v`v Southernmost Illinois Minority Health Disparities in Rural Areas Mike Bularz Fall 2012 Public Health 330 Dr. Richard Barret
3 Southernmost Illinois: Health Disparities in Minority Populations If you ever get a chance to beeline South through Illinois from Chicago, you will probablyexperience vast expanses of the great plains of America’s heartland, interspersed with single-intersection towns, a few aging rustbelt cities, and the college towns. Follow this path for upwardsof 5 to 6 hours, and the view will start to change as you arrive in the rockier and forested landscapeof the southern tip of Illinois. Here exists a paradox between the North and the South in a fewcontexts: The area, referred to as Little Egypt because of the fertile plains fed by the confluence ofthe Mississippi and Ohio rivers,1 was originally staked out to be the central hub of Illinois, Checagou2was just a distant and impenetrable swamp at this time. The unexpected also emerges from theenvironmental geography of the region: great expanses of plains end to yield rock formations andhilly landscapes, this is due to the geological history of the shaping of Illinois: the flattening of theentire state by glaciers during the ice age didn’t reach out this far, and receded to leave the flatmajority of the state, and more interesting topology in Southern and far Northwestern Illinois. 3 Thelast contradiction arises in terms of demography in the area: several urbanized towns boast heavyAfrican-American and Hispanic populations, and are encumbered with poor socioeconomic statusacross several indicators: income, uninsured, teen pregnancies, and a prevalence of several chronicdiseases. Interestingly enough, the distribution of these two minority populations does not exactlymirror the distributions found in more urbanized northern counterparts. The spatial patterns ofthe populations differ somewhat in rural towns: African – Americans are further from city center,Hispanics further than African-Americans, and Whites at the center and far out in the country.The origins of these populations and their concentrations are the outcome of different economicfactors transplanting or attracting different minority populations over time, and are the subject ofspeculation based on history. The causes of the population distributions are speculated in this paper,but it is imperative to first give an overall account of Illinois settlement patterns. Remnants of Un- derground Railroad1 Musgrave, John. “Egypt.” Egypt. American Weekend, 13 July 1996. Web. 12 Dec. 2012.2 Original Native-American term, meaning “stinking onion”. It referred to the odorous andmuddy landscape where the city was founded, and was eventually changed to “Chicago”.3 Testa, Adam. “Our History: How Southern Illinois Came to Be.” Thesouthern.com. TheSouthern, 13 Oct. 2011. Web. 12 Dec. 2012.
4 Early River Barge Early Illinois Settlement Patterns Exploration The earliest settlement of Illinois (not including Native Americans) was by French explorers and fur and hide traders. The confluence of the Ohio and Mississippi rivers made the area an ideal trading post, and the French king even staked out a large buffalo hide tanning operation in the area between Grand Chain and Mound City. Settlement also occurred in Kaskasia, but the area was eventually wiped out by a flooding of the river which wiped out the town.4 Cairo, founded at the southernmost tip of Illinois on a peninsula shaped like a crescent, was strategic for trade and future military operations.5 The War of 1812 established the port for takeover by English settlers, and the Civil War boosted the economy at the strategic location by providing medical services on the Red Rover hospital ship.6 Shift in Transportation and Rise of Industry Hubs came and went in Illinois, the southern tip at Cairo being essentially the first in relation to others: St. Louis and Chicago overtook the spotlight as a canal was dredged through the muddy banks of Chicago, and was primed to be the new center of the Midwest. This all changed with the advent of rail, and boosters and speculators investing in Chicago, such as William B. Ogden, who purchased development rights door to door, and secured rail transport from Galena to Chicago.7 The industrial boon in Galena was mining for materials needed for Chicago’s construction, and similar economies thrived in Southern and Central Illinois, and were eventually connected with the Illinois Central Railroad. Southern Illinois enjoyed industries around coal, mining, and salt mines such as the one in Equality, IL.8 Settlement by Race, Early and Industrial Era Illinois The majority of white settlement occurred from land speculators at this time traveling westward, as well as Appalachian whites who migrated from Kentucky and Virginia.9 Cairo and Equality garnered a large black population from the underground railroad routes by which slaves from the south traversed north to Chicago and Canada,10 theformer being a safe rest-stop and the latter being a capture point by night hunters re-capturing escaped slaves towork in Equality’s salt mines.11 Urbanized areas attracted populations to work, including minority populations, asindustrial processes demanded labor. This was particularly true in what is deemed the “Great Migration” of blacksin the 1950’s during the war, when mostly whites were abroad fighting, and the war itself generated a demand for4 Keller, Fred. “Cairo-Kaskaskia - Southernmost Illinois History.” Southernmost Illinois History. N.p., n.d. Web. 12 Dec.2012.5 Keller, Fred. “Cairo History - Southernmost Illinois History.” Southernmost Illinois History. N.p., n.d. Web. 12 Dec.2012.6 Keller, Fred. “Red Rover Hospital Ship - Southernmost Illinois History.” Southernmost Illinois History. N.p., n.d. Web.12 Dec. 2012.7 History of Chicago – William B ogden, St. Louis Canal8 Musgrave, John. “Black Kidnappings in Southeastern Illinois.” Black Kidnappings in Southeastern Illinois. N.p., Apr. 1996. Web. 12 Dec.20129 Harris, Jesse W. “Dialect of Appalachia in Southern Illinois.” JSTOR. N.p., n.d. Web. 12 Dec. 2012.10 ”The Underground Railroad in Illinois, Freedom Trails: 2 Legacies of Hope.” The Underground Railroad in Illinois, Freedom Trails: 2Legacies of Hope. N.p., n.d. Web. 12 Dec. 2012.11 Taylor, Troy. “The Old Slave House.” The Old Slave House. N.p., 2008. Web. 12 Dec. 2012.
