IS THE LOWER MISSISSIPPI RIVER DELTA “A REGION”?

David M. Mirvis, MDCenter for Health Services ResearchUniversity of Tennessee Health Science CenterMemphis, TN

Beteena Beech, DrPHUniversity of MemphisMemphis, TN

Diana Bowser, MPHDepartment of Population and International HealthHarvard University School of Public HealthBoston, MA

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THE MISSISSIPPI RIVER DELTA

8 states 240 counties 9.4 million

people

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THE MISSISSIPPI RIVER DELTA

Parts of eight states

One–third of counties

22.3% of state populations

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IS THE DELTA “A REGION”?

IS THE DELTA A “POLITICAL FICTION”? IS THE DELTA “A REGION” WITH

DISTINCT DEMOGRAPHIC, HEALTH, EDUCATIONAL AND ECONOMIC CHARACTERISTICS?

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IF THE DELTA IS “A REGION”… Health planning, financing and assessment

are typically conducted at the state level. Needs of regions of a state that differ from

the remainder of the state in key health-related measures may be under-represented in state health planning.

Neighboring portions of different states may have more in common than they do with the remainder of their states.

For these areas, regional rather than state planning may be appropriate.

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IS THE DELTA “A REGION”?

Do counties in the Delta differ from counties not in the Delta in characteristics that impact health and health care planning? Demographics Health status Educational achievement Economic conditions

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METHODS Area Resource File Counties in Delta vs. Counties Not In

Delta by Region and by State Demographics Health status Educational attainment Economic conditions

Proportions, Relative Risk, 95% Confidence Limits

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VARIABLES Demographics Health Status Educational

Attainment Economic

Conditions

Population Size African American

Population Rural Population Population > 65 Yrs Population < 5 Yrs Single Parent

Households Births to Single Mothers Households with >6

Persons

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VARIABLES Demographics Health Status Educational

Attainment Economic

Conditions

Deaths (All Cause) Preterm Births Deaths <1 Yr Late/No Prenatal Care Low Birth Weight

Births Very Low Birth Weight

Births Births to Teenage

Mothers

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VARIABLES Demographics Health Status Educational

Attainment Economic

Conditions

Population with <9 Yrs Education

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VARIABLES Demographics Health Status Educational

Attainment Economic

Conditions

Households with Income <$10,000

Families Under Federal Poverty Level (FPL)

Persons Under FPL Persons <18 Yrs In

Poverty Unemployed >16 Yrs Owner-Occupied

Housing Housing Units Without

Plumbing

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DEMOGRAPHICS

OD

DS

RA

TIO

S (

+ 9

5%

CO

NF

IDE

NC

E I

NT

ER

VA

LS

)

1.00

1.20

1.40

1.60

1.80

2.00

NO

N-W

HIT

ER

AC

E

SIN

GL

EP

AR

EN

TH

OU

SE

HO

LD

S

BIR

TH

S T

OU

NM

AR

RIE

DM

OT

HE

RS

HO

US

EH

OL

DS

WIT

H >

6P

ER

SO

NS

RU

RA

LR

ES

IDE

NC

E

AG

E 65+

YR

S

AG

E <

5 YR

S

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HEALTH STATUSO

DD

S R

AT

IOS

(+

95%

C

ON

FID

EN

CE

IN

TE

RV

AL

S)

1.00

1.20

1.40

1.60

1.80

AL

L C

AU

SE

DE

AT

HS

PR

ET

ER

MB

IRT

HS

DE

AT

H <

1Y

R*

LA

TE

/NO

PR

EN

AT

AL

CA

RE

LB

WIN

FA

NT

S

VL

BW

INF

AN

TS

BIR

TH

S T

OT

EE

NA

GE

MO

TH

ER

S

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EDUCATIONAL ATTAINMENT/ ECONOMIC CONDITIONS

OD

DS

RA

TIO

S (

+ 9

5%

CO

NF

IDE

NC

E I

NT

ER

VA

LS

)

1.00

1.20

1.40

1.60

1.80

HO

US

EH

OL

DS

INC

OM

E<

$1

0,0

00

FA

MIL

IES

UN

DE

R F

PL

PE

RS

ON

SU

ND

ER

FP

L

PE

RS

ON

S 6

5+

YR

S IN

PO

VE

RT

Y

PE

RS

ON

S <

18

YR

S IN

PO

VE

RT

Y

UN

EM

PL

OY

ED

,1

6+

YE

AR

S

PE

RS

ON

S W

ITH

<9

YR

SE

DU

CA

TIO

N

OW

NE

RO

CC

UP

IED

HO

US

ING

UN

ITS

HO

US

ING

UN

ITS

WIT

HO

UT

PL

UM

BIN

G

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IS THE DELTA “A REGION”?

