Nearly two-thirds (64%) of U.S. travelers plan to take a vacation this summer — many escaping to Orlando, Florida; a historical European city; or a city in the American West, AAA recently reported. This divide between domestic and international destinations comes into sharper focus through the prism of the American Communities Project. So, too, do the differences in Americans’ preferred vacation activities. (Discover what type of community you live in using our interactive map.)
Passport or No?
For a majority of Americans, traveling abroad does not appear to be on an immediate itinerary. Just 44% say they have a valid passport, according to recent Simmons Consumer Research data.
The rates are higher in more diverse, urban areas, yet no individual community type crosses the 50% threshold. Urban Suburbs, known for having a highly educated, multicultural population mix, reach 50%, while segregated, diverse Big Cities come up just shy at 48%.
In contrast, Working Class Country, the African American South, and Evangelical Hubs — poorer, more rural communities concentrated in Appalachia and the South — are well below the national average at 32%, 31%, and 30%, respectively. Rural Middle America, full of residents with average incomes and educations concentrated in small towns from Maine to Minnesota, is slightly higher at 37%.
Union-heavy Middle Suburbs, places in the Industrial Midwest hit hard by the globalized economy and more recently by America’s continuing trade fights, reach 40%. Graying America, often in rural areas and home to large numbers of retired seniors of moderate income and education, ticks to 41%.
Running in the middle of the pack are community types filled with educated, global-thinking, bilingual youth. LDS Enclaves, where many of Mormon faith undertake missionary work abroad, post a rate of 43%. Similarly, it’s 42% in College Towns, well-educated bastions where students learn the value of cross-cultural competency and studying abroad is commonplace. Hispanic Centers, home to high numbers of Latinos and youth, many of whom are immigrants, also stand at 42%.
AAA’s Top 10 Summer Vacation Spots
The top 10 vacation destinations, according to AAA’s travel bookings from June 1 to August 15:
Orlando, Florida (in an Urban Suburb)
London, England
Rome, Italy
Vancouver, British Columbia, Canada
Dublin, Ireland
Paris, France
Seattle, Washington (in a Big City)
Anchorage, Alaska (in a Military Post)
Honolulu, Hawaii (in a Big City)
Punta Cana, Dominican Republic
What Americans Enjoy Doing on Vacation
A majority of Americans say they like to sightsee on vacation, according to Simmons Consumer Research. That ranks higher than all other vacation activities. Going to the beach is the second most popular at 43%, and shopping comes in third at 36%. The top seven activities — all above 20% — are depicted in the chart below.
Dig deeper and distinctions emerge. For example, when drilling down to the community type level and looking at some popular activities associated with summer vacations, sightseeing is most favored in the homogenous Exurbs, Aging Farmlands, and LDS Enclaves. Sightseeing ranks below average in more diverse communities: the African American South, Big Cities, and Hispanic Centers.
The pattern is similar for another vacation activity that many Americans would consider a quintessential summer vacation: going to the beach.
People in LDS Enclaves are far and away the most likely to enjoy going camping/hiking on vacation, as the community type holds a rate that’s 56% above the average. Two other predominately rural community types, Aging Farmlands and Rural Middle America, are also more than 20% above average. In general, and perhaps not surprising given people’s comfort with their home terrain, camping/hiking shows a starker divide between rural and urban areas than other activities do.
Americans are recycling now more than ever. In the 1970s, the decade when Earth Day was formally recognized, people recycled just 7% of their waste, compared to about 35% today.
While that number is a clear improvement, it also that means that nearly two-thirds of the items we use, most of which could be composted or recycled, still end up in the trash. According to new data from Simmons Consumer Research, a majority of people across the country say they don’t regularly recycle. About a quarter of the population reports never recycling their glass, paper, metal, and plastic waste.
The U.S. recycling system itself is in dire straits. Prior to 2018, the U.S. shipped about 40% of its recycling to China for processing. But last year, China changed its policies, and the country no longer accepts most of the items the U.S. used to send over, such as mixed paper and most plastics. Municipal programs have struggled to adjust. Some have been cut altogether, with rural areas and small towns hit the hardest.
Differences Between Urban, Suburban, and Rural Communities
Breaking down recycling rates using the American Communities Project types shows that communities already have marked differences in their recycling habits. (You can find out what type of community you live in using our interactive map.)
Suburban communities — Exurbs, Urban Suburbs, Middle Suburbs — report that they recycle “very often” at higher rates, according to the Simmons data. People in Big Cities tend to report recycling only “sometimes.” On the other hand, residents of some more rural communities are more likely to say they do not recycle. Survey respondents from African American South communities, Evangelical Hubs, Native American Lands, and LDS Enclaves report “never” recycling different items at higher than average rates.
Take glass, for example. In the Urban Suburbs, more than half (51%) of people say they recycle glass beverage containers very often and more than one-third (39%) of people report recycling other types of glass very often. In LDS Enclaves, however, just one-third of people (33%) say they recycle glass beverage containers and just over a quarter (28%) report recycling other types of glass at the same frequency.
People also report recycling plastic differently depending on where they live:
One Barrier: Unequal Access to Recycling Programs
A mayor caveat to the findings, of course, is whether people actually are recycling as much (or as little) as they say. Additionally, recycling infrastructure across the country is highly unequal. About 94% of the U.S. population have some type of recycling program available to them. But a recent Pew Research Center survey found that about seven-in-ten people living in urban and suburban communities report having curbside recycling, compared with just four-in-ten rural residents. And an October survey by the Recycling Partnership, a nonprofit aiming to improve recycling, found that more than half of Americans, particularly young and low-income people, feel they don’t have access to recycling programs.
What is clear across the country, however — whether due to a lack of resources, personal decisions, or the struggles of the recycling industry — is that recyclable bottles, bags, cans, and boxes are piling up in our trash.
In his opening presidential campaign speech, Donald Trump declared, “The American Dream is dead,” thus launching his campaign theme: Make America Great Again. This belief in the American Dream’s death was the “defining characteristic” of Trump’s enthusiastic Republican primary support, journalist and conservative commentator Timothy Carney soon realized, as he described in a recent interview with the American Communities Project.
In 2016, Carney set out to understand why the American Dream seemed dead to so many. He knew the widely discussed explanations: factory closures, more equal rights for women and minorities, old white men angry about losing their privilege.
Carney’s new book, full of personal stories and studies, is the product of his search for answers. Alienated America: Why Some Places Thrive While Others Collapse reveals how an invigorated community is the backbone of the American Dream. In his journey through America, Carney uncovered that “places collapse if they are not planted with institutions of civil society that connect people together and provide a sense of purpose. The places that thrive have those institutions, and in America, for the middle class, those institutions are mostly church,” as he put it in our interview.
Read on for more highlights of Carney’s research, his viewpoint shifts, and his ideas for rebuilding civil society. (Click on the anchor links below to jump to specific points of our interview.) Listen to the full, 34-minute interview.
Tie Between Social Capital and 2016 GOP Primary Vote
When I talk about Trump support in the book, I’m almost always talking about the Republican primaries. In the general election, there’s two choices; there’s so many confounding factors. But when there are 17 people on the ballot, for those choosing Donald Trump, my hypothesis was it was an expression that the American Dream was dead. It was borne out by the data in Iowa — the counties with the best measures of social capital were Trump’s worst counties. And Trump’s best counties were the counties with the lowest measures.
Two of the most educated counties in America are in Iowa, and they were two of Trump’s worst counties in the whole country. But Sioux County — where everybody is Dutch (they’re Dutch reformed); they go to church twice on Sundays; there’s two Dutch reformed colleges — was Trump’s worst county in Iowa by far. The other bad counties were where Des Moines is, where Iowa State is, where the University of Iowa is.
