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Culture

How Vaccine Trends Compare Across Community Types

by Dante Chinni September 30, 2021

The Covid-19 virus remains a national story, impacting the U.S. economy and health care system, but as time goes by, local disparities are more obvious. Not every community is experiencing the pandemic in the same way, and the differences are increasingly driven by who is and is not vaccinated. Even as stories of “breakthrough infections” appear in the media, the current story with the pandemic is that those who are fully vaccinated are far less likely to get seriously ill than those who are not. And places with lower vaccination rates are more likely to see problems like ICU bed shortages.

About 52% of all Americans are fully vaccinated nationwide, but viewed through the lens of the 15 county types in American Communities Project, the vaccination stories in the United States look very different. Some county types are hovering near 60% of the total population fully vaccinated, others are far lower, near 35%, according to an analysis from the US COVID Atlas at the Center for Spatial Data Science at University of Chicago and the ACP at Michigan State University.

Overall, urban communities are much more likely to have high vaccination rates than rural ones, and places that lean Democratic politically are more likely to have gotten the shot than those that lean Republican. However, the story is complicated. There are notable exceptions. And behind those variances is a complicated mix of socioeconomics, demographics, and political beliefs. But the net result is different ACP community types are living in very different realities where the pandemic is concerned.

To be clear, no community typology or county is a monolith. Within and between similar communities, access and response to vaccination efforts may be very different. But the wide variation in the ACP types shows there are broad trends in the data that can help us understand the different community needs and experiences of the pandemic.

You can click through the charts below to look at change in vaccination rates over time by individual counties. The counties are color-coded to match the ACP types. You can use the slider bar on top to move forward or back in time on the chart and click the individual types on the key below to see just those counties. You can also look at the changes over time by type in the line chart. These charts will update automatically daily as new data come in. (Note: Due to incomplete data, Texas and Hawaii were excluded from this analysis.)

Vaccination Rates Above 50%

There are seven county types where more than 50% of the total population is vaccinated. They are, in order of vaccination rate as of September 24: the Urban Suburbs, Big Cities, Native American Lands, College Towns, Graying America, Middle Suburbs, and Exurbs.

That’s an interesting mix of places. The two most urban places, Urban Suburbs and Big Cities, are at the top, which might make sense. They account for roughly 45% of the nation’s population. Those places lean left politically, have higher college education rates, and are densely populated. Those three factors are all indicators for people who tend to be pro-vaccination.

Next highest type on the list, the Native American Lands, stands out for a few reasons. Those communities are not densely populated, and they generally do not feature higher rates of educational attainment, so why are the vaccination rates high? It might have something to do with personal experience. Those communities were hit especially hard in the pandemic, experiencing more than their fair share of deaths. Some reservations in those communities kept outsiders from visiting in the initial surge of the pandemic because case rates and deaths were so high. If you look at the line chart, the Native American Lands were by the far the quickest to get to 25% vaccinated, likely for the same reason.

The College Towns are still above 50%, but perhaps a little lower than might be expected, likely due to the younger populations in these places. Young people have not been hit as hard by Covid and, perhaps because of that, were less likely to get vaccinated. Current demographic trends at the national level show vaccination rates aligning with age, except for the oldest Americans. There was also evidence earlier in the vaccine rollout that more vaccine hesitancy existed among people with PhDs than among the U.S. population in general. Although, vaccine mandates at some schools and universities may have pushed rates higher.

Tightly bunched up, just above 50% vaccinated are Graying America, Middle Suburbs, and Exurbs, which account for roughly one-fifth of the U.S. population. They all just crossed the 50% line in mid-September. The Exurbs are lower than one might expect them, considering their higher levels of educational attainment and quasi-urban settings. Politically, however, they lean to the right (a sign of being anti-vaccine in the pandemic). The same is true for the Middle Suburbs, which tend to be more densely populated but which also tend to lean right politically.

The numbers for Graying America are more surprising and higher than might be expected. Their higher vaccination rates belie the fact that those communities tend to be quite rural and politically conservative — generally markers for lower rates. Driving the higher numbers in these communities may be their graying population, which is more susceptible to the virus.

Vaccination Rates Below 40%

At the other end of the spectrum, four community types have under 40% of their total population fully vaccinated. From the bottom up, they are: Evangelical Hubs, Working Class Country, African American South, and Aging Farmlands. For the most part, the low vaccination rates in these places are not surprising considering where the debate on Covid has moved. These are some of the more rural communities in the American Communities Project, and they are largely politically conservative, though not completely.

The Evangelical Hubs, which sit on the bottom of the county types for vaccines, are among the most politically conservative types in the ACP. Former President Donald Trump won them by about 51 percentage points in 2020 and, in recent weeks, some evangelical Christian groups have risen against the vaccine trying to claim a religious exemption. A Public Religion Research Institute poll in June found only 56% of white evangelical Christians said they had gotten vaccinated against the coronavirus or would get the vaccine as soon as possible.

The Aging Farmlands and Working Class Country counties are similarly very conservative politically (Trump won them both by more than 45 percentage points) and very rural. These are places where there probably is not a great interest in getting the vaccine and where “social distancing” is part of everyday life. There are likely fewer interactions with other people and certainly fewer mass gatherings with strangers.

The African American South, however, sticks out as an exception in this low-vaccine group. Those communities are generally quite rural, but politically they don’t lean right or left. They are very closely divided. Yet, the vaccination rates are very low, just above the Evangelical Hubs at about 37%. Driving those lower numbers may be lingering uncertainty about the vaccine in African American communities and ongoing issues of access to vaccination services. While African Americans have been disproportionately impacted by Covid-19 in terms of contracting the virus, they are getting vaccinated at lower rates, with about 45% of African Americans across 43 states having received one dose of vaccine. This may be due to poorer access to vaccine sites and sign-ups, particularly earlier on, as well as mistrust of the medical system and institutions due to many historical and contemporary instances of systemic medical racism.

Some Questions in the Data

The scatterplot visualization above raises questions about a few county types. For the entire selection of counties and for most of the ACP types, there is a downward trend in cases as vaccination rates rise, or at least a flattening out. But that pattern does not hold for the African American South and Evangelical Hubs. In those types, cases rise even as vaccination rates increase.

What’s behind that discrepancy? That’s difficult to answer without more research, but one possibility is the rise of the Delta variant and low vaccination rates overall.

If you look at maps of where those communities are primarily located, stretching from the Carolinas through the deep south, north to Kentucky and west to Oklahoma, you see a lot of areas where Delta has been especially problematic. Add a more contagious variant to a set of communities with lower vaccination rates and spikes in new cases are not a surprise.

It should be noted, however, that even as case rates are rising in those communities, deaths are declining in all the types.

What’s Next?

The outlook on Covid rates for the fall and winter seasons remains uncertain for U.S. communities. The charts in this article will continue to update as new data arrive. Resources like the US COVID Atlas can help you track rates in your community.

As always, keep track and follow the guidelines from your county, state, and the CDC to help keep everyone safe, especially the most vulnerable — children, elderly communities, and those with limited immunity. Consider helping your community and family who might be searching for clarity or access to vaccination options.

If you have questions about this data or how to understand the changing Covid landscape, reach out to the American Communities Project and the US COVID Atlas on Twitter.

This post represents the first in a series of analyses looking at vaccination rates, case rates, and deaths across the ACP types. We plan to check in on these data in the coming weeks as conditions on the ground change in our 15 county types.

African American South Aging Farmlands Big Cities College Towns Evangelical Hubs Exurbs Graying America Hispanic Centers LDS Enclaves Middle Suburbs Military Posts Native American Lands Rural Middle America Urban Suburbs Working Class Country

Vol. 3 2020-2021

Deaths of Despair Across America

The American Communities Project is undertaking a 30-month study of Deaths of Despair in its 15 community types.

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Diversity

Latest Census Shows Sharp Contrasts in Growth, Diversity, and Child Population

by Dante Chinni August 26, 2021

The country is still growing and becoming much more racially and ethnically diverse, but not evenly. And across most of the ACP’s 15 county types, there are reasons for concern about future growth. These are just two of the findings from the American Communities Project’s analysis of the latest census data.

There were more political notes in the data as well. For instance, the 2020 census may also raise concerns for Republicans in some of the communities that matter most to them, if the party continues on its current track with voters.

The data don’t tell a complete story, of course. They measure change over the last 10 years and are a critical piece of the decennial congressional and statehouse redistricting efforts. And the changes brought about by the Covid-19 pandemic or other, smaller trends over the last five years may be obscured in the data.

Regardless, however, the numbers tell a story of change that is remaking the country and all the ACP types.

Growing Fast and Not At All

Much has been made of the slower population growth rate in the latest census, the increase of 7.4% over the past decade was the second slowest rate of expansion in the history of the decennial census. But reading slower national population growth as an indicator of slow change misses a lot of subtlety in the data.

In all, 10 of the 15 county types in the ACP saw their populations increase. As might be expected, the five types with declines are more rural in their makeup: Rural Middle America, African American South, Working Class Country, Native American Lands, and Aging Farmlands.

But the growth within the other 10 community types presents a more complicated picture.

