 2036 before we once again reach today’s number of workers in Iowa.

Kline concluded with this statement:

“The crisis of health care access for Iowans – urban and rural – has been willfully ignored by our policymakers and stakeholders for decades. While it is still possible to avoid or reduce devastation from this entirely foreseeable disaster, make no mistake: The perfect storm of demographics, dwindling resources and systemic fails is no longer approaching. It is here.”

Learn more about Jo Kline at www.JoKline.net.