Deaths from drug overdose dropped sharply in 2024 and 2025, due in part to bold policy decisions, the deployment of overdose reversal treatments, and the strategic use of data to target addiction prevention and recovery outreach.    

The story of how that came about was the focus of PARCA’s 2026 Annual Forum – From Crisis to Collaboration: How Data, Policy, and Partnership Saved Lives in Alabama. 

The March 6 event at Birmingham’s Harbert Center featured leaders who helped bring about the decline, including policymakers from the Legislature, public health, and mental health agencies, as well as frontline doctors, first responders, and peer recovery specialists, who are working to combat addiction.  

Video recordings of the program are featured below, along with Governor Ivey’s keynote address at the Governor Albert Brewer Legacy Lunch.

Background 

In the first half of the 2010’s, Alabama had the nation’s highest opioid dispensing rate, with 121 pills dispensed per Alabama resident that year, according to the CDC. Then, in the midst of the pandemic, a surge of fentanyl in the street drug supply sent an already high rate of overdose deaths soaring. Presentation slides available here.

In response, state and local officials teamed to create an innovative set of policies, programs, and partnerships that empower frontline responders and direct service providers to use their experience and expertise to tackle the addiction crisis.  

View each session below. 

Peer Support and the Path Home

John Bayles, Program Director at Birmingham’s Recovery Resource Center, and Stacey Fuller, Case Manager with the Birmingham Reentry Alliance, opened the program with a conversation about their own experiences with addiction and long-term recovery. They shared deeply personal accounts of their paths through addiction, incarceration, and recovery, highlighting how their lived experiences allow them to better assist others. Fuller, an Army veteran and former nurse, talked about the pressure on healthcare providers to prescribe opioids when pain was added as the “fifth vital sign” in the mid-1990s. Both discussed the vital role that peers like themselves can play in connecting with individuals experiencing addiction who may feel angry, guilty, or hopeless in traditional clinical settings. 

Panel One: Confronting the Crisis: Perspectives from Jefferson County 

Panel One reflected the collaborative public health response to the opioid epidemic in Jefferson County. Participants detailed how data-driven strategies and the passage of critical harm-reduction legislation helped reduce overdose deaths. A central theme was the importance of lived experience, as recovery peers and grieving families successfully lobbied to reduce the stigma surrounding addiction and harm reduction. Speakers described the evolution from isolated efforts to a unified community framework that established the Recovery Resource Center and expanded access to treatment. Ultimately, the panel emphasized that sustainable funding and continued partnership are essential to addressing the ongoing challenges of the evolving drug crisis. 

John Bayles of Recovery Resource Center moderated the panel. Participants included: 

• Mark Wilson, MD, Jefferson County Health Officer, 2011-2023 
• Darlene Traffanstedt, Medical Director, Alabama Medicaid Agency 
• Hon. Allen Treadaway, Alabama House of Representatives 

From Crisis to Collaboration: The Formation and Function of the Alabama Opioid Overdose and Addiction Council 

Kimberly Boswell, Commissioner of the Alabama Department of Mental Health, spoke about the strategic efforts to address the opioid and drug crisis through multi-agency collaboration. Presentation slides available here. Commissioner Boswell, State Health Officer Scott Harris, and State Attorney General Steve Marshall co-chair the Alabama Overdose and Addiction Council, which includes numerous committees focused on tackling the crisis through data-sharing, inventive policymaking, and close communication with frontline workers. Commissioner Boswell emphasized the importance of data sharing agreements and a governance structure that make it possible for agencies to use sensitive data to rapidly inform prevention and response efforts, ultimately leading to a substantial reduction in overdose deaths and enabling the creation of a comprehensive, coordinated strategy that targets resources where they are most needed to save lives. 

Innovating and Iterating: Voices from Across Alabama 

The second panel featured perspectives from frontline workers across Alabama who are doing creative work to ensure that people in crisis have access to the support they need. Speakers highlighted the necessity of low-barrier medical clinics and integrated street psychiatry to reach populations who struggle with traditional treatment hurdles. They stressed the importance of empathetic, human-centered care, which includes understanding substance use as a coping mechanism for mental illness and unprocessed trauma. They also discussed the importance of creating space for law enforcement to receive continuing education and engage in dialogue with clinical experts to address technical concerns and facilitate effective collaboration across the different sectors. Finally, the group noted that ongoing education and policy reform would be essential to staying ahead of the crisis, specifically regarding harm reduction tools like expanded drug testing to combat lethal new contaminants. 

Leah Nelson of PARCA facilitated the panel. Participants included: 

• Reggie Parker, Owner, Parker Counseling and Consulting Services 
• Will Rutland, MD, UAB Heersink School of Medicine, Medical Director, Street Psychiatry Clinic 
• Jonathan Riley, CRSII, OD2A Outreach, People Engaged in Recovery 
• Leah Leisch, MD, Assistant Professor, UAB Heersink School of Medicine 

Governor Albert Brewer Legacy Lunch

Governor Kay Ivey provided the keynote address for this year’s Governor Albert Brewer Legacy Lunch. In her address, Gov. Ivey outlined a clear trajectory of progress and commitment in Alabama regarding two pressing issues—the opioid crisis and education reform. The Governor emphasized Alabama’s progress in combating opioid overdoses and detailed substantial efforts to improve the state’s education system, highlighting measurable improvements and ongoing initiatives. Through strategic programs, legislative action, and community involvement, Alabama has made significant gains in reducing overdose deaths and improving educational outcomes, with continued focus on sustaining and accelerating this progress for future generations.

Decreasing immigration from abroad slowed population growth across Alabama’s counties in 2024 and 2025, though suburban counties and growth magnets in north and south Alabama continued to add new residents. The one-year metro population growth rate for Huntsville (3%) and Baldwin County (2%) put both among the fastest growing Metropolitan Statistical Areas (MSAs) in the US, with Huntsville at No. 6 and Baldwin County at No. 11.

