STATE HEALTH ASSESSMENT - LAST UPDATED 2020

Health Disparities

An individual’s health is impacted by many factors, including their race, age, sex, income, or disability.  Health disparities, when one group has a much higher rate of disease compared to another, is particularly pronounced for different racial and ethnic groups in Arkansas.

There are more than 2,380,000 whites in Arkansas, which makes whites the largest racial group at slightly over 78 percent in 2019. There are more than 471,000 blacks in Arkansas, which makes blacks the second largest group with 15.4 percent of the population. Hispanics are classified as an ethnic group and they comprised 8.5 percent of the state’s population in 2019. While the percentage of blacks in Arkansas is higher than the average for the U.S. as a whole (12%), the percentage of Hispanics is considerably lower than the national average (18%).

Arkansas Percentage of Population by Race/Ethnicity, 2010-2019

Source: U.S. Census Bureau, Population Division

Why Is This Important?

To understand the health problems facing the state it is important to look at the people and how they live. There are close to three million people living in Arkansas.  Children under the age of 18 make up 23 percent of the population while individuals over 65 make up 17 percent, with both rates closely resembling the rates for the U.S. There are 490,000 people in Arkansas who live with a disability, not including those who live in nursing homes. This is 18 percent of the total population, which is much higher than the U.S. rate of 13 percent.

The population in Arkansas is highly concentrated with nearly one-third of the state’s population residing in just three counties – Pulaski, Benton and Washington.

Population in Arkansas by county in 2019

Data Source: U.S. Census Bureau 2019 Population Estimates

Health Disparities

Why Is This Important?

In addition to an individual’s racial or ethnic group and where they live, many other factors have an impact upon their health, influencing not only their likelihood of suffering from a particular disease, but their opportunity to access health care and to practice healthy lifestyles. 

Health Disparities

Life expectancy is impacted by many factors, including an individual’s race or ethnicity, and where they live in the state.  All but one of the 75 counties in Arkansas had life expectancies lower than the national average. Benton County in northwest Arkansas had the longest life expectancy, which was 79.7 years. Monroe County had the shortest life expectancy of 70.6 years. This is a 9-year difference in life expectancy compared to Benton County. Most of the counties with the lowest life expectancies are in eastern and southwest areas of the state.

Life expectancy in Arkansas by county in 2018

Data Source: Arkansas Department of Health, Health Statistics Branch

Why Is This Important?

Life expectancy is a general way of measuring the overall health of a population. It is defined as the average number of years a person is predicted to live, based on the death rates for the year being studied.  In 2018 the average life expectancy in Arkansas was 75.8 years. This was about 3 years shorter than the U.S. life expectancy, which was 78.6 years.

Another important mortality indicator measures premature mortality which focuses attention on deaths that could have been prevented.  This measure - Years of Potential Life Lost (YPLL) - is used to measure the rate and distribution of premature Mortality and to, thereby, address issues of the impact of disease and death and their costs to society.

Health Disparities

Within the ten leading causes of death in Arkansas, the disparity ratio measures how much more likely death from a particular cause is expected to occur between different racial groups.  A higher disparity ratio indicates that a greater disparity exists.  In Arkansas, while Blacks and Whites have a similar likelihood of dying from Flu and Cancer, Blacks are twice as likely to die from Kidney Disease and Diabetes, and five times more likely to die from Homicide.

Leading Causes of Death by Black/White Disparity Ratio Arkansas

Why Is This Important?

Most of the leading causes of death in Arkansas are chronic diseases and these occur at a higher rate in the state over the United States as a whole.  Two common health problems that lead to chronic diseases are obesity and high blood pressure and both of these are widespread in Arkansas.  Another factor which contributes to the high rate of chronic disease in Arkansas is the lack of a healthy lifestyle as evidenced by tobacco use, poor diet, and a lack of physical activity.

Health Disparities

The infant mortality rate varies considerably by race, with the rate for blacks (2018) being nearly twice as high as that for whites or Latinos.

The rates also vary by geographic area, with some counties in Arkansas having rates four times higher than the rates in other counties.

