Today, we are pleased to repost a piece from Comeback Town, a blog that aims to “begin a conversation about a better Birmingham.” We’d like to thank Comeback Town’s editor, David Sher, for featuring our 2018 State of the South report on his blog–especially since the guest writer is a former MDC intern, Natalie Pickett. Natalie is an Alabama native who just completed her Master of Social Work degree from Appalachian State University. She is now a community social worker in Durham, North Carolina.
I am a proud native of the Birmingham area. I grew up in Hoover until I moved out of state for college.
I live in North Carolina now, but I visit Birmingham frequently to see my parents and siblings.
Downtown Birmingham was beginning to change
When I moved away in 2011, downtown was starting to change. Railroad Park and Good People had just opened. The Barons were moving downtown. The Lyric underwent exciting renovations and Iron City was on the way. My family and I went from going downtown only for dance recitals and the McWane Center to frequenting Pepper Place and WorkPlay.
When I introduced myself to new college peers, I proudly said I was from Birmingham—mostly because it’s more recognizable than Hoover, but also because I wanted to belong to a cool city like Birmingham.
My view after seven years
Seven years later, I now have a degree in social work and the beginnings of a career in nonprofit services with historically marginalized populations. I’ve lived in four metropolitan areas across the Southeast, including Birmingham.
Professionally and personally, I am interested in how urban areas, particularly in the South, are currently experiencing periods of rapid growth and development. I am further intrigued by the issue of equity—who is benefiting from revitalization? Who might be harmed by it? And most importantly, what will it take for all residents to have the opportunity to benefit from and contribute to their city’s revitalization?
Birmingham, Baton Rouge, Nashville, Durham—the wonderful Southern cities I’ve called home—they are all asking these questions. I don’t know of any city that is not. We are all grappling with how to revitalize and prosper without unintentionally pushing out our long-term and historically marginalized residents (i.e. our neighbors who are people of color, low income, elderly, disabled, etc.).
Birmingham has a chance to get it right
Birmingham is still young in the life cycle of urban revitalization in the 21st century. It could be the Southern city that gets it right—that invests in developing its native talent as much as attracting new talent from out of state or over the mountain.
But these solutions do not happen by accident or by good intentions alone. It takes innovation, commitment, and courage—three things I know Birmingham has.
The state of the South
I live in Durham, North Carolina, and just finished an internship with an organization called MDC, which recently released its State of the South 2018 report.
MDC’s President, David Dodson, presented it to the Birmingham Rotary Club recently, where its findings were well received—and also eye-opening. The report found that in every state in the South there are more people coming from out of state who have college degrees than the number of people who were born there.
In Alabama, based on 2016 American Community Survey estimates, just over 20 percent of folks born in Alabama have a Bachelor’s Degree, compared to nearly 35 percent of people who moved to Alabama from somewhere else.
If we are going to create a prosperous and equitable Alabama, we must commit to strengthening public schools, community colleges, and universities within our state, rather than fostering a heavy reliance on imported talent.
The report looks back at what things were like in the 1960’s and finds that the South is doing better, but has a long way to go to put everyone on an equal footing.
In 1970 in Alabama, fewer than 5 percent of African Americans had a bachelor’s degree, compared to around 10 percent of Whites. By 2016, the number of African Americans with a BA had risen to nearly 20 percent, while the number of Whites was nearly 30 percent (the U.S. average in 2016 was over 20 percent for African Americans and nearly 40 percent for Whites).
For African Americans, the result was an increase in household income of over 50 percent in that period, but the increase still needed for African Americans to have Black-White parity is over 150%.
Improve educational attainment
In other words, we’ve made great progress, but we still need to address persistent disparities and improve educational attainment for everyone if all Alabamians are to be competitive in a national and global marketplace and earn family-sustaining incomes.
We are not alone in these challenges. “Few Southern cities are achieving growth, prosperity, and inclusive economic outcomes that improve conditions across the socioeconomic spectrum,” the report finds. “[R]egional growth and prosperity, matched with limited inclusion of historically disadvantaged populations, will likely exacerbate social fissures produced by shifting demographics and increased income inequality.”
The State of the South report uses three lenses to address these issues facing the South: belonging, thriving, and contributing.
Belonging means full participation in civic and economic institutions by all Alabamians, especially as rising generations are becoming more racially and ethnically diverse.
Thriving means removing the structural barriers and building the support systems that will generate wealth for everyone and spread its benefits.
And contributing means the engagement of once-marginalized voices who can define their own priorities.
