Health status in the Mississippi River Delta region.Objectives: The purpose of the study was to determine if and where there were counties with significantly better or poorer health than others in the region. Methods: Using Z scores for 6 mortality-related measures, this study identifies counties within the Delta states with the highest and lowest rates. Results: Although Delta counties account for only 33% of the counties in the eight target states, they represent the majority of counties with the highest mortality measures, and represent the minority of counties with positive health outcomes. Conclusions: These findings confirm the appropriateness of targeting interventions, and help pinpoint places where better health is being achieved despite high poverty and other risk factors, where important lessons can be drawn. Key Words: age-adjusted death rate, health status, infant mortality (hardware) infant mortality - It is common lore among hackers (and in the electronics industry at large) that the chances of sudden hardware failure drop off exponentially with a machine's time since first use (that is, until the relatively distant time at which enough mechanical , life expectancy Life Expectancy 1. The age until which a person is expected to live. 2. The remaining number of years an individual is expected to live, based on IRS issued life expectancy tables. , statistical study ********** Called the "Nile of the Western Hemisphere Western Hemisphere Part of Earth comprising North and South America and the surrounding waters. Longitudes 20° W and 160° E are often considered its boundaries. " (see Appendix, Note 1), the Mississippi River Mississippi River River, central U.S. It rises at Lake Itasca in Minnesota and flows south, meeting its major tributaries, the Missouri and the Ohio rivers, about halfway along its journey to the Gulf of Mexico. meanders across middle America Middle America 1 A region of southern North America comprising Mexico, Central America, and sometimes the West Indies. Middle American adj. & n. as it travels south from its headwaters in northern Minnesota to the Gulf of New Mexico New Mexico, state in the SW United States. At its northwestern corner are the so-called Four Corners, where Colorado, New Mexico, Arizona, and Utah meet at right angles; New Mexico is also bordered by Oklahoma (NE), Texas (E, S), and Mexico (S). . The counties located in the Mississippi River Delta For other uses, see Mississippi Delta (disambiguation) The Mississippi River Delta is the modern area of land (the river delta) built up by alluvium deposited by the Mississippi River as it slows down and enters the Gulf of Mexico. make up a region that is rich in natural and human resources The fancy word for "people." The human resources department within an organization, years ago known as the "personnel department," manages the administrative aspects of the employees. and unique in its heritage, history, and culture. Yet the Delta region, especially the Lower Mississippi River
adj. 1. Employed only part-time when one needs and desires full-time employment. 2. Inadequately employed, especially employed at a low-paying job that requires less skill or training than one possesses. , and out-migration. (1) The "plight of the Delta," often the main context in which this region is discussed, has recently been formalized for·mal·ize tr.v. for·mal·ized, for·mal·iz·ing, for·mal·iz·es 1. To give a definite form or shape to. 2. a. To make formal. b. as a national concern through federal legislation establishing the Delta Regional Authority (DRA DRA Delta Regional Authority DRA Developmental Reading Assessment (educational test) DRA Division of Ratepayer Advocates (California) DRA Data Research Associates DRA Directory and Resource Administrator , see Appendix, Note 2). The Figure provides a map showing the Delta counties in the eight states targeted by the DRA. These 240 counties represent 33% of all counties in these eight states. Numerous health and health care indicators have been included in the various needs assessments conducted to justify targeting this region. (2-4) Although the eight states making up the DRA (see Appendix, Note 3) consistently rank at the bottom among US states in terms of health status, (5-10) (see Table 1), the targeted Delta counties (see Appendix, Note 4) have the greatest need within these states. (1,3,11) County level analysis of the DRA region can help