Healthcare Ranks #2 Among Alabama Voter Priorities

In late 2017, the Public Affairs Research Council of Alabama (PARCA) surveyed Alabama voters to determine their thoughts about the general direction of the state and the issues that most concern them. PARCA partnered with Samford University to survey policy professionals from across the state including academics, journalists, business and nonprofit leaders, and lobbyists. Their responses provided a list of 17 critical issues facing Alabama. PARCA partnered with USA Polling at the University of South Alabama to ask registered voters about these 17 issues. The voters’ responses generated the Top Ten list of voter priorities. Details about the survey and its methodology can be found in the full Alabama Priorities report.

Alabama Priorities

1. K-12 Education
2. Healthcare
3. Government Corruption and Ethics
4. Mental Health and Substance Abuse
5. Poverty and Homelessness
6. Jobs and the Economy
7. Crime and Public Safety
8. Job Training and Workforce Development
9. Improving the State's Image
10. Tax Reform

Key Findings

  • Voters broadly agree on the critical issues facing the state.
  • Voters are not polarized along traditional political, ideological, racial, or generational lines. There is a significant gap between the priorities of experts and the priorities of voters.
  • Policymakers have an opportunity to inform and educate voters on critical and systemic challenges facing the state.
  • Policymakers have an opportunity to respond to immediate, often highly personal issues that concern voters.
  • Elected officials and candidates have an opportunity to show leadership and to build broad coalitions to address Alabama’s most pressing challenges.

This summer and fall, PARCA will produce summary briefs on each of the top ten priorities chosen by Alabama voters. Each brief will answer four critical questions: what is the issue, why it matters, how Alabama compares, and what options are available to Alabama policymakers.

#2: Healthcare

What is the issue?

Alabama voters rank healthcare as the 2nd most important issue facing the state, with 65% of voters saying they are very concerned. Majorities of every demographic group and political party say they are very concerned about healthcare. Healthcare is the #2 issue for Democrats, #3 for Republicans, and #4 for Independents. When considering ideology, healthcare is the #3 issue for conservatives, moderates, and liberals. Healthcare is the #1 issue for low-income and middle-income voters and #4 for high-income earners. Those who are self-employed or employed less than full-time are even more likely to say they are very concerned. In this survey, men placed a greater priority on healthcare than did women. Those with lower levels of education also showed more unease related to healthcare. Finally, though there were few differences between African Americans and whites, minorities did voice a greater concern for the current state of healthcare. In a follow-up question, voters indicated their top concerns about healthcare were cost (51%), expanding Medicaid (17%), rural access (16%), and cost of prescription drugs (12%).

Why Does it Matter?

A 2017 study of state health outcomes finds Alabama ranks 42nd in primary care physician access, 43rd in cancer deaths, 44th in physical activity, 46th in frequency of physical distress, 47th in frequency of mental distress, 48th in rate of low-birth weights, 49th in cardiovascular deaths, 49th in diabetes prevalence, and 50th in access to mental health providers. These factors, along with the state’s comparatively low number of primary care providers, mental health providers, dentists, and other healthcare professionals per capita earned Alabama 47th place in the nation for overall health and well-being concerns.[1]

Why does this matter? At the individual level, health and well-being is a critical component to quality of life. At the societal level, a healthy population is a critical component of economic vitality, productivity, and reduced public expenditures. Simply put, healthy people create a healthy, vibrant economy and community.

How Does Alabama Compare?

Healthcare is a very broad topic with many aspects. This brief will explore two core concepts – healthcare coverage and healthcare access.

Healthcare Coverage

Alabamians find themselves in one of four healthcare coverage situations: 52% are covered by a commercial insurer such as Blue Cross and Blue Shield, United, or VIVA through an employer or by self-pay; 19% are covered by Medicaid, 15% are covered by Medicare, 11% are uninsured.[2]

The Affordable Care Act has helped increase the number of people with healthcare coverage. Data suggests the number of insured people under age 65 in Alabama (10% in 2016) matches the national average, but the rate trails a number of states with rates as low as 6%.[3]

Essentially, all Alabamians age 65 and over are covered by Medicare. Policymakers at the national level continuously tweak Medicare, and there are long-term concerns about the program’s viability. Medicare is not a major component of current healthcare policy debate.

In contrast, Medicaid has been at the center of the healthcare reform debate since 2010. Alabama, like 26 other states, chose not to expand its Medicaid program. However, since 2014, nine of those states have reversed course and expanded Medicaid. Three more are currently considering expansion.[4]As currently structured, Alabama Medicaid serves the visually impaired and those with disabilities, as defined by the Social Security Administration, children under 19 living in families earning less than 146% of the poverty rate, adults over 65 in poverty, and other adults, frequently for maternity services only. Save very few exceptions, Medicaid does not cover able-bodied adults, without children, regardless of their income.

Healthcare Access

Healthcare coverage does not necessarily mean healthcare access. Structural barriers like service availability and viable transportation,[6] as well as more individual barriers like job flexibility and the affordability of deductibles and copays, are critical factors in accessing healthcare, regardless of a person’s insurance status. Access to care has been identified as the number one healthcare priority.[7] Only 28 of Alabama’s 67 counties have reached an optimal level of healthcare accessibility, though these counties continue to need special outreach and services to low-income communities.[8]

Further complicating access is the number of healthcare providers. As noted above, Alabama suffers from a lack of primary care providers. The number of primary care providers is a nationwide challenge driven, in large part, by the economics of the healthcare industry – as a society, we prioritize, and thus pay more for, specialty care and treatment rather than prevention and health maintenance. Thus, there are economic disincentives to practice primary care. This helps explain why Jefferson County, the county with the highest number of healthcare professionals in the state, is cited as a Healthcare Provider Shortage Area for low-income residents with only 25 physicians providing primary care to low-income residents in the county.[9]

A second, and increasing, barrier to access is the continued closure of rural hospitals. Since 2010, six Alabama hospitals have closed, tying Georgia with the 3rd highest number of closures in the country.[10] Currently, eight Alabama counties have no hospital. Hospital economics are complex, affected by cost inefficacies, decreasing populations, changing patient preferences, state regulations, and change to federal reimbursement structure.

How Do Alabama Counties Compare?

When Alabama counties are compared, there is considerable variation in essentially every health statistic. Comprehensive county comparisons can be found at http://www.countyhealthrankings.org/app/alabama/2018/overview. While Alabama’s overall uninsured rate was 12% in 2015, the rate ranged from a low of 8% in Shelby County to 18% in DeKalb County. Uninsured rates among minorities in Alabama is between 10% to 28%.[11] There is also considerable variance in healthcare access. The ratio of primary care providers to population ranges from 1:10,461 in Lowndes County to 1:940 in Jefferson County. Nationally, the ratio is 1:1,030. A majority of Alabama counties, 39, had ratios greater than 1:2,060.[12]

When considering outcomes, Shelby County enjoys the highest health outcomes and health factors rating, followed by Madison, Baldwin, Limestone, Colbert, and Lee counties. Shelby County reports the highest in lifespan, quality of life, and access to clinical care. Wilcox County ranked lowest in lifespan, Greene ranked lowest in quality of life, and Conecuh ranked lowest in access to clinical care.[13]

What Can We Do?

Alabama has much room for improvement in healthcare. Robert Wood Johnson’s County Health Ranking and Roadmaps[14] lists several hundred policy recommendations across a broad range of healthcare topics, including access, outcomes, and behaviors. Recommendations can be searched by population, geography, decision maker, and more. This resource, along with community health assessments prepared for the state and each county every five years provide a wealth of recommendations for state and local policymakers.

Changing health outcomes is not easy, but it is not impossible. States like Florida and Utah were able to achieve meaningful change in just one year, changes that resulted in their national average improving by four positions.[15] By improving health behaviors, clinical access, community and environment, and policy, Alabama could see similar changes.

Drafted by Cassidy Clevenger, graduate student, Department of Social Work, Samford University, and the staff of the Public Affairs Research Council of Alabama.