Alabamians must find courage
That means Alabamians must find the courage to recommit to action that will engage progress, not backsliding. As the report says, we must build an “infrastructure of opportunity”—clear pathways to connect young people with educational credentials and jobs that pay a family-sustaining wage.
We must create relationships between our cities, suburbs, and countryside that can connect them and provide opportunities for everyone, regardless of where they live.
We need to make it so our education systems and employers work together so both can be competitive in the marketplace. And we need to recognize and address the shifting demographics of increasing racial and ethnic diversity.
Everyone must enjoy the fruits of new revitalization
Like I said, I’m from Hoover. My family could afford to live in the suburbs, in the “Birmingham Metro Area.” I’ve never lived in the City of Birmingham. My privilege allows me to claim the Magic City as my hometown, and its revitalization has only made me more excited to do so. My upbringing was largely unaffected by anything that happened in downtown Birmingham. We visited when it was convenient and fun.
Since then, downtown has become more convenient and fun for more people, which is a good thing.
But for the downtown natives (and Avondale natives, Crestline natives, Southside natives, and so on), the city of Birmingham is home, through thick and thin. If these folks don’t enjoy the fruits of the new revitalization, if they can’t access opportunities to contribute to Birmingham’s thriving, Birmingham will lose its way just as so many other metro areas—in the South and across the country—have begun to do.
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.
Happy holidays from MDC and the State of the South blog! This is a time of year where many of us pause to be reflective. For some, it’s a season of advent: of waiting in stillness for something we hope for. For some, this is a season of celebrations of culture and self-determination. Many of us may be reflecting on our 2017 new year’s resolutions, asking ourselves what we accomplished this year and setting goals to move forward. MDC is also especially reflective these days, as we celebrate our 50th anniversary. As part of our upcoming events to mark this milestone, we’re releasing a new edition of our State of the South report in early 2018. This report will look back at the state of the South over the last 50 years, examine the present–both our assets and challenges—and consider how we must work toward a future of shared well-being.
In that way, you could say MDC is encouraging the South to have a moment akin to what Ebenezer Scrooge experienced in Charles Dickens’ A Christmas Carol. In Dickens’ classic Christmas tale, Scrooge must confront his past, acknowledge his present, and change his future, or else suffer a fate he does not want. Our 2018 report will encourage leaders in the South to ask themselves similar questions about the direction of the region: to take stock of the past, address the realities of our present, and actively participate to shape a future that benefits all. I wonder what a Southern Christmas Carol would look like?
Though there are a number of areas the South could and should confront, acknowledge, and change, this post provides a brief exploration of the South’s relationship with education. (Our upcoming 2018 report will explore education and a variety of other phenomena more deeply, so please stay tuned.)
In Charles Dickens’ original story, the “Ghost of Christmas Past” shows Ebenezer Scrooge flashbacks of his own past. In the process, Scrooge sees examples of generosity shown to him. But he also sees himself sink into loneliness, because he values his own money and profit above all else. Surely the South can relate to both being the beneficiary of generosity—and to clinging tightly to our own wallets. That’s not to say that the South isn’t itself a generous region. As we’ve just described in our report produced in partnership with the Southeastern Council of Foundations, the region is home to a multitude of philanthropists who care for their home communities. In addition, the concept of “Southern hospitality” conjures images of families opening their homes, widening their dinner tables, and supporting their neighbors through difficult times. However, when we look at systemic investments in practices and institutions that change the odds for people living with poverty and economic insecurity, rather than helping them overcome the odds, we start to get a different picture.
If the “Ghost of the Southern Past” visited us today and gave us a glimpse of the South’s history with education, we might be reminded of an uncomfortable number of efforts to hold power and resources and to keep many people—especially people of color—from accessing the knowledge and tools that could help them advance economically. Maybe we’d see images of families held captive in slavery sneaking their children to dilapidated school houses to learn their ABCs. In the years following the abolition of slavery and Reconstruction, we’d see a mere evolution of similar thwarting efforts. Though Brown vs. Board of Education declared “separate but equal” to be unconstitutional in 1954 and called for the desegregation of schools, states across the South were slow to provide equal quality education, and many white Southern residents met the ruling with resistance and violence. If the “Ghost of the Southern Past” were to take us back 50 years to 1967, we’d still see a raw response to desegregation among Southern communities. We’d see the Supreme Court further handing down rulings to ensure the South gave children of color equal educational opportunities, such as the 1969 ruling asserting that “all deliberate speed” was no longer good enough for Mississippi. Shortly after, we’d be reminded of the 1971 ruling in Swann vs. Charlotte-Mecklenberg Board of Education allowing the use of busing and other strategies to ensure desegregation. And then we’d see the wave of backlash: droves of white families pulling their children out of public schools to maintain racial separation. In The Warmth of Other Suns, her prize-winning book on black out-migration, Isabel Wilkerson caught the situation at that time:
All the marching and court rulings did little to change some southerners’ hearts. A 1968 survey found that eighty-three percent of whites said they preferred a system with no integration. And they acted on those preferences. By 1970, 158 new white private schools had opened up in Mississippi. By 1971, a quarter of the white students were in private schools, the white families paying tuition many could scarcely afford.
