1. Underemployment, Poverty and Access to Health Care in the Mississippi Delta: A Community-Based Approach to Understanding Problems and Exploring Alternatives John J. Green, Ph.D. Institute for Community-Based Research, Division of Social Sciences & Center for Community Development Delta State University In the Shadows of Poverty: Strengthening the Rural Poverty Research Capacity of the South July 21-23, 2004 Memphis, Tennessee

2. Mississippi Delta

3. A more responsive, participatory and action-oriented approach to research should: Acknowledge the existence of power and attempt to develop power-sharing relationships. Involve meaningful participation at all levels of inquiry. Employ multiple research designs and methods, including traditional and alternative models of inquiry. Assess the quality of the endeavor through use of several criteria, especially the soundness of methods and the extent of meaningful participation. Include an action agenda that is empowering to the community-based partners. An Alternative Research Framework?

4. Community-Based Research Framework Look gather data, define, describe & build picture Think explore, analyze, interpret & explain Act report, plan, implement & evaluate (Stringer, 1999)

5. Project Partners Underemployment and Poverty Tri-County Workforce Alliance Aaron E. Henry Community Health Center Coahoma Opportunities, Inc. Quitman County Development Organization CURET (Comprehensive Urban/Rural Ensemble/Tourism) Access to Health Care Mississippi Delta State Rural Development Network Aaron E. Henry Community Health Center Delta Diamond Health Network TCQ Health Network Greater Delta Health and Human Services Network

6. Research Methods: Underemployment and Poverty Analysis of Census Data. Qualitative Telephone Surveys – Employers in Coahoma and Quitman Counties (Total N = 38). Focus Groups – Four focus groups with “underemployed” adults in Bolivar, Coahoma, Quitman and Tallahatchie Counties (Total N = 29). Follow-up Community Meetings - Six follow-up meetings were held for participant validation and program planning.

7. Research Methods (Continued): Access to Health Care Key-Informant Interviews – Thirty-eight key-informant, semi- structured interviews were conducted with residents of communities (Cleveland, Clarksdale, Greenville, Marks, Shaw, Tunica) in seven Delta counties. Focus Groups – Twelve focus groups were conducted with a total of ninety participants. Delta Rural Poll – A series of health-related questions were included in the 2003 Delta Rural Poll, a telephone survey of residents in the eleven core Delta counties conducted through a partnership between the Center for Community and Economic Development (Delta State University) and the Survey Research Unit, Social Science Research Center (Mississippi State University).

8. Community-Based Research in Action!

10. Source: 2000 Census of Population and Housing – Summary File 3, Chart by John J. Green. * “Total” equals more than sum of White and Black.

11. Source: 2000 Census of Population and Housing – Summary File 3, Chart by John J. Green. * “Total” equals more than sum of White and Black.

12. Source: 2000 Census of Population and Housing – Summary File 3, Chart by John J. Green. * “Total” equals more than sum of White and Black.

13. Research Results: Underemployment and Poverty Underemployment and Poverty from the Perspective of Employers and the Underemployed in the Mississippi Delta: Summary Results from Interviews and Focus Groups (2002) EmployersUnderemployed Assets Tourism Farm-related industry Future industrial development opportunities Increased educational stability Existing workforce training programs Strong willingness/desire to work Heightened educational levels Extensive skills and experience Existing workforce training programs Social service organizations Barriers and Challenges Few jobs Inability to attract new businesses Unemployable workforce Low educational levels Crime and drug problems in the community Overall social and economic structure Few jobs Limited educational credentials Lack of dependable transportation to outside jobs Action Ideas Develop more industry and jobs Basic skills education (reading, writing, math) Vocational training High-tech. skills training Hands-on experience Work ethics Move beyond traditional/ established approaches Advocate, search for and help develop “good jobs” Increase educational and training opportunities Mentorship/apprenticeship program Small business incubator

14. Research Results: Access to Health Care Community Social and Health Issues from the Perspective of Delta Residents: Summary Results from Focus Groups and Key-Informant Interviews (2003) Important Social and Health Issues Limited formal education Lack of good jobs, few benefits, poverty Racial barriers and disparities Poor housing conditions Limited access to transportation (especially to access out-of-town services) Lack of insurance (many people slip through the “cracks” in the system) Drug and alcohol abuse Poor diet and nutrition Obesity Diabetes Hypertension Teenage pregnancy Health problems accepted as norm Limited understanding of health issues Ideas for Action Community level Awareness advocacy Prevention/wellness education Information on available health care and social service resources Increase prevalence and awareness of social and health related community Community involvement (parents, family, churches, police, leaders) Policy level Increased insurance coverage, especially for those who slip through the cracks Improved staffing in health care facilities (increase numbers, professionalism, compensation)

18. Program Planning Model Assets: human, community organizational & physical Barriers: block effectiveness of assets Goal: Improve Quality of Life Action Program: increase assets & break down barriers

19. Action Objectives Conduct a social marketing campaign to build awareness of current and potential employment options and the prerequisite skills needed to secure these positions. Coordinate and facilitate efforts to increase participation in existing workforce development education and training programs. Construct and implement a pilot education and training curriculum for professionalism that is considered legitimate and valuable by the underemployed, educators and employers. Program Plan: Workforce Development

20. Action Objectives Coordinate services and case management between health providers throughout the region. Develop partnerships between public schools and community health centers to utilize communication technology to expand access to health care. Survey and catalogue nonprofit health and human service providers to provide individuals, families and organizations more information on existing resources. Program Plan: Access to Health Care