Advancing Health and Resilience in the Gulf of Mexico Region A Roadmap for Progress (2023) / Chapter Skim
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3 Addressing Critical Data Gaps in Human Health and Community Resilience in the Gulf Region
3 Addressing Critical Data Gaps in Human Health and Community Resilience in the Gulf Region
Pages 37-76
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3 Addressing Critical Data Gaps in Human Health and Community Resilience in the Gulf Region Consistent and high-quality data, both specific to and across communities, are critical to assessing and making progress toward improving health and community resilience. In this chapter, the committee attempts to provide perspective on the health of the Gulf region with the available data; historical documentation; and other sources of information, such as the committee's public hearings and site visits.
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However, the committee also sought to categorize and understand the relationships among these variables to better highlight gaps and challenges in the specific context of the Gulf region. To this end, the committee approached the task of operationalizing the concept of human health and community resilience in three fundamental ways.
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With normalized data for the entire Gulf region, across the Gulf states, and across subgroups within the states, we believe a review of the current values for the variables of interest will illuminate gaps and challenges more clearly. As part of this effort, the committee commissioned a paper that aggregates consistent and normalized health indicators as they are currently available in the public domain (see Appendix C)
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figure for the purposes of this report and to provide clarity around the uniqueness of the Gulf region (see Figure 3-2)
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Unfortunately, the quality of granular health data within states, and especially the five Gulf states, is generally poor. Some common sources of statewide data are the respective state departments of public health, often through a center for health statistics; Medicaid agencies; hospital data; state departments of education; cancer registries; and law enforcement agencies.
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. Finding: Major data gaps exist within and across Gulf states for variables related to health and health-related community resilience.
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Regardless of how it is measured, resiliency is enhanced when the baseline levels of stress, discrimination, and suboptimal social determinants of health are minimized, and access to positive resources is equitable.
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. While both approaches can be useful at different junctures, to help ensure that communities derive the most benefit, organizations funding the collection of data on health and community resilience in the Gulf region need to prioritize community engagement over simpler forms of public participation in the research endeavor, helping to ensure that the data collected are fully contextualized -- understood and interpreted consistent with the needs and resources of the community.
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An increased focus on primary data collection specifically for use in assessing health and community resilience in the Gulf region would be one way to help develop a more complete picture for funders, policy makers, and communities. These data would be most useful if granular enough to support geographic analysis across multiple sectors, including environmental, health, education, justice, economic, and political, mapped to the forms of capital -- natural, built, social, financial, human, and political -- that enhance resilience.
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Previous research has captured the extent to which "survey fatigue" and similar factors create obstacles to the community engagement and effective partnerships that are so important in assessing the health and resilience of impacted communities. While the committee does not recommend the adoption of a particular set of instruments for measuring progress toward health and community resilience in the Gulf region, efforts by researchers and research funders to develop a common set of instruments, indicators, tools, and methodologies could contribute to the long-term sustainability of the research enterprise by reducing the resource requirements for research projects and, to some extent, the impacts on communities participating in the research.
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While there may certainly be places and circumstances in which the development of new instruments or tools is warranted, the overall research enterprise benefits if the instruments used to gather data advance a broader understanding. To that end, the greatest benefit can be derived if funders of research on health and community resilience in the Gulf region encourage grantees to make use of a common set of measures, and support investment in new measures only when the gap being filled and the value added by a new measure are clearly identified.
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. In 2018, 63 percent of new infections occurred among Black individuals living in the South, and between 2010 and 2018, five Gulf state cities in Florida (Orlando and Miami)
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. The mental health conditions among young people were likely exacerbated by increased stressors and traumatic experiences related to the pandemic, including reduced connections and in-person interactions with friends, social supports, school supports, and community supports, as well as experiences with death and loss, increased race-related violence, political polarization, and gun violence (HHS, 2021)
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Adolescents in the Gulf region encounter many geographic and socioeconomic obstacles to receiving medical and mental health care. The Southern region remains the poorest region in the nation.
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Finding: When one focuses on health indicators for specific social and demographic groups, disparities in the Gulf states are even more stark than what the aggregate values suggest. African American and Native populations face worse health conditions in the Gulf compared with their counterparts outside of the region, as do low-income households and youth.
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. This work then evolved into studies of latent or later-term consequences, such as the effect of childhood lead exposure on adult health behaviors and mental health (Albores-Garcia et al., 2021)
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. These dynamics are very much relevant to the Gulf region, as they are to any other region of the United States, and can serve as a valuable way to understand health and resilience among and between populations within the Gulf and in comparison with the broader U.S.
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This observation accords with an approach to remedying health disparities that focuses on specifically marginalized or disadvantaged groups, as it considers social position (Penman-Aguilar et al., 2016)
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census's Ameri can Community Survey and American Housing Survey, help fill gaps in available health-related data for the Gulf region. However, these datasets are constructed around demographic variables (such as race and ethnicity, educational attainment, and income and pov erty)
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56 ADVANCING HEALTH AND RESILIENCE IN THE GULF OF MEXICO REGION FIGURE 3-3 Percentage of total population who reported their race as Black or African American alone in the 2020 census at the state, county, and census tract levels.