Read the full PDF Healthcare brief here.

[1] America’s Health Rankings Annual Report 2017, (2017) United Health Foundation. https://assets.americashealthrankings.org/app/uploads/ahrannual17_complete-121817.pdf.

[2] “Health Coverage: State-to-State: 2017,” America’s Health Insurance Plans, https://www.ahip.org/wp-content/uploads/2017/10/StateDataBook_2017.pdf.

[3] “Health Insurance Coverage of Nonelderly 0-64.” (2018) Kaiser Family Foundation. https://www.kff.org/other/state-indicator/nonelderly-0-64/?currentTimeframe=0&sortModel=%7B%22colId%22:%22Location%22,%22sort%22:%22asc%22%7D.

[4] “Status of State Action on the Medicaid Expansion Decision” (September 11, 2018) Kaiser Family Foundation, https://www.kff.org/health-reform/state-indicator/state-activity-around-expanding-medicaid-under-the-affordable-care-act/?currentTimeframe=0&sortModel=%7B%22colId%22:%22Location%22,%22sort%22:%22asc%22%7D#note-1.

[5] “Who Does Alabama Medicaid Serve?”  Alabama Medicaid Agency, http://www.medicaid.alabama.gov/documents/2.0_Newsroom/2.3_Publications/2.3.5_Annual_Report_FY16/2.3.5_FY16_Who_Does_Alabama_Medicaid_Serve.pdf.

[6] “Access to Care,” (August 23, 2018) Alabama Department of Public Health. http://www.alabamapublichealth.gov/healthrankings/access-to-care.html.

[7] State of Alabama Community Health Assessment, (2015) Alabama Department of Public Health, https://www.alabamapublichealth.gov/accreditation/assets/CHA2015_Final_RevAugust_R.pdf.

[8] “Access to Care,” (August 23, 2018) Alabama Department of Public Health. http://www.alabamapublichealth.gov/healthrankings/access-to-care.html.

[9] “HPSA Find,”  U.S. Department of Health and Human Services Health Resources & Services Administration, https://data.hrsa.gov/tools/shortage-area/hpsa-find

[10] Ellison, Ayla, (March 26, 2018), ”7 states with the most rural hospital closures,” Becker’s Hospital Review https://www.beckershospitalreview.com/finance/7-states-with-the-most-rural-hospital-closures-032618.html, and July 13,2018) “9 hospital closures in 2018 so far” https://www.beckershospitalreview.com/finance/9-hospital-closures-in-2018-so-far.html.

[11] Givens, M., Jovaag, A., & Wilems Van Dijk, J. 2018 Alabama State Report University of Wisconsin Population Health Institute http://www.countyhealthrankings.org/rankings/data/al.

[12] Givens, M., Jovaag, A., & Wilems Van Dijk, J. 2018 Alabama State Report University of Wisconsin Population Health Institute http://www.countyhealthrankings.org/rankings/data/al.

[13] Givens, M., Jovaag, A., & Wilems Van Dijk, J. 2018 Alabama State Report University of Wisconsin Population Health Institute http://www.countyhealthrankings.org/rankings/data/al.

[14] “What Works for Health,” University of Wisconsin Population Health Institute,  http://www.countyhealthrankings.org/take-action-to-improve-health/what-works-for-health.

[15] America’s Health Rankings Annual Report 2017, (2017) United Health Foundation. https://assets.americashealthrankings.org/app/uploads/ahrannual17_complete-121817.pdf.

 


Mental Health and Substance Abuse Ranks #4 Among Alabama Voter Priorities

In late 2017, the Public Affairs Research Council of Alabama (PARCA) surveyed Alabama voters to determine their thoughts about the general direction of the state and the issues that most concern them. PARCA partnered with Samford University to survey policy professionals from across the state including academics, journalists, business and nonprofit leaders, and lobbyists. Their responses provided a list of 17 critical issues facing Alabama. PARCA partnered with USA Polling at the University of South Alabama to ask registered voters about these 17 issues. The voters’ responses generated the Top Ten list of voter priorities. Details about the survey and its methodology can be found in the full Alabama Priorities report.

Alabama Priorities

1. K-12 Education
2. Healthcare
3. Government Corruption and Ethics
4. Mental Health and Substance Abuse
5. Poverty and Homelessness
6. Jobs and the Economy
7. Crime and Public Safety
8. Job Training and Workforce Development
9. Improving the State's Image
10. Tax Reform

Key Findings

  • Voters broadly agree on the critical issues facing the state.
  • Voters are not polarized along traditional political, ideological, racial, or generational lines. There is a significant gap between the priorities of experts and the priorities of voters.
  • Policymakers have an opportunity to inform and educate voters on critical and systemic challenges facing the state.
  • Policymakers have an opportunity to respond to immediate, often highly personal issues that concern voters.
  • Elected officials and candidates have an opportunity to show leadership and to build broad coalitions to address Alabama’s most pressing challenges.

This summer and fall, PARCA will produce summary briefs on each of the top ten priorities chosen by Alabama voters. Each brief will answer four critical questions: what is the issue, why it matters, how Alabama compares, and what options are available to Alabama policymakers.

#4: Mental Health and Substance Abuse

What is the issue?

Alabama voters rank mental health and substance abuse as the 4th most important issue facing Alabama, with 56% of respondents indicating they were very concerned about the issue. A plurality of Millennials and majority of voters of every other generation are very concerned about the issue. These findings are in keeping with the State’s Community Health Improvement plan, which found Alabamians rank mental health as the second greatest health concern.[1]

Mental illness includes a range of mental health conditions from mild anxiety, treatable with counseling, all the way to major psychiatric issues requiring psychotropic medication and long-term hospitalization.

An estimated 43.6 million Americans from all backgrounds suffer from mental illness or substance abuse. If current trends continue, by 2020, there will be more people suffering from mental and substance abuse disorders than people suffering from all physical diseases worldwide.[2]

Mental illness and substance abuse disorders share some underlying causes, including changes in brain composition, genetic vulnerabilities, and early exposure to stress or trauma.[3] Individuals that suffer from drug addiction frequently experience one or more symptoms of mental health issues.[4]

Experiencing both mental illness and substance abuse, what professionals call a dual-diagnosis, is very common.

Why Does it Matter?

Mental illness and substance abuse can alter reasoning skills, coping mechanisms, emotions, and behavior. This can have a profound impact on the individual and family, but also on the broader society.

Serious and untreated mental health concerns, including substance abuse, can place a strain on the communities by increasing unemployment, crime, and healthcare costs. Substance abuse alone has been estimated to cost $504 billion in direct and indirect costs, including lost productivity, in 2015 alone.[5]

Left untreated, mental health and substance abuse disorders can hinder an individual’s ability to live a healthy, confident life, and the ability to be productive members within the community. Untreated mental health and substance abuse issues can be significant contributing factors to job loss, homelessness, criminal behavior, and premature death. Suicide and drug-related deaths have increased in the nation in recent years with suicide ranked 11th in 2014 as the leading cause of death.[6]

More than one in four adults living with a severe mental health issue is also struggling with substance abuse issues. The effects on the communities can have direct and indirect consequences. “Direct consequences can include injuries, social and legal problems, impaired health, overdose, deaths, and babies born with neonatal abstinence syndrome. Indirect consequences include higher health care costs, the spread of infectious diseases, drug-related crime, interpersonal violence, unintended pregnancy, and stress within families.”[7]

How Does Alabama Compare?