His best big county was Pottawattamie County, which is where Council Bluffs is. The Trump contingent — a huge number of first-time attendees — didn’t even have a leader. Jeb Bush had a precinct captain in every precinct there, even if he’s only getting five supporters in a precinct. Trump had the most people in that room in Pottawattamie County, but then they sort of disbanded at the end. Pottawattamie has the worst social capital scores of any big county in Iowa.
How Factory Workers’ Skills Relate to Family Formation
I call this the Joe Adams Effect. In 2005, there was a factory in Bloomington, Indiana, shutting down. I stopped by the union hall, and Joe Adams, the vice president, was losing his job. I asked him how he got into factory work. He said, ‘I was kind of surprised when I first wanted a factory job; they asked me if I had experience.’ Joe responded: ‘What do I need experience for? This is unskilled labor, right?’ You pick up a tool, you drive in a rivet, and then you do it again.
And they said, ‘You know what we want from experience? We want to know: Do you show up on time? Do you wait until the whistle to take your lunch, come back before lunch is over, and then stay until the whistle? Do you only call in sick when you’re actually sick? And are you willing to stick around and do this mundane thing for decades?’
This was 2005 — before I was married and had kids. Thinking about Joe Adams years later, I realized this is a prerequisite for being a dad. Can you show up on time, stay for as long as you’re needed, pick up basic unskilled tasks like changing a diaper and not burning the scrambled eggs and commit yourself to something that at times might be crazy-making for decades?
I realized factories cultivated these skills of the unskilled. You could call them basic virtues, and places that lost those factories lost a training ground for those virtues. If you go to college, if you go to a high school that expects you to go to college, a lot of those same things are there, while for the working class, the factory was the prime training ground. I included that because the data show that the retreat for marriage in America is mostly happening in the working class. And one of my explanations is that the loss of the factory job has meant less cultivation of those basic virtues.
Mancamps in Fracking Towns: A Natural Experiment
The mancamp is this warren of trailers and the rooms are fairly nice. It’s a flat-screen TV, a nice bed, good lighting; you are sharing a bathroom but only with three other people. Then there’s these massive quadruple wide trailers with ping pong tables, all you can eat fast-food, 24-hours a day, and big screen TVs for watching the game. It was dude-heaven.
In Williston, North Dakota, they effectively had to import lots of workers, but they also had to pay them a lot of money. It was $18 an hour for unskilled labor. If you had a commercial driver’s license, you were making six figures because this is fracking central.
But there was a study of these various fracking communities because what was the rare thing going on here: blue-collared guys getting a lot of money. So if we saw the loss of these good factory jobs preceded the retreat from marriage among the working class, the return of good jobs for the people without a college education should hopefully bring a return to the marriage and family formation. It didn’t happen in Williston, and it didn’t happen in these other fracking towns, as studied by Melissa Kearney at Brookings.
For me, the lesson of Williston was this isn’t a real human community. You are giving labor and they’re giving you money, which may sound like what all work is, but most jobs are different. They’re more relational. Most places are geared towards family formation.
Biggest Surprises in Research — It Takes a Village
Author Timothy Carney is a visiting fellow at the American Enterprise Institute and the commentary editor of The Washington Examiner.
One of the things that surprised me most is that I would find the phrase it takes a village to raise a family to not only be true but profound. This was, of course, Hillary Clinton’s book title, and to me as a conservative, it sounded like some collectivist thing.
A lot of my individualism faded away while writing this. As a parent, I never thought my wife and I were doing this on our own. But realizing that it wasn’t just that we relied on this help but that the whole undertaking of family formation requires this support structure of a community of multiple institutions.
For other conservative friends, one of the most surprising things is that the liberal elites practice what we social conservatives preach. They finish school. They get a job. They get married. They stay involved in their kids’ lives. I address in the book what I call the Lena Dunham Fallacy: this belief that liberal elites, college-educated elites, are all graduating from Wesleyan and then never getting married, and if they have children, it’s deliberately out of wedlock with no regard for the traditional family. That’s not the way it works.
One of the places I go in the book, Chevy Chase, Maryland, about 10 miles from my house, is overwhelmingly Democratic. It’s overwhelmingly wealthy and educated. If you go to a place like Chevy Chase, you will see them living the traditional family life: finishing school, getting a job, getting married, having kids, staying married — divorce rates in these circles are lower than average by far — and being involved in their kid’s life, coaching T-ball, and even going to church at a higher rate than I would have suspected.
Where Education Fits In
One of the places people thought I would talk more about was education, but I see school as being another institution of civil society, not dramatically different. When people say, ‘Oh, I’m going to send my kids to a good school,’ it doesn’t primarily mean that there’s some extra skilled teachers there or more technology. It means the other parents are very involved in the school. And so school can be a very strong institution of civil society, but it’s only in certain communities.
It’s a little depressing because it means there’s no easy fix. You can’t snap your fingers or pass a new funding bill and create a ton more intact families and involved parents in a school district. There’s deeper systemic things that have to do with the strength of community.
Impact on Young People
Across the board, the data show worse outcomes for people who grow up in places with worse social capital and weaker communities. Raj Chetty is a researcher who found that the No. 1 predictor of upward mobility by children was the number of intact families locally. And No. 2 was measures of social capital.
One of the things I remember from Uniontown, Pennsylvania, was talking to this couple saying, ‘We’re going to beat this place,’ meaning we’re going to be successful, stay married, and raise our kid. They’re trying to overcome the culture in a way that I never felt particular counter-pressure.
Casting Findings After 2018 Midterms
In 2018, notably Democrats did well in places Trump had won in the Rust Belt or working-class places. Trump had won Pennsylvania and Michigan and Wisconsin, and in all three of those states, Democrats won all the big statewide races.
I actually predicted this in a New York Times piece I wrote ahead of the election. I said some people thought Trump had brought about a realignment, bringing working-class communities into the Republican Party. He certainly didn’t do that. I mean the Republican Party still stands for certain ideas: lower taxes, pro-life, Christian conservative things; that’s not the agenda of the American working class.
But more importantly, I thought the vote for Trump was a vote that the American Dream was dead. And some of the very same people were saying the same thing when they voted for Obama, especially in 2008 and also in 2012. So I wasn’t surprised to see counties in Michigan go Obama, then Trump, and then go Democrat again in 2018. It’s not an ideological expression of their vote as much as it is an expression that things are thoroughly broken all the way to the bottom.
Recommendations for Reinvigorating Civil Society
It has to happen on the local level. The last chapter doesn’t have a lot of big federal legislation that can solve it because there’s no Restore Local Institutions of Civil Society bill.
But on the community level, anybody who is near the top of an institution that has any stability should just say wait a second: We are the ones who are going to help people’s lives be better. If you’re running a church in Fayette County, Pennsylvania, you have to think what I thought was the job of some government agency, or what I thought was the job of a nonprofit geared towards helping drug addicts, is my job. Not to just necessarily provide the acute treatment but to build an infrastructure. If you want people to get married, you can’t preach to them about the importance of marriage. You have to build the culture, a society, where there’s support and modeling for that.
A lot of it is on an individual level: Go to church and start a T-ball team. Even while writing this book, I started a T-ball team and coached kindergarten girls basketball and saw a positive value for myself and others.
We have to get rid of, weaken, or reform those policies that kill institutions or try to back them into corners. Sometimes there are people who don’t like the idea of churches and religious organizations getting involved. They say, ‘Your job is to lead worship and spirituality; stay out of civil society.’ I would like to tell people who disagree with religious institutions, OK, but let them do their good work without trying to interfere with them because that is going to be the backbone of the American Dream.
