This is an anonymized excerpt from a chat two good friends of mine found themselves having the other night, which touches on the utter importance of local cultures, and the mysterious matter of what makes the difference between those that are helpful and those that aren’t. R. is a native Kansan physician, educated on the coasts but now working at a clinic in a sub-1000-population town in her home state; D. is a law student. (See also Atul Gawande’s inevitably fascinating New Yorker piece about how differences in local medical culture make healthcare in some places less effective and much more costly.)
D: So the problem isn’t small-town Kansas—it’s a toxic mixture of small-town Kansas plus adolescence? R: I think so. I like the small-town Kansas where we are now but, believe it or not, small-town Kansas is very heterogeneous. The town where we live now and where I grew up have a lot of significant differences in culture. D: Tell me more… R: Mainly it has to do with how people treat each other and how people approach problems. Here, problems are meant to be solved and people have a lot of respect for one another. We have “community conversations” when there’s something that impacts the whole town, and everyone who wants to speak can have their say. Where I grew up, on the other hand, people say all manner of things about other people, and if there’s a problem that affects the town everyone just complains to everyone else. The population even since I left has declined really sharply and everyone just says, “Oh, poor us, look at our dying town, who will save it?” Whereas here they formed an economic development commission and went out looking for new businesses to bring to the community. Some problems are similar, but by and large I think this is a positive place to grow up, and the graduating seniors we know well have said so too. The other great example of small-town heterogeneity is to look at the counties to the north and south of us. To the north we have County A, where people routinely farm well into their 80’s, have active sex lives into their 90’s, and there has not been a teen pregnancy in almost 10 years. These are the ruddy-cheeked insanely healthy country folk you may have read about. To the south, then, we have County B, where everyone over 40 has diabetes, the obesity rate seems like it’s about 90%, STI’s are rampant and there are currently 8 pregnant girls in the high school. What’s the difference? I have been trying to figure this out. The medical care is exactly the same (it’s our group). The physical infrastructure is not that different. But culturally, people in County B have this victimizing, back-biting mentality.D: It’s that stark a difference, huh? That’s astonishing. R: It really and truly is