Before Ben Gilmore was a senator, he lived in the Delta in southeast Arkansas and witnessed firsthand the region's struggles with health care, infrastructure, education and more.
"I think the mindset has been for a long time that if we sit around and wait long enough, somebody will come by and help," said Gilmore, a Republican from Crossett. "And that mindset has got to go away because if we are not fighting and advocating for our part of the state, make no mistake, there is nobody else going to do it for us."
Two events in recent years brought attention to issues in the Delta: The covid-19 pandemic, present since March 2020, stressed the state's health care providers, including in the Delta, and the 2020 U.S. census confirmed the continuing migration of people out of the state's agricultural center.
"I agree with the concern that there is more limited access to health care in the Delta and in some of the rural parts of the state," Gov. Asa Hutchinson said in a recent interview with the Arkansas Democrat-Gazette. "Part of the challenge is getting health care providers to be there. We have to improve health care access by also improving education, improving quality of life and improving the growth in these rural areas."
The federal government has given Arkansas almost $3.2 billion in funds because of the pandemic, and some government officials see this an opportunity to finally address some of the problems in the Delta, along with other state needs.
STAKEHOLDERS NEEDED
Creshelle Nash, the current medical director for health equity and public programs at Arkansas Blue Cross and Blue Shield, said local and state government and businesses must show interest in the Delta for the situation to change.
"If we want to progress a society, we must address health issues," she said.
Nash said the government must have a safety net for people who get in trouble.
"Because guess what? Tomorrow, it might be me," she said. "It's good to have a safety net for folks because growth comes from everybody and it shouldn't be limited to people who have means or are born with means. We are losing great potential if the government is not a stakeholder in this."
Nash said intergovernmental partnerships that formed during the pandemic need to stay in place to really address health disparity in the Delta and across the state.
Mellie Bridewell, president and CEO of the Arkansas Rural Health Partnership and a regional director at the University of Arkansas for Medical Sciences, said the state has a distinct responsibility to the rural Delta.
"Let me put it this way: The vast majority of Arkansas is rural, and we will never be able to achieve what we need to achieve without support from the state," she said. "And by that I mean the state must first prioritize rural health care and rural education and then identify the right people to lead those efforts – those that not only know rural, but know what rural is capable of becoming."
Bridewell said she believes health inequity is a result of neglect and lack of priority to fix what is wrong in these communities.
"We haven't enabled our communities and provided them with the tools to succeed ... and please don't tell me that people don't want to change or make things better (which I hear too much) -- they just don't know how," she said in an email.
HEALTH CARE HELP
Trying to meet the needs of sick covid patients required hospitals and others to work together to solve problems.
Felicia Pierce, chief nursing officer at the Mississippi County Hospital System, said the system faced struggles at the beginning of the pandemic, but partnerships with several industries and businesses helped them navigate uncertainties.
"In the beginning, it was a struggle due to supply chain and staff shortages," she said. "Several industries, businesses and individuals donated [personal protection] equipment and other items to help us. Due to the complexity of ever changing regulations, the hospital system worked together by following the guidelines to ensure safety for all our patients and our staff."
In addition to care for covid patients, the hospital system has improved in other ways.
Pierce said the hospital system now has a level 4 trauma center, has partnered with tertiary centers in Jonesboro to care for heart attack patients and has a stroke telemedicine program.
"The system has also recruited several physicians and advanced practice nurses in the last several years. We currently operate four rural health clinics in the county," she said.
Gilmore said he thinks now is a good opportunity for some of the hospital systems across the state to work together with rural clinics to provide telehealth opportunities.
"UAMS is doing some of that, but we need to increase that," he said. "Maybe you can't recruit to these rural areas, but yet you can utilize telehealth or telemedicine so that you are saving people time, money by not having to commute from Little Rock."
Gilmore said in the long run this telemedicine plan will save the state money, the patients money and time and lead to better health outcomes.
The pandemic also called attention to the problem that some patients have in getting to a health care facility.
"Transportation is a huge disparity for our county," Pierce said. "There are several cab services located in Blytheville and Osceola. We are not aware of any bus or cab services in the areas outside these cities. The cost of transportation from these outer rural areas to our hospital system would be costly, depending on their location."