On a secular level, it would be a big gain for counties and states to move control of schools to as local a level as possible. People always ask me, ‘Are there secular things I can do what you talk about the churches doing?’ And I say, ‘Yeah.’ I’m from New York, and I know places in New England where the local schools really are controlled by the town. So then they become these defining institutions. The high school where I grew up was what made our town our town, and we had control over it.
In my current county, Montgomery County, Maryland, there’s no local control over the schools. It’s run by the county, which runs a dozen schools. Give people control over their community. That gives them a sense of purpose, the modeling, and the safety net to allow them to have the infrastructure around which you build a good life. That would be one public policy proposal that states and counties can carry out.
What Media Miss About Trump Supporters in Depressed Places
I think they’re missing the fact that it’s a local phenomenon, it’s a cultural phenomenon, and it’s a very real phenomenon.
Some people will chalk up it to pure economics. That’s what the populists on the right say sometimes: The steel jobs are lost. The oversimplification on the left is to say it’s cultural anxiety and then skip ahead to say, ‘Oh, this is just backwards and bigotry’ and that sort of thing.
What they’re both missing is the nature and the depth of the loss, that it’s not just that the factory shut down. It’s after the factory shut down, one of the churches had to shut down, and that people then didn’t go to the next church over, and they stopped going to church, and the coffee shop where people meet shut down.
Providing Helpful Reporting for 2020 Election
Looking beyond the purely economic explanations is the first step. And trying to deal with people on their own terms; there’s this bad habit in the press when somebody says something to respond with, ‘Oh, so what you’re saying is…’ and filling in the blanks.
Those are the two types of reporting we’ve had: People who just tried to give a purely economic account for it, or people who, when they gave a cultural account for the suffering, chalked it up to bigotry instead of alienation.
It’s tricky because I find people who live in places that have really suffered under alienation often love where they live, and will be very protective of it, and then can open up to lamenting how it doesn’t have what it needs to have and what it used to have.
Sometimes if I showed up and said, ‘I came to your county because by all measures it’s falling apart,’ they’ll say, ‘You have no idea what you’re talking about. We’re great.’ And then within an hour they’re telling me about how there aren’t these strong bonds. So listening and understanding the complex messages was a much harder undertaking than you might first imagine.
How to Reach Out to Alienated America in 2020 Campaign
It’s tricky because one of the things that made Trump appeal was articulating the pain that people suffer. And that will always be step one. I thought Hillary Clinton was incredibly tone deaf to go to Michigan right before the election and say, ‘The American Dream is alive and well as it’s ever been.’ How does that sound to somebody who remembers a strong town where people had a real ladder, and access to climb up the ladder, and now they don’t?
Trying not to demean and diminish their actual suffering would be the first way to acknowledge that this is real and that the roots of it are not purely economic. And to acknowledge that the repair is going to happen at the community level and that what you as a presidential, senatorial, or congressional candidate can do is provide some support but also make sure that nobody is interfering with people’s ability to build.
Feelings About the American Dream Now
What makes me feel more hopeful is that it’s not that our souls have gotten worse or anything. Looking at middle-class places, like Oostburg, Wisconsin, or Orange City, Iowa, I saw places that on a material level don’t have much more than the real alienated places. But they’ve built and maintained very strong church communities, so that’s made me think we don’t need to totally change the U.S. economy. We don’t need to change the character of Americans in order to turn things around. We need to figure out how to plant and make stick strong institutions in the places that are currently suffering from alienation.
More than 12% of Americans rely on food stamps to feed themselves and their families. The partial government shutdown, which forced operators of the food stamp program to make decisions in a pinch, continues to disrupt the lives of 39 million food stamp recipients.
The Supplemental Nutrition Assistance Program, or SNAP, provides food stamps primarily to low-income working families, seniors, and people with disabilities. “For many poor families, SNAP makes a huge difference in their ability to get by,” Marion Nestle, professor emerita of nutrition, food studies, and public health at New York University, said in an email.
Disruption Can Cause Crisis for Families
The United States Department of Agriculture covers the cost of SNAP benefits, while states distribute them and split administration expenses. Households on average receive about $245 a month and, usually, states distribute SNAP benefits on a 28- to 31-day cycle. But as the shutdown dragged on earlier this year, and USDA’s funding for February remained in limbo, food stamps for the month were given out two weeks early to avoid potentially slashing money for the program.
Though the government is now funded, the cycle of SNAP benefits was drastically disrupted, according to a report from the Center on Budget and Policy Priorities, a progressive think tank.
SNAP households could see an abnormally long gap between February and March benefits, with wait times depending on when states typically issue food stamps. Because of the early distribution of February benefits, CBPP estimated that about 90% of SNAP households, or roughly 30 million people, could experience a more than 40-day gap between receiving food stamps. About 4 million SNAP households faced a gap of more than 50 days between receiving food stamps. Such delays violate SNAP’s own law, which mandates that the program “ensure that no household experiences an interval between issuances of more than 40 days.”
To help lessen the strain, most states are planning to give out March benefits early. But damage has already been done.
“If you have just barely enough money to eke by, any gap will cause a crisis,” Nestle said. “Families count on SNAP benefits in their budget planning. They will have two choices: eat less or give up something else.”
Analyzing the Landscape of SNAP
The distribution of SNAP benefits varies across the country. In Wyoming, for example, about one in 18 people receive food stamps. Just a few states over, in Oregon, one out of every six residents use SNAP benefits. In some states SNAP households are largely concentrated in certain counties, as shown on the map. Alaska, South Dakota, Kentucky, and Texas each have at least one county where more than 40% of households receive food stamps.
In South Dakota, about 11% of the state population, or 93,000 people, rely on SNAP, including several counties where more than a third of households use food stamps. In Oglala Lakota County, a Native American Land in the American Communities Project typology, nearly 55% of households receive SNAP — one of the highest percentages in the nation.
“For many, it’s what they need to bridge that gap in their budgets, so that they are able to survive, pay their bills, and put food on the table,” said Matt Gassen, CEO of Feeding South Dakota, which operates food pantries and warehouses, and partners with organizations across the state to distribute food. He noted that South Dakotans rely on SNAP in all corners of the state, a fact which may be masked in more rural areas.
Monthly SNAP benefits also inject roughly $10 million into the local South Dakota economy. If the program were to lose funding — a real worry during the shutdown — it would take about 5 million pounds of donated food each month to fill that $10 million gap, Gassen said.
How SNAP Works
Eligibility for SNAP is largely determined at the federal level based on criteria such as income and assets. Gross monthly income generally must be at or below 130 percent of the poverty line, or about $26,600 a year for a three-person family. Households with elderly or disabled members are exempt from that limit. In general, childless adults must be employed to receive benefits for longer than three months. States can apply for a waiver of this requirement in areas where unemployment is high and jobs are scare.
Food stamps are not intended to cover the complete cost of food for a household, but many families still count on them for their entire food budgets, Nestle explains. Even when the program is operating normally, most households run out of SNAP benefits before the end of the month.
Food banks and nonprofits like Feeding South Dakota are preparing to face the repercussions of a disrupted SNAP cycle. They know that when food stamps run out, people stream in seeking assistance.
“We are bracing to absorb the additional demand that we are going to see,” Gassen said. “It’s going to be a challenge for them, and in turn a challenge for us.”
Which Community Types Will Hurt Most
There are clear differences in which communities rely the most on SNAP benefits. In Native American Lands, one out of every four households receive food stamps. In African American South communities, the ratio is one of every five households. On the other end of the spectrum, in Aging Farmlands, LDS Enclaves, and Exurbs, less than 10% of households use food stamps.