5 labor as outputs increased.12 Modern Settlement Patterns by Race Hispanics Research by the USDA – ERS (Economic Research Service) reveals a growing trend in Hispanic migrants settling in rural areas of the country, as opposed to the traditional migration pattern of Hispanics into southwestern states. Currently, more than half of Hispanics are settling in non-metro areas.13 The Carsey Institute attributes this trend to new migrants being recruited to work in rural meat-processing plants and other agricultural operations.14 Research into Central Salt Mining Illinois distributions of Hispanics further assesses barriers of integrating into existing communities, discrimination, language barriers, and access to schools and health care.15 Figure 8 Year of U.S. arrival for all foreign-born Hispanics Percent 45 40 High-growth Hispanic Established Hispanic 35 Other nonmetro 30 Metro 25 20 15 10 5 0 pre 1 965 65-6 9 70-74 75-7 9 80-84 85-8 9 90-94 95-2000 Source: Calculated by ERS using data from Census 2000, SF3 files.12 Great Migration – History of Chicago13 Kandel, Willam, and John Cromartie. New Patterns of Hispanic Settlement in Rural America. Rep. no. 99. N.p.:United States Department of Agriculture - Economic Research Service, 2010. Print.14 Jensen, Leif. New Immigration Settlements in Rural America: Problems, Prospects, Policies. Rep. Durham, NewHamspshire: Carsey Institute, 2006. Print.15 Rafaelli, Marcella. “Challenges and Strengths of Immigrant Latino Families in the Rural Midwest.” Journal ofFamily Issues (2012): n. pag. Print.
Figure 4a6 Hispanic share of total county population, 1990 Less than 1 percent 1-9 percent 10 percent or higher Metro Source: Calculated by ERS using data from the U.S. Census Bureau. Figure 4b Hispanic share of total county population, 2000 Less than 1 percent 1-9 percent 10 percent or higher Metro Source: Calculated by ERS using data from the U.S. Census Bureau. 12 New Patterns of Hispanic Settlement in Rural America/RDRR-99 Economic Research Service/USDA
7BlacksThere is increasing evidence of of what is deemed “black flight” of African-Americans from northern tosouthern states, and from urban to more rural and suburban areas. A few trends are speculated to contributeto this pattern of migration: 1) Decrease of industry and jobs in urban areas making it less attractive to livein cities for the urban poor is speculated to be causing blacks and other minorities to seek out jobs in ruralareas and processing plants.16 2) Increasing gentrification of areas within cities is pushing the urban poor andminorities out into suburban and rural areas, and suburban areas are abundant in cheap housing options asproperty owners scramble to sell or attract tenants after the housing crisis.17 3) On a positive note, blacks areseeing an increase in social mobility with higher educational attainment and are populating the farther suburbsof cities, such as Chicago’s southern suburbs.18 4) Decreased racial tensions in urban areas in the southernstates are attracting more blacks than whites.19 These several factors, whether contributing to lower-classAfrican-Americans or higher class, are in general perceived to be causing a reversal of the Great Migration. Figure 1. Black Net Migration, U.S. Regions, 1965–2000 1965–70 1975–80 1985–90 1995–2000 400,000 300,000 200,000 100,000 0 -100,000 -200,000 -300,000 -400,000 South Northeast Midwest West Source: Author’s analysis of 1970, 1980, 1990 and 2000 decennial censuses.16 Godfrey Ukpong, Onoyom. Yankee Migration: Causes and Reverse Trends in Urbanization. Rep. Louisiana:Southern University, n.d. Print.17 Greene, Richard P., Mark Jansen. Bouman, and Dennis Grammenos. Chicago’s Geographies: Metropolis forthe 21st Century. Washington D.C.: AAG, Association of American Geographers, 2006. Print.18Greene, Richard P., Mark Jansen. Bouman, and Dennis Grammenos. Chicago’s Geographies: Metropolis forthe 21st Century. Washington D.C.: AAG, Association of American Geographers, 2006. Print.19 Frey, William H. The New Great Migration: Black Americans’ Return to the South. Rep. Washington D.C.:Brookings Institute, 2004. Print.