Hutchinson said one of the ways the state is trying to address health disparity in the Delta is through programs such as ARHOME, which stands for Arkansas Health and Opportunity for Me. ARHOME, which takes effect Jan. 1 and replaces Arkansas Works, is the expanded Medicaid program that will provide health insurance for more than 300,000 Arkansans between 19 and 64 who earn up to 138% of the federal poverty income level.
"The program utilizes our community hospitals and our rural hospitals and enhances the delivery of mental health services, addiction counseling, focuses on pregnant moms and those that are ex-offenders and those that are coming out of foster care," the governor said.
HEALTH CARE FUNDING
Almost a decade ago, Mississippi County faced a crisis when the then-owners of the hospital system had financial issues.
"The system was previously owned and operated by a small corporation with minimal resources, which resulted in a decline in our hospital system," Pierce said. "In 2009, the county recognized the decline and took back over the management and ownership of our hospitals."
The situation showed how government can play an important role in the health of a community.
"The state, federal and local governments have provided extensive funding for our hospital system," Pierce said. "We were able to complete projects that we would otherwise have not been able to do on our own. One example would be the integration of our telemedicine program."
The federal government gave states billions of dollars to address health needs brought to light by the pandemic.
The U.S. Centers for Disease Control and Prevention awarded the Arkansas Department of Health $40,411,710 to address covid-related disparities.
According to a news release, the state's Office of Health Equity and Office of Rural Health and Primary Care will work within the department and with partners across the state on these issues.
In the interview with the Democrat-Gazette, Hutchinson said the pandemic has given the state an opportunity to expand the use of telemedicine, which he said will be a big benefit to rural communities.
"We have extra rural dollars coming in that helps us with broadband and building up our health care system in these rural areas," he said. "The pandemic has educated us to the problem but also given us an opportunity to fix those problems."
Gilmore said his belief is the state has a large role to play in making sure essential government services are being funded, but at the same time it's also incumbent on them, as government officials, to make sure those tax dollars are being spent wisely.
"Instead of just throwing money at the wall and seeing if it sticks, let's look at what is working in other states, let's look at what's working here in Arkansas," he said. "Let's make sure that the money that is being spent is being spent wisely."
EDUCATION'S ROLE
Hutchinson said the state also must invest in education in rural communities.
"We have a constitutional responsibility to make sure that it's equitably distributed and that everybody has equal access to quality education," he said.
George Makris Jr., chairman and CEO at Simmons Bank and a longtime Pine Bluff resident, said the biggest challenge he's had when trying to recruit people to work in Pine Bluff is the perception of the school system.
"When we try to recruit outside of Pine Bluff and that recruit has a family that has school-age children, we usually don't get very far," he said. "They may choose to work for us and then live somewhere else but that is only a partial benefit to Pine Bluff. I don't believe we will see a great turnaround in this city until we see a turnaround in public schools."
Makris said one way the state could help out cities in the Delta is taking a hard look at how schools are funded, including the ability of districts to provide funds.
"I think there needs to be a way to check and see the ability of a local community to provide for their own well being," he said. "Delta communities are terrible underfunded in comparison to more metro communities where property values are higher. I believe the state has the obligation to use their statewide resources to give equitable opportunities across the state."
Makris said, for example, the school system in Bentonville probably doesn't need as much funding assistance from the state as does Pine Bluff.
Gilmore said education is one of the most important issues that needs to be addressed.
"We need to look at how we fund our overall education budget and making sure that we are spending money as wisely as we can," he said. "In some cases, schools need more money and some schools need less. I just think we need to take a look, and this might be the young person in me, but I think just because a system has been there for decades doesn't make it perfect. We got to be willing to push against the status quo."
Broadband was cited by several government officials as a way the state is trying to level the playing field between the Delta and everybody else.
"We know that we have had a broadband issue in the state and you are starting to see that gap being closed," Gilmore said. "We have done things to address it, but now there is money being allocated to do that. It took federal dollars to help with that and it took the state making it a priority to get us to that point. We have to look at things like that where the state can make a real difference in using taxpayer dollars wisely."
Hutchinson said he believes the state's broadband plan will make the biggest difference in the rural Delta by providing high-speed internet access to everyone.
"We will continue to invest in that until we get everybody covered," he said.
Rep. Vivian Flowers, D-Pine Bluff, said the state should also look into investing into more organizations such as the Minority Health Commission.