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average of 9.3 percent. These stark, widely distributed, and sustained disparities affect health outcomes and resilience in the Gulf region.
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. In Louisiana, structural racism and social environmental risks have been linked to health outcomes as disparate as adverse pregnancy outcomes and COVID-19 mortality, demonstrating the breadth of the effect of race on key health metrics in the Gulf region (Hu et al., 2022; Lopez-Littleton and Sampson, 2020)
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As with social determinants, data on health behaviors in the Gulf are lacking in quality and completeness of indicators, but some notable insights still emerge from comparing the U.S. averages for several health behavior metrics with the averages across the Gulf region as well as within individual states.
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Health behaviors and beliefs, such as diet and food sources, are understood to inform individual, household, and community health conditions.
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. A racial disparity remains consistent throughout this metric as well, with Black individuals showing about a 50 percent greater rate of missing a doctor's visit relative to their White counterparts.
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. ASPE goes on to report in a brief that three of the five Gulf states considered in this report (Alabama, Florida, and Mississippi)
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providers, and other dimensions of the health system, is limited in the Gulf region compared with the rest of the country. Environmental Determinants Environmental factors beyond the immediate control of most Gulf residents and distinct from other factors related to social and economic determinants, health behaviors, and health care access help shape the region's current health conditions and resulting gaps.
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SOURCE: Derived using EPA's Environmental Justice Screening Tool (Version 2.1)
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. Likewise, Cancer Alley, the infamous corridor of major polluting facilities, lies squarely in the Gulf region (Terrel and St.
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SOURCE: Bowe et al., 2019. The most commonly reported effect of climate change with severe health consequences for Gulf communities is coastal flooding (see Figure 3-9)
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SOURCE: Derived using EPA's Environmental Justice Screening Tool (Version 2.1)
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Specific groups in the Gulf, especially low-income households and those living in predominantly African American neighborhoods, suffer disproportionately from historical and intransigent dispari ties in the social and environmental determinants of health, along with high exposure and vulnerability to resilience-challenging shocks relative to their counterparts outside of the Gulf. CONTEXTUAL CAUSES OF HEALTH AND RESILIENCE CONDITIONS IN THE GULF The literature on the role of nonphysiological determinants of health outcomes, such as the social and environmental conditions described above, is consistent and conclusive.
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That this racism, particularly anti-Black and anti-Native, has informed social relations and economic opportunity in the Gulf region cannot be denied. How this phenomenon has played out in each state and in the local jurisdictions within them varies significantly, however.
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. Racism also affects health throughout the life course by directly affecting adolescents and young adults through various mechanisms, affecting their brains and bodies, their parents' ability to protect and nurture them, and a neighborhood's ability to help them thrive, all of which lead to health disparities (Heard-Garris, 2021)
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. It is important to limit the use of race to monitor health inequities, which are rooted in the unequal distribution of the social determinants of health discussed above.
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. Careful consideration of the anthropological, ecological, economic, historical, and social contributors to the complex milieu that constitutes the social determinants of health is necessary to frame health status and outcomes authentically.
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Thus another fundamental contextual factor shaping health determinants is the amount of funding that goes to public health and health interventions, as well as the quality of those programs. The Gulf states are particularly noted for having among the lowest per capita tax revenues in the nation; in 2020, Mississippi ranked 34th among all states and the District of Columbia with its $2,730 per capita tax revenue; Louisiana was 40th with a $2,450 per capita tax revenue; Alabama was 41st with $2,447; Texas was 48th with $2,078; and Florida was 50th with $1,984 (FTA, 2020)
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Further evaluation of the potential causal links between social determinants and environmental and demographic factors would advance understanding of specific interactions and effects with respect to how contextual determinants have evolved and are cur rently experienced.
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Conclusion 3-6: Although financial resources for data collection in the Gulf states and local communities, as well as for their public health of ficials, are a priority, the knowledge and engagement of civil-sector entities and local organizers and leaders are critical as well. It is a best practice to involve and compensate these entities for their health data collection and research design involvement.
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for marginalized communities in particular; • the identification of best practices and supporting mechanisms for engaging a diverse group of collaborators, including com munities, nonprofit organizations, for-profit and nonprofit health care organizations, and academic institutions and re searchers, in data collection and management; and • a strategy for supporting robust, consistent data collection and timely sharing efforts across government through NCHS's en gagement with other federal agencies outside HHS collecting health and resilience data, including the Environmental Protection Agency, the National Oceanic and Atmospheric Administration, the National Science Foundation, and the Department of Housing and Urban Development, as well as state-level data coordinators. Recommendation 3-2: Funders supporting research in the Gulf region should take steps to ensure that local communities are engaged in the research through a range of strategies, including public participation approaches and more in-depth community engagement partnerships.
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