Stakeholders Grappling With Uncertainty
Giving out SNAP benefits early, for the second month in a row, is an unprecedented disturbance to the SNAP cycle. “That’s just kicking the can down the road,” Gassen said. “At some point you have to catch up to get back on cycle.” It remains unclear when states will release April benefits.
Other impacts of a gap in benefits aren’t easily measured, such as the added stress on SNAP households caused by uncertainty and confusion.
“Messing around with SNAP benefits hurts the most vulnerable members of our society,” Nestle said. “We are a rich nation and can easily afford to help the most vulnerable. That we don’t do a better job of that is shameful.”
There are many ways to crack the fissures of the American economy — the impacts are unfolding in real time. Take personal finance in this unpredictable climate for one. Peering into people’s financial accounts on the county level shows the degree to which communities of color lag in creating wealth. In particular, the 161 Hispanic Centers, with their young and growing populations, struggle here.
More than two-thirds of Americans report some form of financial investment for the future, according to Simmons Consumer Research. Across the American Communities Project’s 15 types, 69% say they hold investments. The common link stops there.
Beneath the surface appear obvious cleavages. Whiter, older, rural areas break away from the pack at considerably higher rates: In Aging Farmlands, 79% own investments; in Rural Middle America, 78% do. For these rural areas where the median household income is just below the national average, a mindset of frugality instilled in youth and deepened through experiencing reversals of fortune season to season may be driving these rates; small towns, too, have seen business dry up and people departing for places of greater opportunity.
Other predominately white suburban communities, the Exurbs and the Middle Suburbs, stand at 76%. Exurbs, on the far outskirts of cities, are full of high-earning professionals with the means to invest. Middle Suburbs, found across the Industrial Midwest, are still home to sizable populations of union workers with pensions.
Communities of color, meanwhile, are at the bottom of the pack: In Hispanic Centers, where the median household income is low at $45,800, just 55% hold investments. In addition to having lower incomes and younger, unestablished populations, Hispanic Centers confront the obstacles of documentation status and English literacy, including financial literacy.
For youth-populated Native American Lands, where 31% are under 18, as well as long established African American South counties, the investment figure dips just below the average to 67%; while Big Cities, the most populous, diverse community type with a highest degree of racial and ethnic segregation among the types, clock in at 61%.
The Ability to Save — or Not
The 35-day, partial government shutdown highlighted how many Americans are living without savings. A Huffington Post/YouGov poll taken January 22-23 found that 52% are living paycheck-to-paycheck. The number jumps to 69% if a household earns below $50,000 a year.
This tracks with findings from Simmons Consumer Data last year. While savings accounts are the most used investment instrument, this financial tool doesn’t reach a majority: 47% of Americans across types have at least one. Once again, Aging Farmlands and Rural Middle America are ahead here: 57% of residents in both types have a savings account.
Where banking deserts are common, particularly in communities of color, the savings account rate is much lower. For example, the rate drops to 44% for both the African American South, where the median household income is $37,500, and the Native American Lands, where it’s $41,700. Diverse Big Cities, where the median income is $58,700, come in at 39%.
In Hispanic Centers, the rate plummets to 34%, marking the lowest percentage among the ACP types. It’s worth noting that in Hispanic Centers, 10% of people reported sending money to someone outside the U.S in the past year — the highest percentage among the 15 types. Many may be wiring cash to relatives.
Work Retirement Accounts More Exclusive
For the 24% of Americans invested in work retirement accounts, the topsy-turvy stock market may be of particular concern. In affluent Exurban counties, 30% of people have a 401(k), 403(b), or 457(b), thrift savings plan, or tax shelter annuity. LDS Enclaves, counties with high numbers of Mormons, are the next highest at 27%.
(While 401(k) plans are options in corporations and for-profit companies, 403(b) plans are common in public educational institutions, nonprofits, and churches or church-related organizations; 457(b) plans are offered in state and local government agencies and some nonprofits. A thrift saving plan is a defined contribution plan for U.S. civil service employees and retirees as well as for members of the military.)
Here again communities of color have noticeably lower rates: The African American South comes in at 19%, while Hispanic Centers lag all places at 16%.
For several communities — Middle Suburbs, Aging Farmlands, Military Posts, Urban Suburbs, and Rural Middle America — the average for such plans stands at 26%.
Of these, only Urban Suburbs and Military Posts are known for having more diverse, educated populations. With large numbers of African Americans, Military Posts post a median household income just above the national average at $57,700, while the multiethnic Urban Suburbs have the highest median household income of the types at $67,800.
Who Has a Pension Anymore?
Just 10% of the overall population have pensions — once a staple of the American workplace for loyal employees. Again, places that are whiter do better. The range runs from 8% for the African American South, Hispanic Centers, and Evangelical Hubs to 12% for the Middle Suburbs to as high as 13% for LDS Enclaves and Aging Farmlands.
Watch Disparities in Changing Economy
These financial investment disparities between white and nonwhite communities are worth new scrutiny as America’s demographic shifts continue apace and the economy keeps changing in the months and years to come.
As this contentious campaign season rolls on, the American Communities Project examines how voters see healthcare from recent polls of toss-up Senate elections in November, pointing out uninsured rates at or above the U.S. average as well as common health worries in the dominant community types in each state.
The twin bottom lines: Healthcare matters significantly to voters in the seven states below, and in several cases, keeping costs low is of greater concern than covering everyone.
Arizona
The Grand Canyon State’s uninsured rate: In 2017, 10.1% of Arizonans did not have health insurance, according to the Census. The U.S. average was 8.7%.
Health worries in Arizona’s prominent community type: Arizona is made up of 15 counties, including populous and diverse Maricopa, a Big City county that includes Phoenix. The uninsured rate here is 12%, according to the 2018 County Health Rankings. Access to primary care physicians is also a challenge.
Arizona voters’ healthcare views: In a CBS News/YouGov poll of 1,010 registered voters from Oct. 2-5, voters offered their views on the particulars of healthcare:
78% expressed “a lot” of concern about keeping costs down, 20% shared some “some” concern, and 2% reported “not much” concern.
72% said they are concerned “a lot” with access to treatments and medications, 23% reported “some” concern, and 5% said “not much.”
54% said they are concerned “a lot” about making sure everyone is covered, 29% said they had “some” concern, and 17% said “not much” concern.
How issues stack up: Healthcare is a significant issue in Arizona voters’ decision-making. 77% said a political candidate must agree with them on healthcare to get their vote. In comparison, 81% said a candidate must share their views on immigration, and 69% said a candidate needs to agree with them on taxes.
Healthcare and the horse race: Of registered voters, 43% said Kyrsten Sinema (D) is better on healthcare, 31% said Martha McSally (R) is better, and 17% said they are not sure yet. Overall, McSally garners 47% in the poll; Sinema stands at 41%.
Arizona’s 2016 presidential vote: Arizona ended in President Donald Trump’s column. He drew 48.1% of the vote to Hillary Clinton’s 44.6%.
Florida
The Sunshine State’s uninsured rate: In 2017, 12.9% were uninsured, according to the Census.
Health worries in Florida’s prominent community types: Florida has 67 counties, including 27 in Graying America. African American South is the next highest at 14.
In Florida, Graying America’s average uninsured rate is 17%. The community type’s access to primary care physicians is lower than the national average; injury deaths are particularly high in Graying America.
Meanwhile, the African American South counties in Florida have an average uninsured rate of 16% and struggle with access to care. The African American South has the second-highest premature death rate among all types (more than 10,000 years lost per 100,000 population). Obesity, insufficient sleep, physical inactivity, and smoking rates are high here as well.