While LDS Enclave Salt Lake County is the urban home of Salt Lake City, the more rural counties around it have grown as well and some by even larger percentages. It’s a sign of the impact of those larger LDS families.

While the large growth in the Exurbs was expected (that’s a hallmark of those communities sitting on the edge of urban areas), the double-digit population increase in Graying America is more of a surprise. Those communities also tend to be more rural, and many are resort locations. Their population growth might be read as a sign of the attitudes and intentions of Americans nearing retirement age.

The growth in Big Cities and Urban Suburbs, meanwhile, indicates that the story about the decline of cities may be exaggerated. The increase in those two densely-populated types is larger than the national number.

Where the Kids Are, and Aren’t

While most of the types in the ACP added population, the majority experienced declines in their populations under 18, the child population. Only four community types increased their under-18 populations — LDS Enclaves, Exurbs, College Towns, and Military Posts. The rest had flat or declining numbers, and some declines were noteworthy.

Diversity Grows Everywhere

The story of the nation growing more diverse is not new. It’s been a driving narrative of the decennial census for decades now. But the speed at which that diversification is happening across the 15 county types in the ACP is remarkable.

The Wall Street Journal’s diversity index, which measures the likelihood that two randomly chosen people are of a different race or ethnicity in a place, reveals some big changes. All the types saw an increase diversity, but in 13 of the 15 ACP types, the diversity index increased by 9 points or more. Only the African American South and Native American Lands saw smaller increases.

Some increases in the index were massive. In Hispanic Centers, the index increased by 20 points. In the Exurbs, it was 16 points. And Graying America saw a 13-point increase in the index.

The increases in the Exurbs and Graying America were especially significant, because they pushed the diversity index in both places above 50 — to 55 in the Exurbs and 51 in Graying America. That means in those communities, there is a greater than 50% chance that any two randomly-selected people will have a different race and ethnicity. The makeup of those communities has long been solidly white, non-Hispanic, and that’s starting to change.

Political Impacts?

The increases in diversity also raise some political questions because of where they are happening, particularly in the Exurbs and Middle Suburbs. Those two types are crucial to the Republican Party. As the GOP has increasingly become the party of rural America, the Exurbs and Middle Suburbs have become its primary connection to urban areas.

In 2020, Trump won the Exurbs and Middle Suburbs by 12 and 11 percentage points, respectively. And in those types, the white, non-Hispanic population declined by 5 and 6 points respectively over the last 10 years.

Considering the GOP’s current heavy reliance on white, non-Hispanic voters, that kind of growing diversity could present a problem if it continues. Already Trump’s margins were down in both communities in 2020 compared to 2016.

The Middle Suburbs were key to Trump’s wins in Michigan, Pennsylvania, and Wisconsin in 2016. Declines in margin in those communities were a crucial part of why he lost those states in 2020.

The demographic changes in the Exurbs may be more troubling for Republicans. Those fast-expanding communities make up big parts of growing Southern states, such as Georgia, North Carolina, and Texas. If GOP margins shrink in those places, it could make it harder to overcome Democratic advantages in the Big Cities and Urban Suburbs. Some erosion of Republican support was apparent in those states’ Exurban communities in 2020.

Vol. 3 2020-2021

Deaths of Despair Across America

The American Communities Project is undertaking a 30-month study of Deaths of Despair in its 15 community types.

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Health

What’s Driving Wide Variations in Vaccination Rates in Different Communities

by Dante Chinni July 06, 2021

The 4th of July has come and gone without the United States reaching its Covid-19 vaccination goal — 70% of all adults having at least one dose. In the end, about 67% of adults were poked at least one time by the nation’s birthday.

The American Communities Project offers some insight into where the country is falling short and some idea of why — demographics, geography, and politics all seem to play roles.

A team of researchers at the University of Pennsylvania recently published a short piece in the journal Vaccine about social media conversations around the Covid vaccine using the American Communities Project types. Beyond the illuminating dissection of the online chatter, the piece also contained the remarkable chart below, showing large disparities in the percentage of people who had been fully vaccinated in each community type through early June.

Covid-19 Vaccination Rates by ACP Type

While the data are not up-to-this-minute, the discrepancies between community types are large and suggest storylines worth exploring.

Communities with Large Minority Populations

The first thing that jumps out in the chart: the lower vaccination rates in Hispanic Centers and the African American South. They are the two lowest types on the chart, and Hispanic Centers are below even 15%.

Those numbers fit with more recent findings from the Kaiser Family Foundation that Black and Hispanic populations were getting vaccinated at rates below their percentage of the population.

The reasons are harder to discern. Some of it may be vaccine hesitancy. Early poll data showed these populations were more concerned about the vaccine than other groups. But other factors may include vaccine availability (many of those communities are fairly rural) and fear of losing work time and pay or immigration concerns.

However, Native American Lands stand out at the exception among communities of color. In early June, they were near the top of all the community types, with more than 35% of their population fully vaccinated. That places them up high with large urban communities.

A few points stand out about the Native American Lands. First, they were hit very hard by the virus last year and, for that reason, may have needed less convincing to take get their shots. Second, the tribal lands in those communities tend to have a centralized leadership structure that garners respect. When leaders there spoke, community members were probably more likely to listen.

High Rates in Urban Communities

At the top of the list for fully-vaccinated places in June were the three most densely populated community types in the ACP: Urban Suburbs, Middle Suburbs, and Big Cities. All were north of 35%.

Those communities are very different places. The Urban Suburbs are wealthy with large numbers of people with college degrees. The Big Cities are diverse with a barbelled population — rich and poor, college-educated and not. The Middle Suburbs are generally less-diverse blue-collar communities around big and smaller cities.

They even hold different political leanings: Big Cities and Urban Suburbs lean heavily Democratic while Middle Suburbs tilt Republican.

And yet, despite those dissimilarities, they look very similar in vaccination rates. That suggests that, at least early on in the vaccine campaign, there was an advantage to being more tightly packed into urban areas.

The Riddle of the Exurbs

Proximity and population density doesn’t explain all the differences in the data, however. Rural Middle America and Graying America were both above 30% fully vaccinated in early June. Meanwhile, in the Exurbs, which are often at the edges of metro areas, the fully-vaccinated rate was below 30%.

That number is low for where the Exurbs “should” have been on vaccinations in early June. Those communities are not very rural — many of them are home to good-sized population centers.

They also tend to have higher levels of educational attainment. About 36% of the 25-and-older population has at least a bachelor’s degree. That’s four percentage points higher than the national average. Earlier this year, some opinion surveys found that Americans with higher levels of educational attainment were more likely to want to be vaccinated.

So why is the Exurban rate so low? The divisive political environment may be a factor. Republican Donald Trump won the Exurbs by 12 percentage points in 2020, and the social media analysis by the UPenn team found words such as “Trump” and “fraud” to be big parts of the vaccine conversation in the Exurbs from December to February.

That would help explain the lower vaccination rates in Working Class Country and Evangelical Hubs. These are more rural ACP types where Trump won by more than 40 percentage points in 2020 and where the bachelor’s-degree figures are much lower.

The larger questions are whether these community type differences persist, to what degree, and for how long? Some disparities, in availability and hesitancy, and were bound to be a part of the initial vaccine rollout, but as time goes on and the Covid variants continue, the situation becomes more serious.

African American South Aging Farmlands Big Cities College Towns Evangelical Hubs Exurbs Middle Suburbs Native American Lands Rural Middle America Urban Suburbs Working Class Country

Vol. 3 2020-2021

Deaths of Despair Across America

The American Communities Project is undertaking a 30-month study of Deaths of Despair in its 15 community types.

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As Covid-19 Recedes, an Unequal Economic Recovery Takes Shape Across America

by Dante Chinni June 10, 2021 Print

Unemployment data confirm that, indeed, there is a Covid-19 economic recovery working its way through all the types in the American Communities Project. But that recovery is not equal. The data suggest rural places are coming back sooner, and there is still a lot of room for recovery in the nation’s most urban places in particular.

From December to the end of April, as vaccinations ramped up, unemployment fell in nearly all of the ACP’s 15 community types — Native American Lands were the one exception. But going back over a longer period of time to the beginning of the pandemic, unemployment is still above where it was in February 2020 in nearly all the types. It is still particularly high in the Big Cities and Urban Suburbs.

Furthermore, when you alter the lens to look at labor force participation, some communities are seeing a slower return to work than others. Three communities stand out: the Urban Suburbs, Middle Suburbs, and Rural Middle America.

The data, from the latest Local Area Unemployment Statistics update, only go through April and the employment landscape is changing rapidly. However, the ACP’s analysis offers insights into how and where the economy is making the biggest strides in returning to “normal.”

The Good News in Unemployment

Overall, seven of the 15 community types in the ACP have April unemployment rates of 5% or less, and most of those communities are somewhat rural to sparsely populated — LDS Enclaves, Aging Farmlands, Evangelical Hubs, College Towns, Rural Middle America, Exurbs, and Working Class Country.

The Exurbs stand out as different from the rest of those places because of their higher college-education rates and population density. But there is one common trait all those communities share: On the whole they are not racially or ethnically diverse. In each of the seven types, the median county is at least 80% white and non-Hispanic.