8 Physical Health Disparities in Rural Areas in America Focus Area - Nutrition and Physical Health The focus of this work is the physical health – and inficators manifested in prevalence of chronic diseases such as Obesity, Diabetes, and diseases of the heart, incidence of deaths from stroke, complications from diabetes or obesity, as well as hospitalizations attributed to these diseases. I also examine southern Illinois in terms of indicators linked as contributors to these chronic diseases. Indicators, referred to as “risk factors”, examined at the level of individuals and populations include the availability of healthy food sources and level of physical activity and exercise. Community and environment-level factors examined include availability of preventive, emergency, and supplemental (government-sponsored community health centers) care, as well as broader socio-economic status and indicators by race categories, such as income, poverty, insurance coverage, and ability to drive. Differences between Urban and Rural Health The health problems of rural minorities often mirror the problem of those of urban areas, but are not necessarily of the same causation. For example, poor nutritional environment is may not be because of an abundance of cheaper, high calorie “meals” like in urban areas, but more likely caused by general dearth of grocery outlets and options in less-densely populated areas. Examining the issue in southern Illinois requires understanding rural health disparity patterns, as well as urban ones as there are both, urban and rural areas in this part of the state. Prevalence of Chronic Diseases In general, health disparities are markedly higher in rural areas than in urban areas. African-Americans have higher prevalence of self reported fair or poor health (determined through National HealthInterview Survey asking to rank themselves as on average, very good health, good, fair, poor), and hispanics rank thehighest.Diabetes in Rural AmericaCertain chronic disease categories has significant variation by race in rural and urban areas. Diabetes affected African-Americans significantly higher than Whites, Hispanics, and Asians as a percentage of population. The number wassignificantly higher in areas classified “small-adjacent rural” meaning rural areas adjacent to an urban area; 12.6%of urban blacks had diabetes, while 15.1% of all rural blacks had diabetes. Within the rural category, 17.2% or “smalladjacent rural” blacks had diabetes. Probable cause for this pattern may be the settlement of blacks near urban centersor micropolitan areas as opposed to far rural areas.2020 Van Nostrand, Joan, DPA. Health Disparities: A Rural-Urban Chartbook. Rep. Columbia, SC: SouthCarolina Rural Health Research Center, 2010. Print.
9Obesity in Rural AmericaA similar distribution occurred for blacks andhispanics in the distribution of obesity rates amongrural versus urban classifications, with some minordifferences. Overall, blacks were more obese thanWhites and Hispanics, and obesity was higher in ruralAmerica in general. Hispanics had higher obesityrates within the micropolitan rural and small-adjacentrural areas. This was true for blacks as well, butobesity among blacks increased out into remote ruralareas as well, whereas remote rural hispanics weresignificantly less obese.21Access to Care and Quality of CareAvailability and Quality of Care FacilitiesThe base economics of low density populationhamper rural access to various necessary carefacilities: Doctors need density of patients, Hospitalsneed patients and a labor force, and it is difficultto blanket large regions with community healthcenters and preventive services as well. Further, it ischallenging to maintain a high standard of care with limited training and resources.22Barriers from the Individual’s EndTo complicate things, most rural residents don’t have insurance, as well as money or time to seek proper healthcare.23 Barriers exist in the larger community as well, as individuals’ inner and outer circles, as well as broadercommunity do not promote proper health.24 Contributing factors to health disparity exist in the built environmentas well, with limited availability of quality produce, and oversaturation with convenient and unhealthy mealoptions (“food swamps”).Environment, Community, and CultureNutrition in Rural AmericaSurprisingly, rural residents have poor food choices like their urban counterparts. This is particularly true inmicropolitan areas and small-adjacent rural areas, where there are significant low-income populations either notattracting healthy food options due to financial constraint or healthy food options are limited due to particularcultural choices.25 USDA - Economic Research Service mapping of income and distance to grocery stores posits that21 Van Nostrand, Joan, DPA. Health Disparities: A Rural-Urban Chartbook. Rep. Columbia, SC: SouthCarolina Rural Health Research Center, 2010. Print.22 Maripuri, Saugar, and Martin MacDowell. Addressing Rural Health Disparities in Illinois. Rep. N.p.:University of Illinois at Rockford, n.d. Print.23 Ziller, Erika, and Jennifer Lenardson. Rural-Urban Differences in Health Care Access Vary AcrossMeasures. Rep. N.p.: Maine Rural Health Research Center, n.d. Print.24 Reardon, Kenneth M. “Enhancing the Capacity of Community-Based Organizations in East St.Louis.” Enhancing the Capacity of Community-Based Organizations in East St. Louis. N.p., n.d. Web. 12Dec. 2012.25 Smith, Chery, and Lois W. Morton. “Rural Food Deserts: Low-income Perspectives on Food Access
