How many miles of the pitch-black darkness must one walk to be deemed deserving?
In July, the story of Walter Carter, a student from Lawson State, an HBCU in Birmingham, Ala., went viral, garnering the attention of state and national news.
The story is compelling: a young college student’s car breaks down the night before he was to start a moving company job. After all his back-up options fall through, he decides to walk through the night to a job site nearly 20 miles away—a route that Google maps estimated would take roughly 7 hours. Walter began his walk shortly after midnight. Along the way, he is stopped by a police officer who, after “checking out” his story, gets him some breakfast, and drives him the last leg of his journey.
The customers of the moving company were so moved by the young man’s story and their interactions with him, they posted the soon-to-be viral social media post and started a GoFundMe page to show their appreciation.
Upon seeing the campaign, the moving company’s CEO drove to Birmingham in his own vehicle, which he presented to the young man as a gift in the presence of cameras and onlookers. “Everything he did that day is exactly who we are—heart and grit. So far, he’s batting 1,000,” said Bellhop CEO Luke Marklin.
The campaign has now raised over $45,000 and a local financial advisor has offered Walter pro bono assistance to save and manage his new windfall.
Media Script: Rinse, Repeat
Stories like Walter’s are often a welcome respite from a news cycle that seems increasingly polarized and negative. The pattern of media coverage and viral stories like Walter’s—framed around compelling personal narratives—follows a similar script.
- Person encounters seemingly insurmountable personal roadblock in life.
- Person overcomes roadblock with incredible personal drive, resilience, and/or faith.
- A person of privilege, and influential social media presence, shares the story that goes viral.
- News media pick up gripping personal narrative, with the protagonist receiving generous assistance from an online community (GoFundMe) or a wealthy donor.
Causal responsibility and remedy responsibility
For many, these kinds of stories are inspiring, providing hope in the resiliency of the human spirit and generosity of others. For others, the individual frame, however compelling, leaves an unsettling set of questions about how many others there are who face similar odds in the face of broken systems or disconnected infrastructure. There are yet another group of consumers of this type of individually driven narrative whose notions of “drive,” “personal ambition,” or “values” reinforce a separation between the “deserving poor” from the “undeserving poor.”
Experts at messaging and issue-framing rely upon research that shows the human mind is hard wired to attribute responsibility for the issues raised by Walter’s 20-mile trek. Our brains are subconsciously asking some variation on “Who is responsible?”
For some, the causal responsibility for the daunting 20-mile trek rests solely with the complex and individualized set of factors that are tied to specifically to Walter. For others, the question raises a broader set of considerations about the systems and structures that support, or hinder, mobility and access to employment and essential services. The logical companion question that frames the flip-side to how one reads this story is: “Who or what is responsible for remedying this problem?”
For those interested in dismantling traditional media narratives about the “deserving” poor, we must ask more of the coverage of stories like Walter’s.
We don’t know the full details of Walter’s current financial circumstances. And that’s not the point. If we can agree that getting bogged down in the individual components of one story distracts from a more productive conversation, the bigger question we should be asking is, “What kind of transportation infrastructure is needed to provide a ladder of opportunity for more of our neighbors?” This kind of question, whatever the specific issue, can help us create a region that ensures people who have become most disconnected from the region’s pockets of prosperity have the chance to belong, thrive, and contribute to their communities.
Over the last five years as a health insurance navigator as part of the rollout of the Affordable Care Act, I’ve met with dozens of aspiring students (and non-students) young and old, of all ethnicities and life experiences, whose stories will get never media coverage or a cash windfall.
There is the young man whose life has been derailed because of a seizure disorder, who is reliant upon expensive medication that prevents him from fully using his automotive repair talents. I’ve met countless aspiring nurses who struggle to figure out how to balance their coursework and practicum in the hospital, with obligations to financially support themselves and/or their families. When they are told by school administrators that they shouldn’t be working while enrolled in a rigorous academic program, they are presented with a decision that effectively locks out most students from securing financial assistance through the Health Insurance Marketplace, as well as Medicaid (in a state like North Carolina that has not expanded the program’s eligibility).