illuminate how new resources may best be used, and provide a baseline for measuring change. This report presents findings from one of several studies aimed at highlighting where successes can best be achieved within the context of the Delta. This analysis takes a systematic approach to identifying DRA-designated counties that are faring both poorly and well on selected mortality measures compared with the rest of the region. Although differences have multiple causes, opportunities for program or policy intervention may emerge as important factors worth exploring. Materials and Methods This study made use of existing data examining and comparing county and regional level mortality-related indicators. Measures for each county within the eight Delta states were compared with the same measure for the region as a whole. Counties with measures that were significantly higher or lower than that of the region were identified for counties in all eight states both within and outside of the DRA target area. [GRAPHIC OMITTED] Health status indicators and data sources Six mortality-related indicators were chosen for the analysis because of their widely recognized value as strong, key measures of population health status. (12-15) The specific indicators selected were infant mortality rate infant mortality rate n. The ratio of the number of deaths in the first year of life to the number of live births occurring in the same population during the same period of time. , age-adjusted all-cause mortality rate, age-adjusted cancer mortality rate, age-adjusted heart disease mortality rate, life expectancy for females, and life expectancy for males. County level data for the 720 counties of the eight Delta states were obtained from multiple sources for the years 1994 to 1998 unless otherwise specified. Infant mortality rates (IMRs) were obtained from the Area Resource File. (16) All-cause mortality rates (MRs), cancer mortality rates The introduction to this article provides insufficient context for those unfamiliar with the subject matter. Please help [ improve the introduction] to meet Wikipedia's layout standards. You can discuss the issue on the talk page. (CMRs), and heart disease mortality rates (HDMRs) were obtained from the Centers for Disease Control WONDER Database. (17) Cancer deaths were defined as those with ICD-9 codes The following is a list of codes for International Statistical Classification of Diseases and Related Health Problems. These codes are in the public domain. The US Census Bureau Glossary defines educational attainment as "the highest level of education completed in terms of the level. (18) All indicators are continuous ratio variables. Analysis methods The goal of this analysis was to determine in which counties measures were significantly higher and lower than those of the region as a whole. Therefore, the value for each indicator for each one of the 720 counties in the eight Delta states was compared with the all-county regional mean for that indicator. In the case of HDMR and CMR, only 719 counties were included in the analysis. This was due to the population size of one county, Issaquena County, Mississippi Issaquena County is a county located in the Mississippi Delta region of the U.S. state of Mississippi. As of 2000, the population is 2,274. In population, it is the smallest county in Mississippi. Its county seat is Mayersville6. , which was too small to provide reliable mortality rates for those two diseases. In the case of life expectancy figures, the figure used for a single county may have been calculated based on the clustering of several counties. However, these figures still accurately represent the life expectancy of the single county. County values for each indicator were standardized by using Z scores to determine the extent of deviation from the mean. All counties with a Z score equal to, greater than, or less than 1.96 were identified. For mortality indicators, positive Z scores signify higher mortality, whereas for life expectancy measures, a negative score represents the less-desired outcome. Results Results of these analyses show that geographic health disparities
