Arkansas Town Mobilizing to Overcome Poor Health Rankings
Larry Braden, MD, started practicing medicine in the south Arkansas town of Camden in the early 1980s, soon after completing his residency at the University of Arkansas for Medical Sciences (UAMS). Camden was then a thriving community whose economy was supported by industry. But then key industries left, and by 2014 the county Camden is in was ranked last among Arkansas’ 75 counties for health outcomes and quality of life by County Health Rankings for the United States.
That news jolted Dr. Braden, who rallied other Camden citizens to action. They have resolved to bring their town back. Leaders at the UAMS Fay W. Boozman College of Public Health (COPH) also want to be involved in that effort. Preliminary discussions have centered on possible ways that faculty and doctoral students could lend their expertise; those interested are encouraged to contact COPH Dean James Raczynski, PhD.
Dr. Braden is the President of the Arkansas Board of Health and a family physician at the Ouachita Valley Family Clinic. In a presentation on Oct. 29 at Arkansas Department of Health Grand Rounds, “Is There Any Hope – A Community Response to Health Rankings,” Dr. Braden told the story of Camden’s decline and what the community is doing about it.
“The health rankings are much more than health statistics,” he noted. “They are a measure of human suffering that can be found in every one of our communities.”
In the early 1980s, Camden’s downtown had two department stores, a hardware store and a coffee shop that was a popular early morning gathering place.
“It seemed like a very vital, alive, cohesive community,” Dr. Braden recalled. “Now the downtown is in disrepair, and once beautiful homes are unkempt.”
By the late 1980s, several industries had closed their Camden facilities. The percentage of residents living in poverty in Ouachita County, where Camden is located, was 18 percent. By 2013, that had risen to 26 percent.
“A mobile middle class left our community, and the poor were left behind,” Dr. Braden said. “Poverty is the reason why we have more problems than other communities. The County Health Rankings correlate very well to our experience. We are at the bottom of the heap in regard to health behaviors and economic factors” – the primary drivers of health outcomes according to the ranking system.
Poverty has accentuated divisions of class and race in Camden. Even in a town as small as Camden, whose estimated 2014 population was 11,569, income inequality has frayed the social cohesion of the community, consistent with local and national patterns across the globe, as measured by the Gini coefficient, a measure of the degree of inequality in the distribution of family income across a geographic area.
“With a rise in the Gini Co-efficient there is a decrease in trust,” Dr. Braden said. “The affluent don’t spend time with the poor and don’t know them or understand them. They come to not trust them. That is what is going on in a lot of our communities.”
When a well-to-do Camden resident complained to Dr. Braden about long wait times to see a doctor, he observed, “Build me a community to attract doctors and nurse practitioners and they will come.”
During past 15 months, Camden leaders and regular folks have come together to lay the groundwork for creating a community environment that fosters health. In October the newly formed HOPE coalition – the acronym stands for health outcomes, positive effects – met for the first time. On the drawing board are plans for walking and bike trails, sidewalks, access to fresh and affordable foods, better transportation, renovating an old school gym to be a community center, and a centralized connecting point (“The Hub”) where citizens can access needed services.
“In all these things, Camden has awakened and is getting some things done,” Dr. Braden said. “Apathy and old ways of complaint without solutions have become unacceptable.”
Real change will take more than creation of tangibles such as community gardens and sidewalks, it will take changes in relationships, understanding and attitudes, noted Dr. Braden, who is also an Episcopal priest for a small parish in Camden.
Barriers will need to come down and trust built. Bringing blacks and whites together is the aim of a new venture, Unity in the Community.
“Blacks and whites have pulled together in common activities so that we can love and know each other more,” Dr. Braden said.
The serious public health problems affecting Camden and the health of its citizens will require new understanding about people who are poor and why violence, criminal behavior, poor health choices, teen pregnancy, and dropping out of high school are more common among them.
“The poor are acting in very predictable and consistent ways; the higher the income inequality, the worst behaviors and poorer health,” Dr. Braden said. “We have got to stop sitting around the table and condemning the behavior of the poor. We have got to identify the poor and give them a pathway out of poverty. We have not valued them as individuals and what they might bring to the community. We need to find a way to refranchise the poor.”
Dr. Braden knows that much work lies ahead if Camden’s quality of life and health outcomes are to improve. There have been 15 months of preliminary discussion and planning. In the next phase, the HOPE coalition will develop a set of recommendations for government leaders and citizens. No target date has been set for that to be completed.
“We are getting people talking, and something good will come of it,” Dr. Braden said.