Mississippi Delta Project
Health and Environment
Prospectus
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A partnership project involving communities,
government, accidentia, and private sector organizations
Mav 1995
Current Participants in the Mississippi Delta Project
Health and Environment
Community-Based Organizations
Jesus People Against Pollution
Columbia, Mississippi
Federal Agencies
Agency for Toxic Substances and Disease Registry
Centers for Disease Control and Prevention
National Center for Environmental Health
National Institute for Occupational
Safety and Health
Office of the Associate Director for
Minority Health
Environmental Protection Agency
Office of Environmental Justice
Office of Solid Waste and Emergency
Response
National Institutes of Health
National Institute of Environmental Health
Sciences
National Library of Medicine
State Representatives
Arkansas
Department of Health
Department of Pollution Control
and Ecology
(HBCU to be announced)
Illinois
Department of Public Health
Illinois Environmental Protection Agency
(Academic institution to be announced)
Kentucky
Department for Health Services
Division of Environmental Health
Kentucky State University
Louisiana
Louisiana Department of Health and
Hospitals
Department of Environmental Quality
Southern University at Baton Rouge
Mississippi
Department of Health
Department of Environmental Quality
Mississippi Valley State University
Missouri
Department of Health
Lincoln University
Tennessee
Department of Health
Department of Environment and
Conservation
LeMoyne Owen College
Meharry Medical College
Other Participants
Minority Health Professions Foundation
Contents
Introduction 1
Background 2
The Lower Mississippi Delta Development Commission 2
Minority Health Programs 3
Environmental Justice Emergence 5
Health Promotion and Disease Prevention 6
Project Description 7
Overall Objectives 8
Delta Project's Phases 9
Delta Project's Architecture 10
Collaborative Projects 10
Funding and Adjusted Timelines 1 1
References 1 1
Appendix A 13
Delta Commission Report Goals on the Environment
Appendix B 23
5-Year Plan for the Office of the Associate Director for Minority Health
Appendix C 27
Presidential Document (Executive Order 12898)
Appendix D 35
Historically Black Colleges and Universities in the Lower Delta Region
Appendix E 37
Presidential Document (Executive Order 12876)
"Economic development of the Delta cannot be separated from the cultural
and ethnic realities and cannot be planned apart from careful management of its
resources and protection of its environment. This report envisions a coming time
when ecological mindfulness and economic development are no longer seen as
incompatible but as indivisible."
(Lower Mississippi Delta Development Commission, 1990)
Introduction
The preceding quotation was taken from the report Realizing the Dream. ..Fulfilling the Potential, which was
prepared by the Lower Mississippi Delta Development Commission.' The words reflect a vision for the
Lower Mississippi Delta Region wherein ecological concerns co-exist with economic development and
social advancements. The Commission concluded its work and disbanded in 1990. The Commission's final
report is a key document that combines concerns for improving the health of ethnic and racial minority
populations in the United States and for achieving environmental justice. The work of the Commission
provides compelling support for a demonstration project that forms partnerships in pursuit of regional ex-
cellence in public health and environment protection. The Mississippi Delta Project— Health and Environ-
ment is an attempt by government, academia, private sector organizations, and community residents to
implement, within a key geographic region, a program that demonstrates how partnerships can be formed to
identify and reduce the impact of environmental hazards. This document outlines the background of the
Delta Project, its goal and objectives, its partners, and how the project is organized.
The Mississippi Delta Region was defined by the Lower Mississippi Delta Commission as a 219-county
strip along the Mississippi River in Arkansas, Illinois, Kentucky, Louisiana, Mississippi, Missouri, and
Tennessee. The counties and parishes in the Delta Project are listed on the inside of the back cover page of
this brochure. The Region is populated by approximately 8.3 million people, including a large number of
persons of low income, African Americans, and growing numbers of other people of color.
No comprehensive database currently exists on the environmental hazards in the Delta Region. How-
ever, from databases in several federal and state health and environmental agencies, it is known that the
Region's environmental hazards include the spectrum of non-point environmental problems such as mer-
cury contamination in some states' surface waters, pesticides runoff in agricultural areas, seasonal degrada-
tion of ambient air quality, vector control, and the environmental and health consequences of natural disasters.
Point-source environmental problems include releases of toxic substances from waste sites, lead-based
paint in older housing, hazardous materials handling, chemical spills and explosions, and inadequate mu-
nicipal waste treatment capacity. As one example, within the 219 counties, at least 40 uncontrolled hazard-
ous waste sites are on the Environmental Protection Agency's (EPA) National Priorities List (NPL). The
NPL is a listing of the most hazardous waste sites nationwide. In addition, states in the Region are respon-
sible for managing the health and environmental risks posed by waste management, including non-federal
abandoned waste sites.
Because of the diversity of environmental hazards and the high concern of the public over environmen-
tal and health impacts, government and private sector organizations are challenged to make an impact on
reducing the risks posed by individual environmental hazards. While some communities and government
agencies have worked closely on ameliorating specific environmental problems, a comprehensive regional
plan to mobilize partnerships toward the goal of reducing environmental impacts and enhancing develop-
ment is lacking. By focusing on a region with historic and demonstrated minority health disparities and
identified environmental hazards, it is possible to develop the data and experience that will be necessar) to
shape public health, environmental, and educational interventions within the Region Federal and state
agencies, academic institutions, and community residents in the Region propose that a concentrated effort
of sustainable partnerships be undertaken in the Lower Mississippi Delta Region.
Mississippi Delta Project
Background
The need for a regional demonstration project that proposes to establish regional excellence in public health
and environmental protection, through partnerships, stems from the confluence of three concerns: 1) the
need for further economic development of the Lower Mississippi Delta, 2) the importance of improving the
health of persons of color and underserved populations, and 3) the need to ensure that environmental justice
is achieved as a matter of social justice. Each concern has contributed to the genesis of the Delta Project.
Details of each concern are described in the following paragraphs.
The Lower Mississippi Delta Development Commission
The Lower Mississippi Delta Development Commission was established in October 1988 to study and
make recommendations on economic needs, problems, and opportunities in the Region and to develop a 10-
year economic development plan for it. Two reports have been prepared by the Commission. They are Body
of the Nation: The Interim Report of the Lower Mississippi Delta Development Commission and The Delta
Initiatives: Realizing the Dream.. .Fulfilling the Potential. The latter report, which was the Commission's
final report, notes "This final report is a trumpeting call by the Delta's own people to begin the tasks that will
create a new and better tomorrow for this, the body of the nation, and therefore a brighter future for the
nation as a whole." The same report concludes that the problems found in the Delta are common to all seven
states — Arkansas, Illinois, Kentucky, Louisiana, Mississippi, Missouri, and Tennessee — that have counties
or parishes in the Region. The Commission makes a clear and compelling call for regional cooperation and
cohesiveness in order to reach better solutions to the Region's problems.
The Commission's final report, Realizing the Dream... Fulfilling the Potential, contains sections on
education, health, housing, community development, agriculture, natural resources, public infrastructure,
entrepreneurial development, technology development, business and industrial development, tourism, and
the environment. Each section contains goals and attendant recommendations. The sections on environ-
ment, community development, health, and education are especially pertinent to the Delta Project. The
Environment section states:
A growing awareness of the need to face environmental problems was expressed by
Lower Mississippi Delta citizens in hearings in each state. Yet many people still argue that
environmental protection and economic development are incompatible. In fact, the reverse
is true.
In the 21st Century, the world cannot accommodate growth and economic development
apart from environmental protection. This means that in the long run, protecting the Delta's
environment will pay dividends by attracting more new businesses, tourism dollars, re-
search grants for institutions of higher learning and job opportunities. This new economic
development concept will foster a great sense of "pride of place" among the Region's resi-
dents. All people will have to think of themselves asenvironmentalists. This will build a
new environmental ethic and will create policies that reconcile preserving the environment
with aggressive pursuit of economic growth.
The Commission developed three goals for environmental protection in the Delta Region:
▲ By the year 2001, the Delta will improve its overall environmental quality by meeting or
surpassing national environmental standards, and by preparing for natural and man-made
disasters.
2 Mississippi Delta Project
▲ By the year 2001, the Delta will be at the forefront of environmental research and will
promote community environmental awareness and education throughout the Region.
▲ By the year 2001 , all states in the Delta will achieve methods to dispose of their hazardous
and solid waste without threatening groundwater and surface water and air quality.
Specific recommendations in support of the environment goals were developed in support of each goal.
The set of recommendations is listed in Appendix A of this document.
Goals for community development, health, and education in the Delta include the following:
A Community Development — By the year 2001, all 219 Delta counties and parishes will be
operating in accordance with local strategic plans, integrated with the plans of state, re-
gional, and federal entities. These plans will reflect volunteer initiatives representing local
population diversity.
Attending this goal are recommendations that encourage the development of training pro-
grams for local leaders, volunteers, and community action groups. In particular, institutions
of higher learning are encouraged to develop and implement leadership exchange programs
for individuals from various groups, including academic institutions, businesses, state and
local governments, churches, and communities.
▲ Health — By the year 2001, all residents of the Delta will have access to health education
and promotion programs.
Recommendations attending this goal include encouragement to health care providers to
adopt strategies to enhance health prevention practices, for state departments of education
and local school systems to examine K-12 health education curricula to ensure prevention
material is presented, and for training programs to increase time spent on health prevention.
A Education — Expand the role of Delta higher education institutions in community and eco-
nomic activities by the year 2001 .
Recommendations in support of this goal include encouraging institutions of higher learn-
ing to establish interstate programs among private industry, state government, and commu-
nity-based groups.