Nationwide, the rate of population growth slowed sharply.

Printable PDF available here

Figure 1. Numeric Change by County, 2025

The new estimates released by the U.S. Census Bureau cover the period between July 1, 2024 and July 1, 2025. State-level estimates were released earlier this year. A PARCA analysis of that data showed that Alabama’s population growth hit a peak in 2024, driven in equal parts by international migration, new residents moving to Alabama from other countries, and domestic migration, people moving to Alabama from other U.S. states.

In 2025, the international component dropped sharply, while domestic migration edged down modestly. Deaths outnumbered births in Alabama at large and in all but 17 of Alabama’s 67 counties. Statewide and in most counties, the population would be decreasing without growth through domestic or international migration.

Figure 2. Comparing International Migration in Alabama 2024 vs. 2025

In 2024, central urban counties, like Jefferson, Montgomery, and Mobile, were receiving the bulk of new migrants from abroad. Population increases from international migration helped offset the population decline from people moving from those central counties to surrounding suburban counties or to other states.

However, with the drop in international immigration in 2025, Jefferson and Mobile counties lost population in the latest estimates. In Jefferson County, international migration decreased by almost 2,500 compared to 2024. Nearly 3,000 Jefferson County residents moved to other counties or states in 2025. After accounting for natural change and net migration, Jefferson County’s population decreased by 843 residents. Similar trends led to an estimated population decrease of 535 in Mobile. Montgomery County’s natural increase, plus a decline in outmigration, kept its population about even, increasing by 2, according to the estimates.

Figure 3. Population Change and Migration Components, 2025

National Perspective

These population dynamics within metro areas are not unique to Alabama. In its analysis of 2025 data, the Census Bureau noted that among large metro areas, the fastest-growing counties tended to be on the outer edges, indicating a continuing trend toward suburbanization. Meanwhile, central counties tend to draw the greatest number of international migrants.

For example, the central counties in the Nashville and Atlanta metros also see a net outflow of domestic residents. However, in both those cases, those central counties still attracted enough international immigrants to offset domestic outmigration. And those counties also lie at the center of some of the fastest-growing metropolitan areas in the country.

Figure 4. USA Map of Population Change By Metropolitan Statistical Area, 2025

The decline in inflows of international residents depressed growth in central counties and slowed metropolitan growth rates nationwide. The Census Bureau noted that growth in metro areas declined sharply. Average MSA growth was 1.1% between 2023 and 2024, but fell to 0.6% between 2024 and 2025.

Population growth is occurring disproportionately in southern coastal counties and in metro areas in the south. According to Census:

• Geographically, many of the fastest-growing counties were in states along the Southeast coast of the United States, including Florida, Georgia, South Carolina, North Carolina, and Virginia.
• Among counties with populations of 20,000 or more, nine of the top 10 fastest-growing counties were in the South, as were 45 out of the top 50.

Figure 5. USA Map by County of Rate of Change, 2025

Growth Spots

Madison County, home to Huntsville, continued to add more residents than any other county in Alabama. Growth from domestic migration increased in Madison County, which added more than 10,000 people, even as international immigration decreased.

Figure 6. Population Change and Migration Components, 2025

In neighboring Limestone County, growth tapered as international immigration decreased. However, in adding an estimated 3,285 residents, Limestone continued to rank among the nation’s fastest-growing counties with a 3.3% population increase in 2025. Together, Limestone and Madison County make up the Huntsville Metropolitan Statistical Area, which in 2025 was the nation’s 6th-fastest-growing MSA.

Figure 7. Percentage Population Change in Alabama MSAs

Alabama’s second-fastest-growing MSA consists of just Baldwin County and is officially known as the Daphne-Fairhope-Foley MSA. That MSA also continued to grow rapidly, as part of the growth pattern Census noted: people moving to southern counties along the Atlantic and Gulf coasts.

Despite Mobile County being right next door, Baldwin and Mobile are considered two separate MSAs. According to the Census Bureau’s analysis of commuting patterns, there is not enough daily interchange of populations between the two counties to consider them a single MSA. Mobile County’s population declined, in part due to a drop in international migration.

Figure 8. Numeric Change in Alabama MSAs

Alabama’s largest MSA is Birmingham, which now includes seven counties: Jefferson, Shelby, St. Clair, Blount, Walker, Chilton, and Bibb, with a population of 1.2 million people. That’s more than double the size of Huntsville, but Birmingham’s MSA is growing more slowly.

In 2025, the MSA added 3,450 people. Most of that growth occurred in Shelby County, which added 2,746 new residents, and St. Clair County, which added 1,160. That put both those counties in the Alabama top 10 for growth, both in pace of growth and number added. Walker, Bibb, and Chilton experienced modest gains. Together, that was enough to offset the decline in Jefferson and Blount counties.

The Auburn-Opelika MSA, which consists of Lee and Macon counties, grew by almost 2,000.

Dothan’s MSA, which includes Geneva, Houston, and Henry counties, added about 1,000 in total. Tuscaloosa County added almost 500 new residents, and Hale County added about 50, but the other two counties in the Tuscaloosa MSA, Greene and Pickens, lost population. So, in total, the four-county MSA was up by just over 300 residents.

Over in East Alabama, Etowah County, which makes up the Gadsden MSA, has posted positive growth for the past three years after several years of decline, adding 411 in 2025. Calhoun County, the Anniston-Oxford MSA grew in 2022 and 2023, but in 2024 and 2025, the estimates point to population decline, a decrease of 469 in 2025.