10the distribution of food deserts (defined by census tracts with 33% low income bracket individuals with less than 5grocery stores within driving distance of 5 miles) are not primarily urban, contrary to popular belief and the focus ofmost studies. Although I was not able to calculate percentage Urban Vs. Rural populations for the U.S., for Illinois, 89%of the population living in food desert tracts is Urban, whereas 11% is Rural. This indicates that, although food desertsare located mostly in urban areas, there is still more than 1/10 of the population in food deserts is rural, in Illinois. (SeeIllinois Health section)Exercise & Fitness in Rural AmericaRural populations face similar disparities in terms of exercise and physical fitness26, it is likely that the near-urban andrural environments require a car to get to around in general, and the ability to walk places, accompanied by availabilityof parks and recreation opportunities is limited. Studies show that a portion of rural and near-urban work is shifting toless labor-intensive jobs,27 but the connection between labor intensive jobs and fitness is not necessarily comparable,in fact, many would argue that labor intensive jobs are a cause of poor health.28 Rural populations have very closenumbers to urban populations in terms of general exercise: 45% of Urban Residents met moderate or vigorous exerciseguidelines, while 44 % of rural did the same.29 Hispanics in urban adjacent areas showed higher activity than Hispanicsin other categories, while Blacks showed higher in far-rural areas.Access to CareA key obstacle for good health in rural residents is access to adequate medical care. Many rural residents do notproduce enough of a draw to attract hospitals, doctors, and other wellness / preventive services. Often, rural residentswill need to rely on social safety nets – nonprofit and government sponsored community health centers. The locationsof these are often not sufficient to meet the needs of rural and near-urban residents, as the centers are locatedprimarily in urbanized areas.30in Minnesota and Iowa.” Journal of Nutrition Education and Behavior 41.3 (2009): 176-87. Print.26 Van Nostrand, Joan, DPA. Health Disparities: A Rural-Urban Chartbook. Rep. Columbia, SC: South CarolinaRural Health Research Center, 2010. Print.27 ibid 28 “Labor Intensive Industry.” EconoWatch. N.p., June 2010. Web. 12 Dec. 2012.29 Van Nostrand, Joan, DPA. Health Disparities: A Rural-Urban Chartbook. Rep. Columbia, SC: South CarolinaRural Health Research Center, 2010. Print.v30 Removing Barriers to Care: Community Health Centers in Rural Areas. Rep. N.p.: National Associationof Community Health Centers, 2011. Print
11Illinois “Southern Seven” Diabetes Risk Factors: Indirect Contributing Factors Poor school lunch programs Direct Contributing Factor Limited availability of fruits / Low income neighborhoods vegetables Lack of Farmer’s Markets in all counties Indirect Contributing Factors Cultural / Family norms Direct Contributing Factor High fat diet Abundant Fast Food Restaurants Risk Factor Low income level Poor Diet Indirect Contributing Factors Large serving sizes at restaurants Direct Contributing Factor Portion Sizes Lack of education Cultural / Family norms Indirect Contributing Factors High soda intake Excessive intake of simple sugars / Cultural / Family norms / High poverty caffeine Abundant fast food restaurants Indirect Contributing Factors Lack of self motivation Direct Contributing Factor Sedentary lifestyle Lack of time / resources Nature of employment/physical limitations Indirect Contributing Factors Community Finances Risk Factor Direct Contributing FactorObesity / Diabetes Lack of Physical Walking Routes / Safety / other City Council leaders without health Type II Activity venues focus Crime in the community Indirect Contributing Factors Direct Contributing Factor Inadequate / Lack of incentives Lack of Motivation / Time Lack of understanding / education Indirect Contributing Factors Incomplete records Direct Contributing Factor Lack of Family History Knowledge Lack of communication Lack of genetic testing Indirect Contributing Factors Chemical exposures Direct Contributing Factor Genetic Mutation Radiation exposures Risk Factor Genetics Indirect Contributing Factors Direct Contributing Factor Parents Indirect Contributing Factors Direct Contributing Factor Race / Ethnicity