Other goals could have been cited that would be relevant to achieving regional excellence in public
health and environmental protection, but it is apparent from these goals that the Lower Mississippi Delta
Commission envisioned the need for the creation of partnerships as an essential step in developing the
Region and lor addressing the area's problems. A guiding principle for developing strategies for achieving
quality of life and sustaining the natural resource base in the Region is what has come to be known as
sustainable development.
Minority Health Programs
Preventing adverse health effects in disadvantaged communities and people of color exposed to envi-
ronmental ha/arcls is a priority for government health agencies al all levels. Minority populations, ji.ii tK u
larly African Americans, Hispanics. and Native Amerieans, sutler disproportionately from preventable
morbidity and mortality Regardless of income, education, or geographic locale, these populations are in
Mississippi Delta Project 3
poorer health than their white, non-Hispanic counterparts. However, the health impact of the environment
on minority populations has not been adequately characterized.
Reducing the disparity in health and improving quality of life among disadvantaged groups and among
ethnic and racial populations impacted by environmental hazards will require the collective commitment of
health professionals and environmental health scientists. Federal agencies and state health departments in
the Region all have health outcome data that characterize the health of the public. For example, mortality
data and disease incidence data are generally available. However, resources have generally been lacking in
terms of linking morbidity and mortality databases and environmental quality data.
As illustration of federal minority health programs, the Agency for Toxic Substances and Disease Reg-
istry (ATSDR) and the Centers for Disease Control and Prevention (CDC) have conducted a series of projects
to assess the impact of the environment on health in minority communities. The agencies' efforts since 1987
have evolved into an important Minority Health Program at ATSDR. In 1988, with the appointment at CDC/
ATSDR of the Associate Director for Minority Health, a 5-Year Strategic Plan for Minority Health was
completed (See Appendix B). Over the past several years, four goals have been developed for ATSDR's
Minority Health Program. All or parts of these goals are believed by ATSDR to be shared by other federal
agencies and some state agencies that have undertaken minority health and environmental justice programs.
▲ Demographics — Develop a comprehensive demographic profile of communities living near
hazardous waste sites and other sources of hazardous substances.
▲ Health Studies and Applied Research — Determine associations between identified ad-
verse human health outcomes in disadvantaged communities and people of color and haz-
ardous substances, and implement health interventions based on significant findings from
health studies and other applied research investigations.
▲ Community Involvement and Risk Communication — Develop and execute environmental
risk communication and community education programs to mitigate and prevent adverse
health effects from environmental toxicants in minority communities.
▲ Training and Education — Increase the numbers and racial and ethnic diversity of persons
in the professional disciplines that constitute environmental public health. This includes
assisting with curriculum development in academic institutions, supporting faculty through
research projects, convening seminars and workshops in toxicology and related disciplines,
and conducting short-term training for professionals in disciplines relevant to identifying
and preventing environmental hazards.
Since 1987, ATSDR has investigated the public health impact of hazardous waste sites and other sources
of exposure to environmental toxicants on persons in disadvantaged communities. ATSDR's efforts in mi-
nority health have not been concentrated on any one geographic area of the country. Rather, the Agency has
pursued the four goals of its Minority Health Program in disadvantaged communities around individual
waste sites across the nation. This approach has provided ATSDR with valuable data and insight into envi-
ronmental hazards faced by minority groups. However, the goal of reducing the disparity in health and
improving quality of life among disadvantaged groups and among ethnic and racial populations requires a
more concentrated effort by the public and private sectors than what can possibly be accomplished by using
a site-by-site approach and by any one agency acting alone.
4 Mississippi Delta Project
Environmental Justice Emergence
The emergence of environmental justice as a significant social concern has contributed to identifying
the need for the Mississippi Delta project. Although much of the evidence is anecdotal and circumstantial,
there are mounting concerns that environmental health risks are borne disproportionately by members of the
population who are poor and nonwhite. Concerns that possible disparities in environmentally induced ill-
ness are related to socioeconomic class and ethnicity or race have made this issue a top priority on the
environmental health agenda of the United States.
Most of the studies cited as evidence of environmental inequities are observational. In other words,
these studies document disparities by relying on statistical associations between demographic characteris-
tics of populations, primarily race and income, and indirect surrogates for exposure to hazardous substances,
such as residential proximity to pollution sources. According to a variety of sources,2 these investigations
have been consistent in finding that members of disadvantaged groups are more likely than affluent whites
to 1) live near sources of environmental pollution, such as hazardous waste sites; 2) reside in urban areas
where ambient levels of certain pollutants, such as lead and carbon monoxide, are elevated; 3) eat signifi-
cantly greater amounts of contaminated fish; and 4) be employed in potentially dangerous occupations, such
as migrant farm work.
Inequitable distribution of the costs and benefits associated with environmental regulations has been the
topic of discussion and study for more than 20 years. During the 1980s, hundreds of grassroots and commu-
nity action groups brought attention to the environmental problems facing disadvantaged communities. In
1982, demonstrations by members of a low-income, predominantly African-American community against
the proposed site for a polychlorinated biphenyl (PCB) landfill in Warren County, North Carolina, garnered
national media coverage. The following year, a General Accounting Office (GAO) study found that three of
the four largest operating hazardous waste sites in the southern United States were located in primarily
African-American communities.3 In 1985, the first national African-American environmental organization,
the Center for Environment, Commerce, and Energy, was established. That same year, the National Council
of Churches' Eco-Justice Working Group began to address environmental issues.
The United Church of Christ's (UCC's) Commission for Racial Justice released a nationwide study in
1 987 on the demographics of populations living near hazardous waste sites.4 The report found that in com-
munities with one or more commercial hazardous waste facilities, the proportion of racial minorities was
significantly greater than in communities without such facilities. Similarly, researchers found that African
Americans were disproportionately represented in areas around operating (i.e., controlled) hazardous waste
facilities around Detroit, Michigan. However, a study by University of Massachusetts investigators did not
find any disparities according to racial or cultural groups residing near operating hazardous waste facilities.
ATSDR has completed a study of the demographics of communities located near uncontrolled waste facili-
ties. By its analysis, African Americans are represented in disproportionate numbers in communities located
near Superfund priority waste sites.
In 1990, ATSDR sponsored the "Minority Health Conference: Focus on Environmental Contamina-
tion," which was the first federally sponsored conference of this kind. Media coverage accelerated in 1991
and a number of conferences and symposia were held to examine the issue. In 1993, Congressman Louis
Stokefl convened the U.S. Congressional Black Caucus Mrain Trust Meeting on Environmental Racism. In
February I 994, six government agencies with the support ol community and academic leaders convened (he
first federal symposium on environmental justice entitled "I lie S\ inposmin on Health Research and Needs
to Ensure Environmental Justice." This symposium was attended by approximately 1 ,200 grassroots, aca
demic, government, labor, business, and community leaders During the symposium, President Clinton
signed Executive order #I2K(>n, which states "each Federal agency shall make achieving environmental
Mississippi Delta Project 5
justice part of its mission by identifying and addressing, as appropriate, disproportionately high and adverse
human health or environmental effects of its programs, policies, and activities on minority populations and
low-income populations...." (See Appendix C.)
In response to the Executive Order, federal agencies are developing and implementing strategies to
establish a framework to ensure that they design and conduct research, educational, regulatory, service, and
support programs in full partnership with stakeholders in a manner that considers, and addresses as appro-
priate, disproportionate and adverse environmental and minority populations. Of particular relevance to the
Delta Project are the environmental justice strategies developed by the Department of Health and Human
Services (DHHS) and the EPA in response to the Executive Order. These strategies include several that will
be incorporated into the Mississippi Delta Project. Both set of strategies are consistent with the following
two working definitions developed by EPA's Office of Environmental Justice :
▲ Environmental Justice — means the fair treatment and meaningful involvement of all people,
regardless of race, ethnicity, culture, income, or education level with respect to the develop-
ment, implementation, and enforcement of environmental laws, regulations, and policies.
A Fair Treatment — means that no population, due to political or economic disempowerment,
is forced to shoulder the negative human health and environmental impacts of pollution or
other environmental hazards.
The DHHS strategy for environmental justice covers a range of responsibilities and activities, largely
current, some planned. The activity areas addressed in the strategy are public education, training, services,
data collection and analysis, and health research. These activity areas are complemented by three cross-
cutting efforts that cover DHHS program policies, interagency coordination, and public partnerships.
The goal of EPA's strategy is to ensure that 1) no segment of the population, regardless of race, color,
national origin, or income, as a result of EPA's policies, programs, or activities, suffers disproportionately
from adverse human health or environmental effects, and all people live in clean and sustainable communi-
ties; and 2) those who must live with environmental decisions — community residents; environmental groups;
state, tribal and local governments; businesses — must have every opportunity for public participation in the
making of those decisions. An informed and involved local community is a necessary and integral part of
protecting the environment.
The EPA strategy outlines cross-cutting mission areas in health and environmental research; data col-
lection and analysis; stakeholder access to information; enforcement and compliance assurance; partner-
ships, outreach, and communication with stakeholders; Native American, indigenous, and tribal programs;
and integration of environmental justice into all EPA activities.
Both DHHS and EPA have listed the Mississippi Delta Project as a model interagency environmental
justice project. Strategies outlined in both institutions' environmental justice programs will be incorporated
into the Mississippi Delta Project (where appropriate for conditions in the Region).
Health Promotion and Disease Prevention
Recommendations in the Lower Mississippi Delta Development Commission's final report advocate ac-
tions that would enhance environmental protection and the health and well-being of the Region's people.