Mental health care and substance abuse are critical issues in Alabama. In 2014, Mental Health America ranked the fifty states and Washington, D.C. in a number of mental health categories.[8] Overall, in the composite ranking of 15 mental health metrics, Alabama ranked 41st, ahead of neighboring states South Carolina, Tennessee, Mississippi, but behind North Carolina, Florida, Arkansas, and Louisiana. Georgia led all Southeast states at 26. Alabama ranked 27th in overall adult mental health and 28th in overall youth mental health. Looking at individual components, Alabama ranked:

  • 30th in the number of adults suffering from any mental illness;
  • 18th in the number of adults suffering from acute suicidal ideation;
  • 9th in the number of youth suffering from a major depressive episode in the previous year;
  • 42nd in the number of adults diagnosed with any mental illness without insurance, representing 20.8% of the adult population; and
  • 48th in overall access to care, ahead of only Texas, South Carolina, and Mississippi.

In spite of all this, less than half (43.5%) of adults in Alabama living with mental illness have received any form of treatment.[9]

Alabama now faces the daunting task of combating the opioid crisis. In 2013, Alabama had the highest per capita number of opioid prescriptions in the country – 141.1 per 100 compared to the national average of 79.3 per 100 people. Since then, the rate has dropped to 120.3 per 100 in 2015 – but this number still represents 1.2 prescriptions for every man, woman, and child in Alabama.[10]

While Alabama ranks 34th in deaths from drug overdose, the number of overdose deaths continue to climb: from 169 in 1999 to 756 in 2016, a 347% increase.[11]

Lack of accessible care and lack of sufficient insurance coverage for substance users exacerbates the issue. There is a high correlation between availability of preventative mental health services and mental health treatment. Alabamians have less access to mental health services than do residents of many other states.

What Can We Do?

Access to Care

One of the most significant factors facing mental health and addiction treatment in Alabama is simply the lack of access. Alabama has one mental health provider for every 1,180 people. Mental health providers include psychiatrists, psychologists, licensed clinical social workers, counselors, marriage and family therapists, and advanced practice nurses who specialize in mental health. However, at the county level, the ratio ranges from 270:1 (Macon County) to 33,840:1 (Chambers County).[12] Focusing on just substance abuse, statewide, there are 505 beds for residential and high-intensity residential substance abuse treatment – and these beds are located in just 13 counties. There is a waiting list of 319 people.

Individuals without insurance may wait for months to see a mental health professional. More often than not, this results in a crisis that ends with the individual in the hospital or jail. In effect, Alabama’s hospital emergency departments, jails, and prisons serve as de facto mental health providers. At the same time, while most people know how to access physical health care, people may be less familiar with when and how to access mental health care.

  • The state could expand Mental Health First Aid, described as ‘CPR’ for mental health, and Crisis Intervention Training for law enforcement personnel.
  • The state could also explore a waiver, which would allow Medicaid to fund treatment of substance abuse.
  • The state could explore expanding access to substance abuse treatment, particularly residential treatment. There are currently no substance abuse facilities, public or private, in Autauga, Bullock, Coosa, Lawrence, Lowndes, Perry, Washington, or Wilcox Counties.

Mental Health Workforce

Access is largely, but not exclusively, a function of size of the mental health workforce. Alabama faces a growing workforce shortage in many industries, including mental health services. There is a particular shortage for trained professionals serving the elderly. Unaddressed, this shortage will escalate as the senior population is growing faster than other age groups.

  • The state could explore incentives to attract and retain mental health professionals.
  • The state could explore licensure regulations to allow all medical professionals to practice at the highest levels of their training and certification.

Social Stigma

Mental health experts recognize that even if there were sufficient mental health providers, there is still a significant stigma attached to accessing treatment for mental health or substance abuse issues. Moreover, often when treatment is sought, the individual is already in a state of crisis, rather than seeking care earlier.

  • The state could seek to reduce the stigma by promoting and expanding peer programs—mental health services led by, or in conjunction with a person who has experienced mental illness himself or herself.
  • The state could develop an awareness campaign for the general public.

Standards of Care

There are a number of evidence-based and standards of care treatments that could be considered for expansion or modification in Alabama.

  • The use of medication to treat opioid addiction could be expanded.
  • The state could require healthcare professionals who prescribe medication treatment for addiction, do so only in consultation with a trained mental health professional.
  • The number of state-funded residential beds for substance abuse treatment could be expanded.
  • The number of nonprofit or low-cost methadone clinics for those with heroin addictions who suffer multiple relapses could be expanded.
  • The state could create a harm reduction program for opioid users, which includes education, counseling, referrals to treatment, and needle services and which has been shown to reduce the spread of HIV and Hepatitis C and increase the likelihood an individual will seek treatment.
  • The state could expand mental health and substance abuse treatment in the corrections system, which could also help reduce recidivism rates.

Drafted by Anita Perry, graduate student, Department of Social Work, Samford University, and the staff of the Public Affairs Research Council of Alabama.

Full PDF report available here.

[1] Alabama Department of Public Health, State of Alabama Community Health Improvement Plan (2015), http://www.adph.org/accreditation/assets/CHIP_2015_RevAugust.pdf.

[2] Rosenberg, L. 2012. “Behavioral disorders: the new public health crisis.Journal of Behavioral Health Services & Research 39(1):1-2.

[3]  U.S. Department of Health and Human Services, “Mental Health and Substance Use Disorders” (2017), https://www.mentalhealth.gov/what-to-look-for/mental-health-substance-use-disorders.

[4]  U.S. Department of Health and Human Services, “Mental Health and Substance Use Disorders” (2017), https://www.mentalhealth.gov/what-to-look-for/mental-health-substance-use-disorders.

[5] U.S. Department of Health and Human Services, Substance Abuse and Mental Health Services Administration, Facing Addiction in America: The Surgeon General’s Report on Opioids (2018), https://addiction.surgeongeneral.gov/sites/default/files/surgeon-generals-report.pdf.

[6] U.S. Department of Health and Human Services, Substance Abuse and Mental Health Services Administration, Facing Addiction in America: The Surgeon General’s Report on Opioids (2018), https://addiction.surgeongeneral.gov/sites/default/files/surgeon-generals-report.pdf.

[7] Walden, Nicole. “The Opioid Crisis in Alabama” Alabama Department of Mental Health, November 27, 2017, http://www.alabamapublichealth.gov/alphtn/assets/112717handouts.pdf.

[8] Mental Health America, “The State of Mental Health in America, 2018” (2018), http://www.mentalhealthamerica.net/issues/state-mental-health-america.

[9] U.S. Department of Health and Human Services, Substance Abuse and Mental Health Services Administration, Behavioral Health Barometer Alabama, 2015, (2015), https://www.samhsa.gov/data/sites/default/files/2015_Alabama_BHBarometer.pdf.

[10] National Institute on Drug Abuse, “Alabama Opioid Summary” (2018), https://www.drugabuse.gov/drugs-abuse/opioids/opioid-summaries-by-state/alabama-opioid-summary

[11] U.S. Department of Health and Human Services, Centers for Disease Control, “Drug Overdose Mortality by State: 2016” (2018), https://www.cdc.gov/nchs/pressroom/sosmap/drug_poisoning_mortality/drug_poisoning.htm

[12] Robert Wood Johnson, 2018 County Health Rankings, (2018), http://www.countyhealthrankings.org/app/alabama/2018/measure/factors/62/map


Poverty and Homelessness Ranks #5 Among Alabama Voter Priorities

In late 2017, the Public Affairs Research Council of Alabama (PARCA) surveyed Alabama voters to determine their thoughts about the general direction of the state and the issues that most concern them. PARCA partnered with Samford University to survey policy professionals from across the state including academics, journalists, business and nonprofit leaders, and lobbyists. Their responses provided a list of 17 critical issues facing Alabama. PARCA partnered with USA Polling at the University of South Alabama to ask registered voters about these 17 issues. The voters’ responses generated the Top Ten list of voter priorities. Details about the survey and its methodology can be found in the full Alabama Priorities report.

