1. Racial and Spatial Health Disparities in the Delta Arthur G. Cosby Professor & Director Social Science Research Center Mississippi State University Public Health Systems Research -Creating the Evidence for Policy- February 7-9 th, 2006

2. “ The South is a place, the North is a direction ”

3. “The Most Southern Place on Earth” The Mississippi Delta and the Roots of Regional Identity James C. Cobb B. Phinizy Spalding Distinguished Professor of History University of Georgia

4. The Urbanization of America The demographic history of the United States is a transition from a primarily rural agrarian society to an urban one. There is a tendency for us to view geography in terms of these categories.

5. Rural Population as a Percentage of Total US Population (1790-2000) 2000 US Census (www.census.gov) Year PercentPercent Rural America Urban America

6. The Great Rural-Urban Transition -Helped shape the way in which we think and respond to place and, in this case, health and place in America -Rural health has become an important policy concept Examples : National Rural Health Association Office of Rural Health Policy The Journal of Rural Health etc.

7. Rural Health Versus Healthy and Unhealthy Places A Different Conceptualization of Health and Place

8. “Rural Health” (9,250,000 Google hits) “Unhealthy Places” (16,600 Google hits) A Brief Comparison of the Search for Rural Health and Unhealthy Places

9. 557 times more likely to find the concept Rural Health than the concept Unhealthy Places

10. If you have seen one rural place, you have seen one rural place If you have seen one rural place, you have seen one rural place

11. At this point in history, it may be substantially more important to consider healthy and unhealthy places as a policy concept

12. Advances in Spatial Technologies allow us to think differently about space and health Geographic Information Systems Global Positioning Systems Remote Sensing Spatial Statistics

13. Healthy and Unhealthy Places in America: Average Years of Lost Life (80 – Average Life Expectancy, 1990) Produced by: The Monitor Lab Social Science Research Center Mississippi State University Source: U.S. Department of Health and Human Services, HRSA Community Health Status Indicator Project

14. Clusters of Healthy and Unhealthy Places Some of the Healthiest Places were Rural Some of the Unhealthiest Places were Rural Several of the Unhealthiest Places had regional and cultural identity (The Delta, The Southern Black Belt, and Appalachia) Most Importantly, differences in Life Expectancy were ProfoundMost Importantly, differences in Life Expectancy were Profound

15. “Healthy and Unhealthy Places” Cossman, R.E., Cosby, A.G. Defined by powerful and undebatable index – life expectancy Clearly discernable clusters Profound health disparities Statistically significant clusters Persistent over time

16. Figure 8: SpaceStat Map

17. The DRA Delta: A Congressionally Derived Region 240 county Delta Regional Authority definition

18. Age-adjusted Circulatory Death Rates Deaths/100,000 62.8 – 332.4 332.5 – 368.5 368.6 – 401.0 401.1 – 440.9 441.0 – 1135.1 Source: 1994-1998 Centers for Disease Control and Prevention

19. Age-adjusted Circulatory Death Rates Deaths/100,000 62.8 – 332.4 332.5 – 368.5 368.6 – 401.0 401.1 – 440.9 441.0 – 1135.1 59% of the Delta Counties are in the highest circulatory deaths quintile. Source: 1994-1998 Centers for Disease Control and Prevention

20. Age-adjusted Neoplasm Death Rates Deaths/100,000 0.0 – 185.7 185.8 – 202.4 202.5 – 215.3 215.4 – 231.7 231.8 – 423.7 Source: 1994-1998 Centers for Disease Control and Prevention

21. 54% of the Delta Counties are in the highest neoplasm deaths quintile. Age-adjusted Neoplasm Death Rates Deaths/100,000 0.0 – 185.7 185.8 – 202.4 202.5 – 215.3 215.4 – 231.7 231.8 – 423.7 Source: 1994-1998 Centers for Disease Control and Prevention

22. Age-adjusted Accidental Death Rates Deaths/100,000 0.0 – 34.7 34.8 – 43.1 43.2 – 51.7 51.8 – 62.9 63.0 – 298.3 Source: 1994-1998 Centers for Disease Control and Prevention

