PROJECTS BY STATE

ALABAMA

D60RH03649
Kimbrough Ballard
Alabama Tombigbee Regional Commission
107 Broad Street
Camden, Alabama 36726
Phone: (334) 682-4234 Fax: (334) 682-4205

Fiscal Year 2004 2005 2006
Funding Amount $467,267 $467,267 *$467,267

The Alabama Black Belt-a geologically, historically, and economically loosely defined strip of counties running from east to west across the southern half of Alabama-is part of the crescent- shaped Southern Black Belt that extends from Virginia in the north to eastern Texas in the southwest. This area covers parts of 12 states and includes a high proportion of the U.S. rural population. The Alabama Tombigbee Regional Commission serves a 19-county area known as the Alabama Delta Region (ADR), which is located in Alabama's Black Belt, and is the poorest, most rural, most economically depressed, and most medically underserved region of the State. Four counties within the ADR have no hospitals, 6 have hospitals with fewer than 10 acute care beds, and 13 counties in the ADR do not offer obstetric services. Twelve counties have more than 2,500 residents per primary care physician and, in most counties, there are no or very few ambulatory care specialists. Approximately 23 percent of residents of the region are either uninsured or underinsured. Life expectancy is lower than the State average, and low birth weight rates are higher. Almost 60 percent of the residents of the region are African American who carry both a genetic and behaviorally increased risk of developing certain clinical conditions, for example, hypertension, heart disease and stroke, diabetes, renal failure, glaucoma, and sickle cell anemia. African Americans in Alabama, which is 46th in the Nation in infant mortality and low birth weight, are twice as likely to suffer these pregnancy outcomes as Caucasians in Alabama.

The majority of the hospitals in the region are small and not well equipped to keep up with the latest technological advances, leading most patients to perceive them as low-tech, financially weak facilities. Middle and upper income residents with health insurance and personal transportation tend to by-pass local hospitals in favor of urban facilities, even though the journey may be considerably less convenient. This trend of by-passing regional care to seek care in urban facilities leaves the local hospital to care for an increasing proportion of uninsured or underinsured patients or Medicaid patients, for whom reimbursement may not cover costs, which further threatens financial viability of the local health facility. The lack of up-to-date facilities and equipment within the region combined with the perception of a lower quality of living (e.g., inferior schools and the absence of modern retail malls, restaurants, entertainment, and other social amenities found in major urban areas), makes recruitment and retention of health professionals difficult at best.

Partners in the program include the lead applicant, the Alabama Tombigbee Regional Commission, West Alabama Planning and Development Council, and the South Central Alabama Development Commission. Grassroots input will be sought at a county level. Local community leaders and healthcare professionals will review and refine community input, resulting in buy-in at all levels.

To ensure that the medical, mental, and dental care needs of all underserved residents of the ADR, particularly the uninsured and underinsured, are addressed, the program aims to build a regional health information network using Internet-based technology that will provide effective communications throughout the region; maintain a central organization that will collaborate with all counties in the region to share ideas and resources and assist counties in subcontracting identified needs; involve citizens and identify providers in planning and implementing prevention, detection, and intervention strategies that target high-priority medical, dental, and mental risk areas; design and coordinate promotional programs and community meetings to inform residents about service availability; and perform program evaluation and feedback.

ARKANSAS

D60RH03648
Anna M. Huff
Mid Delta Community Consortium, Inc.
P.O. Box 2524
West Helena, Arkansas 72390
Phone: (870) 572-5518 Fax: (870) 572-5567

Fiscal Year 2004 2005 2006
Funding Amount $934,534 $934,534 *$934,534

The Arkansas Delta Rural Development Network (ADRDN) is a statewide network based in the Arkansas Delta which seeks to improve the health and healthcare of Delta residents by facilitating continued development of local rural health networks serving 38 counties in the Arkansas Delta. The ADRDN is made up of four partners, the Mid Delta Community Consortium (MDCC), the Arkansas Department of Health (ADH), the University of Arkansas for Medical Sciences (UAMS), and the Community Health Centers of Arkansas, Inc. (CHCA). The ADRDN will build on existing collaborative relationships with local partners working in programs in the targeted counties to provide technical assistance and foster local network development. Existing partners and programs include the Arkansas Department of Health's Office of Rural Health and Primary Care, the Critical Access Hospital Program, the Arkansas Southern Rural Access Network Program, the Arkansas Department of Health's Hometown Health Improvement Initiative, Local Community Health Centers, ACE Community Program, Champion Communities, Vision 2010 Communities, and others located throughout the rural Arkansas Delta.