Similar concerns are evident in government agencies' minority health programs and in the emergence of
environmental justice concerns. From experience accrued in many areas of public policy and service, it is
now recognized that the most beneficial approach to solving many health and environmental problems is
through health promotion and disease prevention measures. That is, prevention of factors that cause excess
morbidity and premature mortality is well known by public health officials to be the most cost effective and
6 Mississippi Delta Project
healthful approach. Similarly, prevention of environmental hazards is to be preferred to remediating hazards
after they have occurred. For these reasons, the Delta Project adopts the prevention model as its core con-
cept. Moreover, education strategies to promote and maintain a healthful environment must be undertaken
to institute the ATSDR vision of "Healthy People in a Healthy Environment."
The public health prevention model contains the following elements:
▲ Identify instances of excess morbidity, premature mortality, or unsuspected health risk.
This is often achieved through health surveillance systems, clinical observations, labora-
tory findings, or outcomes of research investigations.
A Assess the causal factors that account for the excess morbidity, premature mortality, or
identified health risk factor. This is pursued through epidemiologic investigations, labora-
tory studies, clinical studies, or other kinds of investigations.
▲ Intervene with actions that interdict or mitigate the causal factors that account for the
identified health risks. Because many adverse health problems are multifactorial in terms of
risk factors, intervention strategies are developed and applied on a small scale to determine
their efficacy. Intervention strategies are then refined and the revised strategies are applied
to the population at risk.
▲ Promote the interventions that prevent or mitigate the adverse health event. This occurs
through dissemination of actions and materials to health care providers, health officials,
and public and private sector agencies that describe the occurrences, causes, and prevention
actions specific to the identified health risk.
▲ Evaluate the effectiveness of the implemented interventions and adjust them where needed
to improve reduction of human health risk.
Project Description
Given the concerns of the Lower Mississippi Delta Development Commission for improvements in the
social and economic conditions of the Region, and recognizing the importance of using prevention methods
to achieve improvements in the public health and environment of the Region in ways consistent with envi-
ronmental justice, the Delta Project has evolved.
The overall goal of the Delta Project is to demonstrate that partnerships between government, academia,
private sector organizations, and community residents can identify key environmental hazards (and barriers to
this identification), promote environmental quality, and reduce and, where possible, prevent these hazards
from impacting on health and the environment, with emphasis on persons in underserved communities. This
goal will be pursued jointly by federal agencies, state and local health departments, local community groups,
and institutions of higher education, particularly those that serve large minority populations.
The federal agencies cooperating in the Mississippi Delta Project are the Office of Solid Waste and
Emergency Response (OSWER), Office of Environmental Justice/EPA, the National Institute of Environ-
mental Health Sciences/National Institutes of Health (NIH), the National Library of Medicine/NIH, the
National Institute for Occupational Safety and Health/CDC, the National Center for Environmental Health/
CDC, the Office Of the Associate Director for Minority Health/CDC, and ATSDR. Each federal agency
brings i<> this project different statutory responsibilities and resources bearing on specific environmental
hazards, Moreover, state and local agencies have Specific health and environmental authorities lor managing
environment.il hazards. By joining the interests, authorities, and resources of the relevant federal and state
Mississippi Delta Project 7
agencies, a more comprehensive and effective effort can be implemented to reduce and, where possible,
prevent the health and environmental impacts of environmental hazards.
Because of the demographics and economic profiles inherent to the Mississippi Delta Region, this
project will give special emphasis to identifying and reducing the disparities of environmental hazards
experienced by disadvantaged communities and persons of color. The participation of communities in the
conduct of the project will be essential for long-term success. Working closely with communities and His-
torically Black Colleges and Universities (HBCUs) in the Region will be an essential component of this
project. (See Appendices D and E.)
Overall Objectives
Therefore, in association with state and local health agencies, regulatory agencies, and academic insti-
tutions in the Delta Region, and consistent with the principles of sustainable development and preventing
adverse health impacts from environmental hazards, the objectives of the Delta Project are these:
▲ Identify key environmental hazards and barriers to recognizing hazards that may affect the
health and quality of life of people who live in communities believed to be at risk.
▲ Assess the potentially harmful impact on high risk-populations of exposure to key environ-
mental hazards.
▲ Increase the awareness of health care providers practicing in the Delta Region of the
adverse environmental health impact of key environmental hazards. Empower and educate
the community about environmental hazards. Evaluate the impact of educational efforts to
ensure that health care providers are familiar with the recognition and treatment of illness
associated with exposure to environmental hazards.
A Enhance capacity building in state and local health departments, environmental depart-
ments, academic institutions, and community non-profit groups to address environmental
public health issues associated with minority health.
A Increase the awareness of the importance of environmental public health among students
at Head Start Centers, other preschools, and primary through college-level institutions in
the Delta Region.
A Provide pollution prevention and health promotion education regarding exposure to
environmental hazards.
A Ensure that efforts occur that lead to enhanced community empowerment and involve-
ment in addressing environmental public health issues.
A Identify and coordinate state and federal actions to address environmental health issues in
the Delta Region.
A Evaluate and disseminate the effectiveness of strategies to prevent health and environ-
mental impacts of key environmental hazards.
These objectives are being pursued through a phased approach for the Delta Project. Bearing in mind
that the Delta Project will attempt to achieve these objectives through formation of partnerships across and
within government and private sector lines, it is fundamental to implement the Delta Project in steps that
8 Mississippi Delta Project
build consensus and cooperation and that draw upon existing resources. Three phases have therefore been
identified for this project.
Delta Project's Phases
Phase 1 — Problem Definition and Needs Assessment
The first step is to determine the problems in the Region that are linked to environmental hazards. This
is being accomplished through a needs assessment. In this context, a needs assessment is expected to ask
what needs to be done, given conditions and circumstances in the Region. For the purposes of the Delta
Project, the emphasis is on key environmental hazards that impact underserved communities and persons of
color. The needs assessment is being conducted by Meharry Medical College, Nashville, Tennessee, in
cooperation with the Minority Health Professions Foundation. The Steering Group for the Delta Project will
advise Meharry on the overall conduct of the needs assessment, based on recommendations from the As-
sessment Workgroup (refer to the following section on architecture).
The needs assessment will be conducted using four profiles developed by Meharry:
1) Profile the key environmental hazards believed to be of consequence to the public health
of communities in the Region.
2) Profile the demographics of the Region, health problems, and associated health status.
3) Profile the providers of health and environmental services in the Region, including state
and local health departments, local health care centers, environmental agencies, health pro-
viders, and non-government organizations that can serve as partners in achieving the over-
all goal of the Delta Project.
4) Profile the education resources in the Region, including HBCUs, that have the capacity or
potential to develop partnerships with communities and state agencies in support of the
Delta Project's overall goal.
Using these profiles, Meharry will develop a list of key environmental hazards and associated public
health concerns. This list will, in effect, represent the outcome of the identification component of the public
health prevention model discussed previously. The list of needs will include recommendations to intervene
in situations where adverse health effects are known to be associated with specific environmental hazards.
Further, some needs will have to be addressed in terms of evaluating potential causal factors related to
environmental hazards and public health consequences.
Phase 2 — Demonstration Interventions
This phase of the Delia Project will consist of selecting a number of needs identified in Phase I and
developing intervention strategies appropriate for preventing health and environmental impacts. The pro-
files will be reviewed by the Steering Group, as advised by its Projecl Structure Workgroup (refer to the
following section on architecture), to determine Specific demonstration interventions recommended for the
Region. The Steering Group in conjunction with local communities will select the problems to be ad-
dressed, help create partnerships lor each demonstration intervention, anil serve as a resource to evaluate the
effectiveness of specific interventions.
Phase .? — Regional Health and Environmental Promotion
Given the outcomes from the demonstration cominuniu Bpecific interventions, successful interventions
will be identified and promoted for adoption within the Region. The specifics of this phase will be contin-
gent on the outcomes and experiences of Phase 2.
Mississippi Delta Project 9
Delta Project's Architecture
A Steering Group will provide guidance and advice to Meharry Medical School and other contractors. This
group comprises representatives from government, academia, private sector organizations, and community
advocacy groups. Federal agencies include ATSDR, CDC, NIH, and EPA. Each of the seven states has
representatives from state health and environmental agencies. The HBCUs, community-based organiza-
tions, and other relevant groups are members of the Steering Group, which will choose its own chairperson.
The HBCUs will play a key role in the conduct of the Delta Project, particularly in efforts to educate
Delta Region residents about environmental hazards. The HBCUs in the Delta Region have educated a large
number of African- American professionals who teach, practice health care, and assume leadership roles in
many of the Delta Region minority communities. These professionals have the credibility needed to ensure
the success of the project and are strongly committed to supporting HBCUs in the Region. Meharry Medical
College serves as the primary HBCU. Meharry's history of providing health care in the Delta Region pro-
vides the credibility needed to ensure the trust of the people in the Region.
Reporting to the Steering Group will be workgroups established to provide advice and guidance in
support of the Delta Project's overall goal and long-term objectives. The following four workgroups have
been established by the Steering Group:
▲ Membership — This workgroup will ensure relevant and current representation of agencies
and groups on the Steering Group.
▲ Project Structure — This workgroup advises the Steering Group on the goals, objectives,
purposes, tactics, and architecture of the Delta Project and its component activities.
A Assessment — This workgroup provides advice to the Steering Group on the design, out-
come, and adequacy of the Delta Project's individual activities, including information pro-
files and demonstration projects.
▲ Executive — This workgroup serves as the primary agent of the Steering Group for the
purpose of developing policies to recommend to the Steering Group and implementing
actions determined by it. This workgroup consists of the co-chairs of the Steering Group,
chairs of the other three workgroups, Meharry officials conducting the needs assessment,
and ad hoc members as appropriate.