Infant mortality rates in Arkansas by county for 2015 to 2019

Data Source: Health Statistics Branch, Arkansas Department of Health

Note: Data are provisional and may change.  Some counties experienced a small number of infant deaths (less than 10) during this five-year period; therefore, caution should be taken when interpreting the data.

Why Is This Important?

High infant mortality is an indication of serious public health problems.  Arkansas has a higher infant mortality rate (death of the infant in the first year of life) than the average for the U.S., a higher neonatal mortality rate (death of the infant in the first 28 days of life), and a higher post-neonatal mortality rate (death of the infant between the ages of 28 days and one year).

Health Disparities

Certain groups of people are at higher risk of low health literacy and these include people who are age 65 and over, racial and ethnic minorities, people with less than a high school education, and people who live in poverty. People who live in rural areas, who are either covered by Medicare or Medicaid, or have no health insurance, are also more likely to have low health literacy. 

Percent of Arkansas population with low health literacy

Data Source: The Rand Corporation Health Literacy Estimates, 2012

Per Person Health care costs related to low health literacy

Data Source:  “The Economic Impact of Low Health Literacy in Arkansas,” Journal of The Arkansas Medical Society, 2017

Why Is This Important?

Low health literacy is a problem because it can lead to poor health and poor quality of life. People who struggle to understand and use health information are more likely to have less knowledge about diseases and conditions, to have serious health problems, and to have serious complications from chronic diseases, such as asthma, diabetes, or heart failure. They are likely to have more emergency room visits, more (or longer) hospital stays, a shorter life expectancy, and higher medical costs. 

Low health literacy also impacts the entire health system which may ultimately result in a higher rate of medical mistakes and higher costs. Low health literacy may lead to the inappropriate use of health services, both in terms of the underuse of needed health services and the overuse of unnecessary services.

Health Disparities

Many of the social and behavior determinants which impact health have a disproportionate impact upon racial and ethnic minorities, as demonstrated in the indicators in this scorecard.

Why Is This Important?

Social and behavioral determinants make up the largest group of factors that determine health.   The social factors which have the most significant impact on poor health for Arkansans include exposure to violence, exposure to suicide, having a family member in prison, and Adverse Childhood Experiences (ACEs).  Behavioral determinants which have a negative impact include drug, alcohol, and tobacco use, obesity and exercise, sleep patterns, and safe practices while in a car (using a seatbelt) and operating a motorcycle (wearing a helmet).

Health Disparities

Higher rates of incarceration are often seen among racial/ethnic minorities and people with lower levels of education.

Why Is This Important?

The United States has the largest prison population in the world and the number of people in prison in Arkansas is growing faster than any other state.  Incarceration can affect the health and well–being of those currently incarcerated, those with a history of incarceration, and their families and communities.  The financial security of a family can be significant impacted by the incarceration of a parent and this, in turn, can make it less likely that children in these families will live in neighborhoods with good schools, have safe and affordable housing, or have good jobs.

Health Disparities

Research shows that children in low-income households or those belonging to racial and ethnic minority groups have disproportionally greater exposure to ACEs compared to white children, and that they experience significant disparities in both early brain development and healthcare access as a result of increased exposure.

Why Is This Important?

Many children in Arkansas suffer an intended or unintended adverse experience which may cause physical, emotional, or psychological harm that cause delays in the development of their social, emotional, or mental abilities.  The effect of these experiences can have lifelong health consequences.

Adverse Childhood Experiences (ACEs) Rates in Arkansas, 2018

Data Source: Child Trends, Research Brief, Updated February 20, 2018

In Arkansas, almost 6 in 10 (56%) children have experienced at least one ACE and over 29% have experienced two or more. Both rates are higher than in the United States as a whole, where less than 5 out of 10 children have experienced at least one ACE and 21% have experienced two or more.

Percentage of Children (Birth – 17) and Number of ACEs, AR and U.S.

 Data Source: Child Trends, Research Brief, Updated February 20, 2018

Health Disparities

Opioid prescribing varies among the regions in the state.

