1. IS THE LOWER MISSISSIPPI RIVER DELTA “A REGION”? David M. Mirvis, MD Center for Health Services Research University of Tennessee Health Science Center Memphis, TN Beteena Beech, DrPH University of Memphis Memphis, TN Diana Bowser, MPH Department of Population and International Health Harvard University School of Public Health Boston, MA CHSR

2. THE MISSISSIPPI RIVER DELTA  8 states  240 counties  9.4 million people CHSR

3. THE MISSISSIPPI RIVER DELTA  Parts of eight states  One–third of counties  22.3% of state populations CHSR

4. IS THE DELTA “A REGION”?  IS THE DELTA A “POLITICAL FICTION”?  IS THE DELTA “A REGION” WITH DISTINCT DEMOGRAPHIC, HEALTH, EDUCATIONAL AND ECONOMIC CHARACTERISTICS? CHSR

5. 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. CHSR

6. 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 CHSR

7. 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 CHSR

8. 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 CHSR

9. 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 CHSR

10. VARIABLES  Demographics  Health Status  Educational Attainment  Economic Conditions  Population with <9 Yrs Education CHSR

11. 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 CHSR

12. DEMOGRAPHICS ODDS RATIOS (+ 95% CONFIDENCE INTERVALS) 1.00 1.20 1.40 1.60 1.80 2.00 NON-WHITE RACE SINGLE PARENT HOUSEHOLDS BIRTHS TO UNMARRIED MOTHERS HOUSEHOLDS WITH >6 PERSONS RURAL RESIDENCEAGE 65+ YRSAGE <5 YRS CHSR

13. HEALTH STATUS ODDS RATIOS (+ 95% CONFIDENCE INTERVALS) 1.00 1.20 1.40 1.60 1.80 ALL CAUSE DEATHS PRETERM BIRTHS DEATH <1 YR* LATE/NO PRENATAL CARE LBW INFANTS VLBW INFANTS BIRTHS TO TEENAGE MOTHERS CHSR

14. EDUCATIONAL ATTAINMENT/ ECONOMIC CONDITIONS ODDS RATIOS (+ 95% CONFIDENCE INTERVALS) 1.00 1.20 1.40 1.60 1.80 HOUSEHOLDS INCOME<$10,000 FAMILIES UNDER FPL PERSONS UNDER FPL PERSONS 65+ YRS IN POVERTY PERSONS <18 YRS IN POVERTY UNEMPLOYED, 16+ YEARS PERSONS WITH <9 YRS EDUCATION OWNER OCCUPIED HOUSING UNITS WITHOUT PLUMBING CHSR

15. 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. CHSR

16. ODDS RATIOS (+ 95% CONFIDENCE INTERVALS) TENNESSEE – AN EXAMPLE CHSR

17.  How homogeneous is the Delta in these variables?  Coefficients of variation IS THE DELTA “A” REGION? CHSR

18. DIVERSITY WITHIN THE DELTA REGION 0.0 20.0 40.0 60.0 80.0 NonWhite Population Unemployed Persons Over 16 Years Old Coefficient of Variation CHSR

19. 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. CHSR

21. THE CONSORTIUM FOR HEALTH AND ECONOMIC DEVELOPMENT IN THE DELTA REGION CHSR

22. 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 CHSR

23. 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. CHSR

24. HISTORY…

25. 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!! CHSR

26. IMPLICATIONS… CHSR “… 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

27. 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. CHSR

28. OTHER ORGANIZATIONS … CHSR

29. 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 CHSR

30. PROJECTS … CHSR

32. TENNESSEE – AN EXAMPLE % of each variable in Delta counties 0% 20% 40% 60% 80% PopulationAfr AmerPopRuralBirthsBirths toUnmarriedMothersLB/VLBBirthsInfantDeathsFamiliesBelowPoverty CHSR