Alabama Priorities

1. K-12 Education
2. Healthcare
3. Government Corruption and Ethics
4. Mental Health and Substance Abuse
5. Poverty and Homelessness
6. Jobs and the Economy
7. Crime and Public Safety
8. Job Training and Workforce Development
9. Improving the State's Image
10. Tax Reform

Key Findings

  • Voters broadly agree on the critical issues facing the state.
  • Voters are not polarized along traditional political, ideological, racial, or generational lines. There is a significant gap between the priorities of experts and the priorities of voters.
  • Policymakers have an opportunity to inform and educate voters on critical and systemic challenges facing the state.
  • Policymakers have an opportunity to respond to immediate, often highly personal issues that concern voters.
  • Elected officials and candidates have an opportunity to show leadership and to build broad coalitions to address Alabama’s most pressing challenges.

In the following months, PARCA will produce summary briefs on each of the top ten priorities chosen by Alabama voters. Each brief will answer four critical questions: what is the issue, why it matters, how Alabama compares, and what options are available to Alabama policymakers.

#5: Poverty and Homelessness

What is the issue?

Poverty and homelessness is the 5th most important issue for Alabama voters, with 58% of voters indicating they are very concerned about the issue. Poverty and homelessness averaged 4.192 on 1–5 scale where 1 is “not at all concerned” and 5 is “very concerned.” The majority of every demographic and political group indicated they were very concerned about this issue.

Why are Poverty and Homelessness Important?

The standard measure of poverty is the percentage of people earning less than a specific dollar amount: the federal poverty line. The federal poverty line is adjusted for the number of people in a household and is revised annually. In 2018, the federal poverty line for a family of four is $25,100. Although the percent of the population living in poverty is in decline, over 39 million people were still in poverty in the U.S. in 2017. Poverty often creates a vicious cycle that can last generations. Poverty complicates and is complicated by almost every other challenge facing Alabama and the nation.

The U.S. Department of Housing and Urban Development defines homelessness, in part, as lacking a fixed, regular, and adequate nighttime residence or a primary residence that was not designed for or ordinarily used as a regular sleeping accommodation for people. On a single night in 2017, an estimated 553,742 people were homeless in the United States. Homeless experts and advocates question the appropriateness of the definition and the accuracy of the number, some suggesting the number to be almost double.[1]

Homelessness can:

  • create new health problems and exacerbate existing ones;[2]
  • increase the chances of entering the criminal justice system and increase the recidivism rate;[3]
  • increase substance misuse;[4] and
  • have a negative economic impact on the larger community.

How Does Alabama Compare?

Population in Poverty

The percent of the population in Alabama living below the federal poverty level has declined from 19% in 2010 to 16.9% in 2017, mirroring declines at the national level. However, the percent of people living below the poverty level in Alabama is still higher than that of the nation. In 2017, Alabama had the 6th highest poverty rate in the U.S. and the fourth highest poverty rate among 10 southeastern states.

Poverty sees no color – while black Alabamians are disproportionately poorer, with 27% living in poverty, white Alabamians are deeply affected as well, with 12% living below the poverty line.[5] Approximately thirty-one percent of Hispanics in Alabama live below the poverty line.

Children in Poverty

Similar to poverty in the total population, the percent of children living in poverty in Alabama is consistently higher than that of the nation. During the period 2010 to 2017, childhood poverty declined for the state, reaching 24.6% in 2017. When compared to southeastern states, the percentage of children in poverty in Alabama ranked higher than all states except Louisiana at 28% and Mississippi at 26.9%.

Homelessness

In 2017, there were an estimated 3,793 homeless people in Alabama, a decrease of 7.7% over the previous year and more than 37% since 2010. In the ten-year period between 2007 and 2017, Alabama’s homeless rate decreased at a faster rate than the national average – a 30% decrease in the state compared to a 14.4% decrease nationally. However, Alabama’s percentage change has been lower than a majority of its southeastern neighbors. Also, while homelessness in Alabama is trending in a positive direction, those still struggling with homelessness are sometimes those facing the most profound challenges, including addictions and mental health issues.

What Can We Do?

There is no single solution to reducing poverty or homelessness. As the causes are varied, complex, and differ from region to region across the state, so too must the responses. Private philanthropy and the faith community can do much to assist individuals and families, but the challenge is too large to be left to the private sector alone. Alabama could consider policy responses and interventions that have demonstrated success around the country, some of which are highlighted below.

  • Increased investment in education: in 2016, Alabama was 39th among U.S. states in per student spending.[6]
  • Expanded student and family support for students in Pre-K through 12th
  • Expanded investment in workforce development for under-employed and unemployed adults.
  • Expanded educational opportunities and supportive services for low-income adults.
  • Expanded access to primary healthcare, especially in rural parts of Alabama.
  • Increase family income for those in poverty through expanded employment (24% of survey respondents indicated the number of available jobs was their top economic priority) or increased wages (32% of respondents said increasing the minimum wage was their top economic priority).
  • Implement a statewide housing first model to address homelessness.

Read full PDF report here.       

[1] National Coalition for the Homeless. “Current State of Homelessness” April 2018 http://www.nationalhomeless.org/

[2] National Health Care For The Homeless Council. “Homelessness & Health: What’s The Connection?”, Fact Sheet, June 2011 https://www.nhchc.org/wp-content/uploads/2011/09/Hln_health_factsheet_Jan10.pdf

[3] Volunteers of America, “Homelessness and Prisoner Re-Entry”, https://www.voa.org/homelessness-and-prisoner-reentry

[4] National Coalition for the Homeless, “Substance Abuse and Homelessness” July 2009. http://www.nationalhomeless.org/factsheets/addiction.pdf

[5] Census Bureau’s Population Estimates Program. (2017). 2017 American Community Survey 1-Year Estimates. [Data file]. Retrieved from https://factfinder.census.gov/faces/tableservices/jsf/pages/productview.xhtml?pid=ACS_15_1YR_S1701&prodType=table

[6] “Annual Survey of School System Finances” U.S. Census Bureau https://www.census.gov/programs-surveys/school-finances.html


PARCA Annual Survey Addresses Representation in State Government, Public Education and Payday Loans

PARCA collaborated with Samford University to conduct our annual telephone survey of Alabama citizens between June 4 and July 18, 2018. The survey was directed by Dr. Randolph Horn and was under the field direction of Grace Okoro.

The survey addressed topics including the quality of representation in state government, and, in partnership with the Alabama Association of School Boards, questions about public education in Alabama, and, in partnership with the Community Foundation of Greater Birmingham, questions about payday loans.

Many trends remained the same from previous years, but some of the results were surprising.

Read the full report here. (PDF)


Crime and Public Safety Ranks #7 Among Alabama Voter Priorities

In late 2017, the Public Affairs Research Council of Alabama (PARCA) surveyed Alabama voters to determine their thoughts about the general direction of the state and the issues that most concern them. PARCA partnered with Samford University to survey policy professionals from across the state including academics, journalists, business and nonprofit leaders, and lobbyists. Their responses provided a list of 17 critical issues facing Alabama. PARCA partnered with USA Polling at the University of South Alabama to ask registered voters about these 17 issues. The voters’ responses generated the Top Ten list of voter priorities. Details about the survey and its methodology can be found in the full Alabama Priorities report.

Alabama Priorities

1. K-12 Education
2. Healthcare
3. Government Corruption and Ethics
4. Mental Health and Substance Abuse
5. Poverty and Homelessness
6. Jobs and the Economy
7. Crime and Public Safety
8. Job Training and Workforce Development
9. Improving the State's Image
10. Tax Reform

Key Findings

• Voters broadly agree on the critical issues facing the state.
• Voters are not polarized along traditional political, ideological, racial, or generational lines. There is a significant gap between the priorities of experts and the priorities of voters.
• Policymakers have an opportunity to inform and educate voters on critical and systemic challenges facing the state.
• Policymakers have an opportunity to respond to immediate, often highly personal issues that concern voters.
• Elected officials and candidates have an opportunity to show leadership and to build broad coalitions to address Alabama’s most pressing challenges.

In the following months, PARCA will produce summary briefs on each of the top ten priorities chosen by Alabama voters. Each brief will answer four critical questions: what is the issue, why it matters, how Alabama compares, and what options are available to Alabama policymakers.

