October 5, 2020

A Public Health Crisis in Rural Communities

Historically, as we know, the deep south was a place where Jim Crow barred African Americans from accessing basic human rights. As a result, African Americans worked low paying jobs and did not have access to medical care or clinics like their white counterparts. On top of that, disparities in housing and economic mobility have destabilized this group, which keeps African Americans and other communities of color disadvantaged. Today, these factors contribute to African Americans experiencing worse health outcomes than any other racial group in America and having less access to America’s healthcare system for treatment and prevention. Nationwide, African Americans are dying of Covid-related illness at 2.3 times the rate of their white counterparts. Racial disparities persist or worsen when comparing rural versus urban populations – exacerbated by factors such as fewer physicians and recent rural hospital closures.

Impact of Housing Segregation and Health Inequity

Intentional and systematic racial housing segregation has had long-term effects on rural African American communities, which are concentrated in the Southern region of the United States. In these communities, social and economic conditions for African Americans continue to lag far behind those of their white counterparts and urban populations overall.

Rural minorities are more likely to live in substandard and cost-burdened housing and are more likely to be poor, two social determinants that can greatly affect overall health outcomes. It has been shown that limited access to stable, quality, affordable housing contributes to a higher prevalence of Infectious diseases, chronic illnesses, poor nutrition, and mental disorders.

As healthcare is so often tied to housing quality and full-time stable employment in the United States, work on housing affordability, economic mobility and access to quality schools can play an important role in overall healthcare outcomes. For example, owning a home is known to decrease inadequate health conditions. Yet, to this day, resources available for health care in rural low-income communities of color are limited.

Refocusing the Work

To address these health disparities between races and in rural areas, our healthcare system needs to be more equitable and inclusive in their approach to health and wellness. The healthcare sector can draw inspiration from a group of black women who came together as part of the oldest black Greek sorority, Alpha Kappa Alpha Sorority, Inc, during the Great Depression at a time when the Mississippi Health Department did not treat African Americans due to segregation. This group of women saw the need to bring the attention of these health disparities to families living in a rural area of the Mississippi Delta. In December of 1935, the Mississippi Health Project was initiated.

In its first year the project operated a local clinic in Holmes county, Mississippi. For several weeks during the summer months of July and August, families were vaccinated and given additional health screenings impacting rates of infectious disease and providing preventive care. The project incorporated evening hours at the clinic that were used for health conferences, lectures on diet and hygiene, and focus groups about the general care of parents and families in the county. This program ended during the summer of 1942.

Programs like these illustrate key concepts for health promotion, including:

1) Leadership from community members and resource management by those community members
2) A focus not only on immediate health needs, but on prevention, learning, and wellness
3) Adaptability to meet the community members needs in terms of location and hours
4) An opportunity to build trust, community and relationship

Models like the Mississippi Health Project can help provide inspiration to new approaches between healthcare and housing sector partners to both meet the social needs of low-income communities of color and targeting the social determinants of health. Enterprise and other organizations are learning to refocus their work to change the outcome. Through our Health & Housing program, Enterprise  has employed multiple strategies to improve housing by implementing programs like Health Begins With Home and Enterprise Green Communities to improve indoor environmental quality, and advocating for healthy, affordable housing. This year, the Rural and Native team has supported 9 grantees with Section 4 funding to support work that aligns with our Health and Housing initiative.

If we don’t continue to learn how to implement models for meeting populations health needs and in partnership with community, existing healthcare systems will continue to struggle with growing healthcare costs and persistent community health needs that are linked so strongly to the wider needs of a community, including housing.

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