Health disparities (also called health inequalities in some countries) refer to gaps in the quality of health and health care across racial, ethnic, and socioeconomic groups. exist between Delta and non-Delta counties. Table 2 illustrates the differences in rates for the six indicators of health status used in these analyses. The median all-cause, cancer, and heart disease mortality rates of the Delta counties are on average 8.5% higher than those of non-Delta counties. The median infant mortality rate for the Delta counties is nearly 30% higher than the rate for non-Delta counties. The six individual tests of statistical significance reinforced the existence of these geographic health disparities (see Table 3). Infant mortality rate The mean IMR IMR - Internet Monthly Report of the 720 counties in Alabama The U.S. state of Alabama is comprised of sixty-seven counties. The oldest and newest counties in Alabama are Washington County (created June 4, 1800) and Houston County (created February 9, 1903), respectively. , Arkansas, Illinois, Kentucky, Louisiana, Missouri Louisiana is a city in Pike County, Missouri, United States. The population was 3,863 at the 2000 census. Louisiana is located in northeast Missouri, on the Mississippi River south of Hannibal. An ammonia plant here was converted to study and produce synthetic fuels. , Mississippi, and Tennessee was 8.35 (SD = 3.31). The mode IMR was 7.30 and median IMR was 8.00. There were nine counties where the IMRs were statistically significantly lower than the mean IMR of the 720 counties. Five of these counties were located within the Delta region. The remaining low IMR counties were located primarily in the northwestern part of the region, with the exception of one county located in eastern Kentucky. Twenty-five counties had statistically significantly higher IMRs than the mean IMR of the 720 counties. All but eight of these counties were located within the Delta Region. These non-Delta counties were located largely in the eastern part of MS and the Appalachian region of Kentucky. Age-adjusted mortality rate The mean MR of the 720 counties in the eight states was 994.66 (SD = 98.25). The mode MR was 949.7 and median MR was 993.65. There were 11 counties that had statistically significantly lower MRs than the mean MR of the 720 counties. Two of these counties were located within the Delta region. Twenty-two counties had statistically significantly higher MRs than the mean MR of the 720 counties. Thirteen of these counties were in the Delta region; eight were not. Cancer mortality rate The mean CMR for 719 counties in the eight states was 223.99 (SD = 24.17). The mode CMR was 204.90 and median CMR was 222.40. Twelve counties had statistically significantly lower CMRs than the mean CMR of the 719 counties in these eight states. All but two were non-Delta counties. Nineteen counties had statistically significantly higher CMRs than the mean CMR of the 719 counties, of which seven were in the Delta region. Heart disease mortality rate The mean HDMR of the 719 counties in the eight states was 330.91 (SD = 53.45). The mode HDMR was 329.70 and median HDMR was 329.70. Seven counties had statistically significantly lower HDMRs than the mean HDMR of the 719 counties. Only one of these counties was located within the Delta region. Twenty-three counties had statistically significantly higher HDMRs than the mean HDMR of the 719 counties, of which 15 were in the Delta region. Female life expectancy The mean LEF LEF Life Extension Foundation LEF Leading Edge Forum (CSC) LEF Local Education Funds LEF Literacy Empowerment Foundation LEF Library Exchange Format (Cadence Design Systems) of the 720 counties in the eight states was 78.01 years (SD = 1.36). The mode LEF was 79.49 years and median LEF was 78.19 years. Five counties had statistically significantly longer LEFs than the mean LEF of the 720 counties. Three of these counties were not in the Delta region and two were in the Delta region. Thirty-two counties had statistically significantly shorter LEFs than the mean LEF of the 720 counties. All but three of these counties were located within the Delta region. Male life expectancy The mean LEM of the 720 counties in the eight states was 70.28 years (SD = 1.88). The mode LEM was 70.20 years and median LEM was 70.27 years. Fourteen counties had statistically significantly longer LEMs than the mean LEM of the 720 counties. All of these counties were located in non-Delta counties. Twenty counties had statistically significantly shorter LEMs than the mean LEM of the 720 counties. All but one of these counties were located in the Delta region. A total of 136 counties were identified at least once across the six tests as having an