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Posts from the ‘Connecting The Dots: Community Health and Economic Vitality’ Category

Thanks, Mr. President, for giving us a new way to think about Georgia’s declining regions

By Charles Hayslett

File this under every-cloud-has-a-silver-lining.  President Trump’s characterization of Haiti and various South American and African countries as “shitholes” may have torpedoed a DACA deal, triggered a global diplomatic uproar and made it more likely that the federal government will shut down this weekend.  On the bright side, it also gives us a memorable way to think about the deteriorating counties and communities right here in Georgia.

Now, because I am a nice guy and don’t want to offend my friends in rural Georgia (and especially because my wife is from South Georgia and would not appreciate it), I am going to refrain from personally applying the president’s epithet to our state’s more unfortunate areas.  You’ll just have to use your imagination.

In the wake of the president’s unfortunate description, his surrogates have worked hard to shift the debate from the seemingly racist overtones of Trump’s reported language to a broader discussion about a merit-based approach to immigration.  I’m generalizing here, but they seem to be saying that Trump’s language wasn’t a commentary on the racial make-up of the nations he referenced (overwhelmingly black or brown), but the supposed economic prowess and productivity of their citizens.

I’m happy to take them at their word.  In that context, and by that standard, it seems reasonable to suggest that America has its own share of such areas – specifically, counties and communities that have long been on a downhill slide just about any way you want to measure it: economically, educationally, in terms of health status, etc.  It also seems reasonable to point out that these areas voted overwhelmingly for Donald J. Trump, and to wonder what he would like to do for voters who were among his most ardent supporters – who, indeed, were a large chunk of his base.

To be fair, Trump also won many of the state’s most affluent counties, which also tend to be deeply Republican, including growing suburban and exurban counties like Fayette, Forsyth, Cherokee and Dawson.  But a review of 2016 General Election results suggests Trump owes a large measure of his margin in Georgia to what might indelicately be called the, well, you-know-what vote.

Altogether, Trump carried 127 counties in Georgia.  Of the 4.7 million people living in those counties, 77.1 percent were white and 18.4 percent were black.  Based on the most recent educational attainment data available, they were also home to slightly more high school dropouts than college graduates – 625,808 adults without a high school degree versus 625,161 with at least a bachelor’s degree.  In contrast, the other 32 counties that went for Clinton were home to more than twice as many college graduates than high school dropouts – 1.2 million to 532,000.

That educational disadvantage translates, among other things, into weaker economic output, poorer health and higher healthcare costs.  The 127 Trump counties generated $10.45 billion in 2013 federal taxes (the most recent IRS data I’ve analyzed) versus $20.5 billion from the 32 Clinton counties.  At the same time, while generating basically twice as much in federal taxes, the Clinton counties (home to the larger population) consumed only about 17 percent more in FY2017 Medicaid costs than the Trump counties: $5.03 billion versus $4.3 billion.  One result of that math is that Medicaid patients from the Trump counties cost the state about 2.2 percent more per patient than those in the Clinton counties: $5,136 to $5,026 each.

What’s more, if educational trends are any indication, the economic and health gaps will almost certainly continue to widen.  In the fall of 2016, the University System of Georgia admitted a total of 41,906 students from throughout the state; 23,325 came from the Clinton counties and 18,581 from the Trump counties. 

But those overall numbers actually mask the extent of the differences.  Of the 41,906 students admitted that fall, 11,756 were accepted at the state’s top four research universities – Georgia Tech, the University of Georgia, Georgia State University and Regents University.  Of those, more than twice as many were from the more economically productive Clinton counties than the Trump counties: 8,421 versus 3,335.

An even starker picture emerges when you look at the state’s most economically depressed counties.  The Georgia Department of Community Affairs (DCA) manages the state’s job tax credit program, which is designed to steer businesses and jobs to the state’s poorest counties by offering substantial tax credits for each new job created.  This year, DCA lists 71 counties in its Tier 1 category.  Only 721 students from those counties made it into one of the top four research universities.

And even that number is deceptive.  Of the 71 Tier 1 counties, the only one in Metro Atlanta is Clayton County, which sent 233 high school graduates to one or the other of the research universities.  The other 70 counties split the remaining 488 students.  Ten of those failed to send a single student to one of the top four Georgia schools.