Counties in the Delta differ in demographic, health, educational and economic characteristics.

These differences exist at the level of individual states as well as for the overall 8-state region.

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0.00

1.00

2.00

3.00

4.00

5.00

6.00

7.00

AFR

ICA

NA

ME

RIC

AN

RU

RA

L

FAM

ILYB

ELO

W FP

L

<9 YR

SS

CH

OO

L

PR

ETE

RM

BIR

THS

VE

RY

LOW

BIR

THW

EIG

HT

BA

BIE

S

LOW

BIR

THW

EIG

HT

BA

BIE

S

LATE

/NO

PR

EN

ATA

LC

AR

E

INFA

NT

DE

ATH

SO

DD

S R

AT

IOS

(+

95%

C

ON

FID

EN

CE

IN

TE

RV

AL

S)

TENNESSEE – AN EXAMPLE

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How homogeneous is the Delta in these variables?

Coefficients of variation

IS THE DELTA “A” REGION?

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DIVERSITY WITHIN THE DELTA REGION

0.0

20.0

40.0

60.0

80.0 NonWhite Population

Unemployed Persons Over 16 Years OldC

oef

fici

ent

of

Var

iati

on

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SO …

Hence, the Delta may be considered a “region”, and regional planning may be appropriate.

This region is, however, heterogeneous, and regional planning may overlook important subregional differences.

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THE CONSORTIUM FOR HEALTH AND ECONOMIC DEVELOPMENT IN THE DELTA REGION

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FOUNDING ORGANIZATIONS …

University of Arkansas for Medical Sciences (College of Public Health)

Harvard University (School of Public Health, Department of International and Population Health)

Mississippi State University (Social Science Research Center)

University of Tennessee Health Science Center (Center for Health Services Research)

Delta Regional Authority

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MISSION… … an inter-disciplinary, multi-institutional and

collaborative organization that strives to promote health and economic development in the Lower Mississippi River Delta region through focused, evidence-based research, health improvement and educational initiatives that enhance knowledge, create a new understanding of underlying factors and successful interventions, and promote informed public policy.

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HISTORY…

From Health to Wealth – Health as an Economic Engine

• Direct medical costs *• Productivity **• Indirect costs to the community ***

Health Wealth

Health is an Economic Engine!!

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IMPLICATIONS…

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“… IT IS STILL NOT UNUSUAL TO FIND THAT THOSE WHO MAKE FINANCIAL DECISIONS ABOUT ALLOCATION TO HEALTH … THINK ABOUT HEALTH IN GENERAL TERMS ONLY AS A GOOD THING, BUT NOT GRASPING THE IMPORTANCE OF INVESTING IN A HEALTHY POPULATION AS A MECHANISM FOR STIMULATING OR PROMOTING ECONOMIC GROWTH.”

- UN Commission on Macroeconomics and Health

GOALS OF THE COLLABORATIVE…

focus on “health as an economic engine” model

promote synergy, and reduce duplication and competition;

increase the visibility of the issues facing the Delta;

focus attention of the participating organizations on Delta issues;

increase the likelihood of an impact; increase the opportunities to attract

the resources.

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OTHER ORGANIZATIONS …

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DISCIPLINES… Data collection and

analysis Demography Health planning Community-based

participatory research

Development economics

Econometrics Health behaviors Health care delivery

Health economics Health systems Health policy International health Nutrition Preventive medicine Public health Organizational

behavior Social work Survey research

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PROJECTS …

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TENNESSEE – AN EXAMPLE

% of each variable in Delta counties

0%

20%

40%

60%

80%

Pop

ula

tion

Afr A

mer

Pop

Ru

ral

Birth

s

Birth

s to

Un

marrie

dM

oth

ers

LB

/VLB

Birth

s

Infa

nt

Death

s

Fam

ilies

Belo

wP

overty

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