Underemployment, Poverty and Access to Health Care in the Mississippi Delta:

A Community-Based Approach to Understanding Problemsand Exploring Alternatives

John J. Green, Ph.D.Institute for Community-Based Research,

Division of Social Sciences & Center for Community DevelopmentDelta State University

In the Shadows of Poverty:Strengthening the Rural Poverty Research Capacity of the South

July 21-23, 2004Memphis, Tennessee

Mississippi Delta

Mississippi Delta

A more responsive, participatory and action-oriented approach to research should:

Acknowledge the existence of power and attempt to develop power-sharing relationships.

Involve meaningful participation at all levels of inquiry.

Employ multiple research designs and methods, including traditional and alternative models of inquiry.

Assess the quality of the endeavor through use of several criteria, especially the soundness of methods and the extent of meaningful participation.

Include an action agenda that is empowering to the community-based partners.

An Alternative Research Framework?

Community-Based Research Framework

Lookgather data, define,

describe & build picture

Thinkexplore, analyze,

interpret & explain

Actreport, plan,

implement & evaluate

(Stringer, 1999)

Project Partners

Underemployment and Poverty Tri-County Workforce Alliance Aaron E. Henry Community Health Center Coahoma Opportunities, Inc. Quitman County Development Organization CURET (Comprehensive Urban/Rural Ensemble/Tourism)

Access to Health Care Mississippi Delta State Rural Development Network Aaron E. Henry Community Health Center Delta Diamond Health Network TCQ Health Network Greater Delta Health and Human Services Network

Research Methods: Underemployment and Poverty

Analysis of Census Data.

Qualitative Telephone Surveys – Employers in Coahoma and Quitman Counties (Total N = 38).

Focus Groups – Four focus groups with “underemployed” adults in Bolivar, Coahoma, Quitman and Tallahatchie Counties (Total N = 29).

Follow-up Community Meetings - Six follow-up meetings were held for participant validation and program planning.

Research Methods (Continued): Access to Health Care

Key-Informant Interviews – Thirty-eight key-informant, semi-structured interviews were conducted with residents of communities (Cleveland, Clarksdale, Greenville, Marks, Shaw, Tunica) in seven Delta counties.

Focus Groups – Twelve focus groups were conducted with a total of ninety participants.

Delta Rural Poll – A series of health-related questions were included in the 2003 Delta Rural Poll, a telephone survey of residents in the eleven core Delta counties conducted through a partnership between the Center for Community and Economic Development (Delta State University) and the Survey Research Unit, Social Science Research Center (Mississippi State University).

Community-Based Research in Action!

Unemployment Rate in 2000

4.1%

14.1%

10.1%

3.0%

11.3%

8.4%

4.6%

13.3%

7.4%

0%

2%

4%

6%

8%

10%

12%

14%

16%

White Black Total* White Black Total* White Black Total*

Coahoma County Quitman County Mississippi

Source: 2000 Census of Population and Housing – Summary File 3, Chart by John J. Green.

* “Total” equals more than sum of White and Black.

Average Household Income in 1999

$51,007

$27,469

$38,372

$25,439

$30,357

$48,457

$29,748

$42,315

$36,008

$0

$5,000

$10,000

$15,000

$20,000

$25,000

$30,000

$35,000

$40,000

$45,000

$50,000

$55,000

White Black Total* White Black Total* White Black Total*

Coahoma County Quitman County Mississippi

Source: 2000 Census of Population and Housing – Summary File 3, Chart by John J. Green.

* “Total” equals more than sum of White and Black.

Percent of Population Below Poverty Line (1999)

11.7%

46.1%

35.9%

17.1%

40.3%

33.1%

11.1%

34.9%

19.9%

0.0%

10.0%

20.0%

30.0%

40.0%

50.0%

60.0%

70.0%

80.0%

90.0%

100.0%

White Black Total* White Black Total* White Black Total*

Coahoma County Quitman County Mississippi

Per

cen

t of

Pop

ula

tion

Source: 2000 Census of Population and Housing – Summary File 3, Chart by John J. Green.

