Huntsville continues its trajectory towards becoming Alabama’s largest city, while Birmingham, Montgomery, and Mobile continue to drift lower, according to the most recent city population estimates released by The Census Bureau. The two major college towns Auburn and Tuscaloosa continue to grow, as do several cities in Baldwin County.

The new estimates cover the time period between July 1, 2017, and July 1, 2018, and also look back to 2010, the year of the last official Census. Data from the same time period has already been released for state level, metro areas, and counties, and PARCA has published analyses and interactive tools exploring that data. The new cities data is below. Use zoom and drag tools to explore a particular area. Use the button in the bottom right corner if you want a full-screen display.

Huntsville and North Alabama

The city of Huntsville added more residents than any other Alabama city with an estimated 2,262 gain in 2018. If current trends continue, Huntsville (197,318) will surpass Birmingham (209,880) as Alabama’s largest city within the next several years. However, Birmingham’s metropolitan area population (1,151,801) is more than twice as large as Huntsville’s MSA (462, 693).

The Huntsville suburb of Madison ranked third in numeric gain adding 1,289. Huntsville has avoided the dilemma faced by many center cities: becoming hemmed in by and losing population to newer suburbs. In fact, Huntsville, through strategic annexation, has now completely surrounded Madison. While Madison can continue to add residents in its current footprint, it will not be able to spread out by annexing contiguous territory.

Though Madison County cities are capturing most of the North Alabama growth, nearby Athens in Limestone County appears to be receiving some of that inflow. In the farther reaches of the Huntsville orbit, Florence and Muscle Shoals had bigger gains in population in 2018 than in any year other in the decade.

Birmingham Area

In the Birmingham metro area, the core city of Birmingham was estimated to have lost over 1,000 residents between 2017 and 2018. Birmingham has bobbed up and down through the decade, but this most recent year saw the steepest decline.

However, there is population growth south and east of the core city, and the most recent estimates indicate that growth is shifting to suburbs farther south. In the most recent year, the suburbs immediately south of core city, Homewood and Mountain Brook show slight population losses, and Vestavia a slight gain. Hoover, while it did add 246 residents, is growing more slowly now than smaller cities to the south like Chelsea (+503), Helena (+457), and Calera (+393). Meanwhile, to the east of Birmingham, Trussville added 446 residents, according to the estimates.

Montgomery Area

The estimates show Montgomery losing 1,674 residents in 2018, while its emerging suburb of Pike Road gained 445. Suburbs to the north, like Prattville (+202), Millbrook (+133), and Wetumpka (+37) saw gains, but the Montgomery metro area as a whole has seen a population outflow.

Some of the population loss in the Montgomery area may be due to the strong growth being seen in Lee County, home to Auburn University. A separate Census survey tracks residential migration across county lines. A look at that data reveals that Elmore County had a net loss of 352 residents to Lee County. Nearby Tallapoosa and Macon County, which are not officially part of the Montgomery metro area, are also losing residents to Lee County.

Meanwhile, Lee County’s two larger cities have been among the state’s biggest gainers in population, according to the estimates. Auburn is second to Huntsville in numerical gain, having added an estimated 12,000 residents since 2010. Over the same period, Opelika ranks No. 10 in the state with an estimated gain of 4,000.

Mobile Area

The 2018 estimates have the City of Mobile declining in population by 953 residents. Census estimates the city has lost about 5,000 people since 2010. Some nearby communities in Mobile County like Semmes and Saraland have gained population over the past decade, but the growth in those communities isn’t enough to offset Mobile’s population loss. One might assume that the rapid growth just across the bridge in Baldwin County is being fed by residents moving out of Mobile. However, other Census data sets indicate that isn’t necessarily the case. While there is some movement from Mobile to Baldwin County, there is also a considerable residential movement back and forth between Baldwin County to Mobile. When moves to and from the county in question are accounted for, Jefferson County had a net gain of about 500 people from Mobile County, compared to a gain for Baldwin of about 250.

Other Urban Centers and the Rest of the State

Like Auburn and Opelika, Tuscaloosa and Northport both continue to grow, though at a slower pace than the rival towns to the east. Tuscaloosa remains substantially larger than Auburn, about 100,000 vs 65,000. Opelika is larger than Northport: about 30,000 vs. 25,000.

As mentioned, Florence and Muscle Shoals showed slight growth in 2018, according to the estimates, as did Phenix City. Dothan was flat, and Anniston and Gadsden both experienced net out-migration.

A scattering of smaller towns in northeast Alabama and southeast Alabama showed population growth. However, most smaller cities in rural counties lost population. Selma was particularly hard hit, with a net loss of almost 500 people in 2018. Since 2018, Census estimates Selma’s population has declined by 2,898 dropping from around 20,000 down to 17,000, a 14 percent population decline. Small towns in Black Belt counties, cities like Tuskegee, Eufaula, and Demopolis, continue to experience population declines, but so do towns in east central and northwest Alabama like Jasper, Alexander City, and Sylacauga.