Huntsville MSA’s north Alabama neighbors in the Decatur and Florence-Muscle Shoals MSA’s grew modestly. In Decatur, Morgan, and Lawrence counties, each added about 200 new residents, a fourth straight year of growth. The Shoals, made up of Colbert and Lauderdale counties, have both been gathering steam in population growth during the current decade, though Lauderdale was estimated to have had a decline of 163 residents in 2025.

Overall, 36 Alabama counties gained population, but only 7 added more than 1,000 people; 31 counties saw population declines.

Rates of Change

The counties losing the population the fastest are in Alabama’s Black Belt. And that trend continued in 2025. Perry, Lowndes, Willcox, Dallas, and Greene counties have each lost 8% or more of their population since 2020. There are now five counties with fewer than 10,000 residents: Bullock, Wilcox, Lowndes, Perry, and Greene.

Figure 9. Rate of Change, Domestic Migration, 2025

Multiple factors are conspiring to drain population from rural Alabama counties. Rural counties also tend not to attract new immigrants from other counties. Domestic migration is also typically low to negative, with younger residents often moving to metropolitan counties where jobs are concentrated. As younger people move away in search of opportunity, the population becomes disproportionately old.

As the Baby Boom ages, that large cohort is beginning to experience increased mortality. As the average age increases, the death rate increases. And since younger people have tended to move to metros, the birth rate has declined.

Figure 10. Rate of Change, Death, 2025

The pattern isn’t confined to rural Alabama. It is also pronounced in the former coal country in the Appalachians, in the Mississippi Delta, and in portions of the West and Midwest.

Figure 11. USA Rate of Population Change by County

Population growth in Alabama and across the country has slowed, particularly when it comes to immigrants coming from abroad, according to the latest estimates from the U.S. Census Bureau. The estimates cover the period between July 2024 and July 2025.

Domestic migration into Alabama also decreased but remains higher compared to rates seen in the first two decades of the century. Due to an aging population and lower birth rates, deaths continue to outnumber births in the state. Thus, without in-migration, Alabama’s population would be declining modestly.

Printable PDF available here.

The Census Bureau estimates that by July 2025, Alabama was home to 5.2 million people, an increase of about 30,000 people or 1% compared to 2024. Alabama ranked No. 15 among U.S. states in population growth and No. 20 in percentage population increase over the period.

Even as growth slows, Southern states continued to outpace states in most other regions. South Carolina was No. 1 in rate of growth, and Texas was No. 1 in numeric population gain, adding almost 400,000 over the period. North Carolina, Georgia, Florida, and Tennessee also ranked in the top 10 for numeric growth. Western states like Idaho, Utah, Washington, and Arizona were also leaders in population growth.

Five states saw population declines, according to the estimates: California, Hawaii, Vermont, New Mexico, and West Virginia.

In 2024, Alabama’s population growth had accelerated to its highest level in decades, adding almost 50,000, but in 2025, growth slowed, according to the estimates.

In 2025, Alabama attracted about 15,000 fewer people through migration. Deaths outpaced births by a slightly wider margin than in 2024.

International migration to Alabama dropped by 13,156, compared to 2024, while domestic migration was down by 1,595.

Despite the slower growth, Alabama’s rate of domestic migration ranked No. 11 in 2025. The domestic migration rate estimates the number of residents from other states moving into a state and adjusts for the receiving state’s population.

Meanwhile, Alabama’s rate of international immigration ranked No. 42 in the US. Historically, Alabama has attracted new residents from abroad at a lower rate than most other states. The most recent estimates capture the last seven months of the Biden administration and the first five months of the Trump administration.

After a surge of immigration in the early years of the Biden Administration, new policies drove down unauthorized crossings sharply in 2024. That trend has continued and accelerated under the Trump Administration, along with a decline in authorized immigration. Thus, the current decline in international immigration is likely to continue.

Alabama’s unemployment rate has been consistently below the U.S. rate since 2019, which appears to be attracting new residents from other states. Census estimates from last year show that population gains are concentrated in metro counties, particularly in North Alabama near Huntsville. Increasing numbers of retirees seeking a warm coastal climate continue to drive growth in Baldwin County on the Alabama Gulf Coast.

Meanwhile, Alabama’s rate of natural population change is weighed down by a higher death rate than most states. Alabama’s death rate is the fifth-highest in the U.S. Only West Virginia, Mississippi, Maine, and Arkansas have rates that are higher. These states tend to share characteristics like elevated poverty, poor health outcomes, and lower rates of access to health care providers.   

See how children in all 67 counties of our state are faring in education, health, economic security, and more. VOICES believers that every child in Alabama should have access and opportunity to thrive and become all they can be, and hopes that by utilizing this book’s insights, we can identify the challenges, set priorities, track our progress, and achieve real outcomes for children and families.

Access the 2025 Alabama Kids Count Data Book here.

The 2025 County Data Profiles are also available for each of Alabama’s 67 counties and the state. These four-page reports provide even more disaggregated data on the indicators presented in the 2025 Alabama Kids Count Data Book. 

Want to see this data at the national level? Visit the national KIDS COUNT Data Center to access hundreds of indicators, download data and create reports and graphics!

Economic footprint

Active nonprofits generate $16.9 billion in annual revenue, but that total is highly concentrated: 0.35% of organizations (the 21 largest) account for nearly half of all income. The median nonprofit operates on about $200,000 a year, with two-thirds reporting less than $500,000.

Public investment

Between 2015 and 2025, Alabama nonprofits received $5.5 billion in federal awards—an average of $553 million per year. More than 60% of those dollars flow through the U.S. Department of Health and Human Services; most reach communities through state agencies such as the Alabama Department of Economic and Community Affairs (ADECA), the Alabama Department of Public Health (ADPH), and the Department of Early Childhood Education.

Philanthropic capacity

Alabama’s 822 foundations hold $4.5 billion in assets—ranking 49th per capita. Assuming a typical 5.6% payout, foundations could distribute about $226 million per year, only one-third of recent federal funding. Private philanthropy cannot replace sustained public investment.

