People are dying earlier and facing more severe health issues in many rural communities

Some Appalachian and Mississippi Delta communities have been designated ‘medically-underserved’ for decades
Published: Mar. 8, 2021 at 8:07 AM EST|Updated: Mar. 8, 2021 at 8:21 AM EST
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INDIANOLA, Ms (Great Health Divide) - In Issaquena County, Mississippi nearly a quarter of all babies born here weigh less than 5 1/2 pounds. The county doesn’t have a single doctor.

In Clay County, Kentucky, residents have battled for access to healthcare for more than 40 years.

In Galax City, Virginia, residents die on average before their 68th birthday – nearly a decade before the average American.

From the Mississippi River east, millions of Americans live in counties where the lack of access to healthy foods, wi-fi, transportation, clean drinking water and medical care have contributed to chronic health disparities, federal data shows.

They are the residents of Appalachia and the Mississippi Delta – two regions that stretch from New York to Louisiana and from Missouri to South Carolina. The regions include parts of 17 states.

The Appalachian and Mississippi Delta areas are regions of contrasts: rich in culture, heritage, and pride but comparatively poor in economic opportunities and quality health care.

The counties that make up the Delta (yellow) and Appalachian (orange) regions have some of the...
The counties that make up the Delta (yellow) and Appalachian (orange) regions have some of the worst health care statistics in the country. Communities in these areas are also working on unique ways to solve disparities.(Gray Television)

Stereotypes of their residents as uneducated people who live unhealthy lifestyles further stigmatize them and create the very barriers to health care that they need, experts say.

“When the perception is that people are unhealthy or they use substances . . . that makes people unwilling to invest or afraid to invest and that causes these problems to get worse,” said Michael Meit, director of research and programs at East Tennessee State University’ Center for Rural Health Research.

Despite programs that encourage doctors to practice in rural areas and government grants directed at improving health care access, more than half of the counties in the regions have been medically underserved since 1978.

InvestigateTV analyzed data from the Centers for Disease Control and Prevention, the U.S. Health Resources and Services Administration, the Robert Wood Johnson Foundation and numerous other federal, state and private sources and found that there are serious health disparities between Appalachia and the Mississippi Delta and the rest of the U.S.

  • A disproportionate number of babies struggle to live to their first birthdays. Many are born tipping the scales at 5 ½ pounds or less. Ten Appalachian and/or Delta counties post some of the highest infant mortality rates in the country.
  • Adults are plagued by diabetes and obesity – two factors that can lead to even more serious medical problems. In nearly two-thirds of the 662 counties in the Appalachia and Delta regions, the percentage of their adult residents with diabetes exceeds the national average. The CDC has dubbed much of the two regions as America’s “Diabetes Belt.”
  • For women in some parts of Appalachia, a diagnosis of cervical cancer is a death sentence. The mortality rate is 20 percent higher than the national rate.
  • Overall, residents of Appalachia and the Delta die younger. In more than three fourths of the counties, residents don’t make it to their 78th birthday, the age average age of death in the U.S. In six counties, they don’t even make it to 70.

“It’s sort of like a perfect storm,” said Dr. Mark Dignan, professor of medicine at the University of Kentucky and executive director of the Appalachian Community Cancer Network. “People who live in rural areas have the same risk factors as people all across the country (but) have less access to health care. So, diseases like cancer and heart disease strike this population at high rates.”

Two federal agencies designed to advocate for their respective areas – the Appalachian Regional Commission and the Delta Regional Authority – have tried to address the ongoing disparities through Congressional funding and grants.

Other federal and state dollars also flow into the regions.

But, “the investment is inadequate,” Dignan said.

Throughout 2021, Gray Television’s InvestigateTV and its local TV stations in the region will explore doctor shortages, lack of emergency care, food insecurity, environmental issues that contribute to poor health and governmental funding to these regions through public health and grants.

The project also will highlight the regions’ champions such as Dr. Katherine T. Patterson, a family doctor who works at the rural South Sunflower County Hospital and cares for patients from “cradle to grave.”

It also will show the emotional costs of these inequities: families who lost loved ones and people traveling great distances for care.

The regions are home to 35 million people, representing just 10% of the U.S. population.

But what they lack in scale, they make up for in might, said Meit, the East Tennessee State researcher.

“If you want food on your table, if you want power when you turn on that light switch, if you want a military that’s protecting you, you need to be concerned about your rural brothers and sisters,” Meit said. “They are out there doing all these things.”


It’s been 14 years since Katherine T. Patterson hung out her family doctor shingle in Sunflower County, Mississippi and yet her patients still ask, “When are you leaving?”

Residents in rural communities are used to doctors coming and going, but mostly going - especially in Mississippi.

But Patterson has no intention of leaving because there are so few doctors like her.

