We are disappointed that, once again, Albany County has neglected the needs of its rural residents.

This week, we have a front-page story about the county being in the midst of a chart-topping surge in new business applications.

Kevin O’Connor, the chief executive officer of the Advance Albany County Alliance, told our reporter Noah Zweifel that the surge is due to a number of factors mostly feeding into a central phenomenon: reshoring of manufacturing jobs that the United States had been outsourcing for decades.

Albany County, home to Plug Power and the Albany Nanotech Complex, is part of what has been called an “early-stage Renaissance.” The Albany Nanotech Complex is the headquarters of NY CREATES (New York Center for Research, Economic Advancement, Technology, Engineering, and Science), which acts as a connective tissue between public, private, and academic entities to further research and development in the high technology sector — most notably semiconductors. 

“Manufacturing, they say, is a high economic-multiplier activity,” O’Connor said, “meaning it spins off a lot of other economic activity in its wake … As manufacturing has increased in the county, I think it’s given way to a whole series of other needs that have been filled by people starting up new companies, whether they be restaurants or retail stores or supply companies to support these manufacturers here.” 

Sales tax is rolling in, and the county still has an enormous fund balance or rainy-day account.

County Executive Daniel McCoy boasted at his presentation Monday of his $847 million budget proposal that taxes have been cut for 11 years in a row.

At the same time, the budget provides a slew of social services that are much needed by city residents. Certainly, county leadership is to be commended for that.

But in the midst of this prosperity, the country should not forget its rural residents. A rising tide should lift all boats.

Last year, eight municipalities that rely on the county EMS — Westerlo, Rensselaerville, Berne, New Scotland, Voorheesville, Bethlehem, Coeymans, and Ravena — had asked that the county create a special district through which it would tax residents directly for emergency medical services, rather than bill the towns, which then issue their own local taxes. 

We supported that plan on this page a year ago and we’re doing so again now.

Last year, as Zweifel has reported, the cost for county EMS went up drastically — 30 percent for both New Scotland and Westerlo — as costs for providing the service have increased and Sheriff Craig Apple is trying to make the positions more attractive so as to ensure adequate staffing.

Municipal leaders have been supportive of the cost increases, recognizing the difficult position that EMS workers are in and the necessity of the service, but still worry about how it will affect their own budgets.

“It’s obviously something that had to be done,” New Scotland Supervisor Douglas LaGrange said last week, “but it’s tough for me, at least … to slide in a 30-percent increase.”

McCoy told Zweifel this week that, until state legislation is passed, there’s nothing the county can do on that front. 

Assemblyman Steve Otis, who sponsored the state legislation that would give the county authority to set up such a district for its ambulance service, told The Enterprise that the bill is intended to give municipalities across the state more flexibility in setting up adequate EMS programs.

“The bill respects the variety of ways that exist around the state and is meant to address a shortage of services and diminishing response times in some areas,” he said. “The goal of the legislation is where things are working well, entities should be able to continue the way they’re functioning, [and] where there needs to be improvement, to give a variety of options by which municipalities, or groups of municipalities or counties, can set up programs they think would best serve them.” 

Otis said the bill is still being fine-tuned after “a lot of work” was done at the end of the most recent legislative session, and that municipalities can either seek special legislation that’s specific to their needs, or “see what happens at the beginning of the next legislative session with our legislation, which may solve the problems of needing special legislation.”

Setting up a special district in Albany County would make for better delivery and coordination of emergency medical services. And public EMS typically costs less than private services.

It would make no difference for residents themselves since the cost would be transferred from their local tax bill to a county tax bill, and there may even be some savings. The problem, of course, is the state-set levy limit, commonly called the tax cap. Not many politicians want to pierce the cap.

But the county is far more able, with its $850 million annual budget, to absorb the cost for an ambulance district while staying under the levy limit than small municipalities with budgets less than $5 million.

Rural areas just by their location, being more distant from hospitals, are already at a disadvantage when it comes to critical lifesaving minutes. Rural residents are 14 percent more likely to die after traumatic injury compared with nonrural residents, one study found.

National Emergency Medical Services Information System data shows that, on average, EMS total call time (from time unit is dispatched, the patient arrives at the hospital, and the EMS unit is ready for the next call) in rural areas of the United States are nearly 20 or 30 percent higher than suburban and urban areas.

“Fatality rates from rural vehicular trauma are almost double those found in urban settings,” one study says, finding that EMS call time in the case of fatal car accidents was over 40 percent higher in rural than in urban areas.