Key finding

Alabama’s progress depends on collaboration among government, philanthropy, and community organizations. Nonprofits are not a substitute for government; they are its local expression. Strengthening this partnership—through data transparency, diversified funding, and civic trust—is essential to building a resilient Alabama.

Click here for the full report, or view below.

Halfway through 2025, Birmingham’s homicide total is half what it was midyear 2024, a dramatic turnaround after a year of record-setting violence.   

According to data from the Jefferson County Coroner’s Office, total homicides in Jefferson County have been trending down from a peak in 2021, despite the record number of homicides in the City of Birmingham in 2024. Countywide, there were 196 murders in 2024. In 2021, there were 216.

Excluding Birmingham, homicides in the rest of the county dropped from 87 in 2021 to 47 in 2024, marking a return to pre-pandemic levels.

Figure 1 shows total homicides by year. The bar is shaded by the means of death. The red-shaded portion of the bar represents homicides involving guns. Most homicides in Jefferson County involve guns.

Figure 1. Jefferson County Homicide Trends, by Means of Death

In the first half of 2025, Birmingham saw a precipitous drop in the number of murders, with 37 murders in the first six months of the year, compared to 76 by midyear 2024, according to data provided by the Birmingham Police Department.

While murders, robberies, and auto theft were all down compared to the first six months of 2024, aggravated assaults, theft, and burglary were up.

Taking the statistics together, Birmingham police have recorded more total criminal incidents in 2025 than for the same period in 2024.

Figure 2. Birmingham Part I Crime Trends

Beyond Birmingham, in the portions of Jefferson County patrolled by the Sheriff’s Office, homicides in the first half of 2025 were even with the total for the first half of 2024.

Aggravated assaults were up, but other Part 1 crimes were down.

Figure 3. Jefferson County Sheriff’s Office Patrol Area

PARCA’s data analysis stems from the Birmingham-Jefferson County Justice Governance Partnership, a collaboration between Birmingham, Jefferson County, the Jefferson County Health Department, the Sheriff’s Office, the District Attorney, and a wide array of other public agencies, nonprofits, and community groups. The BJC-JGP brings stakeholders together around a common pool of community and public safety data. The aim is to increase public safety through effective response and by improving underlying conditions that leave communities more vulnerable to crime.

Context

Homicides began rising in Jefferson County in 2015, which paralleled a national rise in homicides. Then in 2020, the number of murders in Jefferson County and around the country leapt sharply.

Each year from 2020 through the end of 2024, the total number of murders in Jefferson County has been twice that of the total recorded in 2014. Across the country, homicides began dropping in 2022, though in some cities, including Birmingham, the homicides continued to climb. By the end of 2024, homicides nationally were below pre-pandemic levels. Homicides were below the 2019 level in the rest of Jefferson County, excluding Birmingham, in 2024. However, Birmingham’s record total, which included multiple mass shootings in which four or more victims died, kept the county’s overall rate elevated.

The Council on Criminal Justice (CCJ) has been tracking trends in 40 cities across the U.S. and, in a 2024 year-end report published in January, found that homicides had decreased 6% from a 2019 baseline.

Figure 3. 40 U.S. City Homicide Trend

Theories on the National Rise and Fall of Violence

There have been various theories advanced about why murders began increasing in 2015 and continued to rise until recently. The CCJ’s Crime Trends Working Group cited various theories on what led to the rise in homicides. What follows is a summary of the points mentioned. The full text is available at the link above.

• Undermined Police Legitimacy: Beginning with the police-killing of Michael Brown in 2014 in Ferguson, MO, and increasing with the murder of George Floyd by Minneapolis police officer Derek Chauvin, decreased respect for law enforcement led to a surge in murders.
• De-Policing: In the light of the pandemic and protests, law enforcement and the criminal justice system generally decreased interaction and criminal case processing.
• Routine Activity Theory: This theory argues that crime stems from the combination of a motivated offender, a suitable target, and the absence of capable guardians. Covid-19 disrupted normal structures of support and engagement, and, at the same time, decreased protective services, leading to a rise in crime.
• Gun Sales: A spike in gun sales during the pandemic may have had an effect. However, other research suggests the consumers driving the spike in gun sales were largely already gun owners, and thus, the increased number of guns didn’t increase the number of people with guns. In Birmingham, the availability of devices that allow guns to function as if they were automatic weapons may have increased the lethality of shooting incidents.
• Bail Reform and Progressive Prosecution: Some observers blamed criminal justice reforms aimed at reducing long jail stays for people unable to post bail and a perceived pull-back in prosecutions. Covid also led to delays in prosecutions and criminal case backlogs. Other working group members disputed the theory, citing research studies that have found no impact of bail reform on rearrest or overall crime rate. In many jurisdictions, reforms were in place when crime was still falling. Also, after the pandemic spike, violence began falling, even in jurisdictions that maintained the reforms.
• Drug Market Disruption: The pandemic led to changes in where people obtained drugs and the kind of drugs available, including the rise of fentanyl. These disruptions coincided with the 2020-2021 spike in violence, suggesting a connection.
• Crime Reduction Interventions: A suite of approaches to violence reduction has become widely recognized as working together to reduce violence. Some of those programs were disrupted by the pandemic. In response to the violence spike, cities revived or launched new intervention programs, including both law enforcement strategies and community-based interventions, yielding decreases in violence.

Understanding Patterns and Targeting Interventions

Research shows that violence tends to be concentrated geographically and disproportionately between and within social networks. Using Jefferson County Coroner’s data from 2012 to the present to map where homicide victims have been found reveals a stark pattern. Homicides disproportionately occur in Jones Valley in areas east and west of the central city, stretching down as far as Bessemer.