Opioid prescription rate per 100 people per county based on patient address, Arkansas, 2019

Data Source: Arkansas Prescription Drug Monitoring Program

Overdose death rates per 100,000 people per county based on individual address, Arkansas, 2019

Data Source: Arkansas Prescription Drug Monitoring Program

Why Is This Important?

Drug-related deaths are the second leading cause of unintentional injury-related death in Arkansas and in 2019, the prescribing rate for opioids in Arkansas was the second highest in the nation.  High levels of availability of prescription opioids creates more opportunities for misuse and addiction among those at risk.

Health Disparities

People in rural Arkansas are impacted by a shortage of health care options and professionals in their communities.  Many of the rural counties have been designed as Medically Underserved Areas (MUA) and have also been identified as suffering from shortages of Health Professionals in Primary Care, Mental Health Care, and Dental Care.  For example, rural areas in Arkansas have 73 primary care doctors for every 100,000 residents, while cities have 133.

Arkansas medically underserved areas, 2019

Data Source: Arkansas Department of Health Office of Rural Health and Primary Care, April 2019

Arkansas Primary Care Health Professional Shortage Areas, 2019

Data Source: Arkansas Department of Health Office of Rural Health and Primary Care

The ability of rural residents to cover the cost of healthcare also contributes to poor health outcomes in these communities.  While 15.3 percent of Arkansans report that they were not able to see a doctor in the past 12 months due to the cost, more than 20 percent of residents in rural communities did so.

Why Is This Important?

We know that people who live in rural counties tend to have shorter life expectancies.  Babies in those counties tend to have higher infant death rates.  And the people there are more likely to struggle with low health literacy. 

In many ways people who live in Arkansas’s rural areas have the same barriers to good health as people who live in Arkansas’s cities. However, they may also experience barriers that people who live in cities may not.  For example, people who live in rural counties have higher rates of chronic diseases and are more likely to be involved in serious accidents.  Yet people who live in rural areas must travel greater distances to see a doctor or go to the hospital.  In some rural counties, there are no hospitals. People who live in rural communities may not have grocery stores where they can buy food for a healthy diet, such as fresh fruits or vegetables.  Barriers such as these must be removed if we want all Arkansans to have the same chance to enjoy good health. 

Nearly half of Arkansans – 44% - live in rural areas, with 53 of the 75 counties in the state being classified as rural.

Rural counties in Arkansas

Data Source: US Census Bureau, 2018

Health Disparities

Food insecurity is particularly prominent in rural counties, with some having rates considerably higher than the State average of 17%.  Rural Phillips County, for example, has a rate of 30% and the 6 east Arkansas rural counties adjacent to the Mississippi River have rates of at least 25 percent.

Food Insecurity in Arkansas, 2017

Data Source: https://map.feedingamerica.org/county/2017/overall/arkansas

While food deserts can be found throughout the entire State, they are particularly prevalent in rural counties.

Food deserts in Arkansas, 2015

Data Source: U.S. Department of Agriculture Economic Research Service

Why Is This Important?

An estimated 17% of Arkansans suffer from food insecurity, although this rate varies considerably by different regions in the State.  Food insecurity has a disproportionate impact upon children as it can permanently change a child’s brain development, resulting in learning difficulties and poor social skills.

Food deserts, places where convenience stores and fast food restaurants provide the main source of food for residents in these areas, are a main cause of hunger and increase the risk of obesity in children and adults.

Health Disparities

In Arkansas, the groups who encounter the greatest health disparities are Blacks, Hispanics and those who live in rural areas.

Why Is This Important?

Health equity – where everyone has the same ability to use the health care system – is heavily influenced by a myriad of social factors which make it more difficult for some groups to access and receive good health care.

Health Disparities

In Arkansas, over 30% of Hispanics considered their health to be fair or poor in 2018, in comparison to 23.4% of Blacks and 24.3% of Whites.

Why Is This Important?

The health status of a population can be measured by a wide range of factors with life expectancy, general mortality data and infant mortality considered to be the most indicative of overall population health.  However, self-assessed health status is also considered to be a useful indicator because it measures how an individual perceives his or her own health—rating it as excellent, very good, good, fair, or poor. While lacking the statistical validity of the other indicators, self-assessed health status allows for broad comparisons across different conditions and populations.

