The Deep South: Geography as a Risk Factor

Red America forms a thick, inland L in the flat midsection of our country, bordered as much by geography as by political preference. The Rocky Mountains and Mississippi River shepherd the younger constituents of this conservative nation-within-a-nation down towards the Zip-A-Dee-Do-Dah Glory of the American South, where the colors of Old Glory’s stripes mix with the rebel red of the Stars and Bars in a melange of real and imagined patriotism. The original nucleus of the Confederacy lay in the states of Texas, Louisiana, Mississippi, Alabama, Georgia, South Carolina and Florida, who were the only seven ratified states to secede from the Union during that lovely four year trial separation we had in the 19th century. Since then, Texas and Florida have (d)evolved into bizarre mini-regions unto themselves1, while their former Confederate brethren seem to have been preserved in amber. These five states are normally included in any description of the Deep South and are redder than Rudolph’s nose dipped in molten lava.

Louisiana, Mississippi, Alabama, Georgia and South Carolina make up the supple underbelly of America, both literally and figuratively. If you look at America like a slaughterhouse pig, then the Deep South is situated exactly where the butcher would carve up the savory belly meat and bacon. As any bacon and spare rib connoisseur can attest, this is without question the most delectable section of swine there is. Eating a pork belly slider is like chowing down on a giant slab of pig butter sandwiched between two pieces of bread. However, as might be expected, the deliciousness of this cut of pig is indirectly proportional to how healthy it is. I’m pretty sure if you ate pork belly every day for a year that your doctor would be able to hear your heart crying through her stethoscope. Likewise, the Deep South is far and away the most unhealthy region in the United States and may very well get even less healthy in the near future.

According to the 2012 CIA World Factbook, the average life expectancy in the US is 78. 52 years, which ranks us 51st in the world out of 222 countries. This low of a number isn’t anything to write home about, especially considering the fact that America spends more on health care than any other nation on the planet, but it isn’t wholly embarrassing either. The vast majority of the countries that rank above us are fully developed nations with universal health care and our life expectancy is only about a year lower than the European Union. The situation in “Red America” is a totally different story.

When all of the Southern states’ life expectancies are removed from the equation, the average lifespan of an American rises by about 7 months to 79.1 years. This is largely due to the fact that 12 of the 13 US states with the lowest life expectancies are in the American South, with Washington DC being the lone exception. The states that combine to make up the American South have an average life expectancy of 76.4 years, with the 5 Deep South states clocking in at an average of 75.8 years per resident. Living in the South essentially takes 3 years off of your life.

The Deep South has an average life expectancy similar to that of a Third World nation.

The Deep South has an average life expectancy similar to that of a Third World nation.

If we were to put this in a global context and consider the Deep South as being a nation unto itself, it would rank 86th in the world in life expectancy, falling behind 18 developing countries3. The list of healthy, happy countries that have longer-living populations than the Deep South include such humanitarian luminaries as Ecuador, Sri Lanka and Libya. When it comes to long term health outcomes, the Deep South is essentially a Third World country. Mississippi, a state which ranks at the bottom of virtually every measurable standard of living in America4, actually has a shorter average life expectancy than the West Bank and Syria. It is a tragic and unnecessary reality that someone who suffered under the maniacal rule of a genocidal despot for 34 years in the North African desert can expect to live longer than someone with the misfortune to be born on the Mississippi Delta or have George Wallace as their governor. A man living in the former Soviet republic of Georgia now has a longer life expectancy than someone who grew up in Ray Charles’ Georgia.

Naturally, it looks like it’s getting worse before it gets better. In a display of astonishingly infantile petulance, the governors of 9 states, including all 5 states in the Deep South, have publicly stated that they will be refusing Medicaid expansion funds from the federal government under the false pretense that their state governments couldn’t absorb the cost. With that in mind, I invite you to consider the fact that the Fed is set to pick up the entirety of the tab for the three years after Medicaid expansion starts in 2014 and will continue to pay 90% of the cost after that. A recent study by the Kaiser Family Foundation shows that these new Medicaid costs represent a 0.1% increase in total state spending relative to the overall state general fund. With this 0.1% increase, the Deep South would be able to provide over 2 million low income Americans with the health care that they desperately need.

There is nothing new about any of this. The Mason-Dixon line has served to cleave our nation into two separate and unequal halves since the framers of the Constitution put pen to paper. Free vs slave, industrial vs agricultural, integrated vs segregated, Union vs Confederacy—there has never been a moment in the history of America that wasn’t in some way shaped by this divide. In the 1950s and 60s, young men and women flooded in from the North and the West without hesitation to answer the clarion call of the Civil Rights Movement. Things were simpler back then: the racism was more bilious and the poverty more galling. Those that came down only stayed for a short time, leaving once they felt their duty was done. But, as Mississippi’s favorite son once said, the past is never dead. It’s not even past. Though the dirt roads are paved and the schools are mixed, there is still the palpable stench of iniquity in the Deep South. We have been lulled into believing Jim Crow to be dead while the prisons built to house his children and grandchildren are filled to capacity. If the words of the Great Emancipator hold true and a nation divided cannot indeed stand, then we must choose whether we want to come together or lie down.


1 There are still parts of East Texas and North Florida that have remained demographically and ideologically wedded to their Confederate roots, but they are in no way representative of the larger population of the state. Florida voted for Barack Obama the past two elections and has a huge hispanic and Jewish population, while Texas could very easily by divided up into 6 distinct states, as demonstrated in this clip from the Richard Linklater film Bernie:

2 Statistics on life expectancy courtesy of the CIA World Factbook:

3 A “developing country” is defined here using the criteria set by The World Bank, which defines such nations as those that have a Gross National Income Per Capita of less than $11,905.

4 Mississippi ranks dead last (or first, depending on how you look at it) in the US in the following categories: average life expectancy, obesity, diabetes, high blood pressure, median family income, per capita income, residents living below the poverty level, high school graduation rate, infant mortality and I could actually go on, but its too damn depressing.

Categories: General Health/Medical, Social Justice, US Politics

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