When we stop to imagine the magnitude of the lives that are derailed or held back because of the disjointed and broken systems that have created some version a 20-mile walk in the darkness, it presents an opportunity for us to see beyond binaries of “deserving” and “underserving” poor.
To get there, we need coverage of essential stories like Walter’s to provide us with context and history that inform how to mobilize public attention and problem solving to address a community’s critical challenges. But it’s easy to get wrapped up in the details of Walter’s story. It’s much harder to ask the tough questions about the systems that support or inhibit opportunity. Once we ask those questions, there are tough decisions and changes that a community must embrace to ensure that the conditions that underlie Walter’s story are not the defining reality for most families with limited resources.
If we are going to get serious about the challenges to creating a more equitable South—one where young adults growing up in low-wealth families can thrive—we must create a narrative and a way of storytelling that acknowledges not only individual compassion and generosity (as well as “heart and grit”), but also raises the truly important questions about the broader set of conditions for every person who doesn’t find the spotlight.
For more on how system-level investments strengthen the infrastructure of opportunity, check out our new brief: Moving on Up: Transportation and Economic Mobility.
If you travel to the rural Ozark Mountains, you may be surprised to find one of the most dynamic postsecondary institutions in the nation. Located in Harrison, Arkansas, North Arkansas Community College, not only offers education beyond high school for an area that has limited postsecondary options, it offers programs that provide career counseling, assistance with accessing government resources such as housing and day care subsidies, and financial literacy and management training to individuals and families across the rural region it serves. NorthArk is just one example of the ways in which community colleges can help build an infrastructure of opportunity in non-metropolitan communities across the South.
Indeed, for many communities in the rural South a two-year college is the only postsecondary institution in geographic proximity to local residents—and as such, it can, or at least should, play a driving force in improving the economic health of a region. Among other activities this can mean preparing a region’s current and future workforce for job opportunities in the area or helping students pursue higher education opportunities elsewhere.
Of course, the challenge, like all those facing rural communities, is daunting. How does a community college fulfill its traditional role of preparing students for work if there is a lack of good jobs in the area? A recent analysis by the Daily Yonder showed that job growth in the nation’s rural communities is anemic compared to its urban counties: “The number of jobs in the nation’s largest metro areas (those with a million or more people) increased by about 2 percent, or 1.3 million jobs from June 2016 to June of this year. In all rural counties, however, job growth was a bit more than a tenth of that rate, 0.29 percent, or about 60,000 jobs.” And educational attainment in these counties remains far lower than in urban areas. The US Department of Agriculture’s Economic Research Service reports that “the share of the rural working-age population (adults ages 25-64) with a college degree [including an associates degree] or higher was 14 percentage points lower than in urban areas.”
But if the South has traditionally held one educational advantage over the rest of the nation is the sheer number of community colleges in each state. In most Southern states, these two-year institutions’ reach is far and wide including in rural areas. Take a look at the counties with the highest poverty rates in each of the 13 states (in every one but Virginia, it is a rural county); in most cases, a community college provides services at a location within a 30 mile drive of the county seat. (Of course, rural transportation can in many cases make even that distance daunting).
Poorest Counties in the Rural South and Access to Community College
Source for poverty rate: US Department of Agriculture
Of course, not all community colleges are created equal and success requires leadership with the foresight and fortitude to respond to difficult challenges. But throughout our work, especially recently as we work with rural places across the South to build an infrastructure of opportunity, we remain convinced that these dynamic institutions at least hold the potential to address some of the biggest challenges facing rural communities.
We see a variety of roles that community colleges can, and in many cases do, play in assisting in improving the economic vitality and potentially increasing the economic mobility of rural communities.
