The Two Georgias of Health: From Minnesota to Mississippi

For at least 30 years now, editorial writers, politicians and civic leaders have been wringing their hands about the “two Georgias” problem.  The term was reportedly coined by the late Albany, Ga., media magnate James Gray in 1983 to frame a discussion about economic disparities between north and south Georgia.  Generations of leaders have since regularly invoked it as a lament about the state’s seeming inability to bridge myriad gaps among various parts of the state.

The discussions almost always center on economic development and prosperity in different parts of the state and then bridge to other issues, including education and transportation.  Health status and healthcare sometimes make it onto the agenda, but usually as a footnote or an afterthought.

Recently, the Partner Up! for Public Health campaign decided to take a new look at the county-level data we’ve compiled on health and economic status to see what it might tell us about the state of the “two Georgias” discussion.

Mr. Gray would probably be dispirited by what we found.

For the past two years, we have used county-level Health Outcomes Rankings produced by the University of Wisconsin and created maps that broke the state into thirds, showing the healthiest counties in green, the middle tier in yellow, and bottom third in red.  This time around, we decided to zoom in and see if there were discernible regions made up of clusters of counties with similar health rankings and underlying data.

In turns out there was.  It was, for example, fairly common to spot clusters of contiguous counties with health rankings that were very close together.  Down on the Florida line, the counties of Thomas, Colquitt, Grady, Mitchell and Decatur (each of which adjoins at least one of the others) ranked 76^th, 85^th, 86^th, 87^th and 89^th, respectively.

Most interesting, however, was the way a couple of starkly different sub-regions popped off the map – and what they tell us about the extent of health (and economic) disparities in different parts of Georgia.

In the North Metro Atlanta area, for instance, five neighboring counties claim five of the state’s 10 top Health Outcomes rankings: Forsyth is 2^nd, Cherokee 4^th, Gwinnett 5^th, Cobb 6^th and Hall 9^th.

Not coincidentally, these counties almost certainly make up the state’s economically strongest region.  Based on slightly dated numbers compiled by the Georgia Department of Community Affairs for 2012, the five-county territory boasts an average per capita income of more than $36,000 and a poverty rate of less than 10 percent.  These five counties are home to more than two million people (and growing, up 30 percent since the 2000 Census) packed into just over 1,800 square miles (which is bigger than the nation’s smallest state, Rhode Island).  In fact, if this area were a standalone state, it would rank 36^th in population, behind Nevada but ahead of New Mexico.

As it turns out, these five North Metro counties have a mirror image in deep southwest Georgia, where seven neighboring rural counties between Mr. Gray’s home of Albany and the Alabama line lay claim to six of the bottom 10 health rankings in the state: Randolph County is 147^th, Quitman 149^th, Early 150^th, Stewart 153^rd, Calhoun 154^th and Terrell 155^th.  Clay County, on the Alabama line, comes in at 100^th, the best of the bunch.  (The University of Wisconsin report only ranks 156 of Georgia’s 159 counties; three are so small they don’t produce enough data to allow a valid ranking.)

These seven counties cover a slightly bigger territory than their North Metro counterparts – 2,362 square miles – but house only a fraction of the population.  According to the 2010 U.S. Census, only 46,490 people lived in the seven-county area, and that was down 4.42 percent from 2000.  Annual per capita income is less than $27,000, and the poverty rate hovers around 27 percent, nearly triple the North Metro rate.

The data that underlie the aforementioned health outcomes rankings are equally stark.  Consider the premature death rates in the two areas.  Known as the YPLL 75 rate (for Years of Productive Life Lost before age 75), these numbers offer perhaps the best quick snapshot of health status in a given area.  The lower the number, the better.

In the North Metro counties, the YPLL 75 rate is 5,476.  In the Southwest Georgia cluster, it’s 12,610.  As a frame of reference, consider that the best state YPLL 75 rate in the country belongs to Minnesota, at 5,641, and the worst is found in Mississippi, at 11,113.  The takeaway from this is that the five North Metro counties are, by this one measure, healthier than the healthiest state in the nation, and the seven Southwest Georgia counties in the bottom cluster are more unhealthy than the least healthy state.

Put another way: North Metro Atlanta: Better than Minnesota.  Southwest Georgia: Worse than Mississippi.

These contrasts show up in other Health Outcome metrics compiled by the University of Wisconsin, all with profound economic implications:

As always, the question that arises from data of this type is: So what?  Over the course of the Partner Up! for Public Health campaign, we’ve become convinced that the magnitude and gravity of the challenges associated with health status in rural Georgia pose a critical strategic threat to the state as a whole.

The poor health outcomes detailed above – premature death, low birthweight, adult obesity and teen births – come with huge healthcare, social service and opportunity costs, and those costs are inevitably spread and shared throughout the state.

These outcomes, and their costs, obviously threaten any slim hopes for economic revival these seven tiny counties in Southwest Georgia might have.  Nearly a decade ago, then-Governor Sonny Perdue’s Commission for a New Georgia published which identified healthcare, along with education, as a necessary building block for economic development.

The Commission’s Strategic Industries Task Force warned, in diplomatic language, that without “quality healthcare infrastructure,” any “resulting economic development will certainly not be optimal.”

The chairman of that Task Force, David C. Garrett III, was more plainspoken.  In presentations he made about his group’s findings and recommendations, Garrett said he “noted that economic development in the absence of quality healthcare was an illusion.  No community or region in the state was going to experience growth of existing industries, let alone successful recruitment of relocating businesses, without the presence of good hospitals and good and plentiful physicians.”

We suspect James Gray and his neighbors in Southwest Georgia would agree.

                As we were preparing this article for the Partner Up! website, Georgia Health News reported that a 25-bed critical access hospital in Calhoun County had closed its doors.

(Note: The data used in this blog was drawn from the University of Wisconsin’s 2012 County Health Rankings, the Georgia Department of Community Affairs 2012 Job Tax Credit Rankings, and the U.S. Census Bureau.)