Figure 4. Jefferson County Homicides by Zip Code 2012-2025

In 2024, homicides were even more concentrated. Figure 5 tallies homicides by Census tract. Tracts are a more compact geographic area than zip codes. Census tracts also tend to group neighborhoods and populations that are economically and demographically similar. In 2024, four Census tracts experienced seven or eight homicides apiece. Seven additional tracts saw five or six homicides. Homicides occurred in 85 of the 189 Census tracts in the county; 43 tracts experienced two or more homicides.

Figure 5. Jefferson County Homicides by Census Tract, 2024

Homicide is impacting the Black community disproportionately. Blacks make up less than half of Jefferson County’s population, but, in 2024, 88% percent of Jefferson County’s homicide victims were Black.

Interventions That May Be Decreasing Homicides

There is no definitive answer to why homicides have dropped so precipitously and whether the trend will continue. However, the combined effects of multiple approaches to violence reduction may be paying off. These include changes to enforcement strategies and public health-oriented approaches to violence reduction.

Research shows that a small number of individuals are responsible for a disproportionate share of community violence. If the charges filed by prosecutors prove true, the arrest of one individual, Damien Laron McDaniel III, would be a factor in decreasing homicides in Birmingham. Initially arrested in October 2024, McDaniel has subsequently been charged with a total of 14 homicides over a 14-month period, including two 2024 mass shootings, both of which saw four people die.

The Birmingham police department and partner agencies have increased their use of focused deterrence, an approach endorsed by the Birmingham Crime Commission, a panel of community leaders and public health and safety officials convened by Mayor Randall Woodfin. In an interview with the Birmingham Times, Police Chief Michael Pickett described the formation of a Special Enforcement Division focused on high-crime areas and networks of individuals involved in violent crimes. The Division, working with federal and local partners, studies data, looks for patterns in time, geography, and among individuals, and works to interrupt those patterns.

The police department has succeeded in increasing homicide clearance rates, the rate at which a murder is followed by an arrest. By mid-year, arrests had been made in 30 of the 37 homicides from 2025.

Pickett said that community and business owners are increasingly cooperating with police by providing information. That increases the department’s ability to make arrests and allows the district attorney’s office to charge and successfully prosecute. The higher clearance rate increases community trust and encourages more communication and confidence that the information provided will be acted upon.

Beyond Enforcement

Cities across the country have increasingly recognized that improving public safety demands sustained investment in programs that interrupt patterns of violence and address the underlying community conditions. Birmingham, in conjunction with partner agencies, has launched a variety of these initiatives in the past two years.

One with a direct connection to violence is a hospital-linked violence intervention program supported by the Jefferson County Health Department and the City of Birmingham, Violence Intervention and Prevention Partners (VIP2). In recent years, public health officials have noted that violence often behaves like a contagious disease. That insight has led to the deployment of public health strategies designed to reduce violence.

A first step is to identify a population that is particularly susceptible to violent injury and intervene with education and support. Researchers have found that people admitted to the hospital with a gunshot wound are at risk of being shot again, returning to the hospital, or dying. Studies find that between 25%-40% of gunshot victims are, within a relatively short time frame, return to the hospital with another gunshot or are killed in a subsequent violent incident.

Each incident costs society. According to a study by Everytown Research & Policy, a gun safety advocacy group, on average, each nonfatal firearm injury costs taxpayers $25,250. Each firearm death costs taxpayers $273,904 in emergency response, health care, law enforcement, and criminal justice proceedings. In addition to the cost to taxpayers nd direct victims, each gunshot victim is connected to additional community members, from children and spouses, who also suffer costs.

VIP2 attempts to interrupt that cycle. Launched in October 2023, VIP2 provides support for patients admitted to UAB Hospital with gunshot wounds. Social workers with UAB’s Division of Trauma and Acute Care Surgery screen patients and refer willing participants to the Offender Alumni Association, which dispatches trained violence intervention specialists to the hospital.

The specialists, all of whom have had personal experience with gun violence, meet with the gunshot victim. The participants are admitted only if they commit to not retaliating against the person or group who shot them. If they do commit to participating, OAA provides an array of support, directly or through partners. Victims often face difficult physical recoveries. They are often financially devastated, facing medical bills and job loss. To avoid further violence, they may need help relocating.

OAA provides access to group therapy and mental health counseling. It also connects victims with education, job training, and job placement, and case-manages individuals in their recovery.

Since the fall of 2023, 175 individuals have participated in VIP2, with 105 currently receiving support. Only four participants have been reinjured. The Health Department and the City are cooperating to provide $1.1 million a year to support VIP2.

In addition, the City’s Office of Public Safety Initiatives is managing investments of federal and local money in violence reduction programs targeting youth, working with Birmingham City Schools, The Housing Authority, and Jefferson County Family Court and Detention Center.

The city, the Community Foundation of Greater Birmingham, and Regions Foundation are also supporting re-entry services for individuals returning to the community after serving prison terms. The goal of the program is to help returning citizens navigate to stability and avoid recidivism.

Due to a new higher standard, the number and percentage of third graders who failed to meet the grade-level reading benchmark rose in 2025. However, taking the higher standard into account, this year’s third graders showed continued improvement, indicating that the state’s focus on improving early grades literacy is continuing to pay dividends.

This spring, 11.6% of students failed to reach the benchmark on the Reading portion of the state’s standardized test, the Alabama Comprehensive Assessment Program (ACAP). Had the higher bar been in place in 2024, 13.7% of 3rd graders would have scored below the cut. In 2023, 20.8% of 3rd Graders would have scored below the cut.

Printable PDF available here.

In 2025, more students, 49,460, cleared the bar despite the higher standard. At the same time, more students, 6,470, fell below the reading sufficiency benchmark. The 2025 cohort of third graders is larger than previous years. That could mean more students will be required to repeat third grade. However, students who scored below the benchmark are offered intensive summer instruction, retesting, and alternative ways to qualify for promotion.