When you look at more racially and ethnically diverse rural places in the ACP, the unemployment rate was higher, in some places much higher. In the African American South, the unemployment rate was 5.6%, but in Hispanic Centers and Native American Lands, the rate was above 8% — 8.4% and 8.7%, respectively.

In some ways, those numbers suggest a return to “normal,” in that those communities of color had higher unemployment rates even before the pandemic. But the numbers are also a signal to proceed with caution. For all the talk of “jobs returning” and perhaps less need for economic aid, unemployment rates above 8% can cause real hardship. It means in those communities alone, there are nearly 900,000 people who are looking for a job and can’t find one.

And notably, the most urban community types in the ACP — the Big Cities and Urban Suburbs — have unemployment rates above 5%. That’s important because those 153 counties hold roughly half of the nation’s population and, as a group, they usually sit at or below the national unemployment figure. They drive the U.S. economy. It’s going to be nearly impossible for the nation to see a full economic recovery without those places improving.

Urban Areas Hit Harder in Long-Term Unemployment Changes

The problems in the nation’s more urban areas look more problematic when you consider where the unemployment rate in those places stood before the pandemic. The increase in the unemployment rate from February 2020 to April 2021 is highest in the Big Cities and Urban Suburbs.

The figure is 2.4 points higher in the Urban Suburbs and a massive 3.7 points higher in the Big City counties. There are currently more than 5 million people who are unemployed in those counties. If their unemployment rates were at their pre-pandemic levels, there would be about 2.6 million unemployed in them.

Why are the numbers so high? A number of factors could be at play. Many urban schools shifted to remote learning in the pandemic and that meant parents often had to stay home to watch children. But the bigger impact likely came from the change in office work culture and business travel in the pandemic that hit the service sector.

Big Cities and Urban Suburbs are home to a lot of office buildings and office jobs. When that work got shifted to home, it meant there was less need for restaurants and cafés to serve those offices. The pandemic also meant less business travel, which in turn meant fewer hotel stays and fewer meals out.

The numbers suggest that a full “turn around” in these locales may not be possible until workers are back in their offices and traveling again. And there are questions about what that workplace return could look like. Many employers are discussing only partial office returns at least through the end of 2021. That may mean a need for fewer service employees in the establishments that serve them.

A few rural locations stood out in the data for actually having slightly lower unemployment rates in April 2021 than they did in February 2020 — Aging Farmlands and Working Class Country. But these county-level data are “not seasonally adjusted” and some of those improvements may be due to those rural communities having different employment patterns in the spring than they do in the winter. At the very least, the figures suggest those communities are closer to their pre-pandemic norms.

Labor Force Participation

One other factor that’s going to have to change for the nation to get back on track economically: the number of Americans actively searching for a job, the labor force participation number. In April 2021, the number was roughly 160 million people. That was 3.8 million below the number in February 2020.

The labor force participation number is what is used to calculate the unemployment rate. So, in a sense, the current unemployment rate is probably understating the number of people who are actually out of work. Many Americans may simply have stopped looking for a job because there weren’t positions available for them — jobs they have the training and skills to perform.

But in the ACP, a few community types stand out for their change in labor force participation since the beginning of the pandemic.

The Urban Suburbs, Middle Suburbs, and Rural Middle America have all seen declines of 3% or more in labor force participation since the pandemic began. In total, 1.8 million fewer people were looking for jobs in those communities in April 2021 than in February 2020. The biggest drop came in the densely populated Urban Suburbs, where the number was 1.2 million lower.

The Urban Suburbs and Middle Suburbs share some common traits. They are often located in and around major metros. And the April data showed their labor force participation numbers actually shrunk slightly between December and April. That may have something to do with people getting temporary jobs during the holiday season in those big metros.

Rural Middle America is different. Those communities tend to be based around small towns. Even though their labor force participation numbers are still down sharply from pre-pandemic levels, the latest months (from December to April) show a slight increase, suggesting things are improving in these places.

And, again, rural communities seem to be showing a bigger bounce back. Graying America and Aging Farmlands are only showing small declines in labor force participation between February 2020 and April 2021, and the growing LDS Enclaves actually showed an increase.

The ACP will dive into these numbers again in a few months. Summer travel, which looks as though it will be heavily based in the United States due to Covid-19, may provide an extra kick to these some of the rural communities, which draw vacationers. Graying America — in the Upper Midwest, on the East and West Coasts, and in the Mountain West — may be particularly well-positioned.

The Politics of Covid

Throughout the pandemic, Covid-19 has often been viewed through a political frame. If one brings that view to the recovery, it is fair to say that, at the moment, communities that voted for former President Donald Trump are actually doing fairly well.

Of the seven community types with an unemployment rate below 5%, six voted for Trump in 2020. Meanwhile, the communities that have seen the biggest increases in unemployment since the pandemic began, the Urban Suburbs and Big Cities, went for President Joe Biden by large margins.

Ultimately, those differences are less about politics than they are about broader economic and population patterns. However, this should serve as a reminder in these hyper-partisan times that Washington’s pandemic policy does not seem to follow simple blue/red — reward/punish lines.

Health

In President Biden’s First 100 Days, Covid-19 Cases Fall Across America

by Dante Chinni May 10, 2021

One hundred days into the new administration, the Biden White House has seen massive improvements in the new Covid-19 infection numbers — and those improvements are spread across the 15 county types of the American Communities Project, according to data from USA Facts analyzed by the ACP.

To be clear, there are still differences in the 15 types, but every one of them experienced a new infection decline of at least 40% compared to the 100 days before January 20.

There is likely a long list of reasons for that change, of course. The huge spike in new cases that accompanied the holiday season was sliding downward and the rollout of the Covid-19 vaccines undoubtedly played significant roles. But the declines have come on Biden’s watch, which means he is likely to benefit in voters’ eyes.

Measuring the Drops

The uniformity of the change is not something the ACP often sees. Generally, the socioeconomic, cultural, and political differences that define the community types take them on very different paths. (In February, we noted how rural places were seeing jumps in cases.) But these latest data are largely an exception.

The differences between the two ends of the changes are sharp — an 80% drop in Aging Farmlands versus a 43% drop in Graying America — but every community type has seen significant improvement.

The data also show that rural community types in the ACP have seen some of the biggest declines. Along with Aging Farmlands, the LDS Enclaves, Native American Lands, Rural Middle America, and Evangelical Hubs, have all seen drops of 60% or more in new Covid cases. Those are all communities where populations are less densely packed, which may have aided the cause.

Meanwhile, the most urban types in the ACP also saw deep drops, but not to the same degree. The Middle Suburbs, Big Cities, Exurbs, and Urban Suburbs all experienced drops between 53% and 44%. Those numbers at least suggested that, even with the declines, communities with higher population density were more likely to see transmission.

Looking at the data at the county level showed, again, how uniform the declines in new cases were. Of the roughly 3,100 counties in the United States, 3,000 saw declines in new Covid-19 cases in the Biden administration’s first 100 days — and three quarters of those counties saw new cases decline by 50% or more.

Larger Meanings and Politics

The larger meaning of these drops, beyond the obvious impacts of taming the virus, is hard to discern. For much of the past year, Covid-19 has been the dominant news story, viewed through a range of prisms: health and wellness, economic, education. And the pandemic clearly played a large role in the 2020 political campaign.

These numbers could be significant when it comes to politics. The community types seeing the biggest drops in new cases are also heavily Republican in their voting habits and most supported former President Donald Trump by large margins. Trump won the Aging Farmlands by 56 percentage points. He won the Evangelical Hubs by 51 points. He captured Rural Middle America by 28 points and the LDS Enclaves by 26 points. The numbers suggest those communities are solidly with the GOP.

But margin sizes matter. A major political story in 2022 and 2024 may be whether the turnaround on Covid buys Biden or the Democrats goodwill in some of these community types. Democrats aren’t going to win a majority in any of these types, but closer margins (something closer to a 20-point GOP edge in Rural Middle America) could have major implications for statewide and legislative races, particularly if Democrats maintain their big margins in urban communities.

How much the Covid numbers matter politically may depend on whether improvement continues across the ACP types. Do the numbers eventually hit a wall?

Then, there’s the larger question of how long the pandemic continues to shape the news. Does it kick off a prolonged economic boom? Do things quickly settle into a new normal that feels not that different from the old normal?

The midterms are more than 17 months away, and the next presidential election will take place more than 41 months from now. That’s several lifetimes in politics. But the improvement in these numbers across all ACP types suggests the potential for a notable political shift ahead.

Vol. 3 2020-2021

Deaths of Despair Across America

The American Communities Project is undertaking a 30-month study of Deaths of Despair in its 15 community types.

Learn More

How Montana’s Despair Deaths Have Intersected with the Pandemic’s Isolation

by Lee Banville April 14, 2021 Print

There have been a lot of anecdotal accounts of suicide and overdose rates surging during the pandemic. From early reports from Colorado about a tripling of the drug overdose rate to reports from Nevada about teen suicides as young people struggle isolated from schools and peers, the stories are compelling, but incomplete.