How issues stack up: When Florida voters were asked about the national issues currently most important to them, “healthcare was the most frequently selected response, chosen by 17% of respondents,” according to the WCTV-TV poll of 800 likely voters conducted Sept. 17-30.
Horse race: Sen. Bill Nelson (D) is drawing 45%, while Gov. Rick Scott (R) is getting 44%.
Florida’s 2016 presidential vote: President Trump won Florida in a squeaker, 48.6% to Hillary Clinton’s 47.4%.
Missouri
The Show Me State’s uninsured rate: In 2017, 9.1% were uninsured, according to the Census.
Health worries in Missouri’s prominent community types: Missouri contains 114 counties. Working Class Country comprises 33 counties and Evangelical Hubs contain 24 counties.
Missouri’s Evangelical Hubs post an average uninsured rate of 14%. Hubs struggle with healthcare access, having fewer primary care physicians and mental health providers. Also, teen pregnancy is high in these counties.
At the same time, the average uninsured rate for Working Class Country in Missouri is 15%. Access to primary physicians and mental health providers is difficult.
How the issues stack up: In a CNN poll of 1,003 voters who are registered or plan to register by Election Day that was conducted Sept. 25-29, voters were asked to identify the issues that will be most important to them when deciding how to vote for U.S. Senate. Healthcare was first with 31% of respondents, the economy was second with 21%, and immigration was third at 12%.
Horse race: Sen. Clare McCaskill (D) takes 47%; Josh Hawley (R) is at 44%.
Missouri’s 2016 presidential vote: President Trump won 56.4% of the vote; Hillary Clinton received 37.9%
Montana
The Treasure State’s uninsured rate: In 2017, 8.5% were uninsured, according to the Census.
Health worries in Montana’s prominent community types: Montana is made up of 56 counties, 16 of which are classified as Graying America, 15 as Aging Farmlands.
In Montana, Graying America’s average uninsured rate stands at 16%. Graying America’s access to primary care physicians is lower than the national average; the community type’s injury deaths are particularly high.
In the state’s Aging Farmlands, an average of 17% of the population is uninsured. Aging Farmlands counties also struggle with poor access to primary care physicians and drunk driving deaths.
Other notable community types: Native American Lands and Rural Middle America
Montana voters’ healthcare views: In a CBS News/YouGov poll of 543 registered voters conducted September 10-14, voters shared their perspectives on four facets of the healthcare issue:
84% said they have “a lot” of concern about keeping costs down, 14% cited “some” concern, and 2% said “not much.”
72% said they have “a lot” of concern about making sure pre-existing conditions are covered, 19% said “some” concern, and 9% reported “not much” concern.
71% expressed “a lot” of concern with improving healthcare quality, 23% said “some” concern, and 6% said “not much.”
50% reported “a lot” of concern about making sure everyone is covered, 29% expressed “some” concern, and 21% reported “not much” concern.
Healthcare and the horse race: Of registered voters, 41% say Sen. Jon Tester (D) is better on healthcare, 35% say Matthew Rosendale (R) is better, and 17% are not sure yet. In the race, Tester stands at 47%; Rosendale is at 45%.
Montana’s 2016 presidential vote: President Trump clinched Montana with 55.6% of the vote. Hillary Clinton took 35.4%.
Nevada
The Silver State’s uninsured rate: In 2017, the uninsured rate was 11.2%, according to the Census.
Health worries in Nevada’s prominent community type: Nevada is composed of 16 counties, including Clark County, home of Las Vegas. Classified as a Big City county, Clark has an uninsured rate of 15%, according to the County Health Rankings. Access to primary care physicians is another challenge.
How issues stack up: 26% of Nevada’s likely voters said the top issue that might factor into their voting decision is economy and jobs; 25% said healthcare; 18% said immigration; and 9% said taxes and spending, according to an NBC/Marist Poll of 574 likely voters conducted from Sept. 30 to Oct. 3.
Horse race: Sen. Dean Heller (R) is at 46%; Jacky Rosen (D) stands at 44%.
Nevada’s 2016 presidential vote: Hillary Clinton captured Nevada with 47.9% of the vote to President Trump’s 45.5%.
Tennessee
The Volunteer State’s uninsured rate: In 2017, 9.5% of people did not have health insurance, according to the Census.
Health worries in Tennessee’s prominent community types: Tennessee is composed of 95 counties. Evangelical Hubs counties number 43 while 27 counties are classified as Working Class Country.
In Tennessee, Working Class Country’s average uninsured rate is 13%; Evangelical Hubs show a rate of 12%. Both community types struggle with access to primary care physicians.
Tennessee voters’ healthcare views: In a CBS News/YouGov poll of 1,002 registered voters conducted Oct. 2-5, voters were asked about their views on healthcare:
79% reported “a lot” of concern about keeping costs down, 18% cited “some” concern, and 3% reported “not much.”
75% were concerned “a lot” with access to treatments and medications, 21% expressed “some” concern, and 4% said they had “not much” concern.
56% expressed “a lot” of concern about making sure everyone is covered, 30% reported “some” concern, and 14% revealed “not much” concern.
How issues stack up: Healthcare is a big issue in Tennessee voters’ decision-making. 81% said candidates must agree with them on healthcare to get their vote. In comparison, 72% said candidates must share their views on immigration, and 71% said they have to agree with them on taxes.
Horse race: Rep. Marsha Blackburn (R) stands at 50%, and Gov. Phil Bredesen (D) is at 42%.
Tennessee’s 2016 presidential vote: President Trump won 60.7% of the statewide vote; Hillary Clinton took 34.7%.
Texas
The Lone Star State’s uninsured rate: In 2017, 17.3% of people did not have health insurance, according to the Census.
Health worries in Texas’ prominent community type: Texas is made up of 254 counties, 78 of which are categorized as Hispanic Centers. In these Texas counties, the average uninsured rate is 24%. Documentation troubles may be a reason for this high rate. Access to primary care physicians is also poor here.
Other dominant community types: Big Cities, Evangelical Hubs, Graying America, and Exurbs.
Texas voters’ healthcare views: In a CBS News/YouGov poll of 1,031 registered voters conducted Oct. 2-5, voters’ shared their opinions about healthcare:
52% said making sure everyone is covered concerns them “a lot,” 29% said “some,” 19% reported “not much.”
78% said keeping costs down concerns them “a lot,” 19% said “some,” 3% said “not much.”
69% said access to treatments and medications concerns them “a lot,” 23% said “some,” and 8% said “not much.”
How issues stack up: Healthcare is a crucial issue in Texan voters’ decision-making. 76% said candidates must agree on healthcare to get their vote. In comparison, 77% said the same about immigration, and 71% said candidates need to share their views on taxes to get their vote.
Horse race: Sen. Ted Cruz (R) is at 50%, while Beto O’Rourke (D) receives 44%.
Texas’ 2016 presidential vote: President Trump carried Texas with 52.2% of the vote. Hillary Clinton received 43.2%.
Methodology
To calculate the dominant community type averages, the American Communities Project looked at the insurance rates by county broken up into the ACP’s 15 community types by the County Health Rankings team. After adding all the state’s counties and uninsured percentages in each type, we divided the community type’s total uninsured rate by the number of counties in that type.
Your community is more than your home; it defines your life, from job opportunities and consumer choices, to the quality of education, to air quality and exercise options. And just a few miles can make a dramatic difference.
The chart below is interactive. You can choose the indicator you want to explore, from uninsured rates to premature death, by scrolling through the options in the box in the top left. The black line within each type represents its median value. You can also search for any county in the country by entering its name in the “Find a County” box. The chart shows not only the differences in the community type medians but also how communities are clustered in some types and spread across the line in others.