Improved performance

For the second year, the biggest gains in the percentage of third graders clearing the reading benchmark have occurred predominantly in rural school systems in the Black Belt. Those systems have high rates of economic disadvantage among students and have traditionally trailed other systems on various academic measures, but they have been making gains in reading.

This year, only 4% of Wilcox County students scored below grade level. That puts the system in the top 20 for performance, even though 91% of students in Wilcox County are economically disadvantaged.

Two systems, Orange Beach and Satsuma, had all their tested third graders reading on grade.

Breaking the Connection Between Poverty and Poor Reading Performance

While there is still a correlation between higher levels of economic disadvantage and high rates of reading struggles, the relationship has gotten weaker over time, with more high-poverty systems, particularly in rural areas, improving performance.

Other high-poverty systems, often in urban areas, are still struggling to close the gap. Large urban systems like Montgomery County and Birmingham City have higher concentrations and larger numbers of students testing below grade level. However, those systems also have magnet schools where all students achieved the reading benchmark. Within larger school systems, schools with similar demographics vary significantly when it comes to reading results.

The scatterplot chart below compares the percentage of students in the school who are below grade level on reading to the percentage of students from economically disadvantaged households. The higher on the chart a system is, the better its reading performance. The systems shaded green and lying to the right are schools with lower economic disadvantage. The size of the system’s circle corresponds to the number of third graders who failed to achieve the reading benchmark.

Schools

Despite the higher bar, in 42 schools, all third graders who were tested passed the reading benchmark. That included Princeton Elementary in the Birmingham system and three schools in the Montgomery County System: Bear Exploration Center, Macmillan International at McKee, and Forest Avenue Elementary School. The schools where all third graders met the benchmark ranged from Georgiana, where 86% of students are from economically disadvantaged households, to Mountain Brook and Crestline elementary schools, where only 2% of students are economically disadvantaged.

The two schools with the largest number of third graders who are below grade level in reading are virtual schools: the Alabama Virtual Academy at Eufaula City Schools, where 421 students, or 37%, failed to make the benchmark, and the Alabama Connections Academy of Limestone County, where 290 students, or 32% scored under the benchmark.

For Students Who Failed to Score At or Above the Benchmark

The 6,480 students who failed to reach the benchmark are in jeopardy of being required to repeat 3^rd grade, under the terms of the Alabama Literacy Act. However, there are several routes for promotion to the fourth grade.

Students who failed to clear the new reading sufficiency benchmark have access to intensive summer literacy camps sponsored by local school systems. After the intervention, they will be able to retest.

If they still fail to clear the bar, teachers and school officials have alternative means for evaluating the students’ reading skills. Other good-faith exemptions exist. In 2024, 4,808 students failed to pass the reading sufficiency benchmark. After retesting and applying exemptions, only 452 students were retained due to the Literacy Act, according to the Alabama Daily News reporting.

Second Grade Results

Also included in the data release were second-grade results. The cut score also went up for second grade. The second-grade score is intentionally set at a higher threshold so that more students who might be encountering reading struggles can be identified and receive intervention. Due to the higher bar, more students failed to meet the grade level sufficiency benchmark, 19% in 2025 compared to 17% in 2024. The 10,423 second-grade students who scored below the benchmark were encouraged to attend summer literacy camps and should receive special attention throughout their third-grade year.

Background

The intense interest in 3rd-grade reading is the result of the 2019 Literacy Act. The Act was modeled on similar legislation enacted in Florida and Mississippi. Both of those states saw large gains in reading performance on national standardized tests. The laws are based on the premise that students have to be reading on grade level by fourth grade. Students are taught to read from Kindergarten through third grade. In fourth grade, students are expected to read material to learn.

Numerous studies have found that students who aren’t reading on grade level by fourth grade are more likely to struggle academically and fail to complete high school. Low literacy skills are associated with difficulties in the job market and poor health outcomes.

While the Literacy Act’s grade retention provision received attention, the more consequential portions of the bill were its increased investment in improving literacy instruction, early screening for reading difficulties, and requirements for interventions and communication with parents. The Act re-energized the Alabama Reading Initiative and led to statewide training of teachers in techniques grounded in the science of reading.

Since implementation, Alabama has seen various measures of reading performance rise. Alabama is one of only two states (Louisiana is the other) in which 4th-grade students are performing better in reading than before the COVID-19 pandemic, according to the 2024 National Assessment of Education Progress (NAEP).  

Passage of the One Big Beautiful Bill Act (H.R. 1) in the U.S. House has sparked discussions about the impact of reductions in federal funding across the U.S. KFF, a nonprofit policy analysis organization formerly known as Kaiser Family Foundation, estimates that the House Budget Committee’s reconciliation bill would reduce federal Medicaid spending by $791 billion without accounting for interactions that would lower estimates to $723 billion. Almost 85% of the total savings derived from five features:

• Mandating work and reporting requirements ($280 billion),
• Repealing rules simplifying Medicaid eligibility and renewal ($167 billion),
• Creating a moratorium on new or increased provider taxes ($89 billion),
• Revising state-directed payment limitations ($73 billion), and
• Increasing the frequency of eligibility re-determinations for the ACA expansion group ($53 billion).

Approximately $357 billion of the reductions would only apply to states that adopted ACA expansion.

Printable PDF available here.

Federal cuts to states of $723 billion over 10 years would represent 11% of federal spending on Medicaid over the period. KFF estimates that the cuts range from 5% in Alabama, Wisconsin, and Wyoming to 15% in Washington, Louisiana, and Illinois.

