Health Issues in the Delta Region of Arkansas: An Analysis

Underserved Populations and Subgroups

Task:

As a mid-career health policy analyst for the United States Senate Committee on Health, Education, Labor and Pensions (HELP), you have been asked to prepare an analysis of the health issues in the Delta Region of Arkansas in preparation for a major hearing on rural health.  The Delta Region (DR) contains the entirety of 15 counties and portions of another 10, with a population of 1,114,480.

The Arkansas Delta economy is dominated by agriculture.  The main crop is cotton; other crops include rice and soybean.  Catfish farming is a recent source of revenue for Arkansas Delta farmers, along with poultry production.

The Delta has some of the lowest population densities in the American South, in places fewer than 1 person per square mile.  Slightly more than half the population is African American, reflecting a deep history in the area.  Eastern Arkansas has the most cities in the state with majority African-American populations. Urbanization and the shift to mechanization of farm technology during the past 60 years has sharply reduced jobs in the Delta.  People have followed jobs out of the region, leading to a declining tax base.  This hampers efforts to support education, infrastructure development, community health, and other vital aspects of growth.  The region's remaining people suffer from unemployment, extreme poverty, and illiteracy.

Arkansas is served by 73 community hospitals, but six of the Delta counties have no hospital.  In the DR, 100% of the population would be considered rural by Federal standards, and only 23 % live in towns of 20,000 or more.  73% of residents come from families with at least one full-time worker.  In the DR, the residents who do not live in towns tend to be more seasonally employed, in part-time work, or self-employed, with a low likelihood of employer provided insurance.  Historically, of the uninsured who are poor, half (50%) of those are from families with full-time workers.  One-fourth of the uninsured are between the ages of 45 and 64, and 26% report being in fair or poor health.

In addition, recent surveys of the behavioral health system, clinics, and tribal health center report significant rates of depression, post-traumatic stress disorder, schizophrenia and substance abuse / dependence among DR residents.  There is concern that these problems are related to high rates of suicide and domestic violence.

Finally, other reports from social service agencies report that there is a significant population in the DR that is effectively homeless, living seasonally (or sometimes year-round) in campers, tents, or out of automobiles, moving between campgrounds or camping areas in the state park grounds.  This population includes families with children in some cases.

The staff director of the HELP Committee has requested you prepare a briefing discussing the delivery of Health Care Services to the DR residents.  The paper should accomplish the following:

1.Discuss the problem of underserved populations and subgroups, including characteristics of those groups and barriers to delivery.

2.Examine the structure of the delivery system and how this helps or hinders health delivery.

3.Discuss the impact of ACA.

4.Make clear recommendations as appropriate for meeting the health delivery challenges of the DR.