12Illinois Health Disparity PatternsPrevalence of Chronic DiseasesObesityObesity and Nurtition disparities are significant in Illinois, especially when examining rural communities. Illinoisranks at 61.7% obese (gauged by BMI) as compared to the national average of 61.1%. Obesity rates (percentageor population obese) are actually higher in rural communities than urban ones.31 The highest obesity rates are insouthern counties, and counties by the St. Louis / East St. Louis metro area.Obesity and the Environment in IllinoisThe distribution of obesity patterns in Illinois is somewhat correlated with risk factors such as availability ofhealthy food outlets, consumption of fruits and vegetables, and physical activity / inactivity, this is especially truewhen comparing in terms of North vs. West vs. South.Other risk factors include access to healthy food. The USDA Food Desert locator highlights a majority of fooddeserts around St. Louis metro area, far southern Illinois, and parts of Chicago and Rockford.A further complication is the ability for residents to drive in these areas. Examining data from the AmericanCommunity Survey, there are pockets where people walk to work. This could indicate inability to afford a car.DiabetesDiabetes distributions in Illinois seem to mirror the patterns seen in Obesity and Nutrition distributions. Thisisn’t surprising as the Diabetes is often associated with poor diet habits. Diabetes can be closely tied to mostof the same risk factors: Physical Inactivity, Poor Diet (Limited Furits and Vegetables, High-fat Diets), Genetics,as well as contributing factors (ex. Crime and a neighborhood’s walkability, and the amount of physical activityof individuals. See Figure on Next page). Diabetes, and diabetes risk factors are concentrated in Southern andSouthwestern Illinois similarly to obesity. White Population Black Population Asians Hispanic - All Races Mexican Puerto Rican Cuban American Indian or Alaskan Native Single Mothers New Single Mothers 2011 (Under Poverty Line)31 Arnold, Damon T. Illinois Strategic Plan: Promoting Healthy Eating and Physical Activity toPrevent and Control Obesity 2007 – 2013. Rep. Springfield, IL: Illinois Department of Public Health,2012. Print.
13 Overall Illinois Health: National Health Interview Survey participants were asked: On an average day, is you health Very good, Good, Fair, or Poor? Maps show fair or poor healthFair or Poor Health, 2002 Fair or Poor Health, 2003 Fair or Poor Health, 2004 Fair or Poor Health, 2005 Fair or Poor Health, 2006 Fair Poor Health 2007 Fair or Poor Health, 2008 Fair or Poor Health, 2009 Fair or Poor Health, 2010 Fair or Poor Health, 2004 to 2010All Obese Hospitalizations White Obese Hispanic Obese Black Obese All Diabetes Hospitalizations Incidences of Hospitalizations from Diabetes or Obesity Compli- cations, by Race or Ethnicity White Diabetes Hisp Diabetes Uninsured, All Uninsured, Under Poverty Line
14 Obesity Prevalence, NHIS: Figure 11: Percentage of Adults Reporting Cardiovascular Disease Risk Factors, Illinois, 2003 and 2004 Figure 6: 2006 Illinois Adult Weight Prevalence by Region 77.4 Poor Nutrition* 45 77.4 42.4 40.8 39.0 59.8 38.3 38.3 Physical Activity* 36.2 36.2 36.3 36.6 36.0 36.6 34.6 52.6 CVD Risk Factors 22.1 Obesity** 28.8 23.2 30 27.3 24.7 25.5 Percentage 6.1 Diabetes** 7.0 21.0 21.3 22.2 Smoking** 20.8 15 25.9 High Blood Pressure 24.8 34.1 High Cholesterol 33.1 0 0 20 40 60 80 Illlinois Chicago Suburban Collar Urban Rural Percentage Total Cook Counties Counties Counties 2003 2004 underweight/normal overweight obese U. S. Centers for Disease Control and Prevention Behavioral Risk Factor Surveillance Data Source: System; Illinois Department of Public Health BRFSS; *2003, **2004 Data Source: Illinois Behavioral Risk Factor Surveillance System, 2006Risk Factors to HealthThere are several risk factors to consider in assessing risk and prevalence of populations for Obesity, Diabetes, and HeartDisease. Several of these risk factors are prevalent in Illinois rural areas, particularly south and southwest: BMI andoverweight rates are higher in rural areas, poor nutrition is higher in rural areas and rural adjacent to small urban.Food Deserts Rurality of Illinoisans Rural 11%Another risk factor to consider is access to food; the USDA EconomicResearch Service publishes data from their “Food Desert Locator”, living in Foodwhich tracks areas in the US which have low income populations that Urban Deserts:are far away from a healthy food source such as a grocery store. This Ruraldata, combined with the ability to drive to a store (car ownership) 11% Ruralhighlights the issue further - residents in southern and western 89% Urban Urban 89%Illinois need to drive to the majority of destinations, but cannot doso because they don’t own a vehicle and public transportation isoften limited, if an option at all.
