Public health leadership in a disadvantaged landscape

Abstract

Objectives: To explore how Arkansas public health leaders (PHLs) and resident participants (RPs) within the Delta perceive well-being and how PHLs address wicked well-being disadvantages. Methods: GIS mapping and Country Health Rankings data were used to identify areas with high levels of health disparities and social, economic, and environmental disadvantages within the Arkansas Delta. PHLs and RPs were interviewed to determine how services aligned with measured health disparities and social, economic, and environmental disadvantages. Results: Delta PHLs focused on health behavior change and clinical care, despite reporting that social, economic, and environmental challenges thwart efforts. They enlisted cross-sector collaborations to address health disparities but not for social, economic, and environmental disadvantages. Delta RPs reported that health services are adequate, but limited, and most RPs have little awareness, means, or motivation to access services and do not understand the importance of their health. Both PHLs and RPs commented well-being is rooted in deeper social, economic, and environmental issues. Conclusions: Overall, PHLs and RPs recognize the availability of basic health services, yet realize these services alone are inadequate in shaping well-being. Changing health disparities in the Delta may require PHLs and other stakeholders at the state level and in the policy arena to enlist cross-sector collaborations to target wicked social, economic, and environmental disadvantages to well-being.