Local health statistics indicate that the African American population in the target counties is severely impacted by chronic diseases that are preventable through health education and access to healthcare services on a routine basis. Access barriers to services include the lack of sufficient primary care physicians in the target counties, the reluctance of healthcare providers to treat Medicare and Medicaid insured patients because of reimbursement rates (only one-third of the primary care providers in the service area will accept assignments for Medicaid), the lack of reliable transportation, the lack of telephone service (between 12 percent to 20 percent of the population is without telephone service), and the high level of mistrust and apprehension among older members of the target population toward health providers.

The target area encompasses 26,235 square miles, which is half of Arkansas' land mass and contains a total population of 853,959 representing 32 percent of the total population of Arkansas. More than half of the Delta Region's population is rural, with 55 percent of the population residing in communities of fewer than 2,500 persons. According to the Lower Mississippi Delta Development Commission, Arkansas is one of the three poorest and most economically depressed States in the country. Per capita income in Arkansas in 1999 was $22,233, compared to $28,546 for the United States. The average per capita income in the 38 Delta counties, at $18,535, is 20 percent lower than the State's average. As noticed in many rural communities throughout the country, income and health status, along with educational opportunity and achievement, go hand-in-hand in the Delta Region. It is estimated that Arkansas has a 33-percent illiteracy rate, with 42 percent of those age 25 and older in the Delta failing to complete high school. An unusually high teen fertility rate, infant mortality rate, age-adjusted death rate, cancer death rate, cardiovascular disease death rate, low birth weight babies, and women not receiving first trimester prenatal care are representative of the generally poor health status indicators of this region.

ILLINOIS

D60RH03644
Tess D. Ford
Board of Trustees, Southern Illinois University
Center for Rural Health & Social Service Development
c/o Research Development and Administration
900 South Normal - Mailcode 6892
Carbondale, Illinois 62901
Phone: (618) 453-1262 Fax: (618) 453-5040

Fiscal Year 2004 2005 2006
Funding Amount $393,488 $393,488 *$393,488

The Illinois Delta Region is considered part of the Mississippi River Delta and includes primarily small towns, farmland, the Shawnee National Forest, and Southern Illinois University. The coal mines, which were the primary employers for the southern Illinois Delta, have all but vanished, leaving the region without major industries, public transportation services, and qualified health professionals.

The Illinois Delta Network (IDN) is a statewide consortium of 12 health and social services agencies in Illinois including the Egyptian Area Agency on Aging, Illinois Department of Human Services' Division of Mental Health, Illinois Department of Public Health's Center for Rural Health, Illinois Health Education Consortium, Illinois Hospital Association, Illinois Institute for Rural Affairs, Illinois Primary Healthcare Association, Rural Partners, Southernmost Illinois Delta Empowerment Zone, Southern Illinois University Carbondale's Center for Rural Health and Social Service Development, University of Illinois Extension, and the U.S. Department of Agriculture.

The target area of 16 medically underserved counties in southern Illinois includes poor and underserved children, families, single adults, and the elderly, who have limited access to health services because of barriers such as transportation, lack of available services, poverty, disability, and culturally related barriers.

Improving the health status of Delta residents will be accomplished through projects that focus on specific health indicators such as overweight, obesity, physical activity, and tobacco use. Overall, the IDN seeks to improve access to needed health services by addressing key barriers to access such as transportation, lack of needed services, and lack of coordination of and communication about available services. The network aims to strengthen the capacity of community-based organizations in providing healthcare and will implement health education, intervention, chronic disease management, wellness promotion, and care coordination projects by local community organizations.