extreme health status, better or poorer, or both: 46 counties were only identified as having better health, 85 counties were identified as having only poorer health, and 5 counties were identified as having both. Of the 46 counties that were identified with better health, 38 were non-Delta counties and eight were Delta counties. Of the counties that were identified with poorer health, 29 were non-Delta and 56 were Delta. Of the 5 mixed health status counties, 3 were non-Delta counties and 2 were Delta counties (see Table 4). Although Delta counties only account for 33% of all the counties in the eight DRA targeted states, only 17% of the better health counties were Delta counties, whereas 66% of the poorer health status counties were Delta counties. These findings confirm previous health-related studies that support targeting the Delta counties for special attention and investment. (1-3) However, this analysis also highlights counties in the Delta that have significantly better health. Nine Delta counties were identified in at least one of the six tests as having statistically better health for one of the indicators of health status. The better-health counties were: Hardin, IL (for IMR), Massac, IL (for IMR), Webster, KY (for IMR), East Carroll, LA (for IMR), Dunklin, MO (for CMR and HDMR), Reynolds, MO (for CMR), Ste Genevieve, MO (for MR and LEF), Carroll, MS for MR) and Tunica tunica /tu·ni·ca/ (too´ni-kah) pl. tu´nicae [L.] a tunic; in anatomy, a general term for a membrane or other structure covering or lining a body part or organ. , MS (for CMR). In addition to having at least one identified better health outcome, three of these counties were also identified as having poorer health outcomes. These three counties, East Carroll, LA, Carroll, MS, and Tunica, MS, have similar sociodemographic and economic characteristics, and statistically significantly poorer health outcomes. So, how are their residents able to achieve better health outcomes in at least some measures than residents in similar Delta counties? Locally available health care services, social services social services Noun, pl welfare services provided by local authorities or a state agency for people with particular social needs social services npl → servicios mpl sociales , or preventive programs may be producing these results. Further investigation, which is outside the scope of this current research, could identify programs or services that could be replicated in other Delta counties. Discussion Limitations and policy implications This study is limited in the breadth of indicators included and in the depth of its analysis. Although our focus on largely uncontrolled, mortality-related measures reveals only the tip of the iceberg tip of the iceberg n. pl. tips of the iceberg A small evident part or aspect of something largely hidden: afraid that these few reported cases of the disease might only be the tip of the iceberg. , the consistency of the patterns that emerge are a story worth telling, even if only to spur further research that may later prove our findings to be overly simplistic sim·plism n. The tendency to oversimplify an issue or a problem by ignoring complexities or complications. [French simplisme, from simple, simple, from Old French; see simple . A key assumption underlying this study is that identification of communities with unusually high mortality rates is somehow useful from a policy or programmatic standpoint. Clearly, the concept of targeting high-risk populations has been fundamental to many successful public health interventions. (19-21) Program administrators and policymakers could use this identification method to target public health resources to counties with multiple poorer health ratings or poorer health rates over multiple years. However, this traditional approach has been challenged by those emphasizing the importance of highlighting and building on assets and strengths of communities. (22) For this reason, the few Delta counties that seem to be faring well are just as, if not more, important to study than those with higher mortality rates. Program administrators and policymakers should consider Delta counties with better health status measures as potential locations of innovative projects, interventions, and/or social conditions that may serve as valuable models for other Delta counties. It is not the intent of this study to provide insight into the multiple, complex causes