Union County, south Arkansas and rural regions across the country are facing an ongoing health crisis that shows few signs of slowing down.
According to the Congressional District Health Dashboard, a collection of health-related statistics gathered by Department of Population Health at the NYU Grossman School of Medicine, the 4th Congressional District in Arkansas - of which Union County is a part - is below the U.S. average in several areas of physical and mental health.
The District Health Dashboard uses stats compiled from "federal, state, and other datasets with rigorous standards for collection and analysis," according to its website.
Arkansas's 4th Congressional District is made up of the majority of the state's southern and western counties.
Cardiovascular health is an area where the district particularly suffers compared to the rest of the country, with around 305.1 deaths out of 100,000 being cardiovascular-related, compared to 205.7 of 100,000 in the United States as a whole and 277.2 of 100,000 in the state. Heart disease is the leading cause of death in both men and women in the United States, according to the U.S. Centers for Disease Control.
Approximately 41.4% of adults in the district reported high blood pressure, according to an estimate compiled from a 2019 Centers for Disease Control study. The national average is 31.5%.
Diabetes is also more prevalent in the district than it is nationwide, with 13.5% of adults reporting that they have diabetes in the same 2019 Centers for Disease Control study, versus 10.4% nationally.
Obesity is another condition that is somewhat higher in the district, with 37.9% of adults reporting a body mass index (BMI) greater than 30, versus 31.9% nationally.
Julie Wylie, a nurse practitioner (APRN) at Medical Center of South Arkansas, said several factors can combine to cause and exacerbate cardiovascular issues. Preventative care is, essentially, lifestyle related.
"It starts with the patient... It's a matter of taking control of your health, eating healthy, controlling your blood pressure and weight," Wylie said.
Important adjustments include quitting smoking, cutting down on alcohol consumption, controlling blood pressure and weight and exercising, all huge factors in maintaining cardiovascular health.
And although self-discipline and genetic factors can certainly play a part, it still leaves the question of why the South, and largely rural regions within it such as the Arkansas 4th, fare worse on several health metrics.
Dr. Brian Jones, president of the SHARE Foundation, said the realities of rural and small-town living are factors that cannot be counted out.
"With cardiovascular health, just look at how many fried food places we have or how many people eat at gas stations and the kind of food there. There's not a lot of fresh food options and not a lot of restaurants specialize in healthy food options. Food that is unhealthy is cheaper," Jones said.
Jones, who is also currently an adjunct professor at Southern Arkansas University where he teaches a course in health care policy and law, added that other factors, including car-centric transportation rather than biking or walking, and higher rates of smoking are also relevant.
"I used to be on the Parks and Playgrounds Committee, and they've done a lot to improve the parks. But, we just don't have many sidewalks here, even compared to other parts of Arkansas," Jones said, adding that even a visit to to the South Arkansas Arboretum or the Lion's Club walking trail requires most residents to drive to get there.
Another rural and small-town obstacle is the availability of advanced cardiovascular care, as well as post-op care such as rehab.
Cardiologists are available in south Arkansas, including at MCSA, for evaluations and procedures such as stints. Wylie also touted the capabilities of the Medical Center's emergency room health care professionals and their ability to respond to emergency cardiac situations.
For long-term or higher level procedures such as open-heart surgery, however, patients will need to travel, or, in emergency situations, take advantage of MCSA's ability to transport by ambulance or helicopter.
For a rural hospital, Wylie said, one eternal issue is simply attracting health care professionals to the area.
"In a rural area, it can just be harder to recruit providers. It's not something (MCSA) has done wrong; it can just be hard to get people to move to a small town," Wylie said.
But resources are available locally for preventative care.
At MCSA, recent efforts have been made to spread education through wellness initiatives focused on heart health. The hospital emphasized heart health in February with the "'Healthy Heart, Healthy You' event and a 28-day Healthy Heart Challenge for the community," according to MCSA marketing director Alexis Jacob-Jones.
"We do all of these (initiatives) and we always wonder, 'did it really reach the people who come?' But, if just one person has more awareness or makes lifestyle changes, that's one more person who benefits," Wylie said.
The SHARE Foundation also helps fund and oversee agencies focused on wellness such as eXtreme Youth Programs and the HealthWorks Fitness Center.
"A lot of people don't realize that we have 200 people who come to Healthworks every month as members who are referred by their physician and are able to be members at no cost," Jones said.
Another SHARE agency is the Interfaith Clinic, a nonprofit medical clinic that helps provide care to uninsured, low-income patients in the county.
According to a paper published in the American Heart Association's journal "Circulation," "a large study in the United States and Finland found an increased risk of nonfatal myocardial infections and sudden cardiac death in the low-income cohorts that persisted after adjusting for smoking and alcohol consumption."
Economic and quality of life factors also showcase ways in which the district lags behind the country at large. According to data based on stats compiled from American Community Survey, 24.9% of children in Arkansas's 4th Congressional District live at or below the federal poverty level, compared to 16.4% nationally. The state average for the same statistic was 21.5%.
Jones said that Interfaith Clinic sees and helps a number of patients with diabetes who receive prescription assistance for insulin.
Mental health indicators are also reported on the dashboard.
In south Arkansas, 18.9% of adults reported poor mental health for more than 14 days of the last month compared to 14.9% nationally. Firearm suicides in the Arkansas 4th Congressional District are also higher, with 13.8 per 100,000 deaths attributable to that versus 7.6 nationwide.
Jones said that combating stigma for seeking mental health care is important.
"It's interesting; a lot of these issues with cardiovascular health and mental health are rural issues and they are Southern issues, too... When somebody feels they have thoughts that don't make sense or other mental health issues, there are stigmas in rural areas and the South in particular about that," Jones said.
One way of combating this, according to Jones, is to embed mental health checkups into routine doctor visits.
He gave the example of SAMA Healthcare Services in El Dorado, which offers mental health checkups as part of routine visits.
SHARE is currently working to write a grant application for Interfaith Clinic, he added, to similarly add in mental health check-ups in routine visits. Currently, the clinic refers patients in need of mental health care to Newhaven Counseling and Health Services.
"We've worked with Newhaven and it's been great, but it would be nice to have a one-stop-shop," Jones said.
Although none of the statistics show particularly good news for the 4th District, it does parallel or come close to national averages in some areas including unemployment (6%); the percentage of the population at or below 65 years old with no insurance (9.8%); and the percentage of the population where more than 30% of income is spent on rent (43.7%).
For more information on the Medical Center of South Arkansas, visit themedcenter.net.
For more information on the SHARE Foundation, visit sharefoundation.com.
More information about the metrics used for the statistics in this article can be found at congressionaldistricthealthdashboard.org/metrics.