* “Total” equals more than sum of White and Black.

Research Results: Underemployment and Poverty

Underemployment and Poverty from the Perspective of Employers and the Underemployedin the Mississippi Delta:

Summary Results from Interviews and Focus Groups (2002)

Employers Underemployed

Assets

TourismFarm-related industryFuture industrial development opportunitiesIncreased educational stabilityExisting workforce training programs

Strong willingness/desire to workHeightened educational levelsExtensive skills and experienceExisting workforce training programsSocial service organizations

Barriers and Challenges

Few jobsInability to attract new businessesUnemployable workforceLow educational levelsCrime and drug problems in the community

Overall social and economic structureFew jobsLimited educational credentialsLack of dependable transportation to outside jobs

Action Ideas

Develop more industry and jobsBasic skills education (reading, writing, math)Vocational trainingHigh-tech. skills trainingHands-on experienceWork ethics

Move beyond traditional/ established approachesAdvocate, search for and help develop “good jobs”Increase educational and training opportunitiesMentorship/apprenticeship programSmall business incubator

Research Results: Access to Health Care

Community Social and Health Issues from the Perspective of Delta Residents:Summary Results from Focus Groups and Key-Informant Interviews (2003)

Important Social and Health Issues

Limited formal educationLack of good jobs, few benefits, povertyRacial barriers and disparitiesPoor housing conditionsLimited access to transportation (especially to access out-of-town services)Lack of insurance (many people slip through the “cracks” in the system)

Drug and alcohol abusePoor diet and nutritionObesityDiabetesHypertensionTeenage pregnancyHealth problems accepted as normLimited understanding of health issues

Ideas for Action

Community levelAwareness advocacyPrevention/wellness educationInformation on available health care and social service resourcesIncrease prevalence and awareness of social and health related communityCommunity involvement (parents, family, churches, police, leaders)

Policy levelIncreased insurance coverage, especially for those who slip through the cracksImproved staffing in health care facilities (increase numbers, professionalism, compensation)

Miles Traveled One-Way for Specialized Care(2003 Delta Rural Poll)

5 - 15 Miles

19.516 - 30 Miles

12.3

31 Miles or More

44.4

Less than 5 Miles

23.8

Miles Travel One-Way for Routine Health Care(2003 Delta Rural Poll)

5 - 15 Miles30.2

Less than 5 Miles45.4

16 - 30 Miles14.2

31 Miles or More10.2

Method Used to Pay for Visit to Doctor(2003 Delta Rural Poll)

Other1.5%Private

Insurance/Insurance

through Job Benefits46.5%

Government Program29.2%

Out-of-Pocket/

No Insurance22.8%

Method of Payment for Visit to Doctor by Income Group(2003 Delta Rural Poll)

27.2%15.1% 11.0%

41.7%

13.7%9.0%

31.1%

71.2% 80.0%

0%

20%

40%

60%

80%

100%

Less than $30,000 Between $30,000 and $60,000 M ore than $60,000

Per

cent

Out-of-Pocket/No Insurance Government Program Private Insurance/Insurance through Job Benefits

Program Planning Model

Assets:human, community

organizational & physical

Barriers:block effectiveness of assets

Goal: ImproveQuality of Life

Action Program: increase assets &

break down barriers

Action Objectives

Conduct a social marketing campaign to build awareness of current and potential employment options and the prerequisite skills needed to secure these positions.

Coordinate and facilitate efforts to increase participation in existing workforce development education and training programs.

Construct and implement a pilot education and training curriculum for professionalism that is considered legitimate and valuable by the underemployed, educators and employers.

Program Plan: Workforce Development

Action Objectives

Coordinate services and case management between health providers throughout the region.

Develop partnerships between public schools and community health centers to utilize communication technology to expand access to health care.

Survey and catalogue nonprofit health and human service providers to provide individuals, families and organizations more information on existing resources.

Program Plan: Access to Health Care