Collaborative Projects
Because creating partnerships for the purpose of developing regional excellence in public health and envi-
ronmental protection is the heart of the Delta Project, many ongoing projects by federal, state, and private
sector organizations are relevant to the overall goal. The Steering Group encourages the conduct of projects
in support of the overall goal of the Delta Project. These collaborative projects, as they become known to the
Steering Group, will be shared within the Region. Collaborative projects will be selected by the Steering
Group, as recommended by the Structure Workgroup, based upon their project officers' knowledge of and
commitment to meeting the Delta project's overall goal.
Some current examples are the following activities:
▲ National Library of Medicine, NIH — Conducting an environmental information outreach
program (a hands-on training course for staff and students in HBCUs).
1 0 Mississippi Delta Project
▲ Texas Southern University — Conducting environmental health training for pharmacists
who serve in minority communities.
▲ National Institute of Environmental Health Sciences — Sponsorship of the developmen-
tal environmental health science centers at Tulane and Xavier universities.
A National Institute of Environmental Health Sciences — Sponsorship of a worker training
site in Lavonia, Louisiana.
▲ Morehouse School of Medicine and National Medical Association — Providing environ-
mental medicine training for physicians in the Region.
▲ Howard University College of Nursing — Conducting a train-the-trainer program to edu-
cate nurses in the Delta Region about environmental hazards.
▲ Texas Southern University College of Pharmacy — Conducting a train-the-trainer pro-
gram to educate pharmacists in the Delta Region about environmental hazards.
▲ Mississippi Action For Progress (M.A.P.), the largest Head Start agency in Mississippi —
Developing an environmental health curriculum to be tested in 20 counties throughout the
state. The program will focus on Head Start students and their families in 45 of the 82
counties in Mississippi.
Funding and Adjusted Timelines
The funding for Phase I of the Delta Project will be provided by participating federal agencies. It is antici-
pated that the four profiles being developed by Meharry Medical College will be completed by the end of
fiscal year 1 995. Funds for Phases 2 and 3 will be sought from government and private sector organizations,
based on the recommendations from the Steering Group. A timetable for other significant activities for the
Delta Project will be developed by the Steering Group.
References
1. Lower Mississippi Delta Development Commission. The Delta Initiatives: Realizing the
Dream. ..Fulfilling the Potential (Final Report). Memphis (TN): Lower Mississippi Delta Develop-
ment Commission, May 1990.
2. Sexton K, Olden K, Johnson BL. "Environmental Justice": The central role of research in establishing
a credible scientific foundation for informed decision making. Toxicol Ind Health 1993; 9(5):685-727.
3. General Accounting Office (GAO). Siting of Hazardous Waste Landfills and Their Correlation with
Racial and Ecomic Status of Surrounding Communities. Washington DC: GAO, 1983.
4. Commission for Racial Justice, United Chirst of Church (UCC). Toxic Wastes and Race in the United
States: A National Report on the Racial and Socioeconomic Characteristics of Communities with
Hazardous Waste Sites. New York: United Church of Christ, 1987.
Mississippi Delta Project 1 1
12 Mississippi Delta Project
Appendix A
Delta Commission Report Goals on the Environment
The Environment
In Partnership with Economic Development
"Environmental quality and human welfare are
not two independent evaluations. They are two
views of the same system of interactions. It is
not possible for one to remain good while the
other is bad.... poverty, prejudice, public educa-
tion, health, services, militarism, inner cities and
pollution all qualify as environmental crises. "
Frederick £. Smith. Harvard Unuernr.: ecoloipsi. 19~Q
This section of the report deals with the
environment within the broad context of
regional economic and social development. A
growing awareness of the need co race envir-
onmental problems was expressed by Lower
Mississippi Delta citizens in hearings in each
state. Yet many people still argue that environ-
mental protection and economic development
are incompatible. In fact, the reverse is true.
In the 21st Century, the world cannot
5{\7J accommodate growth and economic deveiop-
\*A ment apart from environmental protection. This
means that in the long run. protecting the Delta's
environment will pay dividends by attracting
more new businesses, tourism dollars, research
grants for institutions of higher learning and job
opportunities. This new economic development
concept will foster a greater sense of "pride 1 1|
place" among the region's residents. All people
Mississippi Delta Project 13
will have to think of themselves as environmen-
talists. This will build a new environmental ethic
and will create policies that reconcile preserving
the environment with aggressive pursuit of
economic growth.
Such an objective is not impossible. In fact,
the region already has made progress in this
direction. Aquaculture, a new, already- important
industry', is local labor-intensive, relatively low
polluting and provides an economic opportunity
for which the region is uniquely suited. Current
demand for catfish and crawfish is greater than
supply.
Low- impact nature or eco-tourism represents
another avenue for economic development that
is low polluting and. to this end. the creation
of wildlife sanctuaries and national parks
facilitates a strategy of development. As the
hearing testimony shows, the region's citizens
do not want to endure poor water qualitv. poor
air quality or misuse of any of the Delta's
precious natural resources. That fact heightens
the importance of these new opportunities.
Goals and recommendations presented in this
section of the report are designed to enhance
and protect existing natural resources for long
term, sustained economic growth and to foster
change in traditional attitudes toward the
environment and its ability to be a partner in
the economic development process.
14 Mississippi Delta Project
The Environment
ISSUE:
TEN YEAR GOAL:
SITUATIOiN:
Environmental Standards and Emergency Procedures
By the year 2001. the Delta will improve its overall environmental quality
by meeting or surpassing national environmental standards, and by
preparing for natural and man-made disasters.
As is true for the entire nation, the Delta is fast approaching pollution
saturation points. The effects of urban- industrial and agricultural
pollution are being felt throughout the region. In the past, the region
often ignored environmental quality by stressing growth as a singular
objective. But today it is recognized more than ever before that effective
economic development must go hand- in-hand with protecting the
environment.
In addition, the Delta is known to have a potential for. and a history
of, natural disasters associated with flooding and seismic activity. Without
adequate preparation by state and local governments, businesses and
industries are limited in their insurance options. To pursue sound
economic development and to protect the environment and people
against natural and man-made disasters, comprehensive emergency
contingency plans must be developed for the region and individual
states.
RECOMMENDATIONS:
• Congress should enact uniform national air and water quality standarcis:
EPA should uniformly enforce national pollution standards.
• EPA should study the cumulative effects of contaminants
contaminant loading to ecological systems over time, and — . . ■(
appropriate regulations refecting the results of this research.
• EPA and state environmental agencies should adopt more stringent
regulations in order to lower emissions of toxins into air. water and
soil.
• EPA and states should adopt numerical rather than "narrative" standards
for air and water pollution control for all discharged toxic pollutants
• States should adopt responsible environmental quality stancia
effective continuous monitoring systems and enforcement strategic:
ensure the continued protection of the environment and its
improvement.
• States should require industry to install instalments thai continuously
monitor the waste stream on all industrial out flow pij
the capacity to pollute
Mississippi Delta Project 15
•
•
•
Federal and state governments should require new and existing
industries to bear the Mill cost of negative environmental impacts they
cause.
States should establish a Delta compact to evaluate and recommend
uniform regulations and policies regarding air and water quality
standards for the Delta.
States should offer economic incentives to promote the attainment
of environmental standards by existing industries, agribusinesses and
municipalities that do not have adequate funds for waste management
and equipment modernization.
States and local governments should give preference to environ-
mentally sound industries when considering tax inducements for
economic development.
EPA, in cooperation with the Delta states, should create and fund
a regional river ecology monitoring program for the continuous
measurement of ambient river water quality, sediment quality, and living
resources, at stations along the Mississippi River; EPA should share
data with member states and work with them to produce plans for
reducing river pollution.
States should accelerate development of disaster contingency plans
and require local governments to develop disaster plans and programs.
States, local governments, nonprofit organizations and the
private sector should work to enhance public awareness of the
possibility of natural disaster in the region through educational efforts.
States, local governments and private industries should establish
equipment repositories and designate fast response teams for locations
throughtout the entire Delta for handling hazardous waste and material
spills; they should coordinate these activities with local fire departments
and other emergency response agencies.
16 Mississippi Delta Project
;.•''" Chemical -UsarsfBodbcarsSC^
t- ■:')• .'r": IrorrandSteel-'Mfc.'^f
•' - Coal and Oil Combustiorr t%t— *
(non-residentialK ./..
Other/Unspecified6%i-^
Secondary Formaldehyde; point 2%»
Secondary Formaldehyde; area S%r
0ther/Unspecified2%t-»
SalventUse/Oegreasin<£l%-i
. - • Gasoline Marketing 1%.-
Asbestos. Demolitions
Woodsmoke4V
Tre atment. S to r age and?
Disposal Works 5 "
(doef not add' to, 100%. due to: rounding^
QAreaSourceskaiMfc/ - D Point Sources 2fl%S;;^ X'i"
Cars, homes:- and; businesses* r ' Larger industrial- facilities? - : {■ \
'■'■■■ jV SOURCE. Environmental Protecticrr Agency. \\ .;•„ ";; ' V :-.-'.v. .
Mississippi Delta Project 1 7
The Environment
ISSUE:
TEN YEAR GOAL:
SITUATION:
Environmental Research, Education and Regional Awareness
By the vear 2001. the Delta will be at the forefront of environmental
research and will promote community environmental awareness and
education throughout the region.
An integrated regional environmental plan must include research and
Lin education, information component that builds public awareness and
promotes positive environmental behavior. To produce a more informed
citizenry that can responsibly address environmental problems,
education must be improved on all levels. Initiatives should enhance
environmental awareness and education, as well as promote responsible
waste reduction and the development of environmentally-sound
industries.
