Underemployment, Poverty and Access to Health Care
in the Mississippi Delta:
A Community-Based Approach to Understanding Problems
and Exploring Alternatives
John J. Green, Ph.D.
Institute for Community-Based Research,
Division of Social Sciences & Center for Community Development
Delta State University
In the Shadows of Poverty:
Strengthening the Rural Poverty Research Capacity of the South
July 21-23, 2004
Memphis, Tennessee
Mississippi Delta
Mississippi Delta
An Alternative Research Framework?
A more responsive, participatory and action-oriented approach to
research should:
Acknowledge the existence of power and attempt to develop
power-sharing relationships.
Involve meaningful participation at all levels of inquiry.
Employ multiple research designs and methods, including
traditional and alternative models of inquiry.
Assess the quality of the endeavor through use of several
criteria, especially the soundness of methods and the extent of
meaningful participation.
Include an action agenda that is empowering to the
community-based partners.
Community-Based Research Framework
Look
gather data, define,
describe & build picture
Act
report, plan,
implement & evaluate
(Stringer, 1999)
Think
explore, analyze,
interpret & explain
Project Partners
Underemployment and Poverty
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Tri-County Workforce Alliance
Aaron E. Henry Community Health Center
Coahoma Opportunities, Inc.
Quitman County Development Organization
CURET (Comprehensive Urban/Rural Ensemble/Tourism)
Access to Health Care
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Mississippi Delta State Rural Development Network
Aaron E. Henry Community Health Center
Delta Diamond Health Network
TCQ Health Network
Greater Delta Health and Human Services Network
Research Methods: Underemployment and Poverty
Analysis of Census Data.
Qualitative Telephone Surveys – Employers in Coahoma
and Quitman Counties (Total N = 38).
Focus Groups – Four focus groups with “underemployed”
adults in Bolivar, Coahoma, Quitman and Tallahatchie
Counties (Total N = 29).
Follow-up Community Meetings - Six follow-up meetings
were held for participant validation and program planning.
Research Methods (Continued): Access to Health Care
Key-Informant Interviews – Thirty-eight key-informant, semistructured interviews were conducted with residents of
communities (Cleveland, Clarksdale, Greenville, Marks, Shaw,
Tunica) in seven Delta counties.
Focus Groups – Twelve focus groups were conducted with a total
of ninety participants.
Delta Rural Poll – A series of health-related questions were
included in the 2003 Delta Rural Poll, a telephone survey of
residents in the eleven core Delta counties conducted through a
partnership between the Center for Community and Economic
Development (Delta State University) and the Survey Research
Unit, Social Science Research Center (Mississippi State
University).
Community-Based Research in Action!
Unemployment Rate in 2000
16%
14.1%
14%
13.3%
12%
11.3%
10.1%
10%
8.4%
7.4%
8%
6%
4.6%
4.1%
4%
3.0%
2%
0%
White
Black
Total*
Coahoma County
White
Black
Quitman County
Total*
White
Black
Mississippi
Source: 2000 Census of Population and Housing – Summary File 3, Chart by John J. Green.
* “Total” equals more than sum of White and Black.
Total*
Average Household Income in 1999
$55,000
$51,007
$48,457
$50,000
$45,000
$42,315
$38,372
$40,000
$36,008
$35,000
$30,357
$30,000
$29,748
$27,469
$25,439
$25,000
$20,000
$15,000
$10,000
$5,000
$0
White
Black
Coahoma County
Total*
White
Black
Quitman County
Total*
White
Black
Mississippi
Source: 2000 Census of Population and Housing – Summary File 3, Chart by John J. Green.
* “Total” equals more than sum of White and Black.
Total*
Percent of Population Below Poverty Line (1999)
100.0%
90.0%
80.0%
Percent of Population
70.0%
60.0%
50.0%
46.1%
40.3%
40.0%
35.9%
34.9%
33.1%
30.0%
19.9%
17.1%
20.0%
11.7%
11.1%
10.0%
0.0%
White
Black
Coahoma County
Total*
White
Black
Quitman County
Total*
White
Black
Mississippi
Source: 2000 Census of Population and Housing – Summary File 3, Chart by John J. Green.