The place you live is more than your home; it defines your life, from job opportunities and consumer choices, to the quality of education, to air quality and exercise options. And just a few miles can make a dramatic difference. The American Communities Project combined its community types with data from the County Health Rankings to explore the intersection of health and geography in the United States in 2018.
by Elizabeth Sherwood, Ari Pinkus and Dante ChinniOctober 03, 2018Print
Listed here are the main Health Report findings for the 10 ACP community types the Project didn’t visit for this report. On the bottom of the page is a link to download the health data by community type.
Aging Farmlands: The 161 counties in this group are set on the Great Plains. They are small and rural communities, with only about 3,500 people per county and 92% occupying rural land, according to the U.S. Census. These counties are the oldest on average in the ACP, with more than 23% over the age of 65, and the least diverse racially and ethnically. The Farmlands are 92% white and about 4% Hispanic. These areas experience low rates of higher education. Only 19.6% have a college degree, compared to the national average of about 30%. Though these areas are not prone to excessive drinking, the percentage of driving deaths involving alcohol is 33%, 14% higher than the national average. Access to healthcare is difficult in these communities: The ratio of population to primary care physicians outpaces the national average by more than 1,000:1.
College Towns: These 154 counties are scattered around the country and are generally located near large colleges and universities. Filled with college students, about 8% of the population sits between the ages of 18 and 21 — far higher than any other type. They are also less diverse than the nation as a whole, about 80% white, 7% black and 7% Hispanic. These counties hold a large number of college graduates; 36% have at least a bachelor’s degree, more than any other community type. Despite high levels of education, average median household income in College Towns sits slightly below the national average at $52,100. Access to healthcare in these communities is greater than in other places, with nearly 200 fewer people per primary care physician than the national average. Similarly, the average ratio of population to mental health providers is 359:1, compared to the national average of 470:1. Despite a large population of young adults, excessive drinking only exceeds the national average by 2%.
Evangelical Hubs: Evangelical Hubs are concentrated heavily in the South, forming a belt that spans from Texas to North Carolina. The key distinguishing characteristic for these 372 counties is the high number of religious adherents tied to evangelical churches like the Southern Baptist Convention. Beyond religious ties, a few additional factors drive community culture here: They are less diverse (82% white), and have lower incomes (a median of about $42,700) and lower education levels (about 16% have a bachelor’s degree or more). Access to healthcare in these communities is low, with nearly twice the population per primary care physician and mental health provider than the national averages. Evangelical Hubs are also a leader in teen pregnancy, with a rate of 46 births per 1,000 females ages 15 to 19, nearly twice the national average.
Graying America: Fairly rural and scattered around the country, these 364 counties are full of retirees and those nearing retirement age. Graying America is middle-income, about $47,800 annually for the median household. But, of course, a big defining factor is age. Almost a quarter of everyone in these counties, 24%, are 62 years of age or older; only 19% are under 18. Nearly 80% are white. Healthcare is harder to come by in these areas, with an additional 393 people per primary care physician than the national average. Additionally, injury deaths are particularly high, 94 compared to the national average of 65 deaths due to injury per 100,000 people. Despite a high percentage of the population meeting retirement age, unemployment hovers slightly above the national average by about 1%. The people here also have fewer opportunities to exercise, with 72% having adequate access to exercise facilities compared to the national average of 83%.
LDS Enclaves: Based around Utah and the Mountain West, these 41 counties are the centers of the nation’s Mormon population. The Enclaves are one of the least diverse types, with a population that is 87% white and .5% African American — 9% of the population identifies as Hispanic. The LDS Enclaves are one of the youngest types in the ACP, with 29% of the population under the age of 18. They are middle-income with an average median of $55,600 annually. The people here are fairly well educated, with just over 30% holding at least a bachelor’s degree. Likely due to the large LDS population, there is less excessive drinking in these communities, 4% below the national average. Safety is evident in these communities as well. Reported violent crimes per 100,000 people averages only one-third of the national average.
Military Posts: Marked by the presence of troops and bases, these 89 counties are located largely in rural locales. Their military ties make them relatively young, with only 13% of the population 62 years of age or older. And they feature a larger African American population than average, 16%. The median income in Military Posts sits just above the national average at $57,700. More than a quarter of the people in these communities have a college degree. Health behaviors are not positively emphasized here. These communities report 6% more alcohol impaired driving deaths per 100,000 population than the national average. Adult obesity sits 4% above the national average and physical inactivity hovers just above the national average as well.
Native American Lands: Dotted primarily across the west, these 43 counties are marked by large Native American populations — more than half the people who live in these counties overall are indigenous Americans. College education rates and income are low in these counties. On average, only 14% have a college degree, and the median household income is about $41,700. People have limited access to exercise opportunities, with only 41% of the population receiving adequate access to facilities for physical activity. Combined with other factors, lack of exercise contributes to a high adult obesity rate at 8% above the national average. Likely due to poor health behaviors, nearly one quarter of the population reports fair or poor health, well above the national average of 16%.
Rural Middle America: This collection of 599 counties runs across the northern half of the country, starting up in Maine through the Great Lakes and across to Montana and Washington state. These counties have a less diverse population (91% white) that is spread into less urban locales — 62% of the population lives in places the Census labels as rural. Though they tend to be made up of small towns, these places generally do not rely heavily on agriculture. Wealth in Rural Middle America sits just below the national average, with an average median income of $52,600. Access to healthy food in these communities is favorable, with a Food Environment Index of 8.04, above the national average of 7.7. Although this food is available, these communities still experience a high rate of adult obesity, 32% compared to 28% nationally. This could be due to lack of access to exercise opportunities, which only 65% of adults in these communities have. Despite these issues, healthcare seems accessible here, with only 9% of the population uninsured, 2% lower than the national rate.
Urban Suburbs: These 106 counties hold the wealthy, diverse suburbs of most major cities, and they have come to take on many of those big city characteristics. They are densely populated — the average Urban Suburb is home to roughly 500,000 people — and diverse. The population of these counties is about 58% non-Hispanic white, 11% African American and 16% Hispanic. They are the wealthiest and best educated of all the types in the ACP — average median household income is about $68,000, and 37.2% of adults have a bachelor’s degree. As they grow more dense and urban, poverty rates are increasing. Currently, 15% of children live in poverty and 46% are eligible for reduced price school lunch. People here enjoy more opportunities for physical activities, with 9% more individuals reporting access to exercise facilities than the national average. Healthy foods are also more prevalent, with a Food Environment Index — an index of factors contributing to a healthy food environment — of 8.1 compared to the national average of 7.7.
Working Class Country: Working Class Country counties are heavily clustered in specific rural communities in the eastern half of the United States including Appalachia, the Ozarks and the upper-Midwest. Largely rural in nature, Working Class Country counties are among the nation’s least diverse places — 91% white, 2% African American and 4% Hispanic. These counties generally don’t rely on agriculture but rather exist as small service economies with some small manufacturing. Their average median household income of $42,400, sits about $13,000 below the national median. The percent of people with a college degree, 16.4%, is roughly half the national average. Working Class Country counties tend to be older than the nation at large. About 21% of the population are older than age 65. Nationally that figure is 15.6%. Violent crime rates are low as are home costs. People report more frequent poor mental health days here, 4.3 of the past 30 days compared to the national average of 3.7. Despite elevated needs for care, there are about 1,200 additional people per mental health provider here than the national average.
by Dante Chinni and Ari PinkusSeptember 19, 2018Print
The health of Americans varies greatly depending on the kind of community they call home, and different types of communities have knowledge they can share to improve citizens’ well-being. Those findings are at the heart of months of research and reporting from the American Communities Project (ACP) at The George Washington University.