Dr. Katherine T. Patterson knew when she was in medical school that she wanted to serve rural...
Dr. Katherine T. Patterson knew when she was in medical school that she wanted to serve rural areas. She now practices in Indianola, Mississippi.(Owen Hornstein, InvestigateTV)

She is one of a few family doctors in rural Mississippi that also does obstetrics care. Years ago, before the state capped the amount patients could collect on malpractice cases in 2003, the threat of lawsuits in the state drove many family doctors away from delivery rooms, leaving a void of pre- and post-natal care, she said.

“We have lost the access to obstetrics care in rural Mississippi,” she said. “Driving from here to Jackson, which is 88 miles, there’s not a single person who does OB between here and there.”

She is one of seven primary care physicians in Sunflower County, a place she discovered during medical school at the University of Mississippi and decided to make her home.

“People are afraid of the lifestyle. Some don’t like the (malpractice) liability,” she said of reasons why rural areas have a hard time attracting doctors. “But I see it as a way to help protect our state.”

Even with seven doctors in the county, residents struggle with their health.

Nearly a third of Sunflower’s residents live in poverty.

A staggering 15% of babies are born underweight, which can lead to a lifetime of health issues.

Nearly 15 out of every 1,000 babies die before their first birthdays.

More than half of the adults are obese; 20% have diabetes.

The average age of death is 71 – six years less than the national average.

Patterson is well aware of the challenges she faces practicing in a rural community. She considers herself similar to Michael J. Fox’s character in the movie Doc Hollywood, when a city doctor ends up practicing in a rural town.

Dr. Katherine Patterson holds Jaquana Haley Williams' baby. Patterson helped her find a simple...
Dr. Katherine Patterson holds Jaquana Haley Williams' baby. Patterson helped her find a simple procedure that would allow her to carry babies to term after having two miscarriages. Haley Williams now has two children.(Owen Hornstein, InvestigateTV)

“I take care of patients cradle to grave,” Patterson said. “I never know what my day is going to hold.”

She knows that some of her patients struggle to pay for needed medication and healthy food. The closest critical care hospital is 88 miles away.

“Certain people have access to whatever they want. . . until we can meet somewhere in the middle and everyone can get what they need, we’re going to struggle,” she said. “We’re going to struggle with morbidity and mortality. We’re going to struggle with lots of things.”

Everyone, she says, should care about the inequities in places such as Sunflower County, the rest of the Mississippi Delta and Appalachia “because we’re all human.”


The federal government has considered Sunflower County medically underserved since the 1990s.

In fact, every Appalachian and Delta county in Mississippi except for one has been designated as such – many since the late 1970s when the designation began.

The lack of doctors, a large elderly population and high rates of poverty and infant mortality determine if a county is medically underserved.

Of the 662 counties that makeup the Appalachian and Delta regions, nearly two-thirds are medically underserved.

  • HRSA’s goal is to have one primary care doctor for every 3,000-to-3,500 residents. But in more than 200 counties in Appalachia and the Delta, doctors are treating double, triple, quadruple that number of patients.
  • In New Madrid County, Missouri, there was only one doctor to treat 17,582 patients, the data shows.
  • In Appalachia’s Casey County, Kentucky, the only primary care doctor has 15,750 patients, the data shows.

Data Visualization: Charles Minshew, IRE for InvestigateTV

Even 57 years after then-President Lydon B. Johnson declared the War on Poverty to help rural Americans, many residents in Appalachia and Delta remain poor.

  • In 266 counties of Appalachia and the Delta, at least 20% of residents live in poverty, which is about double the national rate.
  • In East Carrol Parish, Louisiana and Jefferson County, Mississippi nearly half of the residents are poor.
  • In Appalachia, the highest rates of poverty cluster in Kentucky including in the county where Johnson made his historic speech in 1964.
  • The federal government considers poverty by itself a public health issue.

“Residents of impoverished neighborhoods or communities are at increased risk for mental illness, chronic disease, higher mortality, and lower life expectancy,” the Healthy People 2020 report says.

From birth to death, many residents in Appalachia and Delta face greater challenges: underweight babies, infant mortality, diabetes, obesity, cancer, heart disease combined with a limited access to doctors and hospitals.

“In Appalachia Ohio, we have several counties that have no mammography facilities. Several counties that have no hospital,” said Electra Paskett, professor of medicine at The Ohio State University. “It’s a huge issue.”

It’s also an issue that should concern every American from coast to coast.

“Rural is part of your state and it’s part of your country,” Paskett said. “If you want to have a strong country . . . you have to have a healthy country.”

­­­­­­­­­­­­­­Great Health Divide is an initiative addressing health disparities in the Mississippi Delta and Appalachia funded in part by the Google News Initiative.

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