The American Communities Project worked with the Office of Vital Records at Montana’s Department of Public Health and Human Services to get a statistical understanding of the tumultuous intersection of Covid-19 and deaths of despair. The state allowed the ACP to analyze 197,000 death reports from 2000 through the end of 2020 to identify trends and see what may have happened during the worst of the lockdowns and social isolation.

Overall Findings Reveal Alcohol’s Effect

After examining this statewide data over the 20-year span, 2020 stands out in a few important ways:

- First, the surge in alcohol-related deaths was significant both in terms of the rate and the actual number of deaths.
- Secondly, the suicide rate remained largely flat despite the pandemic’s forced isolation and the interruption to normal routines.
- Drug overdoses appeared to be on the rise, but that is mainly attributable to a spike in April. Since then, the numbers have declined steeply.

Despair Deaths Through the ACP Lens Show Volatility

When one examines the same reports through the lens of the American Communities Project, the story of what happened to communities during Covid becomes much less consistent.

As the ACP reported in late March, initial comparison of deaths from Covid and deaths of despair find the mortality rates vary depending on economic and cultural factors.

The same holds true in Montana, but with a sparse population and large counties, data from Montana are often more volatile as individual cases can swing numbers in a county.

But still, sorted through the ACP community types, the portrait of Montana’s fight against deaths of despair during Covid becomes very different.

While deaths of despair appeared to drop toward the end of the year, 2020 still was a record bad year in three different community types in Montana: Native American Lands, Graying America, and Working Class Country. In each of these community types, the deaths of despair rate was up significantly from a five-year average.

Spread throughout the south-central part of the state and along the Rocky Mountain Front, Graying America comprises counties with older populations. Working Class counties are situated in the northwest corner of the state. These two community types saw their deaths of despair soar due to suicide increases. In particular, the three Working Class counties of Lincoln, Sanders, and Mineral saw steep jumps in the number of suicides in 2020.

Although the news was also troubling in Native American counties like Big Horn, Glacier, and Rosebud, where the deaths of despair rates climbed due to major jumps in alcohol-related deaths.

The sparsely populated Aging Farmland counties and College Town communities like Missoula and Bozeman saw either drops or little change during the pandemic.

But even amid these numbers there were promising developments.

Perhaps most striking is the drop in drug overdoses in the state. Overdose rates dropped across all community types, with the steepest drops in rural and Native communities.

Those same communities reported significant declines in suicide rates, as well, with Native counties seeing the largest — a jaw-dropping 49% drop from the five-year average.

It is too early to tell if these mixed experiences during the pandemic will play out similarly nationwide, but in Montana, drug overdoses seemed to drop as the travel limits and lockdowns dragged on and many communities saw a drop in suicide, although there are some troubling exceptions to that trend.

A safety net tested

If there is positive news in the deaths of despair data during the pandemic, it was in the general drop in drug overdoses throughout the state and a targeted drop in suicide rates in large swaths of the rural parts of Montana.

The reasons behind these numbers are more hypotheses than direct evidence but experts point to important changes in healthcare and government policies that greatly improved access throughout rural Montana.

In 2015, the Republican legislature working with a Democratic governor hammered out a deal to expand Medicaid in the state. The program, which was renewed in 2019, offered coverage to at-times nearly 100,000 people in a state with a population just over a million.

For providers in rural and low-income communities this program stabilized care and kept small hospitals and clinics open.

One federally authorized clinic that offers care in Bozeman and more rural communities around it said that before the expansion 56-58% of patients they served were uninsured. That number is now 9-10%.

At the state’s largest healthcare policy nonprofit, Dr. Aaron Wernham said the system kicked in in two important ways in 2020. Ahead of the pandemic, Medicaid expansion enrollment had dwindled to about 80,000.

But then Covid hit.

“When the pandemic hit and people lost their jobs, the program functioned as it’s intended to, which is as a safety net,” Dr. Wernham said. “When something goes wrong in your life, so if you lose your job, you all of a sudden have no income. You’ve lost maybe employer-sponsored insurance. Medicaid picked up the pieces, so we have seen enrollment in the program go back up into the low to mid 90,000 range.”

In addition to the program being there for those with low incomes and for the nearly 17% of Montanans who applied for unemployment during the pandemic, the program also kept the lights on at hospitals.

“Every emergency room in the state, basically any nonprofit hospital, which accounts for almost all of our hospitals, is obligated to see everybody that walks in the door,” he said. “You know [the program] really helped keep hospitals afloat… You can’t check their insurance before you decide if you’re going to take care of their Covid.”

An unlikely hero: the government

With Medicaid offering emergency insurance for those buffeted by the pandemic and reliable payments to hospitals and clinics, the system could stay open, but healthcare providers who were seeing patients also realized that they needed to try to move as much care as possible to telehealth.

“When you talked about rural health everyone was like, ‘well, gosh, telehealth, that’s what you should do. Why are we not doing this’ and it just never took off,” said Scott Malloy, program director at the Montana Healthcare Foundation.

Both the foundation and care providers like Lander Cooney at the Bozeman-based Community Health Partnership clinic said for telehealth to be effective key rules had to change.

Then came what Cooney called “an incredible two weeks in March.”

The federal government made three emergency decisions that changed the face of telehealth, especially in rural states like Montana. First, government insurance programs said they would pay the same amount for telehealth visits as they would for in-person treatment.

But just as important, the government said they would allow patients to receive telehealth treatments in their home and the provider could also be in their home.

That is, before March 2020, telehealth was only covered if the patient came to a clinic. Then they could see a doctor who was in another clinic.

When the laws changed, state governments like Montana worked to quickly draft emergency rules to allow telehealth to move online.

Cooney noted that moving behavioral health to video conferencing or the telephone did two things, it enabled them to offer uninterrupted services to patients and allowed clinics to use the freed up office space to create a safer location for in-person medical care.

She said within a month, nearly 90% of all behavioral health visits were fully online or by phone. The comparison is striking. In 2019, Cooney’s clinics conducts about 100 visits for both medical and mental health visits. By the end of 2020 that number had jumped to more than 15,000.

The clinics are moving toward a return to in-person treatment that never fully went away, but for Community Health Partners, Cooney said, some things have changed.

“Like any business, we need to say, ‘Let’s not go back to the old ways of doing things just because we can. Let’s consider what has changed in the past year,” she said, adding part of that would be to find the “ideal applications of telehealth.”

Screening via screens

This shift to telehealth was happening at a time when the state has also been expanding what the Montana Healthcare Foundation calls behavioral health screening.

Dr. Wernham pointed to the fact that years ago screening blood pressure was not the norm and that lack of screening prompted a “catastrophe” in terms of cardiovascular disease and death.

“We think of drug use and alcohol as being the same thing. You can’t look at someone to know if they’re depressed. You can’t look at someone and know if they are suicidal. You can’t look at someone to know if they’re addicted,” Dr. Wernham said, adding, “so you need to screen for those things just the way we screen for blood pressure, and if you’re not doing that, you know you’re at risk of missing a lethal condition.”

Most of those clinics and hospitals accepting Medicaid and other insurance have expanded the use of behavioral screening to identify drug and alcohol issues as well as depression. The concept, called integrated behavioral health, adds these checks to normal medical visits, not just those seeking some type of mental health assistance.

“By expanding telehealth access, we were more able to reach people in crisis in rural areas, at the same time as having more practices in rural areas now engaged in screening everybody that comes in, through their doors … for depression,” Dr. Wernham said.

This combination of integrated behavioral screening and telehealth is not the sole reason for drops in drug overdoses or suicide rates going down in rural places, but they have clearly helped communities in Montana weather the pandemic. It’s important to note that these changes rely on emergency declarations from federal and state governments.

As the pandemic eases, questions remain about pay parity and telehealth. Communities in far-flung Montana may be deeply affected by the result of these conversations and the continued availability of safety nets like Medicaid when it comes up for renewal in 2025.

Associate Professor Lee Banville joined the University of Montana faculty in 2009 after 13 years at PBS NewsHour, where he was editor-in-chief of the Online NewsHour.

Aging Farmlands College Towns Graying America Native American Lands Rural Middle America Working Class Country

Economics

Communities’ Job Losses Signal Mix of Optimism and Uncertainty for Post-Covid Economy

by Dante Chinni March 29, 2021

As Covid-19 vaccination rates rise, there is hope that the economic hardship that has hammered the country will wane. But a closer look at the pandemic’s impact on jobs, employers, and wages raises questions of what the recovery will look like in the 15 county types of the American Communities Project.

At the national level, most employers seemed to be keeping their doors open, but at greatly reduced staffing levels, according to September data from the federal government’s Quarterly Census of Employment and Wages. Those numbers showed job losses across the board. And within the ACP typology, some communities were hit hard, particularly the densely-packed Big City counties. Other communities, such as the Exurbs, were riding out the virus in better shape.

For this data analysis, the ACP partnered with the Economic Innovation Group to measure changes in jobs and employers as well as average wages from September 2019 to September 2020 in the 15 community types. The data show how varied the impacts are. In short, there is good reason for optimism about a recovery, but there is also reason for uncertainty as the post-COVID economy comes into focus.