The ACP, working with data from the 2018 County Health Rankings and with the support of the Robert Wood Johnson Foundation, examined thousands of data points through the prism of the ACP’s 15 community types — distinguishable by demographic variables such as income, occupation, race and religion — to find common worries and shareable solutions.
Three dominant themes emerged in the analysis.
Communities with large populations of people of color farepoorly on a variety of important health and community measures. The data suggest the scores are less about specific populations in these communities than they are about the economic and cultural divides running through them.
Mental health concerns cross all community types. The ACP’s community types hold very different geographies, people and economies, but the median county in every type has between 10% and 16% of its population reporting 14-or-more poor mental health days per month.
Some commonly held understandings of many communities and the challenges they face are incorrect. For instance, raising children in a single-parent home is not just an urban worry. And the nation’s most racially and ethnically diverse communities, the big cities, are also its most segregated.
The data make clear that all kinds of communities — from well-educated urban enclaves to rural blue-collar boroughs — face health challenges. Furthermore, the data show what those specific concerns are.
The ACP also visited five communities, each representing one of its 15 types, to find best practices to address citizen health. Interviews with community leaders and officials in Dallas County, Texas; Douglas County, Colorado; Hood River County, Oregon; Jones County, Georgia; and Lake County, Ohio, led to insights into how those communities deal with their respective challenges and revealed programs and ideas that others can put into practice.
Combined, the ACP’s research and community investigations encompass a deep examination of the socioeconomic, cultural and health-related ties that bind together the United States’ complicated patchwork of communities in 2018 and an exploration of what these communities can learn from one another.
The Tapestry of American Communities
Your community is more than your home; it defines your life, from job opportunities and consumer choices, to the quality of education, to air quality and exercise options. And just a few miles can make a dramatic difference. Consider three Michigan counties that abut one another — Oakland, Macomb and Wayne.
In the 2018 County Health Rankings & Roadmaps— a partnership of the Robert Wood Johnson Foundation (RWJF) and the University of Wisconsin Population Health Institute — those three neighboring counties are, in essence, different worlds. In wealthy Oakland, 12% of the population report being in only fair or poor health. In Macomb, the number is 15%. In Wayne, it is 19%. Macomb has a significantly higher median household income than Wayne, but it also has a higher rate of drug overdose deaths. And Wayne is the most racially and ethnically diverse, but the economic development and history of the area has also left it more segregated.
The amount of variation in such a small geographic area is noteworthy, but not exceptional. Those communities are not just different places; based on the ACP community types, they are different kinds of places. Oakland, an educated, well-to-do county to the northwest of Detroit, is a quintessential Urban Suburb. Macomb, just east of Oakland, is a blue-collar Middle Suburb. Wayne, just south of both, includes Detroit and, thus, holds the density and diversity of a Big City.
When you look at the nation as a whole, the complexity of community types grows. The ACP’s map of the United States defines 15 community types among the nation’s 3,100 counties. These 15 types were created using dozens of demographic variables and are designed to explore likenesses and differences that exist among communities at the county level. The ACP’s 15 county types are mapped below.
Defining the ACP Types (Click type names to see more on each.)
African American South: Places with large African American populations. Lower incomes and higher unemployment.
Exurbs: Wealthy communities usually on the edge of metro areas, Largely white with lower crime rates.
Military Posts: Located around military installations. Younger, middle-income, diverse communities.
Graying America: Places with large senior communities. Generally rural and less diverse, middle-income.
Native American Lands: Places with large Native American populations. Young communities with lower incomes.
Big Cities: Counties holding the nation’s largest cities. Dense and diverse.
Hispanic Centers: Large Hispanic populations in mostly rural communities. Younger with lower incomes.
Rural Middle America: Largely rural and white communities. Middle income and average educational attainment.
College Towns: Urban and rural communities that are home to campuses and college students.
LDS Enclaves: Places dominated by Latter-day Saints adherents. Younger and middle-income.
Urban Suburbs: Educated and densely populated communities around major metros. Racially and economically diverse.
Evangelical Hubs: Places with above-average numbers for evangelical adherents. Largely Southern with fewer college grads.
Middle Suburbs: Middle-income, blue-collar communities mostly around metro areas.
Working Class Country: Rural, blue-collar communities. Low incomes and college graduation rates.
The ACP’s focus on types of community pairs neatly with RWJF’s County Health Rankings. Undergirding the Rankings is the idea that health is about a lot more than what happens in the doctor’s office. Ultimately people’s health is influenced by a complex mix of factors including family life, environmental inputs and economic circumstances — elements deeply tied to our communities. By merging the ACP and the Rankings we can look at how those small differences at the community level fit into broader, hidden national trends.
What the Numbers Say
On behalf of the ACP, the University of Wisconsin Population Health Instituteused data compiled by the County Health Rankings & Roadmaps programs to determine variation within and across ACP county types. It also calculated a composite measure of length and quality of life for counties, which was then used to sort counties within each typology. The top-performing counties within each typology were further classified by their within-state rank on health outcomes and health factors.
Do the combined Rankings and ACP data suggest one type of community is the country’s healthiest? Not really. There were limitations. The ACP’s types are not evenly spread across the country. Utah, for instance, is dominated by LDS Enclave communities, meaning those places are spread across all four quartiles in that state. And many states have no Big Cities.
That said, there are some broad trends in the numbers. The semi-urban counties known as Exurbs are the most likely to score in the top quartile of their states’ healthiest places. Nearly 73% of those 222 counties placed in their state’s top quartile. The Urban Suburbs were next, with 57% of those 100 counties scoring in their state’s top quartile. The Big City counties and the College Towns, counties defined by academic institutions in them, followed with about 46% scoring in the top quartile.
Certain county types score lower in the rankings. The counties of the African American South and the places known as Hispanic Centers are much less likely to be in their state’s top quartile — about 6% and 13% respectively. The counties of the Native American Lands scored lowest in the rankings; none were in their state’s top quartile.
And a large number of community types reside in the middle of the Rankings. Military Posts, Rural Middle America, Middle Suburbs and LDS Enclaves, all have roughly 25% to 40% of their counties in the top quartile of their state’s health rankings.
But that surface look at the data misses the real story in the numbers and the people and place behind them. For important reasons, this report is not about finding the best type of place to live.
First, much can depend on the place you actually live and the measure you care most about. There is a lot of variation in the numbers even within types.
The chart below is interactive. You can choose the indicator you want to explore, from uninsured rates to premature death, by scrolling through the options in the box in the top left. The black line within each type represents its median value. You can also search for any county in the country by entering its name in the “Find a County” box. The chart shows not only the differences in the community type medians but also how communities are clustered in some types and spread across the line in others.
And, beyond those numbers, consider this: With all the different types of communities in the United States — from sparse rural areas to dense cities — the overwhelming majority of Americans are quite content with their community. In 2017, Gallup asked Americans to rank the statement “The city or area you live is perfect for you” on a scale of 1 (lowest) to 5 (highest). More than 60% of Americans gave the statement a 4 or 5. And that finding was remarkably consistent across the ACP types.
This report does not identify “winners.” Rather, it aims to find what we can learn from each community type about improving health and well-being, so people can make their communities healthier no matter where they live.
What can the Exurbs teach us about growing healthy communities and what can they teach each other? What are the shared drivers behind the challenges faced by the counties in the African American South? Are there lessons in the counties of Graying America for the rapidly aging Middle Suburbs?
Three Trends in the Data
Digging into the numbers, there are marked differences across many measures, including the three key findings in the analysis.
