The first plague hit long before the second one struck this year.

Bill Bynum

Bynum

“The COVID-19 pandemic is pulling the lid off conditions that we have not addressed for generations,” said Bill Bynum, CEO of Hope Credit Union, which serves low-income communities in Mississippi. “These rural and high-poverty areas are being hit harder, because they’re so much more fragile.”

Data analysis by the Mississippi Center for Investigative Reporting shows that coronavirus deaths are twice as high per capita in Mississippi’s poorest counties. The death rate rose to 3.3 times higher when compared with counties where the per-capita income was at least $25,000.

Bynum said that fragility stems from health woes fueled by poverty, which affects one-third of Mississippi children and nearly half of all Black children.

“These are communities where wealth has been extracted, where the poverty rate has been over 20% for half a century,” he said.

Mississippi slave population

This map depicts the population of those enslaved in 1860; the deeper the red, the higher numbers of those enslaved.

Such poverty goes back centuries, he said. “You can take the map of where slaveholding was concentrated and overlap that with the worst health outcomes, the highest unemployment and the worst education outcomes. They’re the same places.”

In fact, he said, much of the nation’s persistent poverty can be found in three states — Mississippi, Alabama and Louisiana.

Overall, nearly two-thirds of Mississippi’s counties suffer from persistent poverty, according to the U.S. Department of Agriculture.

Bynum said inadequate housing, lack of transportation, financial woes, discrimination and violence have plagued these impoverished places for generations, fueling increased stresses on health. He said many in these impoverished counties work in low-wage jobs that don’t include health care as part of their compensation. About 40% of Mississippians who lack a high school diploma possess health insurance.

As a result, he said, Mississippi has “some of the most medically underserved in the nation.”

Since the pandemic began, poverty has deepened.

Dr. Leandro Mena

Mena

Shortages of ICU beds and hospitals

This map depicts the Deep South counties that lack ICU beds (dark gray) and hospitals (light gray). The counties outlined in red are counties that suffer from persistent poverty, many of them the same counties where the enslaved populations were the highest.

Dr. Leandro Mena, director of the Myrlie Evers-Williams Institute for the Elimination of Health Disparities at the University of Mississippi Medical Center, said the state’s poor, many of whom are already battling diabetes, hypertension and related diseases, suffer from a lack of access to quality health care.

There are fewer intensive care beds in many rural hospitals, “especially in areas where you have high proportion of uninsured residents,” he said.

Mississippi Department of Health data shows that 60% of the state’s counties have no intensive care beds, forcing many Mississippians battling for their lives to travel more than an hour to receive care.

Mena said that COVID-19 has exposed our “imperfect, poorly designed health care system.”

Leroy Johnson, a supervisor in the state’s most impoverished area, Holmes County, said what made COVID worse in Mississippi was the lack of health care funding to rural areas, resulting in the shutdown of five rural hospitals since 2014.

And those may not be the last. Nearly two-thirds of these rural hospitals are “vulnerable” or “most vulnerable” to closure, according to a study earlier this year.

Johnson pointed to Mississippi’s decision to refuse to expand Medicaid, as Tennessee, Arkansas and most other states have done, which would have given Mississippi about $1 billion more a year in health care funding.

Overall, Mississippi is leaving more than $11 billion on the table that it could get toward health care over the next decade by failing to expand Medicaid, according to healthinsurance.org.

That would be a life preserver to many of the state’s rural hospitals, nearly two-thirds of which are losing money and vulnerable to closure.

Gov. Tate Reeves said he wants better access to health care in rural Mississippi, but he didn’t explain how. He continues to oppose Medicaid expansion, saying the pandemic should be no excuse for adopting “very liberal policies, and I don’t think that’s a very smart thing to do right now.”

Voters in Oklahoma and Missouri thought otherwise, approving Medicaid expansion months ago. That raises the total number of states approving expansion to 38 states.

A 2016 study by the National Center for Health Statistics showed that more than twice as many people living in states that haven’t expanded Medicaid failed to get care they needed because of the costs.

Fresh vegetables and fruits that can help improve health are now hard to find in some rural and impoverished places in Mississippi, a Feeding America study shows.

Because of this, many living in the state’s poorest places must travel miles to buy this healthy food.

“Not everybody can get a Nissan plant to locate in their community, but to towns like Utica, a grocery store might as well be,” said Sandra Shelson, executive director for The Partnership for a Healthy Mississippi.

Nearly one in five Mississippians live in a food desert — more than any other state.

Dr. Rick deShazo, a professor at the University of Alabama at Birmingham and editor of "The Racial Divide in American Medicine: Black Physicians and the Struggle for Justice in Health Care," said this lack of fresh food contributes to obesity.

West Virginia leads the nation in obesity, followed closely by Mississippi, where 71% of adults are overweight and more than 37% are obese.

“This epidemic uncovers for everyone the underbelly of poverty and inequality we have,” said deShazo, who is also professor emeritus at the University of Mississippi Medical Center. “There’s no excuse for it with the wealth we have in this country.”

Johnson pointed to suffering in his Holmes County.

The state’s policies “have been hurting poor people,” he said. "Now those bad policies are killing people and crushing rural communities.”

• Jerry Mitchell is an investigative reporter for the Mississippi Center for Investigative Reporting, a nonprofit news organization. Samuel Boudreau contributed to this report. This story was produced in partnership with the Pulitzer Center.

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