Congressional Budget Office estimates a 10.3 million loss of Medicaid enrollment by 2034, representing 12% of projected enrollment in that year. At the state level, the largest reductions in Medicaid enrollment would be in Washington and Virginia, decreasing by 25% and 20%, respectively. In Alabama, that would be about 4% or approximately 47,000 people.

As described in a previous post, Alabama receives more than $60 billion in federal transfer payments to individuals from Social Security, unemployment benefits, educational benefits such as Pell Grants, or as payments on behalf of individuals in Medicare or Medicaid, etc.

As the Economic Innovation Group noted in its report, The Great Transfer-mation: How American Communities Became Reliant on Income from Government, the main reason federal transfers have increased is the increase in the percentage of the population over the age of 65. Other economic factors have contributed to a reliance on federal transfers, particularly in rural areas with declining economic conditions.

Currently, among the transfer payments are approximately $15.5 billion (2022) to medical providers on behalf of Medicare recipients and another $7.6 billion (2022) on behalf of Medicaid patients, including covering approximately 44.7% of births in Alabama in 2023. Rates vary dramatically across counties, with 78.6% of births in Wilcox County covered by Medicaid to a low of 23.3% in Shelby County. Georgetown University’s McCourt School for Public Policy found that many small towns are dependent on Medicaid/CHIP funding. With 48.6% of children in rural areas of Alabama enrolled in 2023, the state ranks 12^th in the nation on that metric.

This past legislative session, the Alabama Legislature passed Senate Bill 102, expanding Medicaid benefits for pregnant women “with an estimated addition of $1 million annually for fiscal years 2026, 2027, and 2028, consisting of $726,300 in federal funds and $273,700 in state funds, by providing certain prenatal coverage to women found presumptively eligible by a qualified provider.” Governor Kay Ivey signed the bill on May 1.

Many medical facilities in Alabama depend on federal funding from Medicaid and Medicare patients. According to KFF, Medicare covered 63% of certified nursing facility residents in Alabama, while Medicaid covered approximately 13%, with only 24% covered by other private funding sources.

For the 80 hospitals in Alabama, operating margins were approximately 2.9% in 2023. However, they are generally thinner in poorer rural areas of the state. Nationwide, operating margins in rural hospitals are notoriously thin, with 44% of rural hospitals operating in the red. According to KFF, “As of July 2024, Medicaid was the primary payer for 63% of nursing facility residents; Medicare for 13% of residents; and the remaining 24% of residents had another primary payer (ex. private insurance, out-of-pocket, etc.) Medicare does not generally cover long-term care but does cover up to 100 days of skilled nursing facility care following a qualifying hospital stay.” 

In states without Medicaid expansion, just over half (53%) of rural hospitals operate in the red. Reductions in Medicaid or Medicare could have a significant impact on rural hospitals. KFF reports that rural hospitals had an average operating margin of 1.7% in 2023. Reductions in these amounts, whether direct payments to individuals or payments on behalf of recipients, as in the case of Medicaid and Medicare, would reduce, dollar for dollar, the purchasing power in those communities.

Using the slider and program selector in the visualization below, estimates of how a percentage decrease for each kind of transfer can be adjusted to find dollar amounts for hypothetical decreases:

Alabama is not alone. The same kind of dependence can be seen across the country.

There are common patterns across the places where economic activity has been challenging, including the Texas Valley, the Mississippi Delta, Appalachia, and tribal territories. Still, many communities have aging populations, with high percentages of transfer payments compared to earned personal income, as shown below:

For details on the calculation of personal income and transfer payments, see this post on Github:
https://github.com/EIG-Research/EIG-Great-Transfer-Mation

New population estimates from the U.S. Census Bureau place Mobile as the state’s second-largest city, behind booming Huntsville and ahead of Birmingham and Montgomery, both of which saw population declines according to the most recent estimates from the U.S. Census Bureau.

Mobile’s new status takes into account the city’s 2023 annexations of neighborhoods in Mobile County that were expected to add about 20,000 to the city’s population. According to revised Census estimates, the city jumped from less than 190,000 before 2020 to almost 210,000, pushing it well ahead of Birmingham which, for 2024, had an estimated population of 196,818.

Printable PDF available here.

However, despite its annexation bump, Census estimates show Mobile is still losing population, dropping by over 500 over the past year to an estimated 201,367. Birmingham and Montgomery are also continuing to see population declines. If current trends prevail, the three cities seem destined to continue jockeying back and forth. Currently, the population estimates have Birmingham in third, just in front of Montgomery, at 195,818.

The biggest surprise of the estimates was the small Jefferson County hamlet of Brookside, which had the highest population growth rate of any municipality in the state at 13.2%. The town added 158 residents, bringing its total to 1,357 residents. The town has a new neighborhood under construction that appears to be drawing new residents. Small towns and cities around Huntsville and in Shelby and St. Clair counties, outside of Birmingham, saw higher rates of growth in percentage terms, as did suburban cities around Montgomery. Small towns in Wiregrass surrounding Dothan and Enterprise also showed growth in percentage terms. And several Baldwin County communities ranked near the top in terms of percentage growth.

In terms of growth in numbers, the city of Huntsville is the state champ, drawing in another 4,174 new residents in 2024. The City of Madison, Huntsville’s suburban neighbor, added 3,007, ranking third in the state in numeric growth, and Athens, which also borders Huntsville, added 1,641, ranking fourth.

The City of Foley in Baldwin County grew by 3,012, ranking second in the state in numeric terms and tying for second in percentage growth at 12%. Foley’s fellow Baldwin County city of Loxley also grew 12%. Fairhope added 1,011 according to the estimates, ranking 8th in the state. Gulf Shores and Daphne also ranked in the state’s top 20 in the number of residents added.