#7: Crime and Public Safety

What is the Issue?

Alabama voters ranked crime and public safety as the 7th most important issue among the priorities, with approximately 58% of voters indicating they were very concerned about the issue. The issue averaged 4.10 on a 1 – 5 scale where 1 is “not at all concerned” and 5 is “very concerned.”

Majorities of every racial group are very concerned about this issue. Approximately three-quarters of African-Americans say they are very concerned. Respondents with lower incomes are more likely to say they are very concerned than respondents with higher incomes. While majorities of conservatives and liberals say they are very concerned, only a plurality (more than any other category but not a majority) of self-described moderates holds this view.

Survey respondents were also asked about their top policy responses to crime and public safety. Twenty-seven percent of voters were more concerned about the number of police, 24% civil liberties, and lesser percentages identifying sentencing reform and conditions of state prisons as their top priority.

Why Is Crime and Public Safety Important?

In previous generations, a basic high school education was sufficient for entry into the workforce. Today, an increasing share of entry-level jobs require a level of training beyond a high school diploma. To generate a prepared workforce, there is continued need to improve preparation for and access to two and four-year colleges. However, the demand for advanced training is also being addressed by K-12 schools, where students are increasingly presented with options for earning industry-recognized credentials while still in high school. Certificate programs are being expanded for new graduates and current workers.

Alabama has enjoyed an unprecedented run of industrial recruitment and new job creation. According to the Alabama Department of Commerce, the state has added or announced 138,197 new jobs between 2010 and 2017. In that same time, employment in Alabama has grown from 1,893,169 to 2,081,176 – an increase of 188,007, and the unemployment rate has fallen to 3.8% (December 2017). Recent monthly unemployment rates for the state have hovered between 3.7 and 4.1%, the lowest numbers since at least 1976. Despite the surging demand for labor, Alabama’s population growth has been sluggish, creating a tight labor market and a pending shortage of workers.

How Does Alabama Compare?

Crime has many negative impacts on a community.

Crime and the response to crime create a large economic and social cost, including the direct economic losses suffered by victims and the costs of police protection, legal services, and corrections.

Crime data and perceptions of public safety are widely used in quality of life rankings, which can impact the perceived livability and desirability of a community.[1]

High crime rates deter business. Crime can reduce the size and skills of the labor force. Crime can have a negative impact on education and training, diminishing the long-term creativity and innovative capacity of a community. Crime can deter business investment and location.

The economic, societal, familial, and personal costs of incarceration are immense.

Public safety plays a crucial role in supporting economic growth and vitality by reducing the cost of crime and enhancing the desirability of communities as places to live and locate businesses and has a direct impact on the levels of societal trust and interaction.[2]

How Does Alabama Compare?

The Crime Rate

Alabama reported 532.3[3] violent crimes per 100,000 residents in 2016, placing Alabama 8th highest in the nation for violent crimes. Alabama fared worse than most Southeastern states, except Tennessee, Louisiana and Arkansas. The state fared somewhat better in terms of property crimes, ranking 14th in the nation. Alabama’s property crime index for 2016 was 2,947.8 per 100,000 residents but was lower than that of only four Southeastern states. When violent and property crimes are considered together, Alabama ranked 9th in the nation with a crime index of 3,480.1 per 100,000 residents.

According to the Alabama Law Enforcement Agency’s annual crime report[4], total crime in the state has decreased from 2011 to 2015 but increased roughly 2% from 2015 to 2016.

However, during this same period, the number of violent crimes increased every year except between 2012 and 2014. Violent crime in the state increased from 405.5 per 100,000 residents in 2014 to 518.2 in 2016.

Although the number of violent crimes increased significantly over that two-year period, the number of crimes cleared has been decreasing.[5] In 2014, 45% of violent crimes were cleared, but that percentage decreased to 39% in 2016. The clearance rate for total crime in the state has also been declining over the same period.

The Incarceration Rate

In 2016, there were 27,799 inmates in Alabama prisons, a rate of 633 people per 100,000 – the 3rd highest incarceration rate in the U.S. The state’s incarceration rate is significantly higher than the national rate of 471 per 100,000 residents and lower than only Oklahoma and Louisiana; 700 and 816 per 100,000 residents, respectively.

The high number of incarcerations makes the state’s prisons the most overcrowded in the country; housing almost twice the number of inmates the facilities were designed to house.

In addition to a high incarceration rate, the ratio of supervising probation and parole officers to probationers, parolees, and offenders poses a significant problem for the state’s system. At the end of fiscal year 2017, the total caseload average per officer on any given day was measured at 169 to 1. When broken down by total and active caseloads, the active caseload average per officer was 110 to 1. The American Probation and Parole Association (APPA) recommended caseload is 20 probationers per probation officer for intensive supervision, 50 to 1 for moderate to high-risk offenders, and 200 to 1 for low-risk offenders.

The Recidivism Rate

Recidivism, which refers to a person’s relapse into criminal behavior and is measured by criminal acts that result in rearrests, reconviction, or return to prison within three years, is a major driver of incarceration rates.

In 2017, the recidivism rate in Alabama was 31.5%, including all cohorts.[6] The high percent of recidivists continues to negatively impact the state’s prison system which is already overburdened. It also sheds light on the need for more effective programs to help released prisoners readjust to their communities and rebuild their lives.

Juvenile Detention

The percentage of violent crimes and property crimes committed by juveniles in Alabama decreased since 2013. As of 2016, juveniles account for 6% of violent crimes and property crimes.

Despite the decline in juvenile crime, the number of detained juveniles is also a cause for concern. Alabama’s juvenile custody rate of 184 per 100,000 youths places the state 20th in the nation. When compared to Southeastern states, the state ranked 3rd with only Arkansas and Virginia having higher rates.

There is a long-term impact on juveniles with criminal convictions that goes beyond the immediate effect to individual and family. A study from University of Pittsburgh found that 52% to 57% of juvenile delinquents continue to offend up to the age of 25, and about 16 – 19% up to the age of 30.[7]

Funding

Like many parts of state government, Alabama’s corrections and justice systems struggle with funding. Alabama spends less on corrections than a majority of states across the country.

According to the Alabama Department of Corrections 2017 Annual Report, Alabama spent $52.07 per day per inmate, compared to the national average of $99.45.

Alabama’s low per inmate spending may be seen as a positive by some. However, it is important to remember that with this level of spending comes a Department of Corrections that is understaffed, pays the lowest of any public safety agency in the state, and which suffers from very high turnover rates. The state’s corrections spending also contributes to legal issues facing the state. Alabama is currently engaged in two different lawsuits concerning the healthcare and conditions of Alabama’s prisons. It is highly likely that the outcome of these cases will result in court-mandated increases in Alabama’s corrections budget.

Beyond funding Alabama’s prison system, Alabama’s funding for judicial, legal and police protection is also low. Based on 2016 expenditure data from the Bureau of Justice Statistics, Alabama’s justice system expenditures, which include police protection, judicial and legal, and corrections, were low when compared to more than 30 states across the country and most Southeastern states. In 2016, the state spent $2.5 billion, while other southeastern states spent a significantly higher amount (example Florida’s 2016 expenditures totaled roughly $14 billion and Georgia approximately $6 billion).

What Can We Do?

The state has made recent attempts to address overcrowding in prisons, the high rate of supervision caseloads, and the lack of treatment in the community. In 2015, the state passed the Justice Reinvestment Act (Act 2015-185), which strengthened community-based supervision as an alternative to prison, while prioritizing prison space for violent and dangerous offenders. The legislation also took steps to ensure supervision for everyone upon release from prison. Since then, the state’s prison population has decreased by 15%, and more than 100 new probation and parole officers have been hired to help reduce officers’ caseloads.

In June 2018, the Alabama Department of Corrections announced pay raises of 5% for correctional officers at medium security facilities and 10% for officers at maximum security facilities.

Further reductions of the inmate population will be challenging, and additional investment in the prison system will be fiscally and politically difficult – although court orders may leave the state with no choice.