of the unequal concentration of mortality within the Delta region. Rather, its purpose is to identify more clearly where these extreme pockets exist. Although it is not surprising that the designated Delta counties are disproportionately represented among those with the highest mortality rates and shortest life expectancies, the consistency with which certain counties fall into this category deserves serious attention. Clearly, further targeting of resources and efforts to understand what drives these patterns is needed. At the same time, further examination of Delta counties with lower mortality rates and higher life expectancy may provide some of the most interesting and important lessons about what programs and policies can make a difference in this setting. Although some of the Delta counties with lower mortality rates (eg, Tunica, MS, for cancer mortality rates) are those located near urban areas (Memphis, TN) where services are more widely available, others have fewer obvious reasons for having lower rates for some measures of health status. For example, East Carroll County Carroll County is the name of thirteen counties in the United States of America. All except Carroll County, Tennessee, are named for Charles Carroll of Carrollton, a signer of the United States Declaration of Independence from Maryland:
Conclusion Clearly, further work is needed to fully map the distribution of relative levels of morbidity, disability, and other types of mortality in this region, and to illuminate how disparities within populations and within counties might influence these findings. Although much is known in general about the determinants of health outcomes, less is known about their relative importance, the interaction between proximal health indicators and more distal nonmedical determinants, and the impact within the Delta of specific efforts to intervene. Research findings that document these interactions could be instrumental in guiding the design and implemen 10tation of targeted policies and programs that could have a positive impact on the health of the population in the Delta. I don't know what your destiny will be, but one thing I know: the only ones among you who will be really happy are those who will have sought and found how to serve. --Albert Schweitzer Appendix Note 1. Quote from author John Gunter John Gunter was secretary-manager of Middlesbrough F.C. from February 1909 to June 1910. Following the departure of Andy Aitken to Leicester Fosse, Boro were left without a manager in name for sixteen months, and so the responsibilities of management fell to secretary John found on http://www.cr.nps.gov/delta/ on 10/02/02. Note 2. On December 21, 2000, the Consolidated Appropriations Act 2001 (PL 106-554) authorized the establishment of the Delta Regional Authority (DRA). For further information about the Delta Regional Authority see http://www.dra.gov. Note 3. The eight states included in the DRA are Alabama, Arkansas, Illinois, Kentucky, Louisiana, Mississippi, Missouri, and Tennessee. Note 4. For the purposes of this study, the designation of Delta region counties and parishes established under Public Law 100-460 is used. This includes 20 counties in Alabama (Barbour, Bullock, Butler, Choctaw, Clarke, Conecuh, Dallas, Escambia, Greene, Hale, Lowndes, Macon, Marengo, Monroe, Perry, Pickens, Russell, Sumter, Washington, and Wilcox), 42 counties in Arkansas List of 75 counties in the U.S. state of Arkansas: State Abbr. FIPS State Code State AR 05 Arkansas FIPS County Code County Name 001 Arkansas County 003 Ashley County 005 Baxter County 007 Benton County 009 Boone County 011 Bradley County (Arkansas, Ashley, Baxter, Bradley, Calhoun, Chicot, Clay, Cleveland, Craighead, Crittenden, Cross, Dallas, Desha, Drew, Fulton, Grant, Greene, Independence, Izard Iz´ard n. 1. (Zool.) A variety of the chamois found in the Pyrenees. , Jackson, Jefferson, Lawrence, Lee, Lincoln, Lonoke, Marion, Mississippi Marion is a town in Lauderdale County, Mississippi, United States. The population was 1,305 at the 2000 census. Geography Marion is located at (32.422182, -88.647323)GR1. , Monroe, Ouachita, Phillips, Poinsett, Prairie, Pulaski, Randolph, Searcy, Sharp, Stone, St. Francis, Union, Van Buren, White, and Woodruff), 16 counties in Illinois The links in the column FIPS County Code are to the Census Bureau Info page for that county. Listed are the 102 counties in the state of Illinois. Current