KENTUCKY

D60RH03645
Robert W. Brooks
Trover Clinic Foundation, Inc.
435 North Kentucky Avenue
Suite A
Madisonville, Kentucky 42431
Phone: (270) 824-3443 Fax: (270) 824-3446

Fiscal Year 2004 2005 2006
Funding Amount $467,267 $467,267 *$467,267

The Mississippi River Delta Region in Kentucky encompasses 19 rural Delta counties and has a service area of more than 6,000 square miles. Of these 19 counties, 6 do not have hospitals and 15 counties have a Medically Underserved Area status, while 9 other counties have a Health Professional Shortage Area status. In 6 of the 19 counties, population-to-provider ratios is almost triple that of the State ratio.

The target populations for the project are 375,444 rural citizens in the 19 counties in Kentucky's Mississippi River Delta Region. In addition to availability to services, accessibility is a significant problem in the region. There are no public transportation systems within the region, and the distance between home and primary care appointments can exceed 30 miles each way. With unemployment rates as high as 7.3 percent (compared to a 6.0 percent national average), the economy in these rural counties is distraught. In regard to education, when compared to the rest of the Nation, Kentucky ranks 48th in terms of residents holding high school diplomas. In 1997, a survey conducted in most rural Kentucky Delta counties found that 42.3 percent of the working population age 16 to 64 was functionally illiterate, that is, displayed difficulty using basic reading, writing, and computational skills considered necessary for functioning in everyday life. These factors alone clearly disadvantage the population in regard to accessing and maximizing the benefits of the healthcare system; when combined with the acceptance of many social/cultural norms (e.g., smoking is socially acceptable in Kentucky, and 63 percent of Kentucky adults are overweight, placing Kentucky in a tie for the 2nd fattest State in the Nation), the availability and accessibility barriers are exacerbated, making obtaining quality healthcare a fantasy for many rural citizens of Kentucky's Mississippi River Delta Region.

The consortium partners include the Trover Foundation (lead applicant), Muhlenberg County Health Department, Marshall County Health Department, Green River District Health Department, Pennyrile District Health Department, Hopkins County Health Department, Purchase District Health Department, Methodist Hospital - Union County, and Trigg County Hospital.

Together, this consortium will ensure that existing collaborative relationships among community health providers are strengthened and new relationships are formed to improve the well-being of residents of Kentucky's Mississippi Delta Region; activities geared toward health promotion disease prevention are initiated, for example, milk machines in schools, funding for walking trails, weight control programs; access to prescriptions through Medication-Assist Programs will be made easier; and technical and support services will be provided to the individual counties to assist in establishing their own health resources and service capabilities.

LOUISIANA

D60RH03646
Brian P. Jakes, Sr.
Southeast Louisiana Area Health Education Center
1302 J.W. Davis Drive
Hammond, Louisiana 70403
Phone: (318) 274-2372 Fax: (318) 274-6053

Fiscal Year 2004 2005 2006
Funding Amount $713,197 $713,197 *$713,197

The Louisiana Better Health for the Delta Project will address the unmet health needs and reduce health disparities of 29 Delta parishes in Louisiana, an area covering nearly half the State, stretching from the northern rolling plains to the southeastern piney woods, with residents representing Acadian, Creole, Native American, African American, white, and Asian ancestry (64 percent Caucasian, 34 percent African American, and 2 percent other racial groups). The populations in these rural parishes range from 11 people per square mile and 1 primary care physician for every 3,400 residents in the northeast parish of Tensas to 118 people per square mile and 1 primary care provider for every 1,480 residents in the more densely populated southeastern parish of Tangipahoa.

Historically, the cooperation among Louisiana's health-related organizations has been far less than optimal, with many opportunities for optimizing resources and integrating programs across neighboring communities going by the wayside. Access to care is an ever-growing problem in the target area. Several of the parishes have expressed the need for improved transportation, while other parishes list the lack of qualified healthcare professionals in their communities as the greatest cause for the numerous unmet health conditions of many of Louisiana's rural residents. Eighty-six percent of Louisiana's parishes are designated as Health Professional Shortage Areas. When surveyed by State and local network partners, community residents identified the inability to access health services in a timely manner and the lack of access to routine and preventive healthcare as two of the greatest risk factors in Louisiana's poor health status. In Louisiana, where flu and pneumonia claim more than 1,000 lives each year, fewer adults over age 65 take advantage of flu or pneumococcal vaccine immunizations each year than their counterparts in 48 other States. Cost is the single most important factor in receiving routine, preventive healthcare for those individuals without healthcare coverage and whose income is below the poverty level. Of the 29 Delta parishes targeted by this initiative, 27 have residents with higher poverty levels than the State average, which is tied with West Virginia as the State with the fourth highest poverty rate in the Nation. Even employed individuals receiving employer-sponsored health insurance are now facing increased premiums and decreased benefits, and some employers are forced to eliminate coverage altogether amid rising insurance costs.