Health Disparities

The rate of obesity varies across different demographic characteristics with higher rates in rural areas, in areas characterized by food deserts, and across different race and ethnic groups.

Why Is This Important?

Obesity is a health problem that can lead to several types of chronic diseases, especially diabetes.  In Arkansas, over 2 out of 3 (almost 68 percent) of adults are either overweight or obese. People who live in the counties with the shortest life expectancies are even more likely to be overweight or obese.

A lack of physical activity can hinder a person’s ability to maintain a healthy weight and is a top cause of chronic diseases.

Health Disparities

Although new treatments now mean that HIV is treated as a chronic disease rather than a fatal illness, the success of these treatments is impacted by an individual’s ability to begin treatment early in the disease. This access varies for different groups, particularly among low-income populations and those who are uninsured. The mortality rate for HIV also varies by race in Arkansas, with the death rate for blacks being almost 5 times higher than for whites.

Why Is This Important?

Human Immunodeficiency Virus (HIV) is an important marker for a range of risky health behaviors and it can put a significant burden on the population and the health care system, with estimates suggesting that HIV can cost nearly $40,000 a year to treat the infection for the rest of one’s life.

Health Disparities

From 1993 to 2010, the number of TB cases reported in the United States decreased from 25,103 to 11,182. Despite the decrease, TB continues to affect many communities in the United States disproportionately and unequally, especially racial/ethnic minorities and foreign-born persons. TB remains one of many diseases and health conditions with large disparities and inequalities by income, race/ethnicity, educational attainment, and other sociodemographic characteristics.

Why Is This Important?

The rate of Tuberculosis (TB) in the Arkansas Marshallese community is higher than any other population in the state. There have been 191 reported cases over a 21-year span with 3 major outbreaks (in 2004, 2014, and 2017). Most of these cases happen to children.

Health Disparities

Data indicates that of the main racial/ethnic groups in Arkansas, Hispanics have the lowest level of smokers at 15.6% (2018), compared to 20.8% for Blacks and 23.2% for Whites.

Why Is This Important?

Tobacco use is the most preventable cause of death in Arkansas.  It is a leading cause of short life expectancy in the state and is a major contributor to chronic diseases such as heart disease, cancer, chronic lung disease, and stroke.  In addition to this human toll, smoking is estimated to result in $1.3 billion a year in medical treatment and $1.7 billion in lost productivity. While the percentage of adults who say they are smokers has gradually decreased in the last eight years, the 2018 rate of 22.7% is considerably higher than the rate for the U.S. as a whole (13.7%).

Health Disparities

A lack of sufficient dental providers is one barrier to accessing oral health care and this is prevalent in a number of rural areas in Arkansas.  Sixty percent of the state’s dentists practice in just eight of the state’s 75 counties, although these eight counties have only 40 percent of the state’s population. Nineteen Arkansas counties are designated whole or in part Dental Health Professions Shortage Areas (HPSA) and these are in rural areas.

Why Is This Important?

Poor oral health, which pertains not only to teeth but to the health of the whole mouth and related structures, is another factor that contributes to poor health. Tooth decay in young children can begin shortly after the eruption of their first tooth. When a child starts life with tooth decay, they are much more likely to have severe dental problems as an adult. Untreated dental disease can lead to serious health effects including pain, infection, and tooth loss.  In worst cases, untreated tooth infections and abscesses can lead to death. Poor oral health can also cause cancers of the mouth or pharynx.

Health Disparities

There are substantial differences in uninsured rates for different groups, with people with lower incomes, people in rural communities, and racial and ethnic minorities being most likely to lack health insurance coverage. 

Why Is This Important?

Lack of health insurance coverage may negatively affect health particularly by restricting an individual’s access to health care services.  Uninsured adults are less likely to receive preventive services for chronic conditions and children without health insurance coverage being less likely to receive appropriate treatment for conditions like asthma or preventive services such as dental care, immunizations, and well-child visits.  Out-of-pocket medical care costs may lead individuals to delay or forgo needed care and medical debt is common among both insured and uninsured individuals. 