Community colleges prepare individuals along the school-career continuum
The traditional role of preparing individuals, no matter what age (the average of a community college student is 29), for entering the workforce is of course at the core of any postsecondary institution’s mission. And increasingly, an associates degree is required to get a job that requires a family-supporting wage. For example, in a report on the Arkansas labor force commissioned by the Winthrop Rockefeller Foundation, we found that 84 percent of openings that pay a family wage will require at least an associates degree compared to only 21 percent that require an high school diploma or less. Effective community colleges prepare students for either the workforce or to transfer to four-year institutions. And increasingly community colleges, including those in rural areas are working with their K-12 systems, to make sure students are prepared for the challenges that students will face when they enter the world of postsecondary education.
Community colleges partner with industry to train new and incumbent workers
Of course, preparing students for a job if there is no job to be found in a community is inherently problematic. Effective community colleges operate in constant contact with local industry to ensure that they are meeting the stated demand for skilled workers. And it is important that industry’s role not just be traditional industry advisory boards that meet once a year to listen to a PowerPoint presentation about programs at colleges. Effective institutions remain in constant contact with industry to understand their current and projected needs, along with getting the data support they need from state systems to understand industry growth patterns to see where new opportunities may rise.
And community colleges not only work with individuals who are entering the workforce. Community colleges can work with existing industry to train or retrain their workers to make sure their skills stay up to date. Again, getting involvement from industry at more than a perfunctory level is vital to ensure that the services offered through the college are meeting the needs of the community at large.
While the two roles described above could describe the role of any community college regardless of location, you should remember that in rural areas, these colleges are the only post-secondary institutions that serve the area. The next roles are ones that if not unique to rural community colleges are critical to building an infrastructure of opportunity for these traditionally struggling areas of the South.
Community colleges can be neutral convenors
One of the keys, if not the key to building an infrastructure of opportunity in a community is building effective community partnerships. But to build an effective partnership, a region needs a leader that is generally trusted by the broad community (residents, government, non-profit and private sector) and can have the capacity to rise to the challenge. And in many rural places, community colleges are the only institution that fits the bill.
When MDC rolled out its recent report on economic mobility in North Carolina, we traveled to communities across the state to not only report our findings but to start the conversation on how to create an infrastructure of opportunity. In each rural area we traveled to, we engaged with the local community college to contact a wide variety of individual to attend and participate in a real way in a new effort aimed at community change. An outside entity like MDC or even a less trusted or known local institution would not have commanded the response or participation did our community college partners in places as varied as rural Central North Carolina or the foothills of Appalachia.
Community colleges can provide access to more than educational resources
One of the most important roles that community colleges play in rural areas especially is reaching beyond just the students they serve to provide resources to the surrounding population. And continuing education is just one role that these colleges can play that might be lacking otherwise Let’s just look at two examples: improving a community’s residents fiscal well-being and its health.
Community colleges provide financial management and financial literacy training and support to communities where these services may not be offered. Phillips Community College and several other rural colleges in Arkansas, for instance, provides a wide range of services to both students and the community at large. These services can be as simple as learning to budget already tight finances to steering students and community members to needed public benefits that they otherwise not have been aware.
These institutions can also have a real impact in a region’s quality of life including enhancing health outcomes. For instance, MDC’s Healthy Places NC program through a grant from the Kate B. Reynolds Charitable Trust, is working with seven community colleges across the state to develop new strategies to improve healthy outcomes across rural North Carolina. Community college projects include offering a telemedicine site in rural McDowell County in the western part of the state and building walking trails on a campus in Beaufort in far Eastern NC campus that can be used by all community residents. In addition, community colleges often host health care navigators who can sign up not just students for health insurance but community residents as a whole.
The above four roles are broad and a lot can fall under these categories. And as stated, not all community colleges are able to provide these services to their residents. Many community colleges that serve rural areas have difficulty attracting the leadership and faculty necessary to meet their full potential. But as with all the challenges facing rural communities, there is great potential to rise to the occasion.
Does your community college meet the needs of rural communities in your portion of the South? If not, what are the barriers you see? Are they local or state in nature? We’d love to hear your thoughts.