RECOMMENDATIONS:
States should create centers for environmental research and solid and
hazardous waste research in institutions of higher education, including
components for technology transfer. Such centers should become pan
of a Delta consortium established to share research and technical
information, both regionally and nationally.
Federal and state governments should target funding for health
studies throughout the region. Such studies should include analyses
of potential environmental exposures and the health effects of
environmental hazards to humans.
The federal government, in cooperation with the Delta states.
should establish a regional tumor registry, and secure funding for quality
control and assurance of data.
Federal, state and private research dollars should be targeted to study
the disproportionate effects of environmental pollution and hazardous
materials on minority, low-income and rural communities.
Federal and state governments should continue to fund research
concerning the relationship between surface activities and
ground and surface water contamination, and to clearly define recently-
discovered "windows" in clay layers over aquifers.
The private sector and nonprofit organizations should target funds
and in-house expertise toward solving environmental problems.
1 8 Mississippi Delta Project
The federal and state governments and the private sector should
support and help expand existing efforts by environmental education
centers, networks and community organizations. ( Example: The National
Network tor Environmental Education, jointly organized by EPA and
the Alliance Exchange ;.
Federal and state governments and nonprofit organizations
should cooperate on Community right-to-know law workshops on j
regular basis.
State and local governments and nonprofit groups should conduct
conferences and workshops that acquaint community leaders, educators,
and concerned citizens with environmental issues and information.
(Examples: National Issues Forums; Memphis State University Memphis
Light. Gas and Water's Energy Vision process).
States should integrate environmental topics and issues into appropriate
subject areas at all levels of formal and non-traditional education,
developing and utilizing curricula that include a substantive
environmental component as pan of state curriculum requirements.
• States, the private sector and nonprofit organizations should
create environmental source books for use in classrooms. ( Example:
Louisiana Department of Environmental Quality's Environmental
Sourcebook.)
•
Mississippi Delta Project 19
The Environment
ISSUE:
TEN YEAR GOAL:
SITUATION:
Waste Management
By che year 2001 ail states in the Delta will achieve methods to dispose
ol their hazardous and solid waste without threatening ground and
surface water and air quality.
Waste management has become an important issue for the Delta, and
the focus of many controversies. There are not enough hazardous waste
treatment sites and acceptable landfill locations at present to adequately
handle the region's waste. Concurrently, ground and surface waters have
been degraded because of past practices. This, coupled with resistance
to siting facilities and the importation of waste from other states, has
resulted in severe problems. In many cases this has caused an inordinate
impact on minority, poor and rural populations. The Delta must adopt
waste management models that are appropriate for a developing region.
Delta states must take actions to ensure water quality' protection and
improvements where necessary. Improved siting, clearer regulations and
public awareness programs by the individual states are necessary to
ensure the adequate processing and disposal of hazardous, medical
and solid wastes. Waste reduction, recycling, co-generation and other
methods of waste management should be utilized to ensure the most
efficient and healthful delivery svstem.
— -H — •» —
■ •* w. *» w •' '— r- -• •*■ r-r*- j*; •* — •••— "«*'—■" to'-'-* W •
Industries'
Hazardous Waste
Most of the nation's hazardous waste is
generated by the chemical industry.
: — »s -*•«••» t» -» •«■-., ** w ■».•
■ — *••».-* *T* * •*". •- *■
— « •*■•» ••>•' •*.-•• k'—'**-^ •» *k «.
-» •-.• Wt W »? «i» §».'■»■ ty'
Industries!1
rifcsfel
• Otner idustrws mcmae etedncat euittomer.t rransc *r;att*tn <njutumeni -un»t
.fiastic zra<jui\'s. fttscetianeuus manufacturing, "tnttir 'remit :run*etirturn*fi +t.
preierxwn, am/n recundtttonmie industries una nnnefevfncui tnacnmerv
Stjurve: Er.\:rr)nmenial Protection Anem."'
20 Mississippi Delta Project
RECOMMENDATIONS:
States should form a Delta state compact to facilitate the processing
and disposal of solid and hazardous waste.
The federal government should adopt uniform requirements and
enforcement procedures for solid and hazardous waste management.
States should develop statewide hazardous and solid waste
management and capacity' assurance plans. Sub-state regional and local
solid waste plans should be required, and technical assistance provided
by the states. These plans must become an integral pan of the economic
development planning process.
Federal and state governments should encourage the use or" recycled
paper at all government agencies, and the use of recycled products
by the private sector.
States should create a regional industrial materials exchange service
that matches industrial waste manufacturers with potential waste users.
Federal and state governments should enforce strict regulations to
protect surface and sub-surface waters and recharge areas.
Mississippi Delta Project 21
Federal and state governments should make loans, grant, an,
services accessible to local communities, businesses and organization
iOr the purpose of developing or expanding various tvpes of lo^
recycling and composting programs: to develop markets for recvcle"
materials; to advance and implement innovative technologies in soiic
waste management; and to develop educational programs and initiative'
concerning waste.
The private sector should work to develop markets for recycled
materials. ■
Disposal Sites for
Hazardous Wastes
This chart shows the number of confirmed hazardous-waste
sites in each state. The sites that are eligible for cleanup
under the superfund program are considered the worst
hazardous-waste sites in the nation.
3
o«
T3«
>- a
"O
2 •
c
N —
3
r.
!5
« 00
W J
Q. eo
2 03
State
3 —
van
— • as
55
fl BM
Alabama
12
70
Alaska
1
_
Arizona
9
250
Arkansas
10
13
California
88
250
Colorado
16
74
Connecticut
14
Oelware
21
137
Florida
51
760
Georgia
13
350
Hawaii
6
_
Idaho
4
_
Illinois
39
64
Indlania
37
32
Iowa
23
300
Kansas
11
203
Kentucky
17
26
Louisiana
11
_
Maine
8
36
Maryland
10
30
Massachusetts
22
351
Michigan
81
910
Minnesota
40
83
Mississippi
3
200
Missouri
21
84
Montana
10
26
State
■o
c
3
r .
4) ca
Q. <D
3 —
w<n
3
o .
"O.
m °>
M _
■E o
o5
Nebraska
5
160
Nevada
__
New Hampshire
15
172
New Jersey
110
t400
New Mexico
10
*376
New York
76
420
North Carolina
21
88
North Dakota
2
3
Ohio
32
108
Oklahoma
11
11
Oregon
7
80
Pennsylvania
97
40
Rhode Island
9
20
South Carolina
21
75
South Dakota
1
2
Tennessee
13
255
Texas
28
352
Utah
11
75
Vermont
8
102
Virginia
22
25
Washington
43
131
West Virginia
6
__
Wisconsin
39
321
Wyoming
2
13
Puerto Rico
9
2
Guam
1
_
Total
1.177 7,483
'Final and proposed silts as ,/f June IWX
"Data are for Oct. 19** -h* most wenl Mwlabie
'As of July I9MH.
Sources: Environmental Protection Uer,c, Association ot Sure
Territorial Solid Waste Management Officials
22 Mississippi Delta Project
Appendix B
5-Year Plan for the Office of the Associate Director for Minority Health
CDC/ATSDR Minority Health Strategic Plan 1989
Associate Director for Minority Health
Office of the Director
Centers for Disease Control and Prevention
Agency for Toxic Substances and Disease Registry
Public Health Service
U.S. Department of Health and Human Services
Mission Statement
The Mission of the Office of the Associate Director for Minority Health is to improve the health of the
African-American (Blacks), Asian-American/Pacific Islander, Hispanic American, and Native American/
Alaskan Native citizens, and where appropriate, similar ethnic/racial subgroups in and out of the United
States, through policy development and program analysis at CDC and ATSDR.
The mission will be accomplished through the following major goal, subgoals, and objectives:
Major Goal
To enhance the overall health of the American public by reducing the burden of preventable disease and
illness through health promotion and disease prevention initiatives geared specifically toward U.S. minority
populations and, where appropriate, similar ethnic/racial subgroups inside and outside of the United States.
Subgoals
Measurable subgoals include the following:
A. The assurance that policy at CDC and ATSDR appropriately directs the agencies' activities
toward minority health.
B. The enhancement of the research enterprise through innovative scientific investigations in
health promotion, health protection, and disease prevention to reduce the disproportionate
burden of disease and illness in minority group members.
C. The development of an effective internal and external communication network related to
minority health.
Philosophical Approach
The mission and goal of the Office of the Associate Director for Minority Health are based on the philoso
phy that to be effective, minority health initiatives must be operational in the centers, institutes, program
offices, and programs at CDC and ATSDR. These initiatives, where appropriate, must be transferred to State
and local government and non-government agencies and organizations. The Office, therefore, assumes an
operational versus a programmatic management approach m actualizing its mission. This management ap-
proach demands ongoing interaction and communication between people at CIK . VI SI )R. and Public Health
Mississippi Delta Project 23
Service, other Federal officials, and State and local government officials, and the leadership of non-govern-
ment agencies and organizations (i.e., voluntary agencies, community based organizations, philanthropic
groups, etc.). Programmatic authority and responsibility should be maintained at the program level to maxi-
mize fiscal and human resources. However, assessment, advocacy, coordination, and evaluation of pro-
cesses and outcomes related to the efficacy of minority health activities are focused primarily in the Office
of the Associate Director for Minority Health.
Objectives
The objectives for the Office of the Associate Director for Minority Health related specifically to the
three subgoals include the following:
Subgoal A
To assure that policy at CDC and ATSDR appropriately directs the agencies ' activities towards minority
health.
Objectives
1 . To encourage minority health activities in each center, institute, and program office at CDC
and ATSDR.