Where Jobs Went Away

The pandemic’s biggest economic challenges came in lost jobs. That’s not a surprise to anyone who has followed economic news in the past year. The massive spike in unemployment last spring as the virus left employers and employees in a state of shock — even as the larger story over the summer was one of slow recovery.

But the data here, which again measure September to September changes, show how long-lasting and uneven those job loss impacts were.

Big Cities saw a nearly 10% drop in employment in September 2020 compared to September 2019. That’s a pretty massive shift considering it was months after the initial economic shutdown. And it suggests that even as the employment numbers got better nationally, Big Cities lagged behind.

Native American Lands did not fare much better, with a nearly 9% loss of jobs. Urban Suburbs saw the same drop. In Hispanic Centers and blue-collar Middle Suburbs, the job loss numbers were around 7%.

To be clear, measuring job losses is not the same thing as measuring unemployment. Unemployment measures people looking for a job who can’t find one. These numbers measure the number of people who were employed in 2019 and then in 2020. In some ways, that may be a more accurate accounting of what has been lost in the pandemic.

Driving most of these job losses was a big contraction in the leisure and hospitality sector. In 11 of the 15 ACP types, that sector led the way in job losses and often by a large margin. The exceptions were Working Class Country, where leisure and hospitality tied with manufacturing for job losses. Manufacturing was the leading cause of job losses in Evangelical Hubs. And loss in natural resources jobs was the biggest factor in Native American Lands and Aging Farmlands.

When Rising Wages Isn’t Good News

In most cases, the other big story in the data, rising wages, would be seen as good news, but not in the time of Covid-19.

In fact, the increase in wages that we see in the EIG analysis in this case, just drives home the point of lost jobs. Every one of the ACP’s 15 community types saw increases in wages, and some of the increases were massive.

However, consider where the biggest jumps were. There was a spike in Big Cities — an increase of more than 9%. And the Urban Suburbs are right there with them. Behind those big wage increases is likely the divergent socioeconomic conditions in those places.

For all the people working in office buildings in Big Cities and Urban Suburbs, there are the people who work in the service jobs nearby, the restaurants, cafes, and bars that serve them and make lower wages. And don’t forget the nearby hotels that catered to businesspeople traveling for work. In Big Cities and Urban Suburbs, the leisure and hospitality job losses were massive — reductions of more than 25% in each type.

Lots of employees in Big Cities and Urban Suburbs have been “working from home” for a year now, but those are largely the high-wage, college-educated workers for whom that is an option. Their lives are different, but they are still working. Around their pre-pandemic offices, where they used to go to work, the economic landscape has completely changed. Shifts and hours have been shortened. Staffs have shrunk.

So the average wage is up in those communities, but really only because most of the jobs that disappeared are low-wage jobs. This is true around the country, of course, but it is of special concern in Big Cities and Urban Suburbs, where socioeconomic divides are deeply baked into community life.

It’s worth noting that the Exurbs, which are generally farther from urban core areas, saw smaller drops in employment (about 5%) and smaller rises in wages (about 6%). Those communities are also full of high-wage, college-educated workers, but they also tend to have fewer service jobs. Exurbanites are less likely to live near their place of work and more likely to face long commutes (or they were before Covid).

What Happens Now?

There is some decidedly positive news in the data. In September, even after five months of the pandemic, the number of “business establishments” was up in every one of the ACP types. The increase was very small in Working Class Country, but in 11 of the 15 types the increase was at least 1%.

Considering what the nation was going through at that point, any positive number was a good sign. But the size of the increases in the nation’s most densely populated places was impressive. It was more than a 2% bump in Big Cities and Urban Suburbs. In Exurban communities, it was more than 3%.

In LDS Enclaves, the jump was big — more than 5%. And the increases in some rural communities were encouraging, particularly Graying America.

That kind of consistency is not common in the ACP types, where the socioeconomic climates and populations are so different. These numbers suggest a relatively quick economic turnaround is possible across the country. As of September, many employers had made it through the rough early days of the pandemic and were just waiting to hire again.

But a big question hangs over that positive reading of the numbers: What exactly will the new economy look like as vaccination rates rise and people begin going back to work and school?

Particularly in urban environments, such as the Big City counties, there are questions of how much and how quickly things will go back to pre-pandemic norms. Will workers opt to work from home more? Will their employers let them?

If quarter of the workforce in a major city works from home half the week, what does that mean for staffing at the businesses that served them?

“It does seem like the hole in big cities is so deep and the pace of recovery/return-to-normal slow enough that there will inevitably be a long hangover,” says Kenan Fikri, EIG’s director of research. “The real elastic bounceback was from April to July; now we’re in a long, gradual haul. Many employer-employee relationships in hard hit urban services sectors have been severed; jobs will be harder to restore now that workers are off payroll. And employers may try to run lean for a while to recover their balance sheets too.”

And the recovery in the Big Cities is unlikely to be the same all over. Las Vegas, built on tourism, may come back when most of the population has shots in their arms and begins to travel more. Cities like Detroit, which were economically struggling and not particularly resilient before the pandemic, may see the COVID impacts linger.

Overall, the data suggest that the economy is in better shape than might have been expected in all 15 community types of the ACP, and most places do seem primed for a bounce back. But, even as Covid is being tamed, finding a new economic normal will likely take time.

Vol. 3 2020-2021

Deaths of Despair Across America

The American Communities Project is undertaking a 30-month study of Deaths of Despair in its 15 community types.

Learn More

How Covid-19 and Deaths of Despair Combine to Affect Communities

by Dante Chinni March 24, 2021 Print

The Covid-19 pandemic has torn through the United States in the last 12 months, leaving more than half a million dead and the nation’s economy in tatters, but the virus didn’t arrive on a blank slate. Long before Covid, the Deaths of Despair epidemic was already taking a massive toll in communities of different kinds across the country.

Over the past year, the intersection of those two challenges has created a complicated mix of impacts across county types in the American Communities Project. Some places hit hard by Deaths of Despair seem better equipped to handle the challenges of Covid. Other places that have not seen so many Deaths of Despair have seen higher death rates from the virus.

But in a larger sense, the mortality data for the two national epidemics show how local economic and cultural factors play large roles in communities’ overall health.

This report on Deaths of Despair and Covid-19 is the latest in a series of analyses from the American Communities Project focused on Deaths of Despair, funded by the Arthur Blank Family Foundation. Last summer, the ACP looked at Deaths of Despair across our 15 community types. In the fall, Ray Suarez traveled to Montana to explore the issue on the ground. Also working with the ACP is the Center on Rural Innovation, which gathers and analyzes these data points and builds visualizations.

A year in, the Covid-19 pandemic is ongoing and still relatively new, and gathering data on the virus is not easy. Numbers usually lag real time. That’s also true for the data on Deaths of Despair, which come from national analyses of death certificate data to determine causes of death. But comparing what we know about the geographic footprints of both diseases to the ACP 15 county types, four major points emerge in the data.

There is a collection of communities with low Deaths of Despair rates, but high Covid-19 death rates. And those communities are among the more rural places in the ACP: Aging Farmlands, Hispanic Centers, and the African American South.
Some types of communities have lower death rates for both epidemics. Those types, the Exurbs and Urban Suburbs, have built in economic advantages that seem to insulate them from both challenges.
There seem to be advantages in communities built around youth and structure, enabling them to withstand Covid. Military Posts, College Towns, and LDS Enclaves are among the lowest on Covid death list even though they largely sit in the middle of the pack on the Deaths of Despair list.
Native American Lands stand alone in being hit especially hard by both epidemics.

Many reasons drive those differences. As the ACP often notes, communities are more than just a collection of people. They take the characteristics of the people who live in them. Some are wealthy and some are not. Some are more religious than others. Some are full of people who can transport their work to a home office; some rely on having workplaces where people can punch the clock. Those cultural factors, along with general race and age demographics, are fundamental to understanding their Deaths of Despair and Covid numbers.

The Big Picture in the Data

To analyze the impacts of Covid and Deaths of Despair, we measured the mortality rate for each. While the number of “cases” matters for Covid, Deaths of Despair is ultimately a measure of mortality, so we chose that measure for Covid as well. And when you look at heat maps and charts for each, clear patterns emerge.

Deaths of Despair (DoD) v. Covid-19 Death Rates

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To the north, counties in New Hampshire, Vermont, and upstate New York contain a collection of counties where Deaths of Despair are high while Covid death numbers are lower. Many of these communities are part of Graying America, where this pattern is common. Graying America counties rank second in Deaths of Despair, but 11th for Covid deaths.

Across the Southeast, particularly in the African American South, you can see the counties with fewer Deaths of Despair, but more deaths from Covid. In Appalachia — West Virginia, southern Ohio, and eastern Kentucky — the counties of Working Class Country show Deaths of Despair that are much higher than average and Covid deaths that are lower than average.

And throughout the Mountain West, Native American Land communities stand out for spiking on both measures.

The chart below translates those maps into rates by ACP type. On it, you can see the key findings of this report in a graphic form, the places that struggle and those that do well on each data point. (Note that on the map there are many small-population counties where we could not plot Deaths of Despair due to privacy concerns. However, the chart below contains the rates for all deaths in all communities, even those we cannot map.)