I finally got up the courage to do it. For six months, I had heard about the book rising to the top of the best sellers list and raising the hackles of my fellow rural policy advocates. So I borrowed a friend’s Audible account (shh no telling) and listened to Hillbilly Elegy. Enough has been written about this at times elegantly written but extremely problematic book to take up the entirety of this blog’s existence but what disappointed me most about JD Vance’s memoir was the sense of hopelessness it conveyed about non-metropolitan America. Mr. Vance’s own journey to success is indeed a powerful story of the importance of how personal mentorship and personal perseverance can lead to individual success. But for me it’s biggest failure as a work is its pessimism–the doubt it consistently casts on the ability of rural communities like his own to enact real change. Times may seem dark for our less populated communities, but that doesn’t mean that the solution is to give up—these places have assets, that if tapped into, can revitalize a portion of our country that for too long has been neglected.
At MDC we believe the key to change in any community or region is building an infrastructure of opportunity, and the rural South is no exception. As we say in our 2016 report on economic mobility in North Carolina this means “the myriad systems that must be improved and aligned to prepare ever larger numbers of [individuals] for family-supporting work and a better shot of economic well-being.” This may look different in rural areas than it does in large cities, but it is the key to sustained, shared, economic prosperity. Of course, in rural areas the definition of immediate success or improved economic well-being may be different than in urban areas with more apparent paths to prosperity. Rural areas may, for instance, need to connect young people to jobs outside the region with the long-term goal of creating an economic environment that encourages their return.
Our past work in rural areas is helping us understand what an infrastructure of opportunity might look like in rural communities and importantly what non-metro areas consider a pathway to success. Whether it is addressing rural leadership, improving health outcomes, or addressing job quality, organizations and philanthropy in rural regions are making real efforts to enact effective change in their communities. For instance:
- A health conversion foundation in Danville, Virginia working with a group of young adults to create as path forward for a small city that saw its manufacturing base disappear.
- Rural community colleges in North Carolina developing new programs and services to meet the health needs of not only their students and faculty but also the surrounding community.
- Communities across Arkansas embracing the challenge of “Expecting More” out of their communities and demanding that their economic fate not be tied to low-wage work.
- Wilkes County North Carolina building on its history of entrepreneurship by bringing together businesses, the local community college system and the schools to create to education to career pathways.
The strategies described above not only show a variety of approaches, they show the diversity of the rural South. The challenges of isolated communities in Eastern Kentucky are often extremely different from those better connected to urban centers such as counties just outside the Research Triangle of North Carolina. And of course, as always issues of race are important differences across our region—the demographic make-up of the Ozarks of Arkansas is far different than a few hundred miles away than the Mississippi Delta.
Let’s look at health in rural communities as one example. Each year County Health Rankings analyzes data from every county in the US. In each of the South’s 13 states the worst health outcomes (including how healthy people feel while alive and length of life) were in rural areas.
The table below shows each state’s county with the worst health outcomes for rural counties in the South alongside its racial make-up and its connectivity to urban areas. You can see that nearly all white Grundy County, Tennessee with no city faces equally poor health outcomes as Robeson County, North Carolina, which contains a small city and an extremely diverse population.
Counties in Southern States Ranked Last
by Health Outcomes and Health Factors
Note on rural classification: According to the US Department of Agriculture, “completely rural” means an urban population less than 2,500, “small town/city” means an urban population between 2,500 and 19,999. “Small city population” means a non-metro area with an urban population larger than 20,000. “Metro” refers to a county classified by USDA as a metropolitan county
Source for racial demographics: US Census, American Fact Finder. Racial percentage included if category is more than 5 percent of the population. In Duval County (TX) the white population includes those who do not identify themselves as Latino as well
Beyond health, an even broader indicator of well-being and prosperity (economic mobility) is often worse in rural areas. Take a look at Wilson, North Carolina a small city that lies just outside in the prosperous Research Triangle Region. Data from the Equality of Opportunity Project show that of children born in the lowest quintile of the income distribution in the Wilson commuting zone, 40 percent will stay there as adults, another 32 percent will only move up one quintile, and only 3 percent will make it to the highest quintile. The graph below shows this in reality in stark detail:
Wilson, NC Commuting Zone
Indeed, according to a recent analysis by the Brookings Institution, of the ten lowest mobility rural counties in the US, nine were in the South.