In contrast, Fulton County, whose 5th congressional district Trump once said was in “horrible shape and falling apart,” sent 3,924 students to University System institutions in the fall of 2016, more than all the Trump counties combined; 1,971 of those were selected to one of the top four research universities.  It also generated 8.5 times as much in 2013 federal taxes as it consumed in FY2017 Medicaid benefits (and, of course, it went heavily for Clinton over Trump).

My purpose in writing this is in no way to denigrate Georgia’s poorest and least educated counties, or to in any way re-litigate the 2016 presidential campaign (although I suppose candor requires an acknowledgement that I am no fan of President Trump).  Indeed, I have devoted a fair chunk of the past several years to researching and writing a book aimed at putting a spotlight on the widening divide between Metro Atlanta and the rest of Georgia, especially the state’s poorest areas, and to exploring public policy solutions to the challenges posed.  It’s a tough nut to crack, and there are no easy solutions – either for, well, Georgia’s you-know-what holes, or for the more affluent areas that will inevitably be stuck with the tab. 

In an odd sort of way, President Trump may have performed a useful service where this issue is concerned.  In condemning countries whose emigrants to the United States he obviously sees as unproductive and uneducated drags on the nation’s resources, he has invited what could be a useful discussion about American communities that could be characterized in the same manner.

 

South Georgia vs. Gwinnett County

By Charles Hayslett

Here’s an easy way to understand the widening gap between Metro Atlanta and the rest of Georgia.

Compare all 56 counties of interior South Georgia to Gwinnett County alone.

Gwinnett County’s 2013 population was estimated at 859,304 – just under three-fourths of the 1.16 million people living in our 56-county South Georgia region.

But despite that population disadvantage, Gwinnett County:

  • Generates more income and contributes more in taxes than all 56 counties of South Georgia combined. According to IRS data, Gwinnett County’s total income for 2013 was $21.2 billion versus $17.4 billion for South Georgia.  Similarly, Gwinnett County taxpayers paid $2.5 billion in federal taxes while South Georgia taxpayers contributed $1.7 billion.
  • Consumes substantially less in social services than South Georgia. In 2013, as one example, Gwinnett County consumed less than a third as much in Medicaid services than South Georgia.  The federal share of South Georgia’s Medicaid costs totaled $927.6 million; Gwinnett County, $266.2 million.  The picture for SNAP (food stamps) and other social benefits is similar.South Georgia vs Gwinnett County
  • Is home to significantly more college graduates than South Georgia. Based on data compiled by the U.S. Department of Agriculture’s Economic Research Service (ERS), there were 175,290 college graduates in Gwinnett County over the period 2009-13 versus 110,576 for all of South Georgia.  This hasn’t always been the case.  As recently as 1990, Gwinnett County and South Georgia were basically tied in this category: 65,281 for Gwinnett and 63,073 for South Georgia.
  • Sends more students to University System of Georgia colleges than all of South Georgia. This is also a recent development.  A decade ago South Georgia still sent significantly more kids to college than Gwinnett County – 5,117 versus 3,762.  But by 2011 they were basically tied.  South Georgia sent 5,498 kids to college while Gwinnett County sent 5,493, according to University System of Georgia data.  Since then the gap has widened steadily, and in 2015 Gwinnett County sent 1,100 more freshmen to University System colleges than South Georgia.
  • Is substantially healthier than South Georgia. Using premature death rates as a proxy for health status, Gwinnett County is about twice as healthy as South Georgia.  The 2015 YPLL 75 rate for the 56-county South Georgia region was 9,823.3; for Gwinnett County, it was 5,163.2 (with YPLL 75 rates, the lower the number, the better).   In this category, South Georgia has actually gained a little ground over the past 20 years.  It’s improved about 5.4 percent over that period while Gwinnett County has been essentially flat.  But South Georgia’s numbers in this category are abysmal while Gwinnett County’s are pretty close to optimal, especially for a county as large and diverse as it is.  For 2015, Gwinnett County’s YPLL 75 rate was the fifth best in the state, and it has consistently been in the top tier of counties in this category.
  • Produces about half as many criminals as South Georgia.   In 2015, according to Georgia Department of Corrections data, South Georgia sent more than twice as many people to prison than Gwinnett County did: 2,403 for South Georgia versus 1,049 for Gwinnett.  The picture for new probationers is similar: 5,956 for South Georgia versus 2,630 for Gwinnett County.