Where Deaths of Despair and Covid Have an Inverse Relationship

One of the most surprising findings when comparing Deaths of Despair and Covid data comes when focusing on three diverse county types with small median populations: Aging Farmlands, the African American South, and Hispanic Centers. All are in the bottom third for Deaths of Despair, but they are very high for Covid, Nos. 2, 3, and 4, respectively.

The median populations for all three county types are under 20,000. It’s 17,700 in Hispanic Centers, 15,300 in the African American South, and just 2,800 in Aging Farmlands. Their small sizes would seem to correlate with higher rates of Deaths of Despair, which can be driven by loneliness. On the other hand, this shared characteristic could help combat Covid-19, because rural, sparsely-populated communities seem to have an advantage for social distancing.

But the figures show opposite correlations. These community types do better than would be expected with Deaths of Despair and worse than might be expected on Covid. Why? One possible factor: Community ties that help prevent Deaths of Despair may contribute to higher Covid mortality.

These communities have additional factors that lead to enhanced cohesiveness. In Hispanic Centers, a common ethnicity among a large part of the population helps build bonds. In the African American South, there can often be sharp racial divides between Blacks and whites, but also a support network among Black friends and neighbors. Aging Farmlands, while rural and remote, often have strong individual identities.

Beyond those factors, religious adherence may play a big role in these three kinds of communities. All are among the top five community types in adherents per 1,000 population — more than 50% of people in each community type are active members of a religious congregation, according to the Association of Religion Data Archive.

There are additional factors in these communities, of course, particularly the LDS Enclaves, which are discussed later in this report. But higher levels of religious adherence is an important element in these places.

Not only do churches create social connections in communities, but they also give congregants a larger sense of meaning in life. That can be a powerful one-two punch that offers purpose and belonging. Those thoughts and connections can be a bulwark against Deaths of Despair. Higher rates of religious adherence often signal deeper and broader community connections. For example, a group of people know each other in multiple ways, from the neighborhood and from the pews.

Those tight bonds can pose a problem during Covid. Throughout 2020, funerals turned out to be super-spreader events, and that took a large toll on communities with deeper religious connections. In the virus’s early days, two funerals in Albany, Georgia, in the African American South, turned the town into a “hotspot” in part because many friends, neighbors, and fellow congregants gathered to say goodbye. The stories were similar around the country, particularly in rural, close-knit communities.

To be clear, these communities are home to other health dynamics that push up their Covid numbers: large elderly populations (Aging Farmlands), high diabetes rates (the African American South), and high uninsured rates (Hispanic Centers). But the combination of health and social factors is likely behind the inverse correlations between Deaths of Despair and Covid mortality.

Places that Hold Distinct Advantages

While some communities stand on opposite ends of the most dire consequences of Deaths of Despair and Covid, a few sit on the low end of both epidemics. Urban Suburbs and Exurbs hold socioeconomic advantages over most of the other community types on a broad list of measures, and those advantages extend to both epidemics. The two community types fall in the bottom half for deaths from Covid and the bottom third for Deaths of Despair.

Two advantages of the Urban Suburbs and Exurbs: health insurance numbers (they have low uninsured rates for adults) and median household income (they rank first and second in the ACP). Both suburban community types have larger numbers of people with college degrees and lower unemployment rates than other types.

Where Deaths of Despair are concerned, those kinds of numbers suggest some insulation from the worst outcomes. While they don’t address deeper community ties, friendship, or loneliness, they at least suggest communities where people are economically comfortable, with resources and opportunities.

However, the Urban Suburbs and Exurbs are two of the ACP’s more populous community types. Along with Big Cities and Middle Suburbs, they are the only community types where the median populations are above 100,000. And that kind of population density would seem to be a negative during the Covid-19 pandemic. So why are their figures so low? They are full of people who had jobs that could be made into “remote work.”

A lot of jobs moved into home offices (or kitchens or living rooms) during Covid, but the greatest number of shifts happened in the nation’s most populous counties. On the whole, 31% of American adults, some 77 million people, had their jobs shift to working from home in 2020 due to Covid, according to data from MRI-Simmons, a consumer research firm. But three-quarters of those job shifts, encompassing 59 million people, happened in the nation’s largest counties. The work-from-home numbers got smaller as the counties got more rural.

Those counties, “A and B Counties” in the demographic breakdown, hold the majority of the Urban Suburbs and Exurbs. And when you consider the higher incomes and education levels in both community types, you can see how they were especially protected from the worst parts of the Covid-19 pandemic: fewer interactions in closed spaces with non-family members. And as business travel was pared back, they were spared from exposure they might have had in airports or on planes.

In short, happiness and well-being aren’t all about economic prosperity, but there are people and communities that hold advantages in 21st-century America. The Urban Suburbs and Exurbs have some economic and social factors in their favor that protect against a range of challenges, including Deaths of Despair and Covid.

The Power of Youth and Organization

Three ACP types stand out for having low rates of Covid deaths, ranking in the bottom third, but sitting largely the middle of the pack for Deaths of Despair. College Towns, LDS Enclaves, and Military Posts are an odd mix in some ways. LDS Enclaves have the highest percentage of religious adherents in the ACP, while College Towns and Military Posts are near the bottom. College Towns lean left politically, while the other communities are quite conservative. Military Posts often feature bases where groups of people work in close quarters, while LDS Enclaves are usually rural.

But there are two larger organizing principles for all three types.

First, all these communities have an advantage during the Covid pandemic because of their relative youth. They have the largest percentage of population in the 18- to 24-year-old range. The three are among the top four ACP types for population in 18- to 39-year-old range. (The other is Hispanic Centers.)

Advanced age is one of the biggest comorbidity factors for Covid, and these three community types have larger, younger, and more vital populations than most others. More than 7% of College Towns are 18 to 39. This youth cohort makes up 6.7% in the LDS Enclaves and 6.4% in the Military Posts. That means even if there is more virus spread — which we have seen in the LDS communities and in some College Towns — the impacts are often not severe because the population is less susceptible.

But that doesn’t explain all the differences for these communities. Their Covid death rates are much lower than the nation as a whole — less than 120 per 100,000 people. Other community types that also hold larger shares of young people have much higher Covid death rates. More than 6% of the population in Big Cities and Hispanic Centers fall into the 18-to-39 age group, and their Covid death rates are 165 and 197 per 100,000, respectively.

What other factors might be in play?

A second commonality of these community types: All are tied to a larger community structure that helps organize them. LDS Enclaves are usually deeply connected to the Mormon Church. In many of these communities, the secular leadership is full of church members, which creates a deeper sense of working together. College Towns are often strongly tied to an institution of higher learning — not just students, but professors and other employees as well. This helps create more of a shared purpose or identity. And, of course, Military Posts are not only full of soldiers, but often veterans and contractors who are part of a larger connected atmosphere.

It may be that those kinds of bonds help foster a mission to “work together” to get control of the Covid pandemic. Mitigation approaches like mask mandates might be more easily accepted in communities where people are all on the same page. Leadership matters in any pandemic, but it helps to have populations that are prepared to follow. The structure baked into these communities may make an important difference.

A Double Hit in Native American Lands

A particularly sobering finding in the ACP’s analysis: the deep challenges in the counties we call Native American Lands. As we noted in our first report, those 43 counties experience Deaths of Despair at a rate of more than twice the national average, at 101 per 100,000 population. Last fall, veteran journalist Ray Suarez visited Montana and wrote about what’s happening there.

And the Covid pandemic, which seemed to hit some communities in very different ways than Deaths of Despair, did not have that inverse impact in these parts. Native American Lands saw the worst impacts of both epidemics, ranking No. 1 for both. And, as it was with Deaths of Despair, the figures for Covid deaths stood out for being high above other groups. The Native American Lands were the only community type with a Covid death rate of higher than 300 per 100,000 population.

The Native American Lands did have a few advantages where Covid was concerned. These communities tend to be sparsely populated, which allows for easier social distancing, and they often hold a deep community identity. But a wide range of issues serve as a strong negative counterbalance. If Urban Suburbs and Exurbs offer evidence that socioeconomic advantage can lead to health advantages, the Native American Lands show the opposite is true as well.

Native American Lands scored highest in the ACP types in obesity and smoking rates. They scored in the top two community types in percentage in poor health, uninsured adults, severe housing problems and food insecurity, according to the County Health Rankings. They are among the lowest in median household income and flu vaccination rates.

Many tribal communities understood the dangers of Covid early. Some closed their borders to try to keep out visitors who might more easily spread the virus in what proved to be a more susceptible population. Yet the numbers for Covid deaths stand far above other community types in the ACP, at 318 per 100,000 people.

In some ways the story of Covid-19 in Native American Lands is evidence that strong will and good community effort can only go so far. At some point, the lack of access to the “social determinants of health” is too much to overcome without additional help.

To be clear, this analysis is not exhaustive. Some additional points to note: The Evangelical Hubs are ranked relatively high for Deaths of Despair and Covid mortality. And the communities of Rural Middle America sit in the middle for each. Many socioeconomic and geographic factors play roles in those rankings. Furthermore, there are deeper analyses of Deaths of Despair that will only be possible when those data become available. (It will take years for the county numbers to be released at a national level.)