The network partners are South East Louisiana Area Health Education Center, Community Health Systems of Louisiana, Governor's Office of Community Programs - State Alternate to the Delta Regional Authority, Louisiana Department of Health and Hospitals - Bureau of Primary Care and Rural Health, Louisiana Hospital Association, Louisiana Public Facilities Authority, Louisiana Public Health Institute, Louisiana Primary Care Association, Louisiana Rural Health Access Program, Louisiana Rural Health Association, Louisiana State University Health Sciences Center - Healthcare Services Division, Rapides Foundation, Rural Hospital Coalition, Inc., and the Rural Hospital Performance Improvement Program.

Building on momentum achieved from the unprecedented collaborative support of Phase 1 of this initiative (the original Delta State Rural Development Network Grant awarded to the Southeast Louisiana Area Health Education Center in 2001), in Phase 2, the Louisiana Better Health for the Delta project will support community organizations in the development and implementation of projects to address targeted and unmet local healthcare needs, expand delivery and promote sustainability of healthcare services in rural Louisiana communities, and improve the quality of essential rural healthcare services in the 29-parish region.

MISSISSIPPI

D60RH03650
Mitch Morris
Aaron E. Henry Community Health Services Center, Inc.
510 Highway 322, P.O. Drawer 1216
Clarksdale, Mississippi 38614
Phone: (662) 624-4292 Fax: (662) 624-4354

Fiscal Year 2004 2005 2006
Funding Amount $1,008,313 $1,008,313 *$1,008,313

Formerly known as the Mississippi Delta State Rural Development Network (MDSRDN), the Mississippi Strategic Health Initiative for Network Expansion Commission (The MS SHINE Commission) aims to realize improvements in health status in a 41-county region in rural Mississippi by addressing five primary health needs of the target region: (1) obesity/overweight, (2) cardiovascular disease [CVD], (3) diabetes, (4) teen pregnancy and sexually transmitted diseases, and (5) substance abuse.

The target population includes approximately 927,570 citizens within 41 Mississippi Delta counties covering approximately 23,000 square miles. The area is completely rural with no metropolitan areas found within the 41-county region. In stark contrast to national and State averages, the target area has a greater representation of minority populations, at 48.2 percent Caucasian in the region compared to the State figure of 61.4 percent and the national average of 75.1 percent. African Americans represent more than 50 percent of the regional population, compared to the State and national averages of 36.3 and 12.3 percent, respectively. Hispanic representation in the region (1.1 percent) is comparable to the State average of 1.4 percent.

According to Behavioral Risk Factor Surveillance System data presented by the Centers for Disease Control and Prevention (CDC), Mississippi is the fattest State in the Nation with 63 percent of the population overweight (36 percent of Mississippi adults are overweight, and 27 percent are clinically obese). Likewise, nearly a third of all State high school students are overweight or at risk of being overweight. Being overweight has been proven to cause additional health problems, including cardiovascular disease and diabetes. The Mississippi State Department of Health (MSDH) reports that CVD is the leading cause of death in the State. With 43 percent of all deaths attributed to CVD, Mississippi has the highest rate of CVD mortality in the Nation. CVD represents a key health need in Mississippi, but it is a greater problem in the Mississippi Delta than elsewhere. In 2001, MSDH vital statistics showed the death rate for heart disease within the 41-county region at 353.6 per annum compared to the State's average of 316.7 and the national average of 250.4. Diabetes also is a serious concern in the region. In 2002, CDC figures estimated the Mississippi diabetic occurrence at 8.4 per 100 citizens, nearly twice the national average of 4.5. MSDH estimates that diabetes contributes to 1,600 deaths per year in the State. In 2002, more than 270,000 Mississippi residents had diabetes, and one-third were undiagnosed. In 1997, the estimated cost of diabetes in Mississippi was about $1.7 billion.