counties State Abbr. (Alexander, Franklin, Gallatin, Hamilton, Hardin, Jackson, Johnson, Massac, Perry, Pope, Pulaski, Randolph, Saline, Union, White, and Williamson), 21 counties in Kentucky <onlyinclude> This is a list of the one hundred and twenty counties in the U.S. state of Kentucky. Despite ranking 37th in size by area, Kentucky has 120 counties, third in the U.S. behind Texas' 254 and Georgia's 159. (Ballard, Caldwell, Calloway, Carlisle, Christian, Crittenden, Fulton, Graves, Henderson, Hickman, Hopkins, Livingston, Lyon, Marshall, McCracken, McLean, Muhlenberg, Todd, Trigg, Union, and Webster), 46 parishes in Louisiana <onlyinclude>The U.S. state of Louisiana is divided into 64 parishes in the same way that 48 of the other states of the United States are divided into counties (Alaska is divided into boroughs and census areas). (Acadia, Allen, Ascension, Assumption, Avoyelles, Caldwell, Catahoula, Concordia, East Baton Rouge Baton Rouge (băt`ən r  zh) [Fr.,=red stick], city (1990 pop. 219,531), state capital and seat of East Baton Rouge parish, SE La. , East Carroll, East Feliciana, Evangeline, Franklin,
Grant, Iberia, Iberville, Jackson, Jefferson, Lafourche, La Salle La Salle, city (1990 pop. 9,717), La Salle co., N Ill., on the Illinois River; settled 1830, inc. 1852. It forms a tricity unit with Peru and Oglesby. Corn, wheat, and soybeans are grown, and cattle and hogs are raised. ,
Lincoln, Livingston, Madison, Morehouse, Natchitoches, Orleans,
Ouachita, Plaquemines, Pointe Coupee, Rapides, Richland, St. Bernard St. Bernarda very large (110-200 lb) dog with massive, broad head, medium-sized ears lying close to the head, and a long tail. There are two varieties, the most familiar (rough) has a long, thick coat, while the smooth variety has a shorter coat, lying close to the body. , St. Charles, St. Helena, St. James, St. John the Baptist John the Baptist prophet who baptized crowds and preached Christ’s coming. [N.T.: Matthew 3:1–13] See : Baptism John the Baptist head presented as gift to Salome. [N.T.: Mark 6:25–28] See : Decapitation , St. Landry, St. Martin St. Martin in midwinter, gave his cloak to a freezing beggar. [Christian Hagiog.: Brewer Dictionary] See : Kindness , Tangipahoa, Tensas, Union, Washington Union is a small unincorporated community located in Mason County, Washington, in the United States. The town lies along the southern shore of Hood Canal. There is no U.S. Census data for the location. The ZIP Code for Union is 98592. , West Baton Rouge, West Carroll, West Feliciana, and Winn), 45 counties in Mississippi List of 82 counties in the U.S. state of Mississippi: State Abbr. FIPS State Code State MS 28 Mississippi FIPS County Code County Name 001 Adams County 003 Alcorn County 005 Amite County 007 Attala County 009 Benton County 011 Bolivar County (Adams, Amite, Attala, Benton, Bolivar, Carroll, Claiborne, Coahoma, Copiah, Covington, Desoto, Franklin, Grenada, Hinds, Holmes, Humphreys, Issaquena, Jefferson, Jefferson Davis, Lafayette, Lawrence, Leflore, Lincoln, Madison, Marion, Marshall, Montgomery, Panola, Pike, Quitman, Rankin, Sharkey, Simpson, Sunflower, Tallahatchie, Tate, Tippah, Tunica, Union, Walthall, Warren, Washington, Wilkinson, Yalobusha, and Yazoo), 29 counties in Missouri Missouri has 114 counties and one independent city. St. Louis City is separate from St. Louis County and is referred to as a "city not within a county." Independent cities
FIPS State Code State State Abbr. (Bollinger, Butler, Cape Girardeau Cape Girardeau (jĭrär`dō, jērərdō`), city (1990 pop. 61,633), Cape Girardeau co., SE Mo., overlooking the Mississippi River; founded 1793, inc. as a city 1843. , Carter, Crawford, Dent, Douglas, Dunklin, Howell, Iron, Madison, Mississippi Madison is a city in Madison County, Mississippi, USA. The population was 14,691 at the 2000 census. In 2005, CNN/Money Magazine listed Madison as the 55th best place to live in the United States. , New Madrid New Madrid (mă`drĭd), city (2000 pop. 3,334), seat of New Madrid co., extreme SE Missouri, on Mississippi River at the sweeping New Madrid Bend; inc. 1808. , Oregon, Ozark, Pemiscot, Perry, Phelps, Reynolds, Ripley, Scott, Shannon, St. Francois, Ste. Genevieve Ste. Genevieve can refer to:
State Abbr. (Benton, Carroll, Chester, Crockett, Decatur, Dyer, Fayette, Gibson, Hardeman, Haywood, Henderson, Henry, Lake, Lauderdale, Madison, McNairy, Obion, Shelby, Tipton, and Weakley).