In a future post, we’ll take a look at political and cultural trends in Gwinnett County and South Georgia.

Copyright (c) Trouble in God’s Country 2016

 

Is Rural Georgia Dying? Literally?

A basic premise of Trouble in God’s Country is that rural Georgia is dying.  Truth is, I’ve meant that figuratively rather than literally – a reference to local economies gutted by globalization and other factors, failing schools and small hospitals in danger of closing, among other things.

Recently, however, I read an article that made passing reference to the growing number of rural counties across the country where deaths outnumber births.  I wondered if that might be the case in Georgia.

A quick dive back into the Georgia Department of Public Health’s (DPH) OASIS system produced some pretty startling results. Read more

AJC: Rural hospitals bailing on babies

The AJC is up today with an excellent and hugely important story by Lynne Anderson about the state’s rural hospitals bailing out of baby business.  This is the bow wave in the slow-motion disaster that is rural healthcare in Georgia in the 21st century.

One of several money grafs:

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Forsyth County moves to the top of the 2015 TIGC Power Ratings

With the publication Wednesday of the Robert Wood Johnson Foundation’s 2015 County Health Rankings, we can indeed report that, as expected, Forsyth County has slipped past perennial leader Oconee County and claimed 1st place in the 2015 Trouble in God’s Country Power Ratings. Read more

A new Power Ratings champ?

Every year during the old Partner Up! for Public Health campaign, we built a major part of the annual publicity effort around what we called Power Ratings that paired county health rankings produced by the Robert Wood Johnson Foundation with county economic rankings generated each year by the Georgia Department of Community Affairs (DCA).

Throughout the 2010-through-2014 period for which we compiled rankings, Oconee County reigned supreme.  For each of those five years, it was No. 1 in DCA’s economic rankings,[1] which are generated by a formula that incorporates local unemployment and poverty rates along with local per capita income.   And, it ranked either 2nd or 3rd in RWJ’s annual health outcomes rankings, which are based on a formula that includes premature death rates, the percent of the population reporting being in poor or fair health, number of days worked missed for reasons of physical or mental health, and low birthweight. Read more

Thanks, New York Times!

Over the past several weeks, I’ve been working on a presentation I’ll be delivering next month to the Kentucky Public Health Association.  I was invited to speak to the group after one of its leaders saw me deliver an early version of the “Connecting the Dots: Community Health & Economic Vitality” presentation we developed as part of the Partner Up! for Public Health campaign that officially concluded last year.

It was literally yesterday afternoon that I finished double-checking data and proofing maps I’ll be using to demonstrate the overlap between good health and strong economies in the Bluegrass State – and this morning The New York Times gave me a major assist by publishing a front-page story built around a first-ever look at county-level smoking rates.

Read more

The High Cost of Premature Death

Here at the Partner Up! for Public Health campaign, we’re always looking for ways to illustrate the high cost of poor health.  Recently we began to study the mountains of public health and economic data we’ve collected to see if we could develop a reasonable methodology for putting a price tag on premature death in Georgia.

This is not a new idea, but most of the studies and reports we’ve found rely on complex formulas that most of us can’t understand and produce results that people have trouble relating to.  Truth is, those are easy traps to fall into; it’s difficult to deal with data without dealing with data.  One formula we found looked like this: Read more

Annual Power Ratings stable at the top, volatile at the bottom

Now that we’ve published the Partner Up! for Public Health campaign’s 2013 Community Health & Economic Vitality Power Ratings, we’ve begun to dig into the barrels full of data that underlie those rankings.  What we’re looking for is interesting or useful nuggets of information that help inform the discussion about the relationship between health and the economy at the local level.

Sometimes you spot patterns or trend lines that seem interesting, but it’s not always easy to interpret the data or explain what – if anything – it might mean.  That’s the case with today’s topic. Read more

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.

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