is the lower mississippi river delta “a region”? david m. mirvis, md center for health services...
TRANSCRIPT
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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