Union County, Southern Arkansas, and rural regions across the country are grappling with an ongoing health crisis that shows little sign of slowing down.

According to the Congressional District Health Dashboard, a collection of health-related statistics compiled by the Department of Population Health at NYU Grossman School of Medicine, Arkansas’s 4th congressional district — of which Union County is a part — is below than the US average in several areas of physical and mental health.

The District Health Dashboard uses statistics compiled from “federal, state and other datasets with exacting standards for collection and analysis,” according to its website.

Arkansas’ 4th congressional district consists of most of the southern and western counties of the state.

Cardiovascular health is an area where the district suffers most compared to the rest of the country, with approximately 305.1 deaths per 100,000 from cardiovascular causes, compared to 205.7 per 100,000 in the United States as a whole and 277.2 per 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 US Centers for Disease Control.

About 41.4 percent of adults in the borough reported high blood pressure, according to an estimate compiled from a 2019 Centers for Disease Control study. The national average is 31.5 percent.

Diabetes is also more prevalent in the borough than nationally, with 13.5 percent of adults reporting diabetes in the same 2019 Centers for Disease Control study, versus 10.4 percent nationwide.

Obesity is another condition that is slightly higher in the borough, with 37.9% of adults reporting a body mass index (BMI) greater than 30, versus 31.9% nationwide.

Julie Wylie, a nurse practitioner (APRN) at the Medical Center of South Arkansas, said several factors can combine to cause and exacerbate cardiovascular problems. Preventive care is, essentially, linked to lifestyle.

“It starts with the patient… It’s about taking control of their health, eating healthy, controlling their blood pressure and weight,” Wylie said.

Important adjustments include stopping smoking, reducing alcohol consumption, controlling blood pressure and weight, and exercising, all of which are important for maintaining cardiovascular health.

And while self-discipline and genetic factors can certainly play a role, it still leaves the question of why the South, and the largely rural regions within it like Arkansas 4th, fare worse on several health metrics.

Dr Brian Jones, chairman of the SHARE Foundation, said the reality of rural and small-town life is a factor that cannot be counted.

“With cardiovascular health, you just look at how many fried food places we have or how many people eat at gas stations and the type of food there. There aren’t many fresh food options and not many restaurants that specialize in healthy foods. Unhealthy food is cheaper,” Jones said.

Jones, who is also currently an adjunct professor at Southern Arkansas University where he teaches a course in health care law and policy, added that other factors are also relevant, including transportation that focuses on the car rather than cycling or walking, and rates higher than smoking.

“I was on the parks and playgrounds committee and they’ve done a lot to improve the parks. But we don’t have many sidewalks here, even compared to other parts of Arkansas,” Jones said, adding that even a visit to the South Arkansas Arboretum o to the Lion’s Club walking path requires most residents to drive to get there.

Another barrier in rural areas and small towns is the availability of advanced cardiovascular care, as well as post-operative care such as rehabilitation.

Cardiologists are available in southern Arkansas, including at MCSA, for assessments and procedures such as stints. Wylie also touted the skills of the Medical Center’s emergency room workers 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, an everlasting problem is simply attracting health care workers to the area.

“In a rural area, it can be more difficult to recruit suppliers. It’s not something (MCSA) has done wrong; it can just be difficult to get people to move to a small town,” Wylie said.

But resources are available locally for preventive 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 ask ourselves, ‘did it really reach the people who come?’ But, if just one person has more mindfulness or makes lifestyle changes, that’s another person who will benefit,” Wylie said.

The SHARE Foundation also helps fund and oversee wellness-focused agencies such as eXtreme Youth Programs and HealthWorks Fitness Center.

“Many people don’t realize that we have 200 people who come to Healthworks every month as members who are referred by their doctor and can become a member for free,” Jones said.

Another SHARE agency is the Interfaith Clinic, a non-profit medical clinic that helps provide care for uninsured and low-income patients in the county.

According to an article published in the American Heart Association’s journal “Circulation,” https://www.eldoradonews.com/news/2023/mar/26/check-up-a-look-at-physical-and-mental-health -in/”A large study in the United States and Finland found an increased risk of non-fatal myocardial infections and sudden cardiac death in low-income cohorts that persisted after adjusting for smoking and alcohol consumption.”

Economic and quality of life factors also show the ways in which the district lags behind the country at large. According to data based on statistics compiled by the American Community Survey, 24.9 percent of children in Arkansas’ 4th congressional district live at or below the federal poverty level, compared to 16.4 percent nationally. The state average for the same statistic was 21.5%.

Jones said the Interfaith Clinic sees and helps a number of patients with diabetes who receive insulin prescription help.

Mental health indicators are also shown on the dashboard.

In southern Arkansas, 18.9% of adults reported mental health problems for more than 14 days in the past month compared to 14.9% nationwide. Gun suicides in Arkansas’s 4th congressional district are also higher, with 13.8 deaths per 100,000 attributable to that versus 7.6 nationwide.

Jones said fighting the stigma around 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’re Southern issues too … When someone feels like they’re having thoughts that don’t make sense or other mental health issues, there are stigmas in areas rural and the South in particular about it,” Jones said.

One way to combat this, according to Jones, is to incorporate 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, she added, to likewise add mental health checkups in routine visits. Currently, the clinic refers patients in need of mental health care to Newhaven Health and Counseling Services.

“We’ve worked with Newhaven and it’s been great, but it would be nice to have a one stop shop,” Jones said.

While none of the statistics show particularly good news for the 4th District, it parallels or approaches national averages in some areas, including unemployment (6%); the percentage of the population aged 65 or under who is uninsured (9.8%); and the percentage of the population that spends more than 30% of income on rent (43.7%).

For more information about Southern Arkansas Medical Center, visit themedcenter.net.

For more information about the SHARE Foundation, visit sharefoundation.com.

More information about the metrics used for the statistics in this article is available at congressionaldistricthealthdashboard.org/metrics.