There are additional options the state can explore, including:

  • Continued expansion of day reporting facilities[8] and related programs designed to reduce recidivism;
  • Explore recommendations of the Alabama Juvenile Justice Task Force[9] designed to reform the retention of juvenile offenders; and
  • Expand mental health and drug treatment options both inside state prisons and in local communities.

 

Drafted by Kenesha Reynolds-Allie, Ph.D. and the Staff of the Public Affairs Research Council of Alabama

View the full PDF report here.


[1] Blair, J.P., “Quality of life and economic development policy”, Economic Development Review 16, 1998.

[2] Keeling, Mary and Mark Cleverly, “Accelerating economic growth and vitality through smarter public safety management”, IBM Institute for Business Value, Executive Report.

[3] Crime index (violent and property crimes) was calculated using 2016 Crime in the United States (CIUS) data from the Federal Bureau of Investigation (FBI) Uniform Crime Reporting (https://ucr.fbi.gov/crime-in-the-u.s)  and 2016 population estimates from the U.S. Census Bureau, Population Division (https://www.factfinder.census.gov)

[4] http://www.alea.gov/Home/wfContent.aspx?PLH1=plhACJIC-CrimeInAlabama

[5] A clearance is a measure of law enforcement activity whereby enough evidence is found to charge a suspect and take him into custody (an arrest) or when a crime is solved but no formal charges are brought against a suspect (clearance by exceptional means).

[6] Alabama Department of Corrections – FY2017 Annual Report (http://www.doc.state.al.us/StatReports)

[7] Stouthamer-Loeber, Magda, “Persistence and Desistance in Offending” (unpolished report, Pittsburg, Pa.: Life History Research Program, University of Pittsburg, 2010).

[8] Board of Pardons and Paroles, 2017 Annual Report http://www.pardons.state.al.us/Reports.aspx

[9] Alabama Juvenile Justice Task Force Final Report, December 2017. http://dys.alabama.gov/images/task_force/AL%20JJ%20Task%20Force%20Report_FINAL.pdf


The State’s Image Ranks #9 among Alabama Voter Priorities

In late 2017, the Public Affairs Research Council of Alabama (PARCA) surveyed Alabama voters to determine their thoughts about the general direction of the state and the issues that most concern them. PARCA partnered with Samford University to survey policy professionals from across the state including academics, journalists, business and nonprofit leaders, and lobbyists. Their responses provided a list of 17 critical issues facing Alabama. PARCA partnered with USA Polling at the University of South Alabama to ask registered voters about these 17 issues. The voters’ responses generated the Top Ten list of voter priorities. Details about the survey and its methodology can be found in the full Alabama Priorities report at www.parcalabama.org

Alabama Priorities

1. K-12 Education
2. Healthcare
3. Government Corruption and Ethics
4. Mental Health and Substance Abuse
5. Poverty and Homelessness
6. Jobs and the Economy
7. Crime and Public Safety
8. Job Training and Workforce Development
9. Improving the State's Image
10. Tax Reform


Key Findings

Voters broadly agree on the critical issues facing the state.

Voters are not polarized along traditional political, ideological, racial, or generational lines. There is a significant gap between the priorities of experts and the priorities of voters.

Policymakers have an opportunity to inform and educate voters on critical and systemic challenges facing the state.

Policymakers have an opportunity to respond to immediate, often highly personal issues that concern voters.

Elected officials and candidates have an opportunity to show leadership and to build broad coalitions to address Alabama’s most pressing challenges.

In the following months, PARCA will produce summary briefs on each of the top ten priorities chosen by Alabama voters. Each brief will answer four critical questions: what is the issue, why it matters, how Alabama compares, and what options are available to Alabama policymakers.

#9: The State’s Image

What is the Issue?

The state’s image is the 9th most important issue for Alabama voters, with 57% of survey respondents indicating they are very concerned about improving the state’s image.

When examining the top ten priorities by population, the state’s image made the top ten for most groups. Interestingly, the issue ranked higher for older voters and for those with lower incomes and levels of education.

Some would say that Alabama’s image is well earned. Alabama ranks poorly compared to other states in many measures of corruption, education, health, income, and general well-being – issues that will be explored more fully in future briefs.

The State’s Image by Group – asterisks (*) indicates the issue did not rank in the top ten

Alabamians are reminded of this fact frequently. Every few days there is a story in the media highlighting how Alabama compares to other states on some measure. A simple web search generates many such rankings – some concerning more substantive issues than others and some rankings compiled with more rigor than others. In just the last few weeks, Alabama has been ranked as:

  • 42nd in child-well being[1]
  • schools rank 42nd in the nation[2]
  • #3 in speed-related deaths[3]
  • #1 for fast-food restaurants per capita[4]
  • 41st in places to start a business[5]
  • 40th in children’s health[6]
  • 49th in hiring people with disabilities[7]

Rankings such as these do not tell the whole story, but as has been said, perception is reality.

Why is the State’s Image Important?

Perception

Alabama, like other southern states, labors under stereotypical and outdated assumptions about the rural south: remote, uneducated, and uncivilized. This narrative continues to be nurtured in popular culture and, sometimes by the state and its people. Alabamians, however, and those that visit, know that these descriptions do not reflect the state.

Fairly or not, Alabama must contend with its reputation when attracting new industry and new investment to Alabama. At the same time, the state has been relatively successful on this front in recent years, suggesting that perceptions can be challenged.

Economic developers know that quality of life is fast becoming one of the most important factors businesses consider when choosing a new location. When recruiting a new industry or a new employee, business leaders in Alabama often say, ‘if we can get them to visit, we can get them to stay.’

Reality

At the same time, while some aspects of the state’s image might be misguided or stereotypical, other aspects are based in reality. On average, Alabama students do lag behind their peers in most states. On average, Alabamians are more unhealthy than residents in many other states. Alabama’s median income is in the bottom five in the country, and the state’s recovery from the Great Recession has been slower than many other states.

These are real issues affecting real people, every day – regardless of the state’s reputation.

As noted, the state’s image emerged as a higher priority for voters with lower levels of income and education. The issue also ranked higher for voters generally (9th) than for policy professionals (16th). This could be because policy professionals believe that the best way to change the state’s image is indirectly, by addressing the individual factors that create the image. They are not wrong.

However, that the issue ranks so highly for voters underscores the extent to which voters believe the state’s image affects them personally. We suggest that people with more resources – more education, skills, and income – are held less captive by the state’s reputation. They also have more ability to relocate to other parts of the state or to leave the state altogether to seek other opportunities. Conversely, those with fewer resources – less education, skills, and income – may be, or feel, stuck. In other words, their prospects and those of their families may be more intimately tied with those of the state, their county, and their town.

How Does Alabama Compare?

Rather than attempting to measure Alabama’s image compared to other states, we look at three indicators as proxies: job creation, economic growth, and population. These metrics do not constitute image – but we suggest that the same factors that drive these metrics also drive the larger concept of image.

Job Creation

According to the Alabama Department of Commerce, the state has added or announced 138,197 new jobs and $35.2 billion in investment between 2010 and 2017. This suggests Alabama is increasingly attractive to business. However, as with many issues, the distribution of new jobs is not equal. In 2017, 19 counties reported zero jobs from new industry and three counties reported no new jobs from industry expansion.

Economic Growth

The effects of job growth – and decreasing unemployment – are beginning to show in the state’s GDP. Alabama experienced 3.3% growth between 2016 and 2017, outpacing recent trends, but below its southeastern neighbors. For the period 2010 to 2017, Alabama’s compounded annual growth rate is estimated at 2.7%, lower than every other southern state except Mississippi and Louisiana – and far behind regional leaders Tennessee (4.6%), Georgia (4.3%), and South Carolina (4.2%).

Population

The state may be adding jobs and seeing a positive trend in GDP, but these trends are not correlating to population growth. The state’s image surely plays a large role in people’s decisions to move to, or remain in, Alabama – and in recent years, Alabama has struggled to compete with surrounding states.