Table 1. Morgan Quitno rankings for the eight states in the Delta
Regional Authority, 1996-2001
Mean Highest
2001 2000 1999 1998 1997 1996 ranking ranking
AL 47 48 48 46 47 48 47.33 47
AR 40 44 45 50 50 50 46.50 40
IL 32 26 30 26 17 30 26.83 17
KY 31 33 37 44 45 40 38.33 31
LA 48 49 50 49 48 49 48.83 48
MO 38 36 38 48 43 46 41.50 36
MS 50 50 49 45 42 44 46.67 42
TN 39 40 39 47 46 36 41.17 36
Sources: Morgan & Morgan, 1996-2001.
Table 2. Delta and non-Delta County mean and median mortality rates and
life expectancy figures (a)
Mean Median
Delta Non-Delta Delta Non-Delta
Counties Counties Counties Counties
IMR 9.56 7.74 9.5 7.35
MR 1,047.19 969.4 1,051.10 967.25
CMR 232.08 220.03 232.30 218.10
HDMR 352.05 320.38 347.10 315.10
LEF 77.18 78.42 77.28 78.51
LEM 69.89 70.40 70.20 70.36
(a) IMR, infant mortality rates; MR, all-cause mortality rates; CMR,
cancer mortality rates; HDMR, heart disease mortality rates; LEF, life
expectancy for females; LEM, life expectancy for males.
Table 3. Number of Delta and non-Delta County mean with statistically
better or poorer health status (a)
Better health status Poorer health status
Delta Non-Delta Delta Non-Delta
Counties Counties Counties Counties
IMR 5 4 17 8
MR 2 9 13 9
CMR 2 10 7 12
HDMR 1 6 15 8
LEF 2 3 29 3
LEM 0 14 19 1
TOTAL 12 46 100 41
(a) IMR, infant mortality rates; MR, all-cause mortality rates; CMR,
cancer mortality rates; HDMR, heart disease mortality rates; LEF, life
expectancy for females; LEM, life expectancy for males.
Acknowledgments The authors thank Michelle White and Al McCullough, MA, for assistance in constructing the database used in this analysis. Special thanks go to Marisue Cody, PhD, and the anonymous reviewers of the Southern Medical Journal for their review of and comments on earlier versions of the paper. Accepted July 7, 2004. References 1. Brown DW (ed): The Delta Initiatives: Realizing the Dream ... Fulfilling the Potential. Memphis. TN, Lower Mississippi Delta Development Commission, 1990. 2. Hawkins WF, Hyland SE. Rural health care issues in the Lower Mississippi Delta: an agenda for the Year 2000. J Health Soc Policy 1990;2:79-94. 3. Harrison GG (ed): Nutrition and Health Status in the Lower Mississippi Delta of Arkansas, Louisiana and Mississippi: A Review of the Existing Data. Rockville, MD, Lower Mississippi Delta Nutrition Intervention Research Consortium/Westat, Inc, 1997. 4. Felix, H, Stewart, MK, Rickard, D. A Profile of Health and Health Care in the Delta Region Based on Existing Data: A Report to the Enterprise Corporation of the Delta. Little Rock, AR, Arkansas Center for Health Improvement, 2002. 5. Morgan K, Morgan S (eds): Health Care State Rankings. 1996. Lawrence, KS, Morgan Quitno, 1996. 6. Morgan K, Morgan S (eds): Health Care State Rankings. 1997. Lawrence, KS, Morgan Quitno, 1997. 7. Morgan K, Morgan S (eds): Health Care State Rankings. 1998. Lawrence, KS, Morgan Quitno, 1998. 8. Morgan K, Morgan S (eds): Health Care State Rankings. 1999. Lawrence, KS, Morgan Quitno, 1999. 9. Morgan K, Morgan S (eds): Health Care State Rankings. 2000. Lawrence, KS, Morgan Quitno, 2000. 10. Morgan K, Morgan S (eds): Health Care State Rankings. 2001. Lawrence, KS, Morgan Quitno, 2001. 11. Smith J. Lensing S, Horton JA, et al. Prevalence of self-reported nutrition-related health problems in the Lower Mississippi Delta. Am J Public Health 1999;89:1418-1421. 12. Centers for Disease Control. Consensus set of health status indicators for the general assessment of community health status: United States. Morb Mortal Wkly Rep 1991;40:449-450. 