15Illinois Food Deserts, with darker values representing percentage ofpopulation under poverty with no vehicle. Southern Illinois and the St.Louis metro have the highest number of people with difficulty accessinghealthy food options.
16Access to Rural Health CentersKey potential for attacking the issue of disparities lies in strengthening the effectiveness of our Rural HealthCenters. The current distribution of health centers is primarily in urban areas. An analysis of populations within5, 10, 15, and 20 mile driving distances revealed the following:• Almost no populations under the poverty level live within 5 miles of a community health center• The majority of the poverty population was within the 15 and 20 mile range• Poor Blacks lived primarily within 15 mile, and 20 mile driving distances, whereas Hispanics live in further reaches (20 miles or more)It is evident that siting health centers in small municipalities may be convenient for running the centers, but ishighly incovenient for the rural populations needing the most care. Offering a shuttle service, or working withthe public transportation system may offer a solution other than siting centers in more rural areas. Looking forclusters of low-income individuals may be an option for siting satellite offices, or small scale health centers. Race / Ethnicity by Distance Class Population in Poverty Population per square mile, under poverty line 7000000 by 5, 10, 15, and 20 mile 6000000 (American Community Surevy Estimates) 5000000 driving distances to 4000000 IDPH Rural Health Centers 3000000 2000000 Illinois coverage by 1000000 Dubuque Rural Health Centers Road Sycamore Dekalb Clinton Sterling Population by Distance interval Ottawa Low Kewanee Kankakee Bradley Galesburg Pontiac Bourbonnais 5 10 15 20 High Health miles Canton Morton Pekin Center NormalKeokuk Macomb Peoria Bloomington Rantoul Distance from IDPH Rural Health Center Lincoln Champaign Danville UrbanaQuincy Springfield DecaturHannibal Jacksonville Population under poverty, by distance from IDPH Rural Health Center Taylorville Mattoon Terre Haute by Race / Ethnicity Charleston 4500000 Effingham Godfrey Alton 4000000 Glen Carbon Collinsville Vincennes Population per square mile, under poverty line Edwardsville Centralia 3500000 Population by Mount Vernon (American Community Surevy Estimates) Distance interval 3000000 Low Murphysboro Marion Herrin 2500000 Carbondale Whites in Poverty High 2000000 Blacks in Poverty Hispanic in Poverty Paducah 1500000 1000000 500000 0 5 10 15 20 Distance from Rural Health Center (miles)
! Sycamore Dekalb Sycamore Dekalb 17 Sterling Sterling ! ! ! Ottawa Ottawa Kewanee Kewanee ! Kankakee Bradley !! ! ! ! Kankakee Bradley Galesburg Bourbonnais ! ! ! Pontiac Galesburg ! ! Bourbonnais ! ! Pontiac ! ! East Peoria Peoria East Peoria Peoria ! ! Canton Pekin Normal ! ! ! ! ! ! ! ! Macomb Canton Pekin Morton Bloomington ! Macomb ! ! Morton Normal ! ! Bloomington Rantoul ! ! ! ! ! ! ! !Rantoul ! ! ! Lincoln ! Champaign Urbana ! ! ! Lincoln ! Champaign Urbana Quincy Danville ! ! ! ! ! ! ! ! ! ! Quincy Decatur ! ! Danville ! ! Springfield ! ! ! Jacksonville Decatur Springfield Jacksonville ! ! ! ! ! ! ! ! ! Taylorville Mattoon ! ! !! Charleston ! Taylorville ! ! Mattoon! ! Charleston ! ! ! ! ! ! ! ! Effingham ! ! ! ! ! ! ! !! ! ! Godfrey ! ! Effingham ! Alton ! ! ! !! ! ! Godfrey ! ! ! Alton ! ! ! Glen Carbon ! ! ! ! ! ! Collinsville ! ! Glen Carbon ! Centralia Collinsville ! ! ! ! !! ! ! ! ! ! ! Centralia Mount Vernon ! !! !Poverty population ! Mount Vernon ! ! ! Percent Minority !by closest ! !! ! ! ! within 20 Miles ! !Rural health Center ! ! Herrin ! ! ! ! 0.000011 - 1.013780 ! ! ! ! Marion ! ! ! Population in Poverty Carbondale ! ! !Herrin Marion ! 1.013781 - 2.407460 !! Carbondale ! !! ! Black, up to 20 Miles ! !!! ! !! ! 2.407461 - 4.353350 ! Hispanic, up to 20 Miles ! 4.353351 - 7.076070 ! ! White, up to 20 Miles ! 7.076071 - 12.015400 ! ! ! 12.015401 - 21.952801 ! 