"There is a Minority Health and Health Disparities [Office] within the Health Department. I think that would be a wonderful resource to ensure that all other divisions within the department are culturally competent," she said.
A NEW GENERATION
Gilmore said that, as someone who grew up in a small rural community, he knew he had fewer amenities and advantages than someone living in metro areas.
But he also had more opportunities to get engaged in the future of his region.
"I am now serving as the youngest state senator and chances are if I hadn't grown up in a small rural community, I wouldn't have had the same opportunities," he said.
Gilmore said the need to keep or bring back the younger generation becomes more pressing with each passing year.
"Got to encourage and engage more young people to get involved and not discourage and I think a lot of younger people would like to be involved but they don't feel as comfortable at the table," he said. "We got to get past that and invite more to sit at the table. Look at opportunities to engage younger people even though their ideas might make us uncomfortable and their ideas might push some boundaries but we still need that. We still need to be challenged."
Gilmore said the national push for high schoolers to attend a four-year college probably inadvertently sped up the decline of the Delta.
"The reality is we pushed that, pushed that, and pushed that, at the same time, we lost potentially a generation of young people who went off to college and never came back because we didn't have a movie theater, a coffee shop or things like that," he said. "I think we should encourage that but also encourage those who don't go to college to go into trade businesses and more."
The governor sees opportunities in technology -- specifically, computer science, which all public high schools are required to teach, and expanded broadband access.
"When we had our computer science initiative, we made it clear we wanted to make sure that computer science was available in every [public] school whether it's rural or urban," the governor said. "Secondly, we were one of the first states to have high-speed broadband in our schools and now we are moving that emphasis to high-speed internet to not only the schools but the rural areas of our state and investing hundreds and millions of dollars for that purpose."
Hutchinson said moves like that can help reverse that trend of population loss.
"People like living in a rural area and the amount of people moving to Arkansas is increasing, so if they can work remotely and attract more businesses to the area because of the internet connection, then it will be benefit to the Delta," he said.
Alan Nelson, Mississippi County's county judge, said officials are starting to work on tailoring the area to attract a new generation of young people with projects including bike trails and by working on ensuring high-speed internet is available countywide.
"We are in the process of reinventing ourselves," he said. "These are things we have had to learn are necessary to attract residents. High-speed broadband is something my generation would view as a luxury item but now broadband is as essential as electricity and water."
Nelson said doing trash cleanups, removing abandoned houses and adding amenities make the county more attractive.
"I think it's the government's responsibility to address those issues as best as we can," he said.
Nelson said it's important for rural areas like Mississippi County to maintain close contact with the state leaders in Little Rock and embrace any chance for infrastructure improvements.
"I believe it will be our responsibility to ensure this is a great place to live when the people come," he said.
Flowers said Pine Bluff must start advertising the things it has to encourage investment from Arkansans.
"So, for Pine Bluff, we have great housing stock, so we need to create incentives to buy and renovate those homes," she said. "We have an industrial port. What are we doing to encourage people to live here?"
Hutchinson said it's important for the state to ensure residents have the same opportunity no matter where they live.
"We want to make sure that a child from the Delta has the same opportunities at education and in jobs as someone from an urban area of our state," he said.
Nash said for that to happen, there needs to be accountability at all levels.
"Oftentimes the things we do in the Delta and poor communities don't have an eye towards sustainability," she said.
"For example, when a grant runs out, things stop. That is not helpful for these communities. There needs to be funding towards the actual community organizations who have a plan for the future and that is where we must hold everyone accountable for there to be change."
About this series
These stories on the health and life expectancy issues in the Arkansas Delta were done in partnership with the University of Southern California.
As participants in the USC Annenberg Center for Health Journalism 2021 National Fellowship, Arkansas Democrat-Gazette staff writer Stephen Simpson and reporters for other publications across the country worked on projects of their choosing that addressed health issues. The reporters were assigned advisers with the program and work with their own editors.
To define the Delta, the Arkansas Democrat-Gazette used the Delta Cultural Center’s list of 27 counties: Arkansas, Ashley, Chicot, Clay, Craighead, Crittenden, Cross, Desha, Drew, Greene, Independence, Jackson, Jefferson, Lawrence, Lee, Lincoln, Lonoke, Mississippi, Monroe, Phillips, Poinsett, Prairie, Pulaski, Randolph, St. Francis, White and Woodruff.