13. Manitoba Center for Health Policy. Recommended Health Indicators for Monitoring Regional Health Authority (RHA RHA Residence Hall Association RHA Regional Health Authority RHA Road Haulage Association RHA Rental Housing Association RHA Royal Horse Artillery (a British Regiment) RHA Royal Hibernian Academy ) Performance and Planning Service Delivery; 2001. Concept paper of the Manitoba Center for Health Policy, University of Manitoba Location The main Fort Garry campus is a complex on the Red River in south Winnipeg. It has an area of 2.74 square kilometres. More than 60 major buildings support the teaching and research programs of the university. , Winnipeg, Canada accessed via the Internet at http://www.umanitoba.ca/centres/mchp/concept/concept.frame.shtml accessed in December 2002. 14. Culter DM, Richardson E. Measuring the Health of US Populations. Brookings Papers on Economic Activity. Washington, DC, Brookings Institute, 1997. 15. Bhargava A, Jamison DT, Lau L, et al. Modeling the effects of health on economic growth. J Health Econ 2001;20:423-440. 16. ARFSYS. Area Resource File System. Fairfax, VA, Quality Resource Systems. Inc, 2001. 17. Centers for Disease Control WONDER. CDC Wonder, n.d. Online database accessed via the Internet at http://wonder.cdc See Control Data, century date change and Back Orifice. CDC - Control Data Corporation .gov/ accessed in October 2002. 18. Murray CJL CJL Center for Jewish Life CJL Center for Jewish Living at Cornell (Ithaca, New York) , Michaud CM, McKenna M, et al. US Patterns of Mortality by County and Race: 1965-1994. Cambridge, MA, Harvard Center for Population and Development Studies, 1998. 19. Durch JS, Bailey LA, Stoto MA. Improving Health in the Community A Role for Performance Monitoring. Washington, DC, National Academy Press, 1997. 20. Maxcy KM, Rosenau MJ, Last JM, et al. Public Health and Preventive Medicine preventive medicine, branch of medicine dealing with the prevention of disease and the maintenance of good health practices. Until recently preventive medicine was largely the domain of the U.S. . 14th edition. Stamford, CT, Appleton & Lange, 1998. 21. Smedley BD, Syme SL. Promoting Health: Intervention Strategies from Social and Behavioral Research. Washington, DC, The National Academy of Sciences, 2001. 22. Kretzmann JP, McKnight JL Building Communities from the Inside Out. Evanston, IL, Asset-Based Community Development Asset-based community development is an approach to community development which advocates the use of skills and strengths that are already present within the community, rather than obtaining help from outside institutions. Institute, 1993. RELATED ARTICLE: Key Points * Although most reports document that extreme health disparities exist within the Mississippi Delta, statistical tests identified Delta counties with extreme positive health status indicators. * Targeting local health programs at the county level is an appropriate intervention for Delta-based populations. * Identifying areas with significantly different health status in a region may offer understanding for improving the health of the region. Holly Felix, MPA MPA medroxyprogesterone acetate. , and M. Kathryn Stewart, MD, MPH From the Office of Community-Based Public Health, the Department of Health Policy and Management, College of Public Health, University of Arkansas for Medical Sciences The University of Arkansas for Medical Sciences (UAMS) is part of the University of Arkansas System, a state-run university in the U.S. state of Arkansas. The main campus is located in Little Rock. , Little Rock, AR. Reprint requests to Holly Felix, MPA, 4301 West Markham Street. Slot 820-1, Little Rock, AR 72205. E-mail: felixholly@uams.edu |
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