21.952802 - 53.849602 Hispanic, in Poverty White, in Poverty Black, in poverty Greenville Regional Hospital, Inc. - DBA Greenville Family… Southern Illinois Medical Services NFP - DBA Logan… HSHS Medical Group, Inc. - DBA HSHS Medical Group… Mid-Illinois Medical Care Associates, LLC - DBA Drs.… Hoopeston Community Memorial Hospital - DBA… Steeleville Clinic Medical Associates Of Jerseyville, Inc. Lawrence P. Jennings, M.D., M.S.C. Physicians Group Associates IMH Gilman Clinic Lincoln Family Care Specialists Community Medical Clinic SIU Care-A-Van Mcfarlin Medical Clinic, SC Southern OB/GYN - Highland Elmer Hugh Taylor Clinic Equality Family Practice Family HealthCare of Gibson City Kirby Medical Group Mt. Olive Family Practice Center Nokomis Rural Health Clinic Clark County Family Medicine PC Family Healthcare of Farmer City Paxton Clinic, The Comprehensive Health Center Heartland Pediatric Clinic, LTD - DBA Heartland Pediatris Cowden Medical Clinic LLC Southern Illinois Immediate Care LLC Hygienic Institute for LaSalle, Peru & Oglesby Inc Jacksonville Family Practice Watseka Family Practice Conﬁdence Medical Associates, Ltd. Clinton County Rural Health - Germantown Town & Country Rural Health Clinic Carle Health Care - DBA Carle Physicians Group CMH Palestine Rural Health Marshall Clinic Eﬃngham, S.C.
18 ILLINOIS AND THE PPACA (Patient Protection and Afforable Care Act) Health Insurance Exhanges The Future of Public Health Policy, especially for Southern Illinoisans, is due to change. WIth the passage of the Patient Protection and Affordable Care Act (PPACA)a few years ago, there are two things that will be occuring in the next three or so years: Illinois will set up centers referred to as Health Insurance Exchanges (HIE’s) where private insurance companies will pool resources to provide coverage for many residents who cannot currently afford health insurance, are uninsured, or have pre-existing conditions. These new centers will give residents options for purchasing insurance. HIE purchasing for rural ans small-urban periphery blacks, as well as rural Hispanics will greatly decrease the disease disparities faced by these two minority groups in rural southern Illinois. Increased Community Health Centers Implementation of final stages of PPACA will create more community health centers as demand for services grows. These centers, if placed optimally in rural areas, will ensure that populations in poverty with low access to current centers receive better coverage. Increasing the amount of centers, as well as existing center capacity will allow more preventative care and decrease mortality rates for diseases.Percent Unin- White Unin- Black Unin-sured, Under sured, Under sured, UnderPoverty Poverty Poverty
19 Works CitedArnold, Damon T. Illinois Strategic Plan: Promoting Healthy Eating and Physical Activity to Prevent and Control Obesity 2007 – 2013. Rep. Springfield, IL: Illinois Department of Public Health, 2012. Print.Ashton, Sarah, and Lauren McDonnel. Woody Biomass Desk Guide and Toolkit. Publication. N.p.: National Association of Conservation Districts, n.d. Print.“Black Kidnappings in Southeastern Illinois.” Black Kidnappings in Southeastern Illinois. N.p., n.d. Web. 12 Dec. 2012.Frey, William H. The New Great Migration: Black Americans’ Return to the South. Rep. Washington D.C.: Brookings Institute, 2004. Print.Godfrey Ukpong, Onoyom. Yankee Migration: Causes and Reverse Trends in Urbanization. Rep. Louisiana: Southern University, n.d. Print.Greene, Richard P., Mark Jansen. Bouman, and Dennis Grammenos. Chicago’s Geographies: Metropolis for the 21st Century. Washington D.C.: AAG, Association of American Geographers, 2006. Print.Harris, Jesse W. “Dialect of Appalachia in Southern Illinois.” JSTOR. N.p., n.d. Web. 12 Dec. 2012.Harris, Jesse W. JSTOR. N.p., n.d. Web. 12 Dec. 2012.Jensen, Leif. New Immigration Settlements in Rural America: Problems, Prospects, Policies. Rep. Durham, New Hamspshire: Carsey Institute, 2006. Print.Kandel, Willam, and John Cromartie. New Patterns of Hispanic Settlement in Rural America. Rep. no. 99. N.p.: United States Department of Agriculture - Economic Research Service, 2010. Print.