2. To encourage the employment of significant numbers of minority senior professional and
administrative persons at various policy and program levels within each center, institute,
and program office at CDC and ATSDR and to assist in identifying and recruiting candi-
dates.
3. To facilitate the development of minority health programs in State and local health depart-
ments, national, civic, social, religious, and voluntary organizations, and local community
based organizations.
4. To maximize health services and resources available to minority populations.
Subgoal B
To enhance the research enterprise through innovative scientific investigations in health promotion, health
protection, and disease prevention to reduce the disproportionate burden of illness in minority group members.
Objectives
1 . To enhance applied public health research activities in health promotion and disease pre-
vention among minority investigators.
2. To advise on minority health related research in health promotion and disease prevention
by non-minority investigators, particularly at CDC and ATSDR.
3. To investigate social/behavioral approaches to reducing adverse health and health care indi-
ces in the minority populations.
4. To increase the number of minority undergraduate and postgraduate students interested and
engaged in minority related public health research.
5. To enhance the quality and quantity of publications in the scientific literature related to
minority health.
24 Mississippi Delta Project
Subgoal C
To develop an effective internal and external communication network related to minority health.
Objectives
1. To facilitate the establishment of a minority health component in each agency within the
Public Health Service (PHS).
2. To encourage the development of a minority health focus in each State health Department,
and where appropriate in local health departments.
3. To encourage the implementation of a structured minority health network within the aca-
demic community.
4. To promote minority health educational initiatives in civic, social, religious, community,
and voluntary agencies and organizations in both minority and non-minority communities.
5. To assure that information systems provide data adequate to assess the need for, and evalu-
ate the impact of programs directed to members of minority groups.
Strategies*
Strategies address the question "How do we met objectives?" "How do we get it done?" They should be
supported by a composite of action plans and programs. Strategies are primarily qualitative and can be
translated into quantified tactics and action plans. They should be listed in rational and priority order. (See
Strategies and Tactics)
Tactics*
Tactics detail how the strategies will be implemented and what specific activities are planned. They must be
operational in nature and lend themselves to evaluation. Tactics are subject to change in direction and em-
phasis. They must lend themselves to qualified activities that can be monitored and controlled. (See Prelimi-
nary Assessment of 1989 Strategic Plan under Evaluation)
Evaluation
For the purpose of this report, evaluation is defined as the process of determining the value or amount of
success in the achievement of predetermined objectives. This includes at least the following steps: formula-
tion of the objectives; identification of the proper criteria to be used in measuring success; determination
and explanation of the degree of success; recommendations for future program activities.
The following five areas will be used in evaluating the activities in the Office of the Associate Director
for Minority Health:
1 . Effort — the evaluations in this category have as their criteria of success the quantity and
quality of activities that take place. This represents an assessment of input or energy regard-
less of output that is intended to answer the questions "What did you do?" and "How well
did you do it?"
♦Strategies and tactics developed in 1989 with the CDC/ATSDR Strategic Plan.
Mississippi Delta Project 25
2. Performance — the performance or effect criteria measures the results of the effort rather
than the effort itself. This requires a clear statement of ones objective. How much is accom-
plished relative to an immediate goal? Did any change occur? Performance can be mea-
sured at several levels-the number of cases found, the number hospitalized, the number
cured or rehabilitated. Performance standards often involve several assumptions; however,
in general, evaluation of performance involves fewer assumptions than evaluation of ef-
forts.
3 . Adequacy of performance — this criteria for success refers to the degree to which effective
performance is adequate to the total amount of need. Adequacy is obviously a relative
measure depending upon how high one sets ones goals.
4. Efficacy — a positive answer to the question, "Does it work?" often gives rise to the follow-
ing questions: Is there any better way to obtain the same results? Efficacy is concerned with
the evaluation of alternative paths or methods in terms of cost and money, time, personnel,
and public convenience. In a sense, it represents the ratio between effort and performance,
output divided by input.
5 . Process — in the course of evaluating the success or failure of a program, a great deal can be
learned about how and why a program works or does not work. The analysis of process can
have both administrative and scientific significance particularly when the evaluation indi-
cates that a program is not working as expected. The analysis of process will be made
according to four main dimensions beginning with: 1) the attributes of the program itself;
2) the population exposed to the program; 3) the situation or context within which the
program takes place; and 4) the different kinds of effects produced by the program.
These five criteria will be utilized to measure the impact of each objective for administrative, program-
matic, and outcome purposes.
26 Mississippi Delta Project
Appendix C
Presidential Document (Executive Order 12898)
Mississippi Delta Project 27
28 Mississippi Delta Project
'629
Voi. W. N°- 32
^^.djy, February 16. 1994
Presidential Documents
Tbe President
Executive Order 1289A of February 11, 1994
Federal Actions To Address Environmental Justice hi
Minority Populations and Low-Income Populations
By the authority vested in me as President by the Constitution and the
laws of the United States of America, It is hereby ordered as follows:
Section 1-1. rKPLEMefTATTON.
■ 1-101. Agency Responsibilities. To the greatest extent practicable and per-
mitted by Taw, and consistent with the principles set forth in the report
on the National Performance Review, each Federal agency shall make achiev-
ing environmental Justice part of its rnlssion by identifying and addressing,
as appropriate, disproportionately high and adverse human health or environ-
mental effects of its programs, policies, and activities on minority populations
and low-income populations in the United States and its territories and
possessions, the District of Columbia, the Commonwealth of Puerto Rico,
and the Commonwealth of the Mariana Islands.
1-102. Creation of an Interagency Working Group on Environmental Justice
(a) Within 3 months of the date of this order, the Administrator of the
Environmental Protection Agency ("Administrator") or the Administrator's
designee shall convene an interagency Federal Working Group on Environ-
mental Justice ("Working. Group"). Th« Working Group shall comprise the
heads of the following executive agencies and offices, or their designees
(a) Department of Defense; (b) Department of Health. and Human Services
(c) Department of Housing and Urban Development; (d) Department of Labor
(e) Department of Agriculture; (f) 'Department of Transportation- (g) Depart-
ment of Justice; (h) Department of the Interior, (t) Department of Commerce;
(j) Department of Energy; (k) Environmental Protection Agency; (1). Office
of Management and Budget; (m) Office of Science and Technology Policy;
(n) Office of the Deputy Assistant to the President for Environmental Policy;
(o) Office of the Assistant to the President for Domestic Policy; (p) National
Economic Council; (q) Council of Economic Advisers; and (r) such other
Government officials as the President may designate. The Working Group
shall report to the President through the Deputy Assistant to the President
for Environmental Policy and the Assistant to the President for Domestic
Policy.
(b) The Working Group shall: (l) provide guidance to Federal agencies
on criteria for identifying disproportionately high and adverse human health
or environmental effects on minority populations and low-income popu-
lations;
(2) coordinate with, provide guidance to, and serve as- a clearinghouse
for, each Federal agency as it develops an environmental justice strategy
as required by section 1-103 of this order, in order to ensure (hat the
administration, interpretation and enforcement of programs, activities and
policies are undertaken in a consistent manner;
(3) assist in coordinating research by, and stimulating cooperation among,
the Environmental Protection Agency, the Department of Health and Human
Services, trie Department of Housing and Urban Development, and other
agencies conducting research or other activities in accordance with section
3-3 of this order;
(4) assist in coordinating data collection, required by this order:
Mississippi Delta Project 29
7630 Federal Register / Vol. 59. No. 32 / Wednesday, February 16. 1994 / Presidential Documents
(5) examine existing data and studies on environmental justice;
(6) hold public meetings as required in section 5-502(d) of this order:
and
(7) develop interagency model projects on environmental justice that evi-
dence cooperation among Federal agencies.
1-103. Development of Agency Strategies, (a) Except as provided in section
6—605 of this order, each Federal agency shall develop an agency-wide
environmental justice strategy, as set forth in subsections (bMe) of this
section that identifies and addresses disproportionately high and adverse
human health or environmental effects of its programs, policies, and activities
on minority populations and low-income populations. The environmental
justice strategy shall list programs, policies, planning and public participation
processes, enforcement, and/or rulemakings related to human health or the
environment that should be revised to, at a minimum: (1) promote enforce-
ment of all health and environmental statutes in areas with minority popu-
lations and low-income populations; (2) ensure greater public participation;
{3) improve research and data collection relating to the health of and environ-
ment of minority populadons and low-Income populations; and (4) identify
differential patterns of consumption of natural resources among minority
populations and low-Income populadons. In addition, the environmental
justice strategy shall include, where appropriate, a timetable for undertaking
identified revisions nnd consideration of economic and social implications
of the revisions.
(b) Within 4 months of the date of this order, each Federal agency shall
identify ah internal administrative process for developing its environmental
justice strategy, and shall inform the Working Group of the process.
(c) Within 6 months of the date of this order, each Federal agency snail
provide the Working Group with an outline of its proposed environmental
justice strategy.
(dj Within 10 months of the date of this order, each Federal agency
shall provide the Working Group with tts proposed environmental justice
strategy.
(e) Within 12 months of the date of this order, each Federal agency
shall finalize its environmental justice strategy and provide a copy and
written description of its strategy to the Working Group. During the 12
moath period from the date of this order, each Federal agency, as pan
of its environmental justice strategy, shall identify several specific projects
that can be promptly undertaken to address particular concerns identified
during the development of the proposed environmental justice strategy, and
a schedule for implementing those projects.
(f) Within 24 months ot the date of this order, each Federal agency
shall report to the Working Group on Its progress in implementing its
agency-wide environmental justice strategy.
(gj Federal agencies shall provide additional periodic reports to the Work-
ing Group as requested by the Working Group.
