With Roots In Civil Rights, Community Health Centers Push For Equity In The Pandemic
A federally funded clinic in rural Mississippi embodies the history of community health centers in the U.S., and shows how these safety-net clinics can help minority patients during the pandemic.
In the 1960s, health care for Black residents in rural Mississippi was meager. Most health systems were segregated. Although some hospitals did serve Black patients, they struggled to stay afloat. At the height of the civil rights movement, young Black doctors decided to launch a movement of their own.
"Mississippi was third-world and was so bad and so separated," says Dr. Robert Smith, "The community health center movement was the conduit for physicians all over this country who believed that all people have a right to health care."
In 1967, Smith helped start Delta Health Center, the country's first rural community health center. They put the clinic in Mound Bayou, a small town in the heart of the Mississippi Delta, in the northwest part of the state.
The center became a national model and is now one of nearly 1,400 such clinics across the country. These federally-funded health clinics (often called FQHCs) are a key resource in the states of Mississippi, Louisiana and Alabama, where about 2 in 5 Americans live in rural areas (throughout the U.S., about 1 in 5 Americans live in rural areas.)
The COVID-19 pandemic has only exacerbated the challenges facing rural health care, such as lack of broadband access and limited public transportation. For much of the vaccine rollout, those barriers have made it difficult for providers, like community health centers, to get shots in the arms of their patients.
"I just assumed that [the vaccine] would flow like water, but we really had to pry open the door to get access to it," says Smith, who still practices family medicine in Mississippi.
Mound Bayou was founded by formerly enslaved people who became farmers, and it once had a thriving downtown. The town is now dotted with shuttered or rundown banks, hotels and gas stations that were once some of the first black-owned businesses in the state.
Mitch Williams grew up on a Mound Bayou farm in the 1930s and 40s, and spent long days working the soil with his hands.
"If you would cut yourself, they wouldn't put no sutures in, no stitches in it. You wrapped it up and kept going," Williams says.
Healthcare across the Mississippi Delta was sparse and much of it was segregated. When the Delta Health Center started operations in 1967, it was explicitly for all residents, of all races — and free to those who needed it.
Williams, 85, was one of its first patients.
"They were seeing patients in the local churches. They had mobile units. I had never seen that kind of comprehensive care," he says.
Residents really needed it. In the 1960s, many people in Mound Bayou and surrounding areas didn't have clean drinking water or indoor plumbing.
At the time, the 12,000 Black residents who lived in the surrounding county of Bolivar faced unemployment rates as high as 75% and lived on an average annual income of just $900 (around $7,500 in today's dollars), according to a Congressional report. The area's infant mortality rate, back in the 1960s, was close to 60 for every 1000 live births — four times higher than the rate for affluent Americans.
Delta Health Center employees helped people insulate their homes. They built outhouses and provided food and sometimes even traveled to patients' homes to offer care, if someone didn't have transportation. They believed these factors affected health outcomes too.
Mitch Williams, who later worked for Delta Health, says he's not sure where the community would be today if it didn't exist.
"It's frightening to think of it," he says.
Half a century later, the Delta Health Center continues to provide accessible and affordable care in and around Mound Bayou, just as it did in the 1960s.
That's because Black Southerners still face barriers to health during the COVID-19 pandemic. By April 2020, Black residents accounted for nearly half of all deaths in Alabama and over 70 percent of deaths in Louisiana and Mississippi.
Public health data from May 2021 show that during the pandemic, Black residents have consistently been more likely to die from COVID, given their share of the population.
"We have a lot of chronic health conditions here, particularly concentrated in the Mississippi Delta that lead to higher rates of complications and death with COVID," says Nadia Bethley, a clinical psychologist at the center. "It's been tough."
Delta Health Center has grown over the decades, from being housed in trailers in Mound Bayou, to a chain of 18 clinics across 5 counties. It's managed to vaccinate over 5,500 people. The majority have been Black.
"We don't have the National Guard, you know, lining up out here, running our site. It's the people who work here," Bethley says.
The Mississippi Department of Health says it has prioritized health centers since the beginning of the rollout. But Delta Health CEO John Fairman says the center was only receiving a couple hundred doses a week in January and February. Delta Health Center officials say the supply became more consistent around early March.
"Many states would be much further ahead had they utilized community health centers from the very beginning," Fairman says.
Building on existing community trust
Fairman says his center saw success with vaccinations because of its long-standing relationships with the local communities.
"Use the infrastructure that's already in place, that has community trust," says Fariman.
That was the entire point of the health center movement in the first place, says Dr. Robert Smith. He says states that were slow to use health centers in the vaccine rollout made a mistake, and that now impacts their ability to get a handle on COVID in the most vulnerable communities.
Regarding the slow dispersal of vaccines to rural health centers, Smith called it "an example of systemic racism that continues."
A spokesperson from Mississippi's department responded that it's "committed to providing vaccines to rural areas, but given the rurality of Mississippi it is a real challenge."
Alan Morgan, the president of the National Rural Health Association, says the low level of dose allocation to rural health clinics and community health centers early on is "going to cost lives."
"With hospitalizations and mortality much higher in rural communities, these states need to focus on the hot spots, which in many cases are these small towns," Morgan says.
A report from the Kaiser Family Foundation found that people of color made up the majority of people vaccinated at community health centers, and the centers seem to be vaccinating people at similar or higher rates than their share of the total population. (The KHN newsroom, which collaborated to produce this story, is an editorially independent program of KFF.)
The report adds that "ramping up health centers' involvement in vaccination efforts at the federal, state and local levels," could be a meaningful step in "advancing equity on a larger scale."
Equal access to care in rural communities is necessary to reach the most vulnerable populations, and is just as critical during this global health crisis as it was in the 1960s, according to Dr. Robert Smith.
"When health care improves for Blacks, it will improve for all Americans," Smith says.
This story comes from NPR's partnership with Kaiser Health News (KHN) and the three stations who make up the Gulf States Newsroom: Mississippi Public Broadcasting, WBHM in Birmingham, and WWNO in New Orleans.
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