In the meantime, the ACP will publish a second exploration of this topic, looking at one of our target states, Montana. Working with the state government there, we have obtained detailed data about deaths in the past year — as the two epidemics have been raging simultaneously. We will release that analysis in the coming days.

African American South Aging Farmlands College Towns Evangelical Hubs Exurbs Graying America Hispanic Centers LDS Enclaves Middle Suburbs Military Posts Native American Lands Rural Middle America Urban Suburbs Working Class Country

Environment

Americans More Concerned About Climate Change Than Ever

by Ari Pinkus March 18, 2021

“Last year was a watershed year in terms of climate concern among the public,” shared Jennifer Marlon, research scientist and lecturer with the Yale Program on Climate Change Communication and the Yale School of the Environment, in a recent Q&A with the American Communities Project.

Since 2008, researchers at Yale and George Mason Universities have been conducting nationally representative surveys as part of the Climate Change in the American Mind (CCAM) project. The surveys are conducted twice each year to investigate public climate change beliefs, risk perceptions, policy support, behaviors, and the underlying psychological, cultural, and political factors that influence them.

Marlon, who we interviewed for our 2018 piece “Where American Communities Agree and Disagree on Climate Change,” helps us understand how Americans of different demographic, geographic, and political backgrounds think about climate change and what’s behind the twists and turns in attitudes since the Great Recession in 2008.

Ari Pinkus: Could you describe how Americans’ views on climate change have evolved over time?

Jennifer Marlon: Belief in and concern about climate change is higher now than it has ever been for Americans as a whole. Yet, the path getting here has not just been a steady rise over time. Twelve years ago, in fact, Americans overall were just slightly less concerned about climate change than they are today. In 2008, 62% said that they were somewhat or very worried about the issue, whereas in 2020, 66% said that. Given that the survey margin of error is three percentage points, that is not much movement. But that slight difference masks a large decline in beliefs, risk perceptions, and policy support that occurred between 2008 and 2010.

Since 2010, beliefs that global warming is happening, human-caused, and that scientists agree about these facts have been steadily rising, as have several measures of concern. Support for climate policies continued to decline after 2008 until 2013, but these, too, have subsequently increased since then.

The increase in concern about climate change since 2010 has been much steadier among Democrats, and it has been greatest among moderate/conservative Democrats. Among registered voters who are moderate/conservative Democrats, for example, worry increased by 23 percentage points (from 63% to 86% between 2010 and 2020), whereas it increased 10 percentage points among liberal Democrats during that same period.

Independents and Republicans have also become more likely to think that global warming is happening and human caused in the past decade, and also that scientists agree. Belief in the scientific consensus increased 12 percentage points from 19% in 2010 to 30% in 2020, for example. Gains in concern and policy support have been more modest among Republicans, however, and in one case — funding research for renewable energy — support has declined among conservative Republicans.

Pinkus: What is driving these attitude views?

Marlon: The remarkable decline in beliefs, risk perceptions, and policy support that occurred between 2008 and 2010 was coincident with the Great Recession. One hypothesis is that individuals have a “limited pool of worry” and so short-term economic concerns took precedence over longer-term environmental concerns during those years. This idea is plausible given that beliefs, risk perceptions, and policy support all declined and that these declines were evident across the political spectrum.

Careful research by Matto Mildenberger at University of California, Santa Barbara and colleagues, however, shows that individual opinions did not vary in places where job growth, housing prices, and other losses were most severe. Changes in political leadership and messaging may have therefore contributed more to that decline than individual economic fortunes. The role of media effects (e.g., overall proportion of issue coverage) and vicarious experience, however, probably warrant further examination.

The subsequent increase in Americans’ understanding of the nature, cause, and scientific consensus on climate change, as well as the increase in perceived harm to future generations, developing countries, the U.S., and more has undoubtedly been caused by a variety of factors working synergistically. The mobilization of climate advocates; an increasing number of political, community, and other leaders speaking out about climate; and the steady drumbeat of unusually severe weather events have all likely reinforced one another.

As a result, more Americans than ever are now convinced that the Earth is warming; that human activities are responsible; and that the consequences are dangerous not only to the environment, but also to human health, economies, national security, and more. More Americans than ever also now understand that a variety of solutions exist, and Democrats increasingly support policy interventions to reduce carbon emissions.

Pinkus: Was 2020 a watershed year? If so, how?

Marlon: Last year was a watershed year in terms of climate concern among the public. One of the ways we track public opinion about climate is through our “Six Americas” audience segmentation. The segments represent the full spectrum of views about climate change.

The Alarmed are convinced global warming is happening, human-caused, an urgent threat, and strongly support climate policies.
The Concerned also think human-caused global warming is happening, a serious threat, and support climate policies, but they tend to believe that climate impacts are still distant in time and space.
The Cautious haven’t yet made up their minds about whether global warming happening or not, what is causing it, and how serious it is.
The Disengaged know little about global warming as they rarely or never hear about it.
The Doubtful do not think global warming is happening or believe it is just a natural cycle and not a serious risk.
And lastly, the Dismissive believe global warming is not happening, human-caused, or a threat, and most endorse conspiracy theories (e.g., “global warming is a hoax”).

Looking back over the past five years, we find that the Alarmed group has increased from 11% to 26% — the largest increase in any of the segments. The Dismissive, in contrast, shrank from 12% to only 7%. The Dismissive and Doubtful are overrepresented in Congress, however, and have more vocal proponents than do the Disengaged or Cautious. As a result, many Americans overestimate the sizes of these population segments and underestimate how many people actually worry about climate change and want to transition more quickly away from fossil fuels and toward renewables as our primary energy sources.

Pinkus: What are the regional differences in the ways people view and talk about climate change?

Marlon: People’s views about climate vary from state to state, and many differences reflect political patterns that we’re familiar with. For example, Americans in blue states, often along the coasts, tend to show greater concern for climate change than those in red states, often in the Midwest and South, for example.

There are some surprises, however. People of color are generally more concerned than Whites about climate change, for example, and Hispanics/Latinos, in particular, tend to be the most concerned. As a result, places with large non-White populations, such as southern Texas, in the Black Belt of the southeastern U.S., and on tribal lands show higher-than-average belief in global warming, concern about its impacts, and support for policy.

Perhaps surprisingly, however, majorities of Americans in every state think citizens and corporations should do more to address global warming. And majorities in all but three states (Wyoming, North Dakota, and West Virginia) think Congress should do more to address global warming as well.

Pinkus: How could policymakers and community leaders leverage these mindset shifts to strengthen their communities?

Marlon: Given that so many Americans underestimate how many people actually worry about climate change and want different stakeholders to take more action, policymakers and community leaders should be working to bridge this gap in awareness.

Social norms are a powerful influence on individual’s attitudes and behaviors, so providing information about the growing strength of the social and scientific consensus that global warming is happening and is already having serious consequences can help promote dialogue about which solutions we can and should pursue, whether as individuals, communities, or as a nation.

Recent research also suggests that lasting engagement with climate change is more likely to arise from:

deeper discussion with one’s family, friends, and colleagues;
greater understanding of the problem, its impacts, and solutions, which can motivate action; and
reinforcement of the changing social and cultural norms toward greater acceptance of the problem and engagement in solutions to it.

These findings point toward the importance of not only policymakers and community leaders in driving behavioral change, but also individuals and decision-makers in all domains, from the public and private sectors, and at all levels of society.

One of the primary reasons that we’ve seen such strong growth in concern during the past five to ten years is that the voices talking about and engaging with the issue have become much more diverse. There is great strength in this diversity, and we need to continue expanding our conversations and efforts to bring more communities into the fold.

As many leaders have noted, climate change doesn’t care whether you are a Republican or a Democrat, or whether you live on a coast or inland, in the mountains or on the plains; it is affecting us all, and we all have a role to play in reducing the impacts occurring today and in the future.

Vol. 3 2020-2021

Deaths of Despair Across America

The American Communities Project is undertaking a 30-month study of Deaths of Despair in its 15 community types.

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Environment

Mapping Climate Risks by County and Community

by Ari Pinkus February 17, 2021

With the Biden administration elevating climate change concerns to the national agenda, the American Communities Project leveraged data from Four Twenty Seven, a physical climate risk data firm and affiliate of Moody’s, to understand how the risks manifest by ACP type — and where populations and infrastructure may be especially vulnerable.