1-104. Reports to the President. Within 14 months of the dato of this
oruer, the Working Group chall submit to the President, through the Office
of the Deputy Assistant to the President for Environmental Policy and the
Office of the Assistant to the President for Domestic Policy, a report that
describes the implementation of this order, and includes the final environ-
mental justice strategies described in section l-103(e) of this order
Sec. 2-2. FEDERAL AGENCY RESPOMSWIUTIES FOR FEDERAL PROGRAMS. Each
Federal agency shall conduct its programs, policies, and activities that sub-
stantially affect human health or the environment, in a manner that ensures
that such programs, policies, and activities do not have the effect of excluding
persons (including populations) from participation in. denying persons (in-
cluding populations) the benefits of. or subjecting persons (including popu-
30 Mississippi Delta Project
Federal Register / Vol. 59, No. 32 / Wednesday, February 16, 1994 / Presidential Documents 7631
lations) to discrimination under, such programs, policies, and activities,
because of their race, color, or national origin.
Sec. 3-3. RESEARCH, DATA COLLECTION, AND ANALYSIS.
3-301. Human Health and Environmental Research and Analysis, (a) Envi-
ronmental human health research, whenever practicable and appropriate,
shall include diverse segments of the population in epidemiological and
clinical studies, Including segments at high risk from environmental hazards,
such as minority populations, low-income populations and workers who
maybe exposed to substantial environmental hazards.
(b) Environmental human health analyses, whenever practicable and appro-
priate, shall Identify multiple and cumulative exposures.
(c) Federal agencies shall provide minority populations and low-income
populations the opportunity to comment on the development and design
of research strategies undertaken pursuant to this order.
3-302. Human Health and Environmental Data Collection and Analysis.
To the extent permitted by existing law, Including the Privacy Act. as
amended (5 U.S.C section 552a): (a) each Federal agency, whenever prac-
ticable and appropriate, shall collect, maintain, ana analyze Information
assessing and comparing environmental and human health risks born"1 by
populat1 .; identined by race, national origin, or income. To the .ent
practical and appropriate, Federal agencies shall use this information to
determine whether their programs, policies, and activities have disproportion-
ately high and adverse human health or environmental effects on minority
populations and low-income populations;
fb) In connection with the development and implementation of agency
strategies in -section 1-103 of this order, each Federal agency, whenever
practicable and appropriate, shall collect, maintain and analyze information
on the race, national origin, income level, and other readily accessible and
Appropriate information for area* surrounding facilities or sites expected
to nave a. substantial environmental, human health, or economic effect on
the surrounding populations, when ruch facilities or sites become the subject
of -a. substantial Federal environmental ^administjative or Judicial action.
Such information shall be made available to the public, unless prohibited
by lawr and
(c) Each Federal agency, whenever practicable and appropriate, shall col-
lect, maintain, and analyze infbrmation on the race, national origin, income
level, and other readily accessible and appropriate information for areas
surrounding Federal facilities that are: (1) subject to the reporting require-
ments under the Emergency Planning and Community Right-to- Know Act.
42 U.S.C section 110O1-110SO as mandated in Executive Order No. 12856;
and (2) expected to nave a substantial environmental, human health, or
economic affect on surrounding populations. Such Information shall be made
available to the public, unless prohibited by law.
(d) In carrying out the responsibilities in this section, each Federal agency.
whenever practicable and appropriate, shall share information and eliminate
unnecessary duplication of efforts through the use of existing data systems
and cooperative agreements among Federal agenciesand with State, ocal,
and tribal governments.
Sec 4-^4. SUBSISTENCE CONSUMPTION Of F\SH AND W1LDUEE.
4-401. Consumption Patterns. In order to assist in identifying the need
for ensuring protection of populations with differential patterns of subsistence
consumption of fish and wildlife. Federal agencies, whenever practicable
and appropriate, shall collect, maintain, and analyze information on the
consumption patterns of populations who principally rely on fish and/or
wildlife for subsistence. Federal agencies shall communicate to the public
the risks of those consumption patterns.
Mississippi Delta Project 31
7632 Federal Register / Vol. 59. No. 32 / Wednesday. February 16. 1994 / Presidential Documents
4-402. Guidance. Federal agencies, whenever practicable and appropriate,
shall work in a coordinated manner to publish guidance reflecting the latest
scientific information available concerning methods for evaluating the human
health risks associated with the consumption of pollutant-bearing Fish or
wildlife. Agencies shall consider such guidance in developing their policies
and rules.
Sec. 5-5. PUBLIC PARTJCJPATTON AND ACCESS TO INFORMATION, (a) The public
...ay submit recommendations to Federal agencies relating to the incorpora-
tion of environmental justice principles into Federal agency programs or
policies. Each Federal agency shall convey such recommendations to the
Working Group.
(b) Each Federal agency may, whenever practicable and appropriate, trans-
late crucial public documents, notices, and hearings relating to human health
or the environment for limited English speaking populations.
(c) Each Federal agency shall work to ensure that public documents,
notices, and hearings relating to human health or the environment are con-
cise, understandable, and readily accessible to the public.
(d) The Working Group shall hold public meetings, as appropriate, for
the purpose of fact-finding, receiving public comments, and conducting in-
quiries concerning environmental justice. The Working Group shall prepare
for publi" -eview a summary of the comments and- recommendations dis-
cussed at tue public- meetings.
Sec. 6-6. GENERAL PROVISIONS.
6-601. Responsibility for Agency Implementation. The head of each Federal
agency shall be responsible for ensuring compliance with this order. Each
Federal agency shall conduct internal reviews and take such other steps
as may be necessary to monitor compliance with this order.
6-602. Executive Order No. 12250. This Executive order is intended to
supplement but not supersede Executive Order No. 12250, which requires
consistent and effective implementation of various- laws prohibiting discrimi-
natory practices in programs receiving Federal financial assistance. Nothing
herein shall limit the effect or mandate of Executive Order No. 12250.
6-603. Executive Order. No. 12875. This Executive order is not intended
to limit the effect or mandate of Executive Order No. 12875.
6-604. Scope. For purposes of this order, Federal agency :neans any agency
on the Working Group, and such other agencies as may be designated
by the President, that conducts any Federal program or activity that substan-
tially affects human health or the environment. Independent agencies are
requested to comply with the provisions of this order.
6-605. Petitions for Exemptions. The head of a Federal agency may petition
the President for an exemption from the requirements of this order on
the grounds that all or some of the petitioning agency's programs or activities
should'not be subject to the requirements of this order.
6-606. Native American Programs. Each Federal agency responsibility set
forth under this order shall apply equally to Native American programs.
In addition, the Department of the Interior, in coordination with the Working
Group, and. after consultation with tribal leaders, shall coordinate steps
to be taken pursuant to this order that address Federally-recognized Indian
Tribes.
6-607. Costs. Unless otherwise provided by law, Federal agencies shall
assume the financial costs of complying with this order.
6-608. General. Federal agencies shall implement this order consistent
with, and to the extent permitted by. existing law.
6-609. Judicial Review. This order is intended only to improve the internal
management of the executive branch and is not intended to. nor does it
create any right, benefit, or trust responsibility, substantive or procedural,
32 Mississippi Delta Project
Federal Register / Vol. 59, No. 32 / Wednesday, February 16, 1994 / Presidential Documents 7633
enforceable at law or equity by a party against the United States, its agencies,
its officers, or any person. This order shall not be construed to create
any right to judicial review involving ihe compliance or noncompliance
of the United States, its agencies, its officers, or any other person with
this order.
(J0"^Oa*aAA ^\^<J^QAjs
[JTt Doc »4-06«5
BUUj* cocW 31W-01-P
THE WHITE HOUSE,
February 11, 1934.
E&tariftl Dote For the memorandum thai wa* concurrently issued on F»d«ral environmental
program reionn, »ee iwu4 No. 8 of th« Weekly Compilation of Presidential Documents.
Mississippi Delta Project 33
34 Mississippi Delta Project
Appendix D
Historically Black Colleges and Universities in the Lower Delta Region
Arkansas
Arkansas Baptist College
Philander Smith College
Shorter College
University of Arkansas at Pine Bluff
Kentucky
Kentucky State University
Louisiana
Dillard University
Grambling State University
Southern University System
Southern University A & M College
Southern University at Baton Rouge
Southern University at New Orleans
Southern University at Shreveport
Xavier University
Mississippi
Alcorn State University
Coahoma Community College
Hinds Community College
Jackson State University
Mary Holmes College
Mississippi Valley State University
Rust College
Tougaloo College
Missouri
Harris-Stowe State College
Lincoln University
Tennessee
Fisk University
Knoxville College
Knoxvillc College-Morris Town
Lane College
Lemoyne-Owen College
Mcharry Medical College
Tennessee State University
Mississippi Delta Project 35
36 Mississippi Delta Project
Appendix E
Presidential Document (Executive Order 12876)
Mississippi Delta Project 37
38 Mississippi Delta Project
58735
M*dm»f Presidential Documents
Vol. 54. No. 212
Ttiindt). Novtmb«r 4. 1W3
Title 3— Executive Order 12876 of November 1, 1993
The President Historically Black Colleges and Universities
By the authority vested in me u President by the Constitution and the
laws of the United States of America, in order to advance the development
of human potential, to strengthen the capacity of historically Black colleges
and universities to provide quality education, and to increase opportunities
to participate in and benefit from Federal programs, it is hereby ordered
as follows:
Section 1. There shall b«j established in the Department of Education the
President's Board of Advisors on Historically Black Colleges and Universities
("Board of Advisors" or "Board"), a Presidential advisory committee. The
Board of Advisors shall issue an annual report to the President on participa-
tion by historically Black colleges and universities in federally sponsored
programs. The Board of Advisors will also provide advice to the Secretary
of Education ("Secretary") and in the annual report to the President on
how to increase the private sector role in strengthening historically Black
colleges and universities, with particular emphasis on enhancing institutional
infrastructure and facilitating planning, development, and the use of new
technologies to ensure the goal of long-term viability and enhancement
of these institutions. Notwithstanding the provisions of any other Executive
order, the responsibilities of the President under the Federal Advisory Com-
mittee Act, as amended (5 U.S.C. App. 2), which is applicable to the Board
of Advisors, shall be performed by the Secretary, in accordance with the
guidelines and procedures established by the Administrator of General Serv-
ices
Sec. 2. The members of the Board of Advisors shall be appointed by the
President. The Board shall include representatives of historically Black col-
leges and universities, other institutions of higher education, business and
financial institutions, private foundations, and secondary education.