With opioid overdoses, a patient typically has depressed respiratory function so, one study found, the 9.4 extra minutes, on average, that it takes to transport a rural overdosed patient to a local hospital is often the difference between life and death.

This is not a new issue. Over the years, we have covered the demise, one by one, of the volunteer ambulance crews that used to serve our small towns and villages. The latest casualty was the closure of the Altamont Rescue Squad, the oldest in the state.

Guilderland, which has its own EMS operation, has picked up the territory once covered by the village squad. That suburban town has a large enough tax base to support its own ambulance service.

In fact, Guilderland’s proposed $46 million budget for next year includes hiring more EMS workers. “The need is there,” Guilderland Supervisor Peter Barber said as the volume of calls has increased.

For most municipalities, it has been the county crew that has stepped in when there are no longer enough volunteers to answer calls.

The need is there in the county’s rural areas, too — and has been for a long time.

Five years ago, when we called the county executive’s office to ask if McCoy would back a special district for ambulance services, spokeswoman Mary Rozak said that was the first she’d heard of it.

“We do anything and everything we can — the county executive is clear on that — to work with and help out every municipality in Albany County,” she said. “We don’t have any further information. If someone were to reach out to us, we could look into seeing if anything could be done.”

Last year, when Zweifel asked about the special district again, Rozak said the county was “looking to do whatever we can to help local municipalities so they can keep their taxes under the cap.” 

At that time, Assemblyman John McDonald was drafting a bill that would have allowed Albany County’s EMS district — but it has now become a statewide initiative as Otis explained.

Last week, Rozak said she could not talk about the ambulance district because those who would know were in “the thick of budget work.” 

This week, McCoy told Zweifel that he “can’t just pick out certain places and say, ‘Hey, you’re just going to pay taxes here.’ It has to be county-wide.”

As Otis explained, it does not have to be county-wide; municipalities can seek special legislation that’s specific to their needs.

Albany County should use this avenue to help its neglected rural areas. It’s time to stop equivocating.

The inequity is nationwide. On average, rural Americans are older, sicker, and poorer than their suburban or urban counterparts.

A study published by the Centers for Disease Control and Prevention in 2017 found, “Compared with metropolitan areas, nonmetropolitan areas have higher age-adjusted death rates and greater percentages of potentially excess deaths from the five leading causes of death, nationally and across public health regions.”

The study teases out many reasons for this. Among them are that rural residents tend to have less access to health care and preventative measures and are more likely to live in poverty, to smoke, and to suffer from hypertension and obesity.

The five leading causes of death during the time of the CDC study, from 1999 to 2014, were heart disease, cancer, unintentional injury, chronic lower respiratory disease, and stroke. For all of those causes, rural residents had a higher percentage of potentially excess deaths.

The gap is widening between rural and urban Americans not just in poverty rates but in life expectancy.

A study published by American Journal of Preventive Medicine in 2014 shows that, based on data from 1969 to 2009, the average life expectancy of rural Americans was 76.7 years, which is almost 2.5 years less than for metropolitan Americans.

Another study, based on data from 1980 to 2014, looked at life expectancy on a county-by-county basis across the nation where, in some places, the difference in life expectancy between rural and urban areas was more than 20 years.

The map of New York state shows downstate — the New York metropolitan area and the part of Long Island closest to the city — colored blue, meaning a life expectancy of 84 to 87 years. Most of the state is colored green, indicating a life expectancy of 78 to 81 years, while some rural areas are colored yellow, signifying a life expectancy of 75 to 78 years.

“In the face of this glaring healthcare disparity, rural Emergency Medical Services (EMS) often become the only guaranteed access to health services, and ultimately, the safety net for underserved rural communities,” writes the National Rural Health Association in a policy brief.

“However, dwindling population, losses in the volunteer workforce, and decreased reimbursement threaten continued access to these services. Nearly one-third of rural Emergency Medical Services (EMS) are in immediate operational jeopardy.”

This is the situation our rural communities in Albany County find themselves in. But the solution is right in front of us.

All Albany County has to do is work with the state legislature to create a special district of the municipalities that want to be part of one. This will both ensure fair pay for ambulance workers while also ensuring rural towns don’t go broke.

While we commend the county leadership for the surge in business growth, we need a county government that values equity and will share the wealth. When it comes to ambulance service, it is a matter of life or death.