Four Twenty Seven analyzes several physical risks to the U.S. landscape, including sea level rise; hurricanes; extreme rainfall; water stress; and heat stress, characterized by higher temperatures. Many of Four Twenty Seven’s projections through 2040 show the risks are regional, as illustrated in maps below. We also parse the degree to which high risks differ by ACP type. Six key takeaways emerge from filtering:

Sea level rise stands out as a climate hazard in Military Posts, based on the percentage of these counties affected compared with the ACP’s 14 other community types.
The threat of hurricanes hangs over a clear majority of African American South counties, where the populations tend to have lower incomes and less higher education experience. No other community type reaches the 50% threshold, though Military Posts come close.
Extreme rainfall is also expected in a majority of counties in the African American South as well as mostly-white Working Class County and blue-collar Middle Suburbs. When it comes to the African American South’s two big climate risks, many Black homeowners and renters, in particular, live in low-lying areas and lack flood insurance, making them more vulnerable. In Middle Suburbs, where the manufacturing sector has been hit hard by globalization these past 30 years, intense floods could pose additional economic harm, negatively impacting industry and transportation into the future.
More than three-quarters of two rural community types with young populations — Hispanic Centers and LDS Enclaves — expect to experience significant drought conditions in the coming years. This may be especially harmful in Hispanic Centers, where agriculture is a key industry and heavily dependent on water availability.
Heat stress is forecast in a majority of Evangelical Hubs, i.e. lower-income, less educated, and less diverse communities with a large number of Evangelical adherents, located in the Midwest and South. That education and income are the strongest socioeconomic drivers of health effects from heat may make Evangelical communities more sensitive to absorbing these perils.
Among the 47 Big City counties, all five physical risks are notable, with hurricanes, water stress, and heat stress the most prevalent by percentage. For these stratified, diverse communities, populations are likely to be unevenly affected by the hazards.

Where East Meets West: Rising Seas

It’s unsurprising that sea level rise presents the greatest threat to populations living along the U.S. coastline — most of the country’s geography is in no danger of rising seas. There are several zones to watch. The mid-Atlantic region into the upper South — from New Jersey to North Carolina — contains a dozen counties deemed red flag for their significant exposure of coastal flooding. These counties have a combined population of 863,519, based on U.S. Census estimates in 2019. South Florida and counties in Louisiana, Mississippi, and Texas ringing the Gulf of Mexico are red flag or high risk. A few patches of the Alaskan coastline, too, are in the red flag zone. The Pacific Northwest holds about a dozen counties with a high risk of sea level rise. (Scroll over the map to see a county’s risk level and community type designation.)

As mentioned above, rising sea levels are a great danger in Military Posts. Of the 89 counties, 19% are dubbed red flag or high risk. According to a Union of Concerned Scientists’ report in 2016, “The military is at risk of losing land where vital infrastructure, training and testing grounds, and housing for thousands of its personnel currently exist.” This could have a real impact on military readiness by reducing operational capacity.

Communities of color and diverse, densely populated places are also in the line of danger. For the 43 Native American Lands, the 370 African American South counties, and the 47 Big Cities, the numbers are 14%, 13%, and 13%, respectively. Many non-white households living near the coasts, particularly in the African American South and Big Cities, haven’t received sufficient flood investment protection and don’t have flood insurance. Four Twenty Seven explored the link between race and climate change in a piece in July 2020. Meanwhile, 12% of Urban Suburban counties face red flag or high risk.

The Dividing Line for Hurricanes

More of the U.S. population faces the danger of hurricanes. Consider that the entire coastlines of the Carolinas, much of Florida as well as the Louisiana and Alabama coastlines are deemed red flags. Beyond those red zones, the risk is high in all the states along the eastern seaboard and the Gulf of Mexico. Hurricanes are low or no risk moving westward. (Scroll over the map to see a county’s risk level and community type designation.)

As we’ve seen in recent years, hurricanes can wreak havoc on the regional infrastructure, impeding a community’s recovery. In the article “The Effects of Infrastructure Service Disruptions and Socio-Economic Vulnerability on Hurricane Recovery,” the author-researchers surveyed nearly 1,000 households in Florida after Hurricane Irma and found “that physical damage to property, disruption of infrastructure services such as loss of electric power and cell phone/internet services and other factors (i.e., homeowner’s or renter’s insurance coverage, receiving disaster assistance and loss of income) are significant predictors of post-disaster recovery when controlling for age and race/ethnicity.”

Drilling down, hurricanes are of the greatest risk in many densely populated and diverse places. In this rich mosaic, the standout is the African American South, with 64% of counties at red flag or high risk, and where populations are vulnerable because of housing conditions. Two other community types see close to half of their counties in the danger zone: 48% of Military Posts and 45% of Urban Suburbs face red flag or high risk of hurricanes. The same is true of more than a quarter of Big Cities.

Appalachia’s Ground Zero for Extreme Rainfall

For extreme rainfall, the risk picture looks markedly different, covering more of America’s interior. The Midwest’s Ohio, Appalachia’s West Virginia and Kentucky, and Washington State’s coastline are dubbed red flag. But high risk fans out across the Midwest as well as the South, Northeast, and Pacific Northwest. In March 2020, severe weather in the Midwest and Ohio Valley, including Missouri, Ohio, Kentucky, Tennessee, West Virginia, and Pennsylvania, caused $2.6 billion in damage, according to NOAA estimates. (Scroll over the map to see a county’s risk level and community type designation.)

More intense patterns of extreme rainfall are expected to hit the Middle Suburbs particularly hard, as 62% of these 77 average-income, mostly white counties face red flag or high risk. Meanwhile, 58% of the 337 counties of Working Class Country, known for mostly white populations without much higher education, are red flag or high risk. The African American South is not far behind, with 56% of counties deemed red flag or high risk.

Drought Conditions Most Everywhere

Water stress risk covers much of America’s interior, many sparsely populated places that make up the country’s breadbasket as well as swaths of more densely populated ones, including along the East Coast. Red flags show up in many regions: a small pocket of the Midwest, chunks of the Plains, including the Ogallala Aquifer, the intermountain West, the Southwest, as well as sizable portions of California, including the Central Valley. The Department of Homeland Security reports that “water and wastewater systems, energy, and food and agriculture are the critical infrastructure sectors most vulnerable to drought conditions.” (Scroll over the map to see a county’s risk level and community type designation.)

Community types known for having younger populations are poised to experience much water stress. Of the 161 agriculture-dependent, lower-income Hispanic Centers, 85% face drought-like conditions that are considered red flag or high risk. The pattern is similar for nearly all 41 of the rural, middle-income LDS Enclaves. Of the Big City counties, 62% expect to contend with water stress deemed red flag or high. Of the 154 College Town counties, 38% are in the red flag or high risk categories.

The Midwest — Hot, Hot, Hot

More and intense hot days are red flag risks in almost all of Missouri, much of Illinois, southwestern Iowa, and a touch of Arkansas. However, most of the Midwest is in the heat zone. Risk is high for nearly half of Ohio, all of Indiana and Oklahoma, part of Wisconsin, most of Iowa, Nebraska, Kansas, Kentucky, Tennessee, and the tip of Texas. Note that humidity, an important heat stress factor for assessing heat-related health risks, is not included in Four Twenty Seven’s analysis.

Then, perhaps not surprising, the southern part of Arizona, part of the Deep South, Florida, and Hawaii are at high or red flag risk for extreme heat. (Scroll over the map to see a county’s risk level and community type designation.)

Increasing temperatures have the potential to gravely impact public health. Affected communities are home to many lower-income families that often cannot afford air-conditioning, work outdoors for a living, and/or live in difficult housing conditions. Four Twenty Seven’s white paper “Heat and Social Inequity in the United States” examines heat vulnerability in detail.

Heat waves can also take a toll on physical infrastructure, particularly in cities, and the EPA recommends protecting roads and bridges with materials that can withstand heat as well as bolstering energy efficiency to avoid power problems. Arizona, for its part, maintains a detailed extreme heat response plan.

In the Midwest and South, Evangelical Hubs are expected to bear the brunt of the heat, with 65% of its 372 counties falling into the red flag or high risk categories. Working Class Country stands at 51%, while 50% of Rural Middle America’s 599 counties, running across the country’s northern half, are deemed red flag or high risk. This has the potential to affect labor productivity because many jobs in these parts are performed outside or near machines radiating heat.

A variety of diverse and more homogeneous suburbs should expect challenges here as well, including 34% of the 77 Middle Suburbs, 32% of the 222 Exurbs, 32% of the 47 Big City counties (which often include suburbs), and 22% of the 106 Urban Suburbs.

Climate Change in Focus

The Biden administration is taking these physical risks to the U.S. seriously based on its early actions, budget, and personnel. On Inauguration Day, President Biden signed several executive orders on climate, including recommitting the U.S. to the Paris climate accord to reduce greenhouse gas emissions and adapt to the effects of climate change. Moreover, Special Presidential Envoy for Climate John Kerry and White House National Climate Advisor Gina McCarthy are putting job creation at the center of the climate agenda and taking a more focused approach to tackling environmental inequities. The administration is also raising up the issue globally, hosting a climate summit of world leaders on April 22, the 51st Earth Day.

Vol. 3 2020-2021

Deaths of Despair Across America

The American Communities Project is undertaking a 30-month study of Deaths of Despair in its 15 community types.

Learn More

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The American Communities Report

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Americans Across Communities Want Focus on Climate Change and the Environment

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Deaths of Despair Across America

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Appalachia’s Ground Zero for Extreme Rainfall

Drought Conditions Most Everywhere

The Midwest — Hot, Hot, Hot

Climate Change in Focus

Americans Across Communities Want Focus on Climate Change and the Environment

How a Native American Land Community Is Dealing with Drought and Poisoned Creeks

Deaths of Despair Across America