Considering this legacy of institutional efforts to keep nonwhite children across the South from quality education, we shouldn’t be surprised today to reflect on Southern data from 50 years ago and see the glaring disparity in who was equipped with a postsecondary credential and who was not:
What if the “Ghost of the Southern Present” came to visit? We might breathe a sigh of relief, ready for some good news and knowing that things can’t be as bad today as they were 50 years ago. In Dickens’ tale, Ebenezer Scrooge sees the present from a new vantage point, and this forces him to acknowledge issues that were around him all along, but that he did not want to see because it was inconvenient to his own greed. When Scrooge sees clearly the reality of his employee’s life, struggling to support an ill son (Tiny Tim), he sees the present with new eyes. Here at MDC, we hope our 2018 report will also encourage leaders across the South to see our present with new eyes. Because while the South has made progress increasing equitable conditions in education, there is still much to confront—or as we say, the state of education in the South is better than it was, but not good enough.
“The Ghost of the Southern Present” may commend the South for strides on academic completion. If we look at Virginia, for example, we see that whereas in 1970, only around 14 percent of whites and five percent of blacks in the South had a bachelor’s degree, in 2015 those numbers went up to 40 and 22 percent, respectively. However, we see that disparities remain. Our warning visitor might give us glimpses of the lived realities of students today: students who know that a postsecondary credential is key to economic success, but who face seemingly insurmountable odds of tuition fees, limited access to financial aid, and logistical barriers like inadequate transportation. We might also confront resegregation efforts across the South that exclude poor and minority students in the name of local control and school choice, with the ultimate effect of unequal school quality, given school funding formulas that rely on property taxes. At the same time, we’d see that local school quality is key to upward economic mobility and that a postsecondary credential makes a difference to students’ eventual earnings:
But the “Ghost of the Southern Present” might show us something else, too—something MDC has seen in our work with community colleges, leaders in higher education, and other concerned residents across the South: a determination to address systemic problems, value student voices, and expand access to education. For example, in a forthcoming report for the ECMC Foundation, we saw the thoughtful way Southern community colleges are making transfer easier for students who aspire to attain a four-year degree. Through our work with Healthy Places North Carolina, an initiative by the Kate B. Reynolds Charitable Trust, we see how community college leaders are ensuring their students have access to the resources they need to maintain a healthy diet and lifestyle. And we’re now seeing North Carolina establish a statewide educational attainment goal through My Future NC, a commission designed to advance this goal with attention to equity.
The state of education in the South in 2017 is a blurred image of progress and disparities. Depending on the sustainability of our current efforts, our future could look very different. In A Christmas Carol, Ebenezer Scrooge realizes his present matters for his future. When he sees that his current track leads to neglect and unhappiness, he makes a choice to do better. I imagine the “Ghost of the Southern Future” would encourage us to see that the region’s history of exclusion and lack of upward mobility also leads to a place of repression and economic instability. Our future, too, is not yet determined: if we continue on a path of divestment and exclusion, we could see an even more widely stratified society. As we become increasingly racially and ethnically diverse, we could see huge segments of the population barred from the tools and knowledge they need to be economically secure. That would put a drain on communities, the region, and the nation as a whole. But, if we intentionally confront barriers to education, all the way from pre-K through a postsecondary credential, by investing more in teachers, infrastructure, and supplies; by amending current funding formulas that rely on property taxes; and by addressing the financial and logistical barriers that keep students from attaining a credential, we could start to see more people equipped with what they need to be upwardly mobile. The South as a whole would prosper as a result, because, as we say at MDC, “society benefits with everyone succeeds.”
Like Ebenezer Scrooge, the region has a choice to make going into 2018. Leaders in the South can soberly confront the region’s past, clearly examine its present, and choose to proactively shape our future, so that the South is a place of shared well-being. We hope you will be on the look-out for our report in 2018 and consider together with us the kind of place we want the South to become—and what we need to do now to make that happen.
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.
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!