In Arkansas 25 percent of working-age adults have no health insurance.

Why Is This Important?

Each year new issues emerge which have an impact upon public health.  In some cases, these issues are short-lived, impact only a small number of people, or are heavily concentrated in a particular region.  Unfortunately, the three emerging issues covered in this section – drug misuse, antibiotics, and COVID-19 – have none of those characteristics and are taking a significant toll upon individuals and societies across the U.S., and in the case of COVID-19, across the entire world.

Health Disparities

Drug related death rates are highest in the White population.

Data Source: Centers for Disease Control and Prevention WONDER

Why Is This Important?

The issue of drug misuse and addiction has become a serious public health emergency for the United States over the past twenty years.   In 2016, over 60,000 Americans died from drug overdoses, making overdoses cause more deaths than motor vehicle crashes.  Arkansas has also seen a rise in drug overdoses in recent years and in 2018, 426 Arkansans died from a drug overdose with opioids being the most widely identified drug.

Why Is This Important?

With antibiotics being the most commonly prescribed drugs, it is estimated that up to half of the antibiotic use is not needed. Antibiotic resistance caused by the overprescribing of antibiotics is a public health threat that has a significant impact upon the healthcare system, demonstrated by longer and more costly treatments, longer hospital stays, and extra doctor visits. In Arkansas, there are 1,154 antibiotic prescriptions filled for every 1000 people. This is the seventh highest rate in the United States.

Antibiotics dispensed in U.S. community pharmacies in 2018

National: 763 per 1,000 population

Arkansas: 1011 per 1,000 population

Data Source: Centers for Disease Control and Prevention

Health Disparities

The health risks and impacts of climate change are not equally distributed across people, communities or nations, and they differ by geographical location, race/ethnicity and income.  For individuals, two critical components that make them more susceptible to the effects of climate change are pre-existing health status and living conditions.  As these conditions are disproportionately found in low-income and communities of color, they are, and will continue to be, unequally affected by the health impacts of climate change.  How this will be manifested in Arkansas specifically, has not yet been determined.

Why Is This Important?

The effects of climate change on human health are significant and, across the globe, increases in starvation, heat injury, allergy, mental health problems, and infectious diseases, are being recorded.  While the worst effects of climate change are, and will continue to occur at the north and south poles and at the equator, changes are having an impact across the planet and in Arkansas as well.  While an increase in night-time temperatures is already being recorded, other changes, potentially resulting from climate change, are anticipated including rainfall rates, pollen levels, and air pollution levels.   Many of these changes will directly and indirectly impact the health of individuals and the healthcare system in general.  As an example, treatment for heat exhaustion in Pulaski County during the last 7 years has nearly doubled, and these treatments happened when temperatures were above 90 degrees F.

Number of individuals in Pulaski County hospitalized with heat exhaustion 2012-2018

Data Source: Hospital Discharge Data, Health Statistics Branch, Arkansas Department of Health

Health Disparities

During January 1 - August 10, 2020, an estimated 5 million cases of COVID-19 were reported in the United States and data indicated that the rates of infection, as well as the severity of the illness, the rate of hospitalization, and the risk of death, were not evenly distributed across racial and ethnic groups, with Hispanic and Black individuals being impacted at a disproportionate level.  In Arkansas, data collected on 9/1/2020 revealed that, among racial groups, Blacks accounted for 24% of total cases which is higher than their population rate for the state of under 17% (for 2019).  As an ethnic group, Hispanics accounted for over 21% of total cases which significantly exceeds their population rate for the state of 8.5% (for 2019).

Why Is This Important?

The COVID-19 pandemic has had a profound impact in Arkansas, the entire U.S. and across the globe.  While the long-term effects of the pandemic will continue to unfold, the short-term effects have been felt by every individual and across every sector.  With the impacts upon the healthcare industry being most apparent, the impacts upon the economic, educational, manufacturing, transportation and other sectors have also been severe.