‘Back to the Future’ in Mississippi Delta
“Food in the South, especially in Mississippi, is not just food,” says Kathleen Banks. “It’s history. It’s culture.” It is also public health.
Banks, a DrPH student, is completing her practicum in Mound Bayou, Mississippi, at the Dr. H. Jack Geiger Medical Center, part of Delta Health Center (DHC), Inc. When DHC, the nation’s first rural community health center, opened in the 1960s, Banks says, “it was probably the first place in the country where they were giving out prescriptions for food.”
Back then, the center had its own community farm to help battle the widespread hunger plaguing the Delta, and to teach community members to grow their own healthy produce for their families and for income.
Banks is now helping to integrate a community garden into the Dr. H. Jack Geiger Medical Center. “We’ve been growing okra, we’ve been growing corn, we’ve been growing purple hull peas— which I didn’t know about until I came down here,” she says. “We’ve been growing pumpkins, zucchini, yellow squash, cantaloupe, and watermelon, and we’re about to till over the corn to grow five different kinds of greens, which are a huge part of the diet down here.”
Once again, the center is providing fresh produce to community members struggling to put healthy food, or any food, on the table. “Back to the future,” in the words of DHC CEO John Fairman, Banks says.
Banks first came to the center in May with David K. Jones, assistant professor of health law, policy & management, as his research assistant for a project comparing the social determinants of health in the Delta in the 1960s and today. They learned about the history of the center as one of the first American institutions combining health care with work on social determinants like sanitation, housing, employment—and food. They learned about its conception during the Freedom Summer, and how the creation of a health center in an African American community, run by African Americans, was as much about civil rights and social justice as about health. “For me it just all clicked,” Banks says. “I have to work here. This has to be my practicum.”
A DrPH practicum has to be in a different area from a student’s previous work. After Banks completed her MPH at SPH in 2008, she spent almost a decade working on improving the quality of maternal health care in sub-Saharan Africa, particularly patient–provider relationships. “Now I’m working with a community garden attached to a health center in rural Mississippi,” she says, “so in some ways it’s about as far from my previous experience as you can get.”
Some health outcomes in the Delta do rival those in the countries where Banks has worked, she says, but the reasons are frustratingly different. “One of the hardest things about working here is that Mississippi hasn’t done the Medicaid expansion under the Affordable Care Act,” she says. “The maximum a family of two can make in order to be eligible for Medicaid is about $6,000 a year, and if you’re single you don’t get Medicaid no matter how poor you are.” In other words, the money to improve health in the Delta was offered, and turned down by state government. “That has been very difficult to see—as a human being but also as an American. This is how we are treating our citizens.”
Health outcomes and health determinants in Mississippi continue to be some of the worst in the country—with malnutrition now often coupled with obesity rather than hunger. “It’s either the top or the bottom,” Banks says, ranked first in the country for premature death, diabetes, and hypertension, and in the bottom five states for social determinants of health like education, healthcare access, and the economy.
Infant mortality also remains high, Banks says—with a dramatic gap by race. The infant mortality rate has gone down overall, but the rate for babies of color is twice that of white babies, she says, “and that’s something that is very similar to what you would see back in the ‘60s.”
Fighting the persistent racial disparities in the Delta has always been at the core of the DHC’s work—and, again, its work to improve health in the Delta comes back to food with the community garden, which is funded in part through a grant from the Community Foundation of Northwest Mississippi. “The ‘a-ha’ moment for me was realizing that, if a community is not food secure, if a community is hungry and they don’t have access to basic food, then they are fighting to survive,” Banks says. “If they are fighting to survive, that is their number one focus. They can’t do anything else.”
Banks has spent the summer looking for ways to get the most out of the community garden—which is less than one acre—by integrating it into the center’s primary care, and by using the garden not only to provide produce but also to encourage community members to grow and eat more fruits and vegetables themselves. She has researched community health programs, community garden initiatives, and childhood obesity programs; completed a needs assessment for the health center and the catchment area; and looked at the management structure of the garden to make it sustainable from year to year. She has toured school gardens and talked with local farmers to consider what garden design might work best for DHC.
Perhaps most importantly, she says, she has worked with community members to find out what they want the garden to be—and especially what they want to eat. “Making sure that we meet people where they are is really important for the garden’s success,” she says—especially in a place where food is not just medicine, but history and culture too.
Kathleen Banks is taking over the SPH Instagram account from August 25 through 28 to share photos from Mississippi. Follow along at Instagram.com/BUSPH/.