Commentary: health and economic development in the Mississippi Delta region.
Article Type: Report
Subject: Economic conditions (Influence)
Economic conditions (Health aspects)
Public health (Demographic aspects)
Public health (Economic aspects)
Public health (Research)
Equality (Health aspects)
Author: Graham, Garth N.
Pub Date: 06/22/2008
Publication: Name: Journal of Health and Human Services Administration Publisher: Southern Public Administration Education Foundation, Inc. Audience: Academic Format: Magazine/Journal Subject: Government; Health Copyright: COPYRIGHT 2008 Southern Public Administration Education Foundation, Inc. ISSN: 1079-3739
Issue: Date: Summer, 2008 Source Volume: 31 Source Issue: 1
Topic: Event Code: 310 Science & research
Product: Product Code: 8000120 Public Health Care; 9005200 Health Programs-Total Govt; 9105200 Health Programs NAICS Code: 62 Health Care and Social Assistance; 923 Administration of Human Resource Programs; 92312 Administration of Public Health Programs SIC Code: 8000 HEALTH SERVICES
Geographic: Geographic Scope: Mississippi Geographic Code: 1U6MS Mississippi
Accession Number: 180948024
Full Text: In the last twenty years, there has been a growing recognition among policymakers that efforts to reduce economic and health disparities in the United States are and must be interconnected. These two dimensions of disparity are clearly linked to a variety of other factors, including economic development, education, medical care and public health service provision, and the evolution of the physical environment. It is therefore important that researchers carefully examine these interrelationships in their efforts to understand the causes of (and remedies for) individual, group, and geographic disparities.

Those who live in poverty usually have poor health outcomes. As we have seen in the U.S. and throughout the world, economic development can result in improved health status in populations. In turn, improved population health can also result in substantial economic development. A variety of studies have suggested that this "virtuous cycle" exists, with improved health status having positive impacts at the industrial, individual, and societal levels. Health can thus serve as an "economic engine," with increased growth providing additional resources for further improving health services, followed by improved health outcomes, and so forth (Bloom & Canning, 2000; World Health Organization, 2001). On the other hand, it must be noted that other research indicates that the relationship is quite complex--an increase in life expectancy, for example, does not necessarily lead to either an immediate or a long term increase in a nation's economic growth rate. Nor does it necessarily mean that poor population health is a root cause of poverty (Acemoglu & Johnson, 2006).

Whatever the uncertainties and ambiguities found in research, it cannot be denied that improving population health is, at least, one of the more promising strategies for enhancing economic growth and reducing disparities. While heterogeneous, the Mississippi Delta is clearly a region in the United States with enormous health and economic challenges and disparities. The Delta covers 8 states, 240 counties or parishes, and 9.4 million people (Mirvis, Beech, & Bowser, 2006). Its history features damaging and long-term social, educational, and economic problems that are strongly linked to great inequalities in health access and outcomes.

There are great disparities in available healthcare and public health resources throughout the Mississippi Delta Region. Part of this pattern of failure to ensure the health of the population is certainly due to gaps in access to care and an inadequate public health infrastructure--especially difficult to maintain in the small, isolated rural communities that make up so much of the Delta region. Delta residents pay the price, with tragically poor health outcomes--lower male and female life expectancy, and higher rates of cancer, heart disease, and infant mortality. These deficiencies might be best addressed through the development of regionalized public health service delivery systems with pooled resources. This could include shared services, mutual aid agreements, joint ventures/alliances, and perhaps formal consolidations or mergers (Mays, 2006).

Given the challenge of Delta health and economic development, and the responses to date, where do we go from here? Two imperatives stand out:

* We need to greatly improve research and evaluation capabilities in the Delta. Before we can seriously start testing and refining the "health as an economic engine" proposition, we need to improve our abilities to do multidisciplinary research at the systems level and on program services, as well as evaluation. More examinations are needed to investigate for associations between economic development strategies, community network structures, and health disparities. Such investigations are important to uncovering factors at the individual, community, and systems levels that contribute to health disparities.

Expanding these capabilities will require both better community level data collection and corresponding assessments along with monitoring resources "on the ground" in the Delta, and more advanced public health research methods and models. To prove that "economic health is an engine" through systematic experimentation, we need to measure what we are doing and be able to find out what works and what does not. We are not yet at this point.

* With improved research and evaluation tools, we need to experiment. While improving health status may be related to faster economic growth (and vice versa) and reducing disparities, the relationships between these factors are certainly not always self-evident (Honore, Simoes, Moonesinghe, Wang, & Brown, 2007). Given the size, diversity and complexity of the Delta region, the best approach might be to try out a variety of cooperative public and private sector approaches that attempt to reinforce the positive linkages between health and economic performance.

To address the challenges of inequalities and disparities throughout the United States, a multidimensional approach clearly must be taken. The exploration of the relationships between economic and

health development in the Delta region is a challenge well worth the effort. The resources put into measurement, research development, and program experimentation could well result in a large and socially beneficial return on investment. The American people of all regions and in all social groups would be much the better for it.

REFERENCES

Acemoglu, D., & Johnson, S. (2006). Disease and development: the effect of life expectancy on economic growth. Presented at the Brookings, Brown, Chicago, Harvard,-MIT Development Seminar.

Bloom, D. E. & Canning, D. (2000). The health and wealth of nations. Science, 287, 1207-1209.

Honore, P. A., Simoes, E. J., Moonesinghe, R., Wang, X., and Brown, L. (2007). Evaluating the ecological association of casino industry economic development on community health status: A natural experiment in the Mississippi Delta Region. Journal of Public Health Management and Practice, 13, 2, 214-222.

Mays, G. (2006). Disparities in public health resources in the Delta: Implications for regionalization. Presented at the Conference on Public Health Finance: Advancing a Field of Study Through Public Health Services Research, Washington, DC, February 8-9.

Mirvis, D. M., Beech, B, & Bowser, D. (2006). Is the lower Mississippi River Delta "a region?" Presented at the Conference on Public Health Finance: Advancing a Field of Study Through Public Health Services Research, Washington, DC, February 8-9.

World Health Organization, Commission on Macroeconomics and Health (2001). Investing in

Health for Economic Development. Geneva, Switzerland: World Health Organization.

GARTH N. GRAHAM

Office of Minority Health

U.S. Department of Health and Human Services
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