‘It’s Hard to Say Whether It’s Better or Worse’.

What brought you to the Mississippi Delta?

In April 2017 it will be the 50th anniversary of a trip that Robert Kennedy took to the Mississippi Delta. I’m retracing his steps, writing a book looking at the social determinants of health in the Delta, trying to understand why things are so bad there, and trying to learn lessons about the Delta that can help the Delta but also can help the rest of the country.

What was Kennedy’s trip?

Robert Kennedy went down to the Delta in 1967 as part of a subcommittee for the Senate, really to look at poverty, and to look at hunger in particular.

He went down there on a challenge from the activist Marian Wright. She told the Senate subcommittee in DC, ‘If you really want to understand hunger in America you need to leave DC and come with me to Mississippi.’ The subcommittee went down to Mississippi, and Marian Wright said, ‘If you really want to understand hunger you need to leave Jackson and go with me to the Delta.’ Senator Kennedy and one other member of the subcommittee were the only ones who took her up on that challenge.

They were there for one day, and they visited the towns of Greenville, Clarksdale, and Cleveland. They had an itinerary, but Robert Kennedy decided he wanted to knock on doors, and in some cases he would go into people’s homes.

There was one home Wright describes going into where he got down on the floor with this baby who had a distended belly. This baby looked lifeless, so he picked up the baby and was trying to get a response. She describes Robert Kennedy crying, and coming out of that home he said he just didn’t know that kind of poverty was possible in America.

How is the Delta different now from 1967?

Ironically, 50 years later there’s still a malnutrition problem, but the obesity rates are really high. It’s flipped from hunger to severe obesity.

I really like the metaphor of a ‘food swamp’ rather than a food desert. There’s food there, but it’s food like fried chicken sold at gas stations. Those are the affordable options, so in a lot of ways they’re the rational choice.

David Jones Assistant Professor, Health Law, Policy & Management

Age: 36

Hometown: New York, New York (“I was going to enough Yankees games in the mid-90s that my mom encouraged me to flip the economics of it, so I got a job selling pretzels and hotdogs at the games.”)

Breakfast: “I had a bite of my son’s English muffin, and a bite of banana bread that I made with my daughter yesterday.”

Is it better than when he was there?

No.

That’s the short answer. It’s hard to really make definitive statements about 1967 versus 2017, because the most reliable comparative data we have only goes back to the 1990s. Conditions have clearly improved in some ways, but it’s hard to say whether it’s really better or worse than it was. If you look at the Delta compared to the rest of Mississippi now, the Delta has significantly worse outcomes. And if you pick any measure across the country—obesity, maternal mortality, infant mortality—Mississippi is if not the very worst then among the worst, so the Delta is the least healthy part of the least healthy state.

How that compares exactly to 1967 is actually less important to me than the disparity to the rest of the country.

How does the Affordable Care Act affect the Delta?

One of the things that got me really interested in starting this project was wondering, even if Mississippi did expand Medicaid and state leaders didn’t block implementation of the ACA there, would it really solve the problems? The problems are so deep that I don’t think it would. I support the ACA, I think it would do a lot, but I really think we need to move the conversation beyond insurance to a conversation about population health.

In a lot of places around the country, the people who would benefit the most from the ACA voted overwhelmingly for Donald Trump—the person who promised to take away their health insurance—but in the Delta that’s not the story. The Delta voted overwhelmingly for Barack Obama in previous elections and voted for Hillary Clinton in this election, but they’re so outnumbered by the rest of the state. It’s a lot of the old racial dynamics, where a lot of the state doesn’t want to support social programs because they’re seen as helping poor Black people in the Delta, and I think we’ll continue to see this dynamic play out in this post-ACA world.

Marian Wright said the senators really needed to go the Delta to understand it. Why did you feel you needed to go?

There are the things that I get from being there that I couldn’t get any other way, like seeing the number of wild dogs walking down the street. We say, ‘If you just exercise more, if you went jogging or just out for a walk every once in a while, you would be healthier.’ But when you talk to people there, they tell you, ‘I can’t go for a walk, there are dogs on the street,’ or ‘It’s just not safe,’ because the murder rate is so high.

One of the real challenges about this project is wanting to respect the South and respect the Delta, understanding that I’m a white, straight man of privilege from the North, and not wanting to come down to people in the South and say, ‘Here’s what’s wrong with you and here’s how to fix it.’ As part of the book I’m using this ethnographic technique called ‘photovoice,’ where I give people cameras to take pictures of their environment, and have them tell me the story instead of me imposing interpretations on them.

Another responsibility I feel like I have with this project is to tell the whole story, including the inspiring, good things, the people who really just dedicate their life to trying to make things better. But there is a lot of really bad poverty, bad violence, bad health. That’s real.

Who was one of those people dedicating their lives like that?

I met this 76-year-old nun in Tunica County who felt she had been called by God in her 40s to go to medical school and provide care to poor people. She runs a free health clinic that survives on Medicaid and donations, but gives out lots of free care. Now she has a brain aneurysm, but she still works 60 hours a week because she is afraid that when she stops working health in the community is totally going to fall apart. That’s how fragile the safety net is in the Mississippi Delta.

One of the best things is really just meeting the people. As bad as things are, they’re really making a difference. That and the barbecue is really good—that’s a fun perk of these trips.

What’s the best barbecue you’ve had in the Delta?

Abe’s, on the corner of Highway 61 and Highway 49—it’s the corner where this famous blues singer, Robert Johnson, sold his soul to the devil. It’s on that intersection, and it’s really good barbecue.

—Michelle Samuels