Sec 3. The White House Initiative on Historically Black Colleges and Univer-
sities, housed in the Department of Education, shall: (1) provide the staff,
resources, and assistance for the Board of Advisors: (2) assist the Secretary
in the role of liaison between the executive branch and historically Black
colleges and universities; and (3) aerve the Secretary in carrying out h:s
responsibilities under this order.
Sec. 4. To carry out the purposes of this order, each executive department
and each agency designated by the Secretary shall, consistent with applicable
law, enter into appropriate grants, contracts, or cooperative agreements with
historically Black colleges and universities. The head of each agency subject
to this order shall establish an annual goal for the amount of funds to
be awarded in grants, contracts, or cooperative agreements to historically
Black colleges and univertities. Consistent with the funds available to the
agency, the goal shall be an amount above the actual amount of such
awards from the previous fiscal year and shall represent a substantial effort
to increase the amounts available to historically Black colleges and univer-
sities for grants, contracts, or cooperative agreements. In order to facilitate
the attainment of the goals established by this section, the head of each
agency subject to this order shall provide technical assistance and information
to historically Black colleges and universities regarding the program activities
of the agency and the preparation of applications or proposals for grants
contracts, or cooperative agreements.
Mississippi Delta Project 39
58736 Federal Register / Vol. 58. No. 212 / Thursday, November 4. 1W3 / Presidential Documents
Sec 5. Each executive department tod designated agency shall appoint
a senior official, who is a full-time officer of the Federal Government and
who is responsible for management or program administration, to report
directly to the department or agency head or designated agency representative
on department or agency activity under this order and to serve as liaison
to the Board and White House Initiative. To the extent permitted by law
and regulation, each executive department and designated agency shall pro-
vide appropriate information requested by the Board and the White House
Initiative staff pursuant to this order.
Sec 6. Each executive department and designated agency shall develop
an annual plan for. and shall document, the agency's effort to increase
the ability of historically Black colleges and universities to participate in
federally sponsored programs. These plans shall describe the measurable
objectives for proposed agency actions to fulfill this order and shall be
submitted at such time and in such form as the Secretary shall designate.
In consultation with participating agencies, the Secretary shall review these
plans and develop, with the advice of the Board of Advisors, an integrated
Annual Federal Plan for Assistance to Historically Black Colleges and Univer-
sities for consideration by the President The Secretary shall ensure that
each president of a historically Black college or university is given the
opportunity to comment on the proposed Annual Federal Plan pnor to
consideration by the President Each participating agency shall submit to
the Secretary and the Director of the Office of Management and Budget.
an Annual Performance Report that shall measure each agency's performance
against the objectives set forth in its annual plan. The Director of the
Office of Management and Budget shall be responsible for overseeing compli-
ance with the Annual Federal Plan.
Set 7. Each year the Board of Advisors shall report to the President on
the progress achieved in enhancing the role and capabilities of historically
Black colleges and universities, including findings and recommendations
on the Annual Performance Reports, described in Section 6. submitted by
the participating agencies. The Secretary shall disseminate the annual report
to appropriate members of the executive branch and make every effort to
ensure that findings of the Board of Advisors are taken into account in
the policies and actions of every executive agency.
Sec 8. The Department of Education, along with other Federal departments
or agencies, shall work to encourage the private sector to assist historically
Black colleges and universities through increased use of such devices and
activities ar. (1) private sector muring funds to support increased endow-
ments: (2) private sector task force* for institutions in need of assistance,
and (3) private sector expertise to facilitate the development of more effective
ways to manage finances, improve information management, strengthen facili-
ties, and improve course offerings. Thee* steps will be taken with the goals
of enhancing the career prospects of graduates of historically Black colleges
and universities and increasing the number of such graduates with degrees
in science and technology.
Sec' t. In all its recommendations, the Board of Advisors shall emphasize
ways to support the long-term development plans of each historically Black
college and university. The Board of Advisors shall recommend alternative
sources of faculty talent, particularly in the fields of science and technology,
including faculty exchanges and referrals from other institutions of higher
education, private sector retirees. Federal employees and retirees, and emeri-
tus faculty members at other institutions of higher education
Sec 10. The Board of Advisors, through the White House Initiative, shall
provide advice on how historically Black colleges and universities can
achieve greater financial security. To the maximum extent possible, the
Board of Advisors shall consider how such institutions can enlist the re-
source* and experience of the private sector to achieve such security.
40 Mississippi Delta Project
Sec. 11. The Director of the Office oi Peraonnel Management. In consultation
with the Secretary and the Secretary of Labor, thill develop i program
to improve recruitment and participation of graduates and undergraduate
students of historically Black colleges and universities in part-time, summer
and permanent position* in the Federal Government.
Sec. 12. Administration: (a) Members of the Board of Advisors shall serve
without compensation, but shall be allowed travel expenses, including per
diem in lieu of subsistence, as authorised by law for persons serving miermr.-
tenUy in the Government service, (5 U.S.C. 5701-5707).
(b) The Board of Advisors and the White Hous* Initiative shall cb:a:n
funding for their activities from the Department of Education.
(c) The Department of Education shall provide such administrative ser\.ces
for the Board as may be required.
Sec. 13. Executive Order No. 12677 of April 28. 1989, is hereby revoked
O^rtJu*'^*^
:n o« U-J7J09
Fil*4 11-2-43. 2 10 pml
! -| cod* 319S— 01-P
THE WHITE HOUSE,
November J, 1993.
EcLtoniJ note For lh« Prttid«nt'i rmn*xL» oo signing ihis Lxecutiv* order, see :.*.e l*e«.
Cowpdation of PretldenLaJ Documtna (vol. 29. tssua 44 )
Mississippi Delta Project 41
42 Mississippi Delta Project
Lower Mississippi Delta Counties and Parishes
Arkansas
Illinois
Kentucky
Louisiana
Mississippi
Missouri
Tennessee
Arkansas
Alexander
Ballard
Acadia
Adams
Bollinger
Benton
Ashley
Franklin
Caldwell
Allen
Amite
Butler
Carroll
Baxter
Gallatin
Calloway
Ascension
Artala
Cape Girardeau
Chester
Bradley
Hamilton
Carlisle
Assumption
Benton
Carter
Crockett
Calhoun
Hardin
Christian
Avoyelles
Bolivar
Crawford
Decatur
Chicot
Jackson
Crittenden
Caldwell
Carroll
Dent
Dyer
Clay
Johnson
Fulton
Catahoula
Claiborne
Douglas
Fayette
Cleveland
Massac
Graves
Concordia
Coahoma
Dunkin
Gibson
Craighead
Perry
Henderson
East Baton Rouge
Copiah
Howell
Hardeman
Crittenden
Pope
Hickman
East Carroll
Covington
Iron
Hardin
Cross
Pulaski
Hopkins
East Felicia
DeSoto
Madison
Haywood
Dallas
Randolph
Livingston
Evangeline
Franklin
Mississippi
Henderson
Desha
Saline
Lyon
Franklin
Grenada
New Madrid
Henry
Drew
Union
Marshall
Grant
Hinds
Oregon
Lake
Fulton
White
McCracken
Iberia
Holmes
Ozark
Lauderdale
Grant
Williamson
McLean
Jackson
Humphreys
Pemiscot
McNairy
Greene
Muhlenberg
Jefferson
Issaquena
Perry
Madison
Independence
16 Counties
Todd
Lafourche
Jefferson
Phelps
Obion
l/ard
Trigg
LaSalle
Jefferson Davis
Reynolds
Shelby
Jackson
Union
Lincoln
Lafayette
Ripley
Tipton
Jefferson
Webster
Livingston
Lawrence
St. Genevieve
Weakley
Lawrence
Madison
Leflore
St. Francois
Lee
21 Counties
Morehouse
Lincoln
Scott
21 Counties
Lincoln
Orleans
Madison
Shannon
Lonoke
Ouachita
Marion
Stoddard
Marion
Poinle Coupee
Marshall
Texas
Mississippi
Plaquemines
Montgomery
Washington
Monroe
Rapides
Panola
Wayne
Ouachita
Richland
Pike
Wright
Phillips
St. Bernard
Quitman
Poinsett
St. Charles
Rankin
29 Counties
Prairie
St. Helena
Sharkey
Pulaski
St. James
Simpson
Randolph
St. John the Baptist
Sunflower
St. Francois
St. Landry
Tallahatchie
Searcy
St. Martin
Tate
Sharp
St. Tammany
Tippah
Stone
Tangipahoe
Tunica
Union
Tensas
Union
Van Burcn
Union
Walthall
While
Washington
Warren
Woodruff
West Baton Rouge
West Carroll
Washington
Wilkinson
42 Counties
West Felicia
Winn
45 Counties
Yalobusha
Yazoo
45 Counties
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