* “Total” equals more than sum of White and Black.
Total*
Research Results: Underemployment and Poverty
Underemployment and Poverty from the Perspective of Employers and the Underemployed
in the Mississippi Delta:
Summary Results from Interviews and Focus Groups (2002)
Employers
Underemployed
Assets
Tourism
Farm-related industry
Future industrial development opportunities
Increased educational stability
Existing workforce training programs
Strong willingness/desire to work
Heightened educational levels
Extensive skills and experience
Existing workforce training programs
Social service organizations
Barriers and Challenges
Few jobs
Inability to attract new businesses
Unemployable workforce
Low educational levels
Crime and drug problems in the community
Overall social and economic structure
Few jobs
Limited educational credentials
Lack of dependable transportation to outside jobs
Action Ideas
Develop more industry and jobs
Basic skills education (reading, writing, math)
Vocational training
High-tech. skills training
Hands-on experience
Work ethics
Move beyond traditional/ established approaches
Advocate, search for and help develop “good jobs”
Increase educational and training opportunities
Mentorship/apprenticeship program
Small business incubator
Research Results: Access to Health Care
Community Social and Health Issues from the Perspective of Delta Residents:
Summary Results from Focus Groups and Key-Informant Interviews (2003)
Important Social and Health Issues
Limited formal education
Lack of good jobs, few benefits, poverty
Racial barriers and disparities
Poor housing conditions
Limited access to transportation (especially to access
out-of-town services)
Lack of insurance (many people slip through the
“cracks” in the system)
Drug and alcohol abuse
Poor diet and nutrition
Obesity
Diabetes
Hypertension
Teenage pregnancy
Health problems accepted as norm
Limited understanding of health issues
Ideas for Action
Community level
Awareness advocacy
Prevention/wellness education
Information on available health care and social service
resources
Increase prevalence and awareness of social and health
related community
Community involvement (parents, family, churches,
police, leaders)
Policy level
Increased insurance coverage, especially for those who
slip through the cracks
Improved staffing in health care facilities (increase
numbers, professionalism, compensation)
Miles Travel One-Way for Routine Health Care
(2003 Delta Rural Poll)
31 Miles or More
10.2
16 - 30 Miles
14.2
5 - 15 Miles
30.2
Less than 5 Miles
45.4
Miles Traveled One-Way for Specialized Care
(2003 Delta Rural Poll)
Less than 5 Miles
23.8
31 Miles or More
44.4
16 - 30 Miles
12.3
5 - 15 Miles
19.5
Method Used to Pay for Visit to Doctor
(2003 Delta Rural Poll)
Private
Insurance/
Insurance
through Job
Benefits
46.5%
Other
1.5%
Out-ofPocket/
No Insurance
22.8%
Government
Program
29.2%
Method of Payment for Visit to Doctor by Income Group
(2003 Delta Rural Poll)
100%
Percent
80%
31.1%
71.2%
60%
40%
20%
80.0%
41.7%
27.2%
13.7%
15.1%
0%
Less than $30,000
Out-of-Pocket/No Insurance
Between $30,000 and $60,000
Government Program
9.0%
11.0%
M ore than $60,000
Private Insurance/
Insurance through Job Benefits
Program Planning Model
Assets:
human, community
organizational & physical
Action Program:
increase assets &
break down barriers
Goal: Improve
Quality of Life
Barriers:
block effectiveness of assets
Program Plan: Workforce Development
Action Objectives
Conduct a social marketing campaign to build awareness of
current and potential employment options and the
prerequisite skills needed to secure these positions.
Coordinate and facilitate efforts to increase participation in
existing workforce development education and training
programs.
Construct and implement a pilot education and training
curriculum for professionalism that is considered
legitimate and valuable by the underemployed, educators
and employers.
Program Plan: Access to Health Care
Action Objectives
Coordinate services and case management between health
providers throughout the region.
Develop partnerships between public schools and community
health centers to utilize communication technology to
expand access to health care.
Survey and catalogue nonprofit health and human service
providers to provide individuals, families and
organizations more information on existing resources.