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IS THE LOWER MISSISSIPPI RIVER DELTA “A REGION”?

CHSR. CHSR. 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

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IS THE LOWER MISSISSIPPI RIVER DELTA “A REGION”?

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  1. CHSR CHSR 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

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

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

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

  5. CHSR CHSR 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.

  6. CHSR CHSR 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

  7. CHSR CHSR 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

  8. 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 CHSR VARIABLES

  9. 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 CHSR VARIABLES

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

  11. 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 CHSR VARIABLES

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

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

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

  15. CHSR CHSR 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.

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

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

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

  19. CHSR CHSR 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.

  20. CHSR CHSR

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

  22. CHSR CHSR 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

  23. CHSR CHSR 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.

  24. HISTORY…

  25. CHSR CHSR From Health to Wealth – Health as an Economic Engine Health Wealth • Direct medical costs * • Productivity ** • Indirect costs to the community *** Health is an Economic Engine!!

  26. CHSR CHSR IMPLICATIONS… “… 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. CHSR CHSR 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.

  28. CHSR CHSR OTHER ORGANIZATIONS …

  29. 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 CHSR DISCIPLINES…

  30. CHSR CHSR PROJECTS …

  31. CHSR CHSR TENNESSEE – AN EXAMPLE % of each variable in Delta counties 80% 60% 40% 20% 0% Pop Rural Births Births Below Infant Deaths LB/VLB Poverty Mothers Families Births to Afr Amer Unmarried Population

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