Cross state rivals Tuscaloosa and Auburn continue to grow with Auburn adding 1,310 to edge out Tuscaloosa’s gain of 1,272 new residents. Auburn also has the secret weapon of Opelika next door, which added 1,313 new residents in 2024. That far outpaces Northport which grew by 280. Together, Tuscaloosa and Northport have about 150,00 residents compared to Auburn and Opelika’s 120,000.

The sharp drop in overdose deaths in 2024, both nationally and in Jefferson County, wasn’t an accident, according to members of the task force that works to combat the epidemic of drug-related deaths. Instead, it resulted from public policy changes and the geographically targeted deployment of resources.

Figure 1. Trends in Accidental Drug and Opioid Overdose Deaths in Jefferson County, 2012-2024. Source: Jefferson County Coroner’s Office data.

Printable PDF available here.

Thanks to those interventions, Jefferson County saw its first decline in overdose deaths since 2018. According to data from the Jefferson County Coroner’s Office, drug overdose deaths peaked in the county in 2023, with 483 accidental drug-related deaths. That is more than double the number of people who died by homicide (197) in Jefferson County in 2023. And it is more than triple the number of overdose deaths Jefferson County experienced in 2012.

Accidental overdose deaths from opioids began rising in the 1990s with the proliferation of prescription pills. That was followed by a resurgence in heroin use, which was in turn followed by the arrival of fentanyl, an extremely potent synthetic opioid. Beginning in 2020, traffic fentanyl surged into Jefferson County, resulting in a skyrocketing death toll from overdoses.

In Jefferson County, the arrival of fentanyl hit the Black community especially hard. Historically, White deaths from drug overdoses had greatly outnumbered Blacks. But by 2023, Black overdose deaths eclipsed whites.

Figure 2. Trends in Overdose Deaths By Race, Jefferson County. Source: Jefferson County Coroner’s Office data.

Health officials nationally and in Alabama have been working to catch up with the epidemic. In 2017, Governor Kay Ivey established the Alabama Opioid Overdose and Addiction Council, which pulled together the state departments of Public Health and Mental Health, local health providers, and a broad coalition of health care providers, drug treatment non-profits, and first responders. Much of the coordinating and data-gathering work has been funded by the Centers for Disease Control and Prevention and its Overdose Data to Action grant program. According to the CDC, factors driving the decline in overdose deaths include the “widespread, data-driven distribution of naloxone, which is a life-saving medication that can reverse an overdose; better access to evidence-based treatment for substance use disorders; shifts in the illegal drug supply; a resumption of prevention and response after pandemic-related disruptions; and continued investments in prevention and response programs like CDC’s flagship Overdose Data to Action (OD2A) program.”

OD2A funding to the Alabama Department of Public Health and the Jefferson County Department of Health has supported the creation of a data-gathering and sharing program that is providing real-time information about where overdoses are occurring. Emergency medical services providers and hospitals are reporting overdose encounters as they happen, allowing public health officials to zero in on communities and even specific neighborhoods where overdoses are on the rise. Jefferson County’s Health Department has worked with the Jefferson County Coroner’s Office, health care providers, and researchers at the University of Alabama at Birmingham and other local agencies to gather, analyze, and act on the data.

With the data mapped and analyzed, partners from the healthcare and treatment community, first responders, and public health officials routinely meet to discuss patterns and develop a concerted approach to overdose prevention. Figure 3 shows the concentration of overdose deaths by zip code, for the peak year, 2023. Using the slider and directional arrows, you can cycle through years of data to see the rising numbers and shifting geographic concentration.

Figure 3. Mapping Overdose Deaths By Zip Code, by Year. Source: Jefferson County Coroner’s Office data.

Policy changes identified and lobbied for by the Overdose and Addiction Council set the stage for the interventions that appear to be driving down deaths. First, in June of 2022, the Alabama Legislature decriminalized Fentanyl test strips. Before the change, the strips that allow the detection of potentially fatal levels of the drug were considered drug paraphernalia, discouraging their availability and use.  Then, in March 2023, naloxone was made an over-the-counter medication, increasing access to the overdose-reversing treatment and allowing for distribution in the community.

In the wake of the changes and with an influx of funding from both federal and state opioid settlement money, a coalition of groups pushed out resources and training to make the life-saving resources available. The Alabama Department of Mental Health significantly increased naloxone distribution, distributing 46,482 kits at Back-to-School events, End Addiction Walks, and conferences and trainings for treatment providers serving high-risk individuals, local and rural law enforcement officers, and first responders. JCDH has an online Naloxone education portal on its website, www.jcdh.org, and sends Naloxone Kits and Fentanyl Test Strips by mail at no cost to people who request the kits through the website. In addition, JCDH provides both products through dispensing boxes at its health centers and at distribution boxes in other community locations.  JCDH also partners with local EMS, police, fire and rescue, and some independent pharmacies to provide the supplies as well.

Using Jefferson County Coroner’s data, the Jefferson County Health Department identified particular neighborhoods where overdose deaths were on the rise. To counter the trend, the department found avenues to distribute free Naloxone and Fentanyl test strips. They also launched public information campaigns, advertising the dangers of the drugs and resources for treatment services, in some cases, displaying the messages on the public transit buses that served the affected areas.

Jefferson County Health Officer Dr. David Hicks applauded the cooperation and the progress but stressed the need to sustain the effort.

“As we continue to address the challenges posed by overdose deaths in our community, it is crucial to recognize the progress we have made and the work that still lies ahead,” Hicks said. “Our collective efforts in prevention, education, and treatment are making a difference, but we must remain vigilant and committed to saving lives. Together, we can build a healthier and safer Jefferson County.”

PARCA is involved in an effort to encourage similar efforts to share, analyze, and act on data. The Birmingham-Jefferson County Justice Governance Partnership brings together county government, municipalities, multiple law enforcement agencies, schools, health providers, non-profits, and community groups to develop a common understanding and cooperative solutions to community challenges. For more information, visit the BJC-JGP website.