Communities with large populations of people of colorfare poorly on a variety of important health and economic measures. This seems to be less about the specific populations in these communities than it is about the socioeconomic and cultural divides running through them. Those pressures create special challenges for these communities. The challenges are visible in data on the African American South, Hispanic Centers and Native American Lands.
The median county in those three types stands apart on a range of important factors and outcomes. They sit above the other county types on the percentage of people reporting they are in poor or fair health and the percentage of uninsured adults, but also on broader socioeconomic measures, including the percentage of disconnected youth and the percentage of children eligible for free or reduced school lunch. That combination of scores suggests that limited economic and educational opportunities are at the root of the obstacles these communities face.
In a sense, these data speak to the long-term challenges these communities face and how interconnected those challenges are — for all age groups. Children in these places start off behind their peers in other community types and are more likely to need aid in school. Later, as adults, they are less likely to have health insurance and, ultimately, less likely to be healthy. Again, these splits aren’t just about the lower incomes in these communities, but about deeper community rifts. (We explore these rifts further in the community narratives of this report.)
Mental health concerns cross all community types. The ACP’s community types look very different in their geographies, people and economies, but the median county in every type has between 10% and 16% of its population reporting 14-or-more poor mental health days per month.
Those numbers are particularly arresting when you take into account the Centers for Disease Control 2018 report that death by suicide climbed by 25% between 1999 and 2016. And while the figures are higher in some places than others, they seem to defy simple explanation. The well-to-do, semi-urban Exurbs and Urban Suburbs, at 11%, look the same as middle-income Rural Middle America. The number for the youthful College Towns, 12%, is the same as the number for the aging Graying America counties.
Furthermore, we found mental health concerns to be a top priority in every county we visited — though the driving factors were not necessarily the same. The one true outlier in the data is the Native American Lands.
The data also reveal how we may misunderstand different kind of communities. Some findings in the County Health Rankings are somewhat counterintuitive.
For instance, while urban areas are often viewed as the core of the nation’s struggle with single-parent homes, the figures are actually spread across the country to many different kinds of communities. About 38% of the children in the median Big City county, as well as 36% in the Middle Suburbs, live in single-parent homes.
Looking at diversity, we also found noteworthy revelations. Big City communities are among the most diverse in the country — the median Big City is only about 47% white. But those same communities also score higher on segregation than other kinds of communities, even those with fairly multicultural populations such as the Urban Suburbs, African American South and Hispanic Centers. That is to say, even if you live in a place that looks like a melting pot from 30,000 feet, on the ground it may look much more monochromatic.
The numbers show that the much-publicized racial and ethnic diversification of the nation has a hard time breaking through the racial and ethnic boundaries that define many communities — even in places that look diverse in high-level data. Those boundaries often have deep historical roots that were created by generations of migration patterns — conscious and unconscious decisions by racial and ethnic groups that essentially remain in effect today, particularly in Big Cities.
And rural living doesn’t necessarily mean long, solitary drives. In fact, the county type known as the Aging Farmlands is among the least likely to have long commutes driving alone. In the median Aging Farmlands county, only 22% of the people who drive to work alone have a commute time of more than 30 minutes. The figure is 27% in the median Rural Middle America county, 39% in the dense, prosperous Urban Suburbs and 45% in the Exurbs. In other words, small town/rural communities seem to offer drivers an advantage over more densely populated areas.
Next Steps
There are other large patterns in the data, which can be explored in the index of this report. Short analyses of all the ACP community types as well as an excel sheet with data can be downloaded by individuals and communities. We believe these community trends and data sets are crucial to communities and community leaders. First, they allow community leaders to see how their home compares to similar places — and whether their community is an outlier in certain statistical areas. Second, the trend data should give communities other places to turn to for models and approaches to community health and engagement.
To see what these data look like on the ground, we visited five specific communities and talked to local leaders about how they are handling the concerns they face every day. How do they strive to make their communities better? What challenges do they face? What successes have they had? You can read descriptions and solution highlights below, and dive deeper into the communities by clicking the links.
Scattered around the country, the Big Cities stand out for their diversity. These counties are a true mosaic socioeconomically, racially and ethnically (48% white, non-Hispanic, 16% African American, 11% Hispanic and 6% Asian). They are also the most segregated communities in the country.
Collaborations among nearly 100 community nonprofits, including the North Texas Food Bank, large shelters and faith-based institutions, share information about patients to better coordinate care and understand the social and economic factors that shape health.
An initiative started by Children’s Health in Dallas integrates mental health care within children’s primary care — with encouraging results.
Paul Quinn College, a historically black college in southern Dallas, has adopted the work-college model, reducing its graduates’ student-loan debt. The college has also turned its football field into a farm, helping alleviate food insecurity in a food desert.
Exurbs, which tend to sit on the edge of major metropolitan areas, are generally wealthy (median household income of more than $65,000), well educated (34% with a bachelor’s degree) and not especially diverse (81% white, non-Hispanic). They are also known for long, solo commutes by car; 83% of workers drive alone to work. In short,they are communities where the old suburban ideal still reigns.
Through the Douglas County Mental Health Initiative, 40 community partners help connect people with mental health services they need. Since May 2017, the county has created two Community Response Teams, each composed of fire/EMS, law enforcement and a clinician — with promising results.
To cope with rapid growth, including an increasing senior population, the county is helping seniors, people with disabilities, low-income residents and others get from one point to another through a partnership with Lyft and faith-based organizations.
The Regional Transit District is extending light rail lines in the county.
Heavily rural and based primarily in the nation’s Southwest with pockets in the Northwest, Hispanic Centers face significant socioeconomic and health challenges. Only about 17% of these individuals hold a bachelor’s degree and the average median household income sits low at $45,800. These communities have limited access to care. About 19% are uninsured, nearly twice the national average.
Community health workers have long facilitated residents’ connections with healthcare and social service providers. The successful model is now helping Latinos launch businesses.
As state-issued IDs have become harder for immigrants and others to obtain, a community ID card, approved in June, is expected to allow county residents to connect with civic, public safety and other community services.
Built in 2011, Hood River Crossing contains 40 one-, two- and three-bedroom units, and more affordable housing is in the works to address access to safe and affordable housing.
Based heavily in the Southeast states, the counties of the African American South struggled on the whole in the County Health Rankings, having the second-highest premature death rate among all types (more than 10,000 years lost per 100,000 population). Obesity rates (35%) and smoking rates (21%) also tend to be higher.
The initiative Live Healthy Jones aims for residents to better attend to their health, including choices about diet and exercise.
To provide for residents without health insurance, Community Health Care Systems opened in Jones County about five years ago.
A group of white and African American pastors meets regularly and discusses touchy issues, including politics and racial profiling. African American and white churches worship together over holidays.
Primarily nestled in the aging, inner-ring suburban areas of the Industrial Midwest, Middle Suburbs contain a unique mix advantages and challenges. They hold the lowest percentage of uninsured people (7%), but they score highest for drug-overdose deaths (26 per 100,000 people).
Lake County General Health District generated an idea that uses Geographical Information Systems to tackle the opioid crisis.
The Better Flip is an initiative by the Lake County Ohio Port & Economic Development Authority to make post-World War II homes on the west end of the county more attractive to young potential homeowners.
Leadership Lake County started a program two years ago to help millennials see their place in the county. The organization encourages other groups in the county to diversify their boards, including appointing two millennials at a time because the buddy system works.
More to Come
In a country as big and diverse as the United States, we need a new way to understand geography. Sometimes a community has more in common with a place hundreds of miles away than it does with the city or county next door. This report begins to explore this idea. There will be more deep dives in subsequent work, including one into the complexities of rural America.