20Keller, Fred. “Cairo History - Southernmost Illinois History.” Southernmost Illinois History. N.p., n.d. Web. 12 Dec. 2012.Keller, Fred. “Cairo-Kaskaskia - Southernmost Illinois History.” Southernmost Illinois History. N.p., n.d. Web. 12 Dec. 2012.Keller, Fred. “Red Rover Hospital Ship - Southernmost Illinois History.” Southernmost Illinois History. N.p., n.d. Web. 12 Dec. 2012.“Labor Intensive Industry.” EconoWatch. N.p., June 2010. Web. 12 Dec. 2012.The Law of Biomass Guide. Rep. Los Angeles: Stoel Rives Attorneys at Law, 2010. Print.The Law of Biomass Guide. Rep. Los Angeles: Stoel Rives Attorneys at Law, 2010. Print.Loomis, David, and Anthony Pagan. The Illinois RPS: Context, Structure, History, and Policy. Rep. Bloomington, IL: Center for Renewable Energy - Illinois State University, 2011. Print.Maripuri, Saugar, and Martin MacDowell. Addressing Rural Health Disparities in Illinois. Rep. N.p.: University of Illinois at Rockford, n.d. Print.Musgrave, John. “Black Kidnappings in Southeastern Illinois.” Black Kidnappings in Southeastern Illinois. N.p., Apr. 1996. Web. 12 Dec. 2012.Musgrave, John. “Egypt.” Egypt. American Weekend, 13 July 1996. Web. 12 Dec. 2012.Rafaelli, Marcella. “Challenges and Strengths of Immigrant Latino Families in the Rural Midwest.” Journal of Family Issues (2012): n. pag. Print.Reardon, Kenneth M. “Enhancing the Capacity of Community-Based Organizations in East St. Louis.” Enhancing the Capacity of Community-Based Organizations in East St. Louis. N.p., n.d. Web. 12 Dec. 2012.Removing Barriers to Care: Community Health Centers in Rural Areas. Rep. N.p.: National Association of Community Health Centers, 2011. Print.
21Smith, Chery, and Lois W. Morton. “Rural Food Deserts: Low-income Perspectives on Food Access in Minnesota and Iowa.” Journal of Nutrition Education and Behavior 41.3 (2009): 176-87. Print.Taylor, Troy. “The Old Slave House.” The Old Slave House. N.p., 2008. Web. 12 Dec. 2012.Testa, Adam. “Our History: How Southern Illinois Came to Be.” Thesouthern.com. The Southern, 13 Oct. 2011. Web. 12 Dec. 2012.Testa, Adam. “Subscribe Now!” The Southern. The Southern, 13 Oct. 2011. Web. 12 Dec. 2012.“The Underground Railroad in Illinois, Freedom Trails: 2 Legacies of Hope.” The Underground Railroad in Illinois, Freedom Trails: 2 Legacies of Hope. N.p., n.d. Web. 12 Dec. 2012.Van Nostrand, Joan, DPA. Health Disparities: A Rural-Urban Chartbook. Rep. Columbia, SC: South Carolina Rural Health Research Center, 2010. Print.“Waste Management Introduces Fleet of CNG Trucks in Louisville.” Work Truck. N.p., 03 Aug. 2012. Web. 11 Dec. 2012.Ziller, Erika, and Jennifer Lenardson. Rural-Urban Differences in Health Care Access Vary Across Measures. Rep. N.p.: Maine Rural Health Research Center, n.d. Print.