Between 2010 and 2017, the population of southern states has grown an average of 5.6%. Florida leads the pack at 11.6%. More comparable to Alabama however, are South Carolina, North Carolina, and Georgia. These states have grown 8.6%, 7.7%, and 7.6% respectively.

Comparatively, in this same period, Alabama grew at 2.0%. This translates to a net population increase of 95,000 people in seven years – compared to an increase of 398,988 in South Carolina – a state that was approximately the same size as Alabama in 2010.

Moreover, the source of our population growth is telling. In the past seven years, Alabama has added population through natural growth (number of births minus number of death) and international migration. Alabama’s rate of international in-migration is much slower than most states, and its rate of domestic migration is lower than most other Southeastern states. Domestic migration – people moving from other states to Alabama – has accounted for a net increase of 1,153 people – less than 1% of the state’s population growth since 2010.

Alabama is adding jobs – but not people.  Alabama did see a larger year-over-year population increase in 2017. Perhaps this is the beginning of a new trend.

What Can We Do?

What, then, does this suggest for policy makers?

We suggest that policy makers recognize and prioritize the issues that give rise to a negative reputation. They have a real and profound impact on real people’s lives. As Alabama finds and implements effective responses to education, healthcare, jobs and the economy, crime and more – the state’s image will improve. More importantly, the lives of Alabamians will improve.

At the same time, leaders have an opportunity to remind Alabamians, and a larger national and international audience, of a broader story.

Alabama is emerging as a leader in advanced manufacturing and enjoys a growing reputation in research and innovation, as well as arts, culture, and cuisine.

Successes such as these should be celebrated. At the same time, the state’s challenges should be addressed in a straightforward manner, with an inclusive, broad-based program for expanding opportunity for all.

For the PDF version of the State’s Image summary brief, click here.

1] http://www.gadsdentimes.com/news/20180729/alabama-ranks-42nd-in-child-well-being

[2] http://www.waaytv.com/content/news/New-study-Alabama–489500431.html

[3] http://www.waff.com/story/38728591/alabama-ranks-no-3-in-speed-related-deaths

[4] https://whnt.com/2018/07/03/alabama-ranks-number-one-for-the-most-fast-food-restaurants-per-capita/

[5] https://www.bizjournals.com/birmingham/news/2018/07/02/alabama-ranks-low-for-best-places-to-start-a.html

[6] https://www.bizjournals.com/birmingham/news/2018/04/26/alabama-ranks-near-bottom-for-childrens-health.html

[7] https://www.al.com/business/index.ssf/2018/03/alabama_ranks_49th_among_state.html


The Priorities of Alabama Voters

In 2018, Alabamians will elect a governor and five other statewide executive branch officers, 140 legislators, and scores of local officials. Those elected will lead Alabama for the next four years. These leaders should be responsive to the concerns of those they represent but also willing to help citizens understand critical, but perhaps less obvious, public policy issues. Such leadership requires understanding what issues most concern voters and what issues voters may not fully appreciate.

In this election year, PARCA surveyed Alabama voters to determine their thoughts about the general direction of the state and the issues that most concern them. We found broad agreement on the critical issues facing the state. Based on voter response, PARCA identified and ranked voters’ top 10 critical issues. Alabama Priorities explores this issue.

The Priorities

Alabama voters are eager to see improvement in K – 12 education, with 70% indicating they are very concerned about the state’s education system. Voters are worried about healthcare , particularly access and cost. With the recent resignations of a Governor, a Speaker of the House, and a state Supreme Court Justice, it should come as no surprise that voters are concerned about corruption and ethics. For many voters, mental health and substance abuse are not just theoretical problems—56% of Alabamians indicate they are very concerned about the issue. The poor and homeless have not been forgotten.

These issues, along with jobs and the economy, crime and public safety, job training and work force development, the state’s image, and tax reform comprise the top 10 list of Alabama’s priorities.

Perhaps this list should not come as a surprise. Previous polling by PARCA and other organizations have found similar results.

What is perhaps more surprising, however, is the extent to which these are shared priorities. We found few significant differences between Republicans and Democrats, liberals and conservatives, blacks and whites, or other groups. While differences exist, Alabama voters are not polarized.

Alabama Priorities

1. K-12 Education
2. Healthcare
3. Government Corruption and Ethics
4. Mental Health and Substance Abuse
5. Poverty and Homelessness
6. Jobs and the Economy
7. Crime and Public Safety
8. Job Training and Workforce Development
9. Improving the State's Image
10. Tax Reform

Experts and Voters: Differing Priorities

At the same time, while the data suggests broad agreement among voters, there is an area where significant gaps exist. PARCA surveyed business, civic, and nonprofit leaders, journalists, and academics. The differences between the priorities of these experts and voters were noticeable.

Four top 10 issues for voters fell outside the top 10 for experts:

  • Mental health and substance abuse
  • Poverty and homelessness
  • Job training and workforce development
  • Improving the state’s image

Conversely, experts identified four issues that did not register high on voters’ list of concerns:

  • Infrastructure and transportation
  • Prison and sentencing reform
  • Funding state government
  • Civil rights

Possible explanations as to why some issues are more important to voters and others more important to experts are offered in the “Differences Between Experts and Voters” section of the report. three implications are suggested.

Implications

The data suggest four implications.

  1. Voters are not polarized along traditional political, ideological, racial or generational lines.
  2. There is a significant gap between the priorities of experts and the priorities of voters.
  3. Policymakers have a two-fold opportunity to inform and educate voters on critical and systemic challenges facing the state.
  4. Policymakers have an opportunity to respond to immediate, often highly personal issues that concern voters.

This research suggests that elected officials and candidates have an opportunity to show leadership and to build broad coalitions to address Alabama’s most pressing challenges.

Read the full report here.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 


Population Change in Alabama Counties and Metro Areas

As a follow-up to PARCA’s previous post on estimated changes to Alabama’s population in comparison to other states, we now present recent U.S. Census estimates of population change in Alabama counties and metro areas.

As a state, Alabama’s population has increased 2 percent since 2010, a faster rate of growth than Mississippi, but slower than other Southeastern states. A closer look, examining population change at the county level, reveals a wide disparity between the population growth rates within the state, with 45 of Alabama’s 67 counties experiencing population loss between 2010 and 2017, according to the Census estimates.

Rural counties in Central Alabama, particularly in Alabama’s Black Belt have experienced the greatest losses in percentage terms. The steepest loss was Macon County, which has experienced a 12.6 percent population decline since 2010, according to the estimates. Dallas County has lost the greatest number of residents over the time period, with the estimated population dropping by 4,605.

Meanwhile, in percentage terms, the strongest growth over the course of the decade is occurring in coastal Baldwin County and in Lee County, home to Auburn University.

The Huntsville area counties of Madison and Limestone counties are continuing to grow at a rapid pace, as are the suburban counties around Birmingham. Tuscaloosa County also continues to grow. Suburban counties around Montgomery are growing but at a slightly slower pace. Houston and Coffee counties, in the Wiregrass region, are also seeing moderate growth.

As for the state’s largest counties, Jefferson County and Mobile counties are seeing minimal growth while Montgomery County is losing population, according to the estimates.
Looking at the estimates for the most recent year, 2016-2017, there appears to have been positive population growth in most of the counties bordering Georgia.

Examining the components of change, the central counties of the three largest metro areas, Jefferson, Montgomery, and Mobile, are losing large numbers of residents through domestic migration. Residents of the central counties moving to suburban counties or elsewhere in the U.S.

That population loss in the central counties is offset by the natural increase in those counties and by international in-migration. Tuscaloosa, Lee, and Madison counties are also seeing population gains through international in-migration. Much of the rest of the state, particularly rural counties, have received little in terms of international in-migration.