Despite these challenges, MDC believes that there are ways for rural communities to build an infrastructure of opportunity in regions and communities that are too often left behind In our next post, we’ll look at the critical elements of an infrastructure of opportunity and how they are could be addressed in rural communities. In every case, we want to emphasize the importance of developing and implementing strategies that are rooted in place—just as there is no one solution for the challenges facing big cities, there is no panacea for non-metropolitan areas. And, we will also be looking to you—what does success in rural areas look like? For instance, is it the goal for all rural areas to find high wage jobs with career pathways for their young people in the town in which they grow up if those types of jobs are few and far between? Or is it to prepare them to find these opportunities elsewhere with the hope that they will return? Not easy questions to answer. Some of those critical elements are:
- The role of community colleges in enhancing rural growth
- Engaging employers and the business community.
- How social disparities in health can impact economic mobility and how systemic change can address it.
- National, state and local philanthropy’s role in creating systemic change
- How communities are addressing creating a trained workforce that can find better jobs in communities that often have seen those very jobs disappear.
- Creating partnerships between businesses, schools and non-profits to ensure that the entire community benefits from any economic advancement.
Increased attention on rural America should not mean that we must choose working in this part of our country over addressing the real challenges facing metropolitan America. It does mean that some of the same systemic change applied in our larger cities may also be possible in our less populated areas. We’re looking forward to a deep discussion with you as we explore these issues.
View from Moratoc Park in Williamson, NC, overlooking the Roanoke River
For communities across the U.S., the wrap-up of summer means the start of school, crisper and cooler air, and college football season. For Southern and East Coast states, this time of year is also marked by the looming threats of hurricane season. Already this season, we’ve seen two significant hurricanes, Harvey and Irma, bring destruction to coastal islands and Southern communities. A natural disaster that damages homes, businesses, and local infrastructure can be an inconvenience at best and a devastating set-back at worst for communities that are working hard to improve outcomes for their residents. When we consider what it takes to create Southern places characterized by belonging, thriving, and contributing, we know it’s important for communities to be forward-thinking about equitable growth and bright spots of opportunity—and we’re reminded that environmental resiliency is crucial to these efforts. We’ll be exploring the need for this kind of resilience in Southern communities. We’ll talk about the risks posed by climate change, who is particularly vulnerable to these risks, and why this matters for communities that seek to propel their residents toward higher levels of upward economic mobility.
Today, we begin with an examination of 17 northeastern North Carolina counties that know all too well the frustrations and obstacles brought on by environmental vulnerability. These counties—Beaufort, Bertie, Camden, Carteret, Chowan, Craven, Currituck, Dare, Gates, Hertford, Hyde, Martin, Pamlico, Pasquotank, Perquimans, Tyrrell, and Washington—comprise North Carolina’s “Inner Banks,” part of the focus region of North Carolina Land of Water (NC LOW). NC LOW is a nonprofit organization supporting sustainable development of northeastern North Carolina’s natural resources and cultural history. While they focus on eastern parts of the state including the Outer Banks, NC LOW recently commissioned MDC to conduct a data scan of the state’s Inner Banks to examine educational attainment, poverty, upward economic mobility, availability of living-wage employment, and emerging industries. MDC visited some of these counties’ lovely natural spaces and spoke with local business owners who are dependent on the tourist economy driven by the region’s natural assets.
Pettigrew State Park Trail, by Somerset Place (formerly Plantation) in Creswell, NC
It’s not surprising that many entrepreneurs in the Northeastern part of the state have invested in the tourism industry, hunting and fishing services, and restaurants that welcome tourists. For rural communities close to the water and characterized by unique ecosystems, tourism can revitalize towns and turn communities into centers of celebration and festivities, as Chowan County has seen in the small town of Edenton. In fact, NC LOW would like to see local leaders in government and economic development place their bets even more on the ecotourism industry, rather than recruit industries that have the potential to harm the area’s natural resources.