23. Age-adjusted Accidental Death Rates Deaths/100,000 0.0 – 34.7 34.8 – 43.1 43.2 – 51.7 51.8 – 62.9 63.0 – 298.3 42% of the Delta Counties are in the highest accidental deaths quintile. Source: 1994-1998 Centers for Disease Control and Prevention

24. Disabilities per 100 Persons Disabilities/100 10.9 – 27.3 27.3 – 31.6 31.6 – 36.3 36.3 – 42.9 42.9 – 85.0 Source: 2000 Census SF3

25. 1990 Average Life Expectancy Years of Life 65.6 – 73.7 73.8 – 75.1 75.2 – 76.0 76.1 – 76.9 77.0 – 79.9 Source: 2000 Community Health Status Report (HRSA)

26. 1990 Average Life Expectancy 63% of the Delta Counties are in the lowest life expectancy quintile. Years of Life 65.6 – 73.7 73.8 – 75.1 75.2 – 76.0 76.1 – 76.9 77.0 – 79.9 Source: 2000 Community Health Status Report (HRSA)

27. What if We were Equal?

28. Age Adjusted Mortality Rates 3-Year Averages 1968 – 2001 Age Adjusted Death Rate Per 100,000 Population

29. Difference in Age Adjusted Mortality Rates 3-Year Averages 1968 – 2001 Age Adjusted Death Rate Per 100,000 Population

30. Additional Deaths in Delta Metro Area 3-Year Averages 1968 – 2001 Additional Number of Deaths

31. Age Adjusted Mortality Rates 3-Year Averages 1968 – 2001 Age Adjusted Death Rate Per 100,000 Population

32. Difference in Age Adjusted Mortality Rates 3-Year Averages 1968 – 2001 Age Adjusted Death Rate Per 100,000 Population

33. Additional Deaths in Delta Non-Metro Area 3-Year Averages 1968 – 2001 Additional Number of Deaths

34. Additional Deaths Delta Metro 7351 Delta Rural 8321 Total 15,672

35. The Implications for Public Health Systems There are clearly regional clusters that can be defined by health outcomes These regional clusters appear to be associated with a distinct history, subculture, etc. The health outcomes are profoundly different between these regions Large spatial disparities

36. In the Delta region, there is evidence that health improvement may have leveled Health disparities between the Delta and the rest of the nation appear to be increasing These patterns transcend state and community boundaries Should we redefine our approaches to addressing the spatial aspects of health from one based on demographic history to one based on health conditions and outcomes The Implications for Public Health Systems

37. Thank You www.ssrc.msstate.edu Arthur.Cosby@ssrc.msstate.edu

39. 1972 1976 1980198419881968199219962000 19701974197819821986199019941998 2002 Difference Between White and Black Male Heart Disease Mortality: Mississippi -50 0 50 100 150 200 -200 -150 -100 -250 Note: Numbers are calculated as the yearly MS Black rate minus the yearly MS White rate. Positive numbers indicate years where the black heart disease rate is higher, negative numbers indicate years where the white heart disease rate is higher. The Y-axis indicates the difference in the number of deaths per 100,000.

41. 50 100 150 200 250 1972 19761980198419881968199219962000 19701974 1978 198219861990199419982002 Difference Between White and Black Female Heart Disease Mortality: Mississippi Note: Numbers are calculated as the yearly MS Black rate minus the yearly MS White rate. Each number is positive, meaning that the black rate is greater than the white rate in each year. The Y-axis indicates the difference in the number of deaths per 100,000.

42. 400 300 200 100 0 -100 -200 -300 1970 1972 19741978 19761980 1982 198419881968 19861990 1992 19941998 19962000 2002 Note: Numbers are calculated as the yearly MS Black or White (Male and Female) rate minus the yearly US White (Male and Female) rate. Positive numbers indicate years where the MS rate is higher than the US rate, negative numbers indicate years where the US rate is higher than the MS rate. The Y-axis indicates the difference in the number of deaths per 100,000. Magnitude of CVD Disparities