In 40 out of the 67 Alabama counties, the number of deaths outnumbers the number of births, leading to a negative rate of natural increase. Counties where deaths outnumber births tend to have an aging population and low levels of population in-flow. Poorer health in those counties may also contribute to higher rates of death.

When looking at population change at the metropolitan level, the Birmingham-Hoover metro area is seeing modest growth. Mobile County, which is its own metro area, has grown only slightly since 2010, but neighboring Baldwin County, a separate MSA officially called the Daphne-Fairhope-Foley MSA, is the Alabama’s fastest growing in percentage terms (16.7 percent growth since 2010) and is second to the Huntsville MSA in numeric growth over the period.

Looking at the bigger picture, the visualization below allows you to compare rates of population change across all the metropolitan statistical areas in the U.S. It is worth noting that despite, Alabama’s slow growth overall, the Auburn-Opelika and Daphne-Fairhope-Foley MSA rank in the top 20 of the U.S. in terms of percentage growth. With the exception of Huntsville, which ranks 75th in terms of percentage growth since 2010, Alabama’s major metros, Birmingham, Mobile, and Montgomery, are growing more slowly than major MSAs in Florida, Georgia, and the Carolinas.


Alabama Grows, but Slowly, Weighed Down by High Death Rate and Low Rate of International Migration

Alabama’s pace of population growth increased in 2017, but the state remains slow-growing compared to most of its Southeastern neighbors, according to the latest estimates from the U.S. Census Bureau.

Two factors holding down growth: Alabama has the nation’s second-highest death rate and one of the lowest rates of immigration from other countries.

Domestic in-migration

For the first time in several years, Alabama had a positive rate of domestic in-migration — more people moving to the state than leavingvfor other states, according to PARCA’s analysis of the recently released data.

For most of the past decade, more U.S. residents have left Alabama than moved into the state. While the new Census estimates show Alabama with a net positive in domestic migration, most other Southeastern states have much higher rates of domestic in-migration. That’s been true since 2010.

A case in point is South Carolina. In 2010, Alabama’s population was greater than South Carolina’s: 4,785,579 vs. 4,635,834. But since 2010 South Carolina has added almost 400,000 new residents with the strongest source of growth being through domestic in-migration. Alabama has added fewer than 100,000 residents over the same period. According to the estimates, South Carolina’s population now exceeds Alabama’s, with 5,024,369 residents to Alabama’s 4,874,747.

After the next Census, due to its relatively sluggish population growth, Alabama is expected to lose a seat in the U.S. House of Representatives. North Carolina is expected to gain a seat and Florida is expected to gain two.

A high death rate

Though Alabama may be beginning to attract residents from other states, our state residents are dying faster and earlier than residents of other states.

Alabama has the country’s second highest death rate in 2017, according to Census estimates (only West Virginia’s is higher). Over 52,000 Alabamians died in 2012, yielding a death rate of 10.8 per 1,000 population. That’s twice the rate of death rate of the leading state, Idaho, which has a death rate of 5.4. And 2017 is not an anomaly: Alabama has been No. 2 every year of this decade, except for 2012 when our death rate ranked No. 3.

Alabama’s high death rate isn’t just noted in Census estimates. The Centers for Disease Control consistently ranks Alabama’s death rate from a variety of leading causes of death in the country’s top 10.

In 2016, Alabama had the fourth highest death rate from heart disease, the nation’s leading cause of death. Alabama also had the country’s highest death rate from stroke, ranked No. 7 from deaths from cancer and Chronic Lower Respiratory Diseases.

In 2016 Alabama had the country’s highest infant mortality rate and the second highest rate of deaths from firearms.

The more than 58,000 births in Alabama, a rate of 12 per 1,000, more than offset the number of deaths, resulting in a net positive natural increase in the population of approximately 6,000. Alabama’s birth rate ranked 30th among the US states, slightly below the U.S. average of 12.16.

International immigration

A final factor in population change is international migration and relatively few migrants from other countries are moving to Alabama. In 2017, Alabama ranked No. 46 among U.S. states in its rate of international in-migration. Five states attracted less than 1 foreign immigrant for every 1,000 residents: Alabama, Mississippi, West Virginia, Montana and Wyoming.


Overall picture

Most states added population in 2017, according to the estimates. Only, Illinois, West Virginia, Wyoming, Louisiana, Alaska, Mississippi, and Hawaii lost population.

Alabama had a net addition of 14,202 residents from July 1, 2016 to July 1, 2017, a 0.3 percent increase in the state’s population. Alabama’s percentage population increase ranked 33rd.

Since 2010, Alabama’s population has increased by 94,612, or 2 percent, ranking 38th among the states in percentage population growth during that period.


How Alabama Roads Compare, 2017

PARCA’s latest report, How Alabama Roads Compare, provides an in-depth analysis of the conditions, funding and future of our state’s roads and bridges. Data presented in the report can also be viewed through interactive tables here.

Alabama Roads: Where are we now?

Alabama’s roads and bridges are in relatively good condition compared to other Southeastern states. The percentage of roads in good condition is higher than most other states and the percentage of roads in poor condition is lower than most other states. The percentage of bridges in need of replacement because of deficiency is about average for the Southeast.

However, those generally good conditions on existing roads have come at a cost.

The Alabama Department of Transportation has had to devote an increasingly large share of its budget to preserving the existing road system, with a shrinking pool of money available for new projects to address congestion or expand the road system to foster transportation improvements and economic development.

Currently, only $150 million per year is available for system enhancement and expansion projects, a drop in the bucket considering the billions of dollars in projects needed to address existing congestion issues, much less the additional billions that would be needed to finance aspirational projects like Birmingham’s Northern Beltline, a new Mobile River bridge, and variety of other projects desired by communities large and small.

Alabama’s road spending in recent years has been supplemented by more than $1.3 billion in borrowing. That has allowed state and local governments to tackle needed improvements and perform in the present projects that will pay dividends in the future. However, that borrowing authority has been exhausted, and future road spending will be curtailed. The infusion of borrowed money is ending and the demands of paying back what has already been borrowed money will consume a greater share of road money.

This impending road revenue crunch is rooted in a fundamental problem in how we pay for roads: a set 18-cents per gallon motor fuels tax. Per-gallon motor fuels taxes were last raised in the early 1990s. The buying power of that 18 cents on each gallon has eroded due to inflation. On top of that, the greater fuel economy of cars and trucks on the road today means that less gas in being purchased to fuel more miles of travel.

The wear and tear of traffic on the roads continues to increase, but revenue from per-gallon taxes is not keeping pace. Per vehicle mile traveled, Alabama is collecting half what it did in the early 1990s, when adjusted for inflation.

In the immediate term, the 2018 transportation budget will contain about $200 million less in revenue than it has enjoyed for the past 5 years, revenue provided through the ATRIP borrowing program. The debt service required to pay that borrowing back has been steadily climbing. In 2018, it will leap to $114 million, almost $50 million more than the 2017 total, and remain locked in for the next 19 years. As a bottom line, in 2018, there will be about $250 million less to spend on roads than there was in 2017.

Where do we want to be in the future?

Alabama needs sufficient revenue to pay for the upkeep of its current system, plus an adequate pool of money available to add capacity to address congestion problems and to improve the transportation network. That revenue for roads also needs to cover the cost of paying back the money the state has already borrowed.

How do we get there?

Alabama hasn’t raised its per gallon gas tax in 25 years. Only 8 other states have gone as long without an increase. In recent years, most states have raised per gallon taxes and have also adopted mechanisms to address the drain on buying power created by inflation and greater fuel economy.

In the past several legislative sessions, Alabama lawmakers have introduced various proposals to address the impending shortfall in road funding but none of those proposals have gathered sufficient support.

As those proposals resurface in subsequent sessions, attention should be paid not only to preventing the immediate shortfall but to preventing the perpetual erosion of road dollars. Many of our Southeastern neighbors have crafted long-term approaches to road funding from which Alabama could learn.

Click here to read the full report, including information on traffic vs. capacity, construction and maintenance, road debt and more.