According to Dr. Stanley Riggs, the Chair of the Board of Directors for NC LOW, in the past few years a new generation of young people returned to these counties with aspirations of starting guide services in the unique swamps and waters of the Roanoke River and Albemarle-Pamlico sounds. However, the localities hadn’t yet invested in the infrastructure needed to make this sector robust. Since then, some municipalities have built camping platforms, boat ramps, new parks, and other features that undergird the ecotourism industry.
For this economic development strategy to work, however, communities in Northeastern NC need to have environmental resiliency: decreased vulnerability to natural disasters and other forces that could harm the area’s natural resources. Last year’s hurricane season provides a case study of the damaging effects natural disasters can bring to local economies. In 2016 alone, Windsor, a small town in Bertie County, saw 10 to 20 feet of flooding in some areas three times over the course of the hurricane season, with Hurricane Matthew doling out particularly devastating effects on the heels of previous floods. Local business owners we surveyed referenced the area’s vulnerability to natural disasters as they discussed the challenges of having a brick-and-mortar business. One Windsor restaurant transitioned to a food truck after repeated flooding; the state’s FEMA policy covers homes, but not businesses. While this adaptation has been an exciting new experience and challenge for the business owners, closing their restaurant meant laying off many employees whom they valued and who, in turn, surely valued that source of income.
These effects are particularly troubling considering the high rates of poverty, low rates of educational attainment, and low chances for upward economic mobility in the Inner Banks counties. In Bertie County, for example, where the Windsor business is located:
- 22 percent of the population lives in poverty (nine percent of the white population and 30 percent of the black population) (U.S. Census Bureau American FactFinder)
- Only three percent of those born into the lowest income quintile in the area will make it to the top earnings bracket as adults, according to the Equality of Opportunity Project. Conversely, 72 percent of these individuals will stay in either the lowest or second-lowest earnings bracket as adults.
- Only 47 percent of the white population and 27 percent of the black population have at least some education beyond high school.
- In 2016, only 17 percent of jobs paying between $20-30/hour were occupied by workers with just a high school degree. Meanwhile, a single adult supporting one child must make an average of $20.98/hour to meet basic living expenses in Bertie County. (MDC analysis of EMSI data and the MIT Living Wage Calculator)
These factors alone create a discouraging situation for economic resilience—add recurring natural disasters to the mix, and it’s clear that communities like Bertie County, in which 62 percent of the population is black and 35 percent is white, are particularly at risk for the crippling effects of natural disasters, especially as those events are projected to occur with increasing frequency and strength.
Source: Equality of Opportunity Project
We sometimes think about climate change affecting endangered species or making snow a little less likely here in the South. While scientists warn of the likelihood of both scenarios, it’s worth considering the economic dangers of climate change. Current global practices, such as relying heavily on fossil fuels, contribute to increasing atmospheric temperature, which may explain in part why we’re seeing such intense storms that relentlessly hit communities in the South. As we know, many of these communities are vulnerable due to proximity to water, low-lying lands, higher rates of poverty, lower levels of educational attainment, and policies that don’t adequately support recovery.
So what can communities like Bertie County—and its neighboring Inner Banks counties—do to increase environmental resiliency in its area, particularly when ecotourism seems like a promising economic development strategy? “Resiliency” doesn’t mean that a community is utterly invincible; it’s about being prepared so that recovery from unexpected set-backs like natural disasters or economic recessions can be as smooth and strong as possible. Resiliency can be built at local or state levels, for example, by creating recovery policies that more accurately reflect the realities of flooding or by ensuring that local manufacturers and other industries don’t contribute to the degradation of natural resources. Forward-thinking leaders in education and employment also can help build community resiliency by providing education and employment opportunities that lead to credentials and living-wage employment, so that residents can acquire the savings and safety net needed to literally “weather” life’s storms.