The program's partners are the Aaron E. Henry Community Health Services Center (lead applicant), Mississippi Primary Healthcare Association, Mississippi Hospital Association, and the Mississippi AHEC Program.

MS SHINE will maintain a proactive, wellness approach to improving health by increasing awareness of primary health needs; providing health education programs; promoting healthy lifestyle choices; and expanding access to screening, early detection, and chronic disease management services. MS SHINE will work with individual communities to create health networks (three or more entities sharing common health interests, geographic regions, and mission to increase the health status of their communities) that will work collaboratively to address defined health needs of their communities by implementing health education initiatives targeting the five primary health concerns, encouraging increased physical activity and improved nutrition, conducting abstinence-only sex education for school-age children, expanding the capacity and accessibility of the local health system, and promoting economic development within their communities.

MISSOURI

D60RH03643
Joseph Pierle
Missouri Primary Care Association
3325 Emerald Lane
Jefferson City, Missouri 65109
Phone: (573) 636-4222 Fax: (573) 636-4585

Fiscal Year 2004 2005 2006
Funding Amount $713,197 $713,197 *$713,197

The Missouri Delta Health Network (MDHN) initiative aims to create affordable pharmacy assistance programs, develop a First Call for Help system, initiate disease collaborative participation, and replicate successful approaches to achieving healthy outcomes to low-income, Medicaid populations and uninsured residents of the rural 29-county Delta Region in Southeastern Missouri. The population density in some of these rural counties approaches Frontier Status, and all 29 counties are designated Health Professional Shortage Areas as well as Dental Professional Shortage Areas. In fact, several counties do not have dental providers that are not associated with a Federally Qualified Health Center (FQHC). Furthermore, the FQHC clinics serve as the only option for uninsured and State-sponsored insurance residents throughout the region.

To improve accessibility and affordability issues in obtaining prescription medicines as identified by all eight members of the MDHN, the program will develop pharmacy assistance programs in all 29 Missouri Delta counties. MDHN proposes to appoint an organization within individual communities to serve as a resource where consumers can enroll in one of many indigent drug programs offered by pharmaceutical companies and obtain valuable information on their communities' prescription assistance program. To make citizens of the Missouri Delta Region more aware of available preventive care services at affordable prices, the MDHN plans to utilize the "First Call for Help - '211' Service." First Call for Help, a replication of a successful strategy employed and supported for several years by one of the consortium's partners, is a telephone-based information and assistance program that will provide communities with vital statistics and information about what needs a community has, and which of those needs are most often going unmet. To address unmet health needs in chronic disease management, MDHN is stressing the importance of participation in federally recognized disease management workshops/courses. MDHN members will garner immeasurable information and ideas and will be able to provide technical assistance and peer support throughout the region. In addition, MDHN plans to implement a community-based approach to chronic disease issues very similar to the REACH model being implemented in Kansas City, Missouri. This model provides small grants to community-based and faith-based organizations willing to implement minor changes to their programs and activities to encourage "Healthy Habits."

Forty percent of the target populations have incomes below 185 percent of the Federal poverty level, 16 percent are older than age 65, and only 70 percent have attained a high school diploma. Caucasians make up 93 percent of the region's population, while African Americans represent 4 percent, Hispanics represent 1 percent, and other races represent 2 percent of the target populations. Forty-five percent of household incomes are less than $25,000 annually, and the 2003 annualized unemployment rate charted the region at 7.2 percent compared to the national average of 5.6 percent. Forty-eight percent of children and teens under age 19 are currently enrolled in Medicaid, but most adults have no insurance. In addition to these discouraging statistics, MDHN realizes that several other barriers must be addressed to eliminate the health disparities noted in the 29-county region, including an increase in knowledge of available resources; increased usage of resources designed to promote healthy living; an increase, where justified, in the number of new access points; and increased linkages between FQHCs, other safety net providers, and the communities that these organizations serve.

The consortium's members include the lead applicant, Missouri Primary Care Association, Big Springs Medical Association, Central Ozarks Medical Center, Cross Trails Medical Center, Douglas County Public Health Services, Great Mines Health Center, Southern Missouri Community Health Center, and the Southeast Missouri Health Network.

