Starting in 2000, a program in Mexico’s Coahuila state called “Piso Firme” (Firm Floor) offered up to $150 per home in mixed concrete, delivered directly to families who used it to cover their dirt floors. Scholar Paul Gertler evaluated the impact: Kids in houses that moved from all-dirt to all-concrete floors saw parasitic infestation rates drop 78 percent; the number of children who had diarrhea in any given month dropped by half; anemia fell more than four-fifths; and scores on cognitive tests went up by more than a third. (Perhaps unsurprisingly, mothers in newly cemented houses reported less depression and greater life satisfaction.) By 2005, Piso Firme had spread to other states, and 300,000 households—about 10 percent of dirt-floor houses in Mexico—had taken part in the program.

It helps if the street outside the house gets paved, too—not so much for health reasons as for economic ones. Economists Marco Gonzalez-Navarro and Climent Quintana-Domeque found in a 2010 study that paving the street in the town of Acayucan, Mexico, added more than 50 percent to land values and caused a 31 percent rise in rental values. It also considerably increased households’ access to credit. As a result, households on paved streets were 40 percent more likely to have cars.

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.

Nate

While the report said Australia had overtaken the United States as the fattest nation on the planet, recent U.S. studies show around 34 percent of Americans are overweight or obese.

And small Pacific nations top World Health Organization lists, with 94.5 percent of people in tiny Nauru classed as overweight, leading to chronic diabetes problems on the island.

The Federated States of Micronesia (91.1 percent), the Cook Islands (90.9 percent), Tonga (90.8 percent) and Niue (81.7 percent) rounded out the WHO top five, while the United States came in at number nine, with 74.1 percent overweight or obese.