In our next State of the South blog on climate change in the South, we’ll examine an effect of natural disasters that doesn’t discriminate between rural and metro areas: the threats to healthcare centers and the patients they serve. Stay tuned, and from all of us here at MDC and State of the South, we extend our sincere condolences and hopes for recovery to those affected by Hurricanes Harvey and Irma. To support local and national recovery efforts, you can donate to one or more of the many organizations assisting victims and their families in Houston and areas affected by Irma and Maria.
Today is the first post from our 2017-18 Autry Fellow, Rishi Jaswaney. We’re happy to have him at MDC and writing for the State of the South blog!
We’ve all felt it before. That sinking feeling before a big exam, an interview, or when your favorite character on Game of Thrones is “removed from casting” in the throes of battle.
Stress. Side-effects may include: nausea, indigestion, headaches and excessive perspiration.
In limited amounts, stress can motivate us to pursue our personal and professional goals. As stressors pass in and out of our lives, the stress hormone, cortisol, naturally fluctuates, but as challenges persist, cortisol levels remain elevated. When stress is a chronic condition, it can be linked to anxiety, depression, and other developmental and psychological issues. Research documenting income-based patterns in health outcomes—including disparities in who is more likely to experience chronic stress—raises new questions regarding the state of health equity in our nation.
As seen in the Centers for Disease Control and Prevention (CDC) chart below, serious psychological distress is associated with severe health problems, including chronic obstructive pulmonary disease (COPD), heart disease, and diabetes. Even more concerning is the disproportionate clustering of these conditions in high-poverty communities, as reported by the CDC: “A total of 8.7 percent of adults with income below the federal poverty level had serious psychological distress, compared with 1.2 percent of adults with incomes at or above 400 percent of the poverty level.”
The daily economic, educational, and social challenges facing those in poverty can create barriers to health services and lead to poorer health outcomes. This idea is captured in the Social Determinants of Health framework, which The World Health Organization (WHO) has defined as the “the conditions in which people are born, grow, live, work and age.” The general argument is that people in high poverty communities are more susceptible to certain illnesses, have less access to health care providers, and are frequently forced to delay care or medicine for financial reasons. The proximity of clinics, public transportation options, and the quality of food vendors, all affect one’s ability to address health concerns and seek care. As the social determinants of health concept has taken hold, organizations like Kaiser Family Foundation have adopted more nuanced definitions, incorporating more detailed categories, as shown below.
The WHO and others have emphasized how money, power, and the distribution of resources (through institutional decisions and policy implementation) shape community conditions and drive health outcomes. In places where education, employment, and accessibility are falling behind national averages, health outcomes are trailing along with them. For example, in North Carolina, counties with the lowest rates of postsecondary attainment and employment (Robeson and Warren counties) also rank poorly on measures of low birthweight, obesity, and diabetes prevalence. Counties with the highest rates of postsecondary attainment and employment (Wake and Orange counties) have the lowest rates of these indicators.
Source: National County Health Rankings
If education and employment are key drivers of upward economic mobility, then people must be healthy enough to take advantage of these opportunities. There are many narratives about educational attainment as a predictor of health outcomes. Formal education often provides foundational principles of nutrition, healthy behaviors, and general health literacy. Education is also an avenue for insurance benefits through school plans or future employment opportunities. Lastly, education provides individuals with an intangible set of resources such as social networks, norms, and relationships that can cultivate healthy practices.
It is important to recognize that poorer health outcomes in high poverty areas have been driven by policy that marginalizes low-income communities. The provisions of the Affordable Care Act made strides in addressing issues of healthcare access, but in order to holistically address health equity, we must also consider the underlying environmental, social, and economic factors that enable good health. Improving preventative initiatives, health education, and access to nutritious foods are a few measures that could begin to eliminate these disparities, improve public health, and encourage, rather than hinder, economic mobility. Throughout my Autry year with MDC, I hope to continue shedding light on the social determinants of health that persistently marginalize low-income communities. Stay tuned for more posts on how these issues play out in Southern communities!