This Missouri Delta Region project is building on the efforts of the previously awarded Delta States Rural Development Network grant award from the Office of Rural Health Policy in 2001. Because of the successful relationships FQHCs have built working with the uninsured, underinsured, and Medicaid/Medicare recipients in the region, and because MDHN believes that strengthening these relationships is the best way to overcome the previously mentioned barriers, MDHN has placed the region's FQHCs at the center of its network. MDHN will distribute funds directly to seven FQHCs dispersed throughout the 29-county region. These FQHCs will be responsible for developing and supporting local networks, assuring that local priorities are included in the work plans for their service area, and, ultimately, increasing the number of individuals and families in the Missouri Delta Region that have access to primary and dental healthcare.

TENNESSEE

D60RH03647
Richard C. Swiggart
West Tennessee Regional Health Office
Tennessee Department of Health
295 Summar Avenue
Jackson, Tennessee 38301
Phone: (731) 421-6768 Fax: (731) 421-5148

Fiscal Year 2004 2005 2006
Funding Amount $393,488 $393,488 *$393,488

The West Tennessee Regional Public Health Office (WTRO) and its network partners, the State Office of Rural Health (SORH) and the University of Tennessee at Martin, aim to improve the health status of local residents by encouraging creative and lasting collaborative relationships among a variety of health service providers throughout western Tennessee and to support these community health providers in the development and implementation of innovative projects and products to address four specific unmet healthcare needs of the rural population of the Tennessee Delta. The program's efforts are focused on reducing morbidity and mortality from heart disease, stroke, cancer, and diabetes using a collaborative approach combining primary care and behavioral change.

In the past, the individual counties in the 16-county Tennessee Delta Region all shared a common dependency on the agricultural and textile industries. Economically, the region has suffered since these industries were moved overseas and unemployment and chronic poverty are now overwhelming realities for most of the region. In fact, the target populations are twice as likely to be poor, uninsured, and in need of primary care, prenatal and pediatric care, behavioral health services, and social services compared with other area residents. Moreover, geography, low levels of educational attainment, and language, cultural, and transportation barriers prevent many from seeking and receiving the care they need. As another major access barrier, the rate of illegal immigration among the Hispanic population is estimated to be four illegal residents for every one legal immigrant.

With a rapidly increasing Hispanic population and some counties in the region reporting minority populations as high as 40 percent, racial and ethnic disparities are serious co-contributors to the overall poor health status of many of the region's residents. Unemployment figures top 9 percent for the region, and 15 percent of the target populations are living below the federally recognized poverty level; the average per capita income in the region is barely $15,000. The elderly population (65 and older) represents 15 percent of the region, and 29 percent of residents living in the Tennessee Delta Region are receiving Medicaid or TennCare assistance; this figure is more than twice the national average at 14 percent. Less than 68 percent of the target populations are high school graduates. Residents in the target area have death rates from heart disease, cancer, stroke, diabetes, and infant death that far exceed the State and national averages.

This Tennessee Delta Rural project is building on the successes of the 2001 Mississippi Delta Special Initiative award from the Office of Rural Health Policy. The Tennessee Delta Special Initiative comprises primary care physicians and other healthcare providers, local government officials, social service providers, postsecondary educators, faith-based agencies, and other consumers of the local healthcare delivery system. An assessment performed on the health status of the region's communities identified four primary health conditions for intervention. These conditions include heart disease, stroke, cancer, and diabetes. In response to these health disparities and the access barriers previously mentioned, the SORH will collaborate with the project to improve accessibility, availability, and affordability of quality healthcare in the Tennessee Delta. The SORH also will assist the project with the identification of Health Professional Shortage Areas and other healthcare needs in the region and will help promote the project and disseminate health intervention models and strategies developed through the Delta initiative. The University of Tennessee at Martin Department of Nursing will develop, test, and disseminate a health education behavioral change curriculum that focuses on prevention and self-management of chronic illness. Curriculum development will focus on these needs and include strategies for establishing relationships, communicating, influencing lifestyle changes, and teaching methods. The project will determine how healthcare providers can impact the health status of West Tennesseans by providing healthcare consumers with skills of empowerment, problem solving, coping strategies, and self-management.