Dr. Sai Kurmana shared his data-driven approach to addressing health inequalities in the Mississippi Delta in this breakout session at NNPHI’s Open Forum Next Generation conference held in Indianapolis, Indiana. Epidemiologist by training, Dr. Kurmana focusses on non-communicable diseases such as heart disease, strokes, and cancers. He is currently the Director for Health Surveillance and Research within the Office of Preventive Health at the Mississippi State Department of Health and has been in the field of Public Health for over 10 years.
The Mississippi Delta is in the northwest section of the state and is between the Mississippi and Yazoo Rivers. The counties that make up this region “are characterized by high levels of poverty, high prevalence of chronic disease, and mortality rates that significantly exceed the national average” (Ross, 2020). An assessment of factors contributing to health disparities pointed to historical socioeconomic disadvantages as well as health factors such as tobacco use, diet, exercise, and alcohol and drug use (Gennuso 2016). It is also well established that income is a predictor of mortality, and the legacy of chattel slavery in the region still negatively impacts residents’ health (Owens 2019). The Mississippi Delta region grapples with the nation’s most alarming rates of infant mortality, heart disease, and other cardiovascular mortalities in the nation.
Dr. Kurmana approaches this health disparity by using a data-driven approach and specifically looks at heart disease as an indicator. He has developed a “Social Disadvantage Index” to use the data to quantify the communities of disadvantage. This index uses multiple and overlapping forms of community disadvantages, including poverty, unemployment, underemployment, poor housing, social isolation, poor health, and limited access to education and services. This comprehensive index assigns each community to categories ranging from the most disadvantaged to the most advantaged.
Using this Social Disadvantage Index, the team identified priority communities and looked at the root causes of both hypertensive and ischemic heart disease. A significant focal point emerged: access and utilization of care. Local experts actively gather data on care access and utilization. This data, funneled to Dr. Kurmana’s group, is processed and fed back, establishing a cyclical and collaborative framework. The data collection spans a spectrum of locations: from unconventional venues like a barbershop-based blood pressure clinic to mayoral health councils, churches, community-based organizations, community health centers and lifestyle change programs and other specialized cardiac rehabilitation units.
One of the most advantageous aspects of this approach is its ability to calculate the number of people needed to be reached by the healthcare system in order to set about change. The team can analyze how many people in each area need to be contacted to change the overall county’s health outcomes. One reason that these targeted interventions are possible is the diverse stakeholders and teams that work together, both to collect data around access and utilization of care and to analyze the data for suggested targeted interventions. Data analysts, local health advocates, and programmatic experts converge to both garner insights and orchestrate interventions, ranging from comprehensive health screenings to bespoke educational campaigns. Another example of an intervention is community pharmacists educating people about their heart medications in a more targeted manner.
Central to this data-anchored methodology is an expansive collaboration. Collaboration between the epidemiologists and the local healthcare systems, local governments, local hospitals, local health departments, providers, and countless other members is crucial to this data-driven approach. Health equity is fundamental and promoting inclusivity is key to health and wellbeing, as well as the success of this project.
Navigating the intricate maze of health disparities necessitates a multifaceted strategy. The complex strategy encompasses data, policy, systems change, cultural norms, and environmental change to find where a discernable improvement can be achieved. While health challenges in Mississippi Delta’s core remain formidable, innovative epidemiological techniques paired with actionable insights augur a future marked by incremental yet impactful betterment. Overcoming challenges, such as health disparities in the Mississippi Delta, requires a collaborative effort across public health organizations and sectors.
Gennuso KP, Jovaag A, Catlin BB, Rodock M, Park H. Assessment of Factors Contributing to Health Outcomes in the Eight States of the Mississippi Delta Region. Prev Chronic Dis 2016; 13:150440.
Owens DC, Fett SM. Black Maternal and Infant Health: Historical Legacies of Slavery. Am J Public Health. 2019 Oct;109(10):1342-1345. doi: 10.2105/AJPH.2019.305243. Epub 2019 Aug 15. PMID: 31415204; PMCID: PMC6727302.
Ross LA, Bloodworth LS, Brown MA, Malinowski SS, Crane R, Sutton V, et al. The Mississippi Delta Health Collaborative Medication Therapy Management Model: Public Health and Pharmacy Working Together to Improve Population Health in the Mississippi Delta. Prev Chronic Dis 2020;17:200063.