Energized by a climate of opportunity and a burst of positive attention for the region, civic leaders in the Shoals have launched a new effort to improve the economy and quality of life through cross-community collaboration.

More than 150 people attended the launch of the effort, which is organized by the Committee for a Greater Shoals, a group of Shoals business leaders. The event featured the release of A Greater Shoals: a Pathway, a report authored by PARCA on the current state of the region and avenues of opportunity.

Shortly after the event, 110 people had signed up for one or more of six committees:

• Broadening the Definition of Economic Development
• Developing High-Tech Infrastructure/Recruiting
• Quality of Life
• Workforce Development and Education
• Unified Tourism
• Government Cooperation and Structure.

Off the Interstate corridor and tucked away in the Northwest corner of the state, the Shoals is often described by residents as a well-kept secret. That is part of the region’s charm, but it’s also a frustration.

Taken together, the four cities at the heart of the Shoals — Florence, Muscle Shoals, Sheffield, and Tuscumbia — have a population of over 70,000. A combination of the four adjacent cities would rank as Alabama’s 7th largest city. Leaders in the Shoals have long wondered if the region was held back by the fragmented nature of the Shoals, with four principal cities, and six school systems spread across two counties.

Building off research PARCA performed on the Birmingham metro area, PARCA found evidence that fragmentation did have discernable negative effects in the Shoals but also identified cooperative structures the Shoals has developed to pull the region together.

The report recommended building on those existing cooperative structures to capitalize on immediate opportunities, while embarking on a longer-term process to decrease governmental duplication and work toward greater unity.

The report found success to build on in the area of education. According to PARCA’s analysis, when the K-12 school systems in the Shoals metropolitan area were considered together, they produce a higher college and career readiness rate among high school seniors than any other Alabama area.

The Shoals also has the second highest college-going rate among Alabama MSAs, thanks in part to a local civic initiative, Shoals Scholar Dollars, that provides scholarships for residents of Colbert and Lauderdale counties. The Shoals is home to a community college, Northwest-Shoals Community College, and a four-year university, the University of North Alabama, both of which are poised for growth.

The Shoals has developed vehicles for bringing its counties and cities together in pursuit of economic development, including a unified economic development authority, a unified economic development fund, and a united two-county Chamber of Commerce.

Those cooperative structures create a strong competitive position for the Shoals in pursuing industrial projects, like suppliers for the Toyota-Mazda Manufacturing plant under construction in Huntsville. But they also provide a framework for cooperation on further developing the Shoals natural and cultural assets.

With the Tennessee River running through its heart, the Shoals has unrivaled natural assets, ripe for further recreational development. On the cultural front, the Shoals has enjoyed a surge of national and international attention to the Shoals’ historic and contemporary contributions to American music. That’s drawn a stream of tourists to the FAME and Muscle Shoals Sound Studios. Florence has emerged unexpectedly as a fashion hub, serving as home base for designers Billy Reid and Natalie Chanin. That new interest builds on top of tourist attractions like Helen Keller’s home in Tuscumbia and W.C. Handy’s in Florence. Traditional down towns in Florence, Sheffield, and Tuscumbia have been revitalized with local investment.

A coordinated cooperative effort to build on these strengths would bring more resources and reach, the report observes. Though traditional economic development has focused on developing sites and luring employers with incentives, contemporary economic development includes a focus on developing an ample and high-quality workforce and providing a high quality of life that benefits locals and attracts new residents and businesses.

As Alabama approaches its 200^th birthday, the state is still adding population but at a slower rate than most of its Southeastern neighbors.

The U.S. Census Bureau released new state-level population estimates in December, providing estimates of state populations as of July 1, 2018. The data release also includes state-level estimates for the underlying components of population change.  A closer look at the components provides insight on the factors affecting Alabama’s growth rate. According to the Census, Alabama has:

1. The second highest death rate among U.S. States. West Virginia’s is the highest.
2. The fourth lowest rate of international in-migration.
3. A positive rate of domestic in-migration, but a rate that is slower than some Southeastern neighbors.

For the most part, the 2018 estimates extend trends among Southeastern states that have been in place since 2010: more rapid growth along the East Coast and in Tennessee, slower growth and even some estimated population loss in the Southeastern interior states.

In the national context, the highest percentage population growth is taking place in the Mountain West states of Nevada, Idaho, Utah, and Arizona, with Texas and Florida also placing near the top. A second group of states — Washington and Oregon on the West Coast; Colorado in the Mountain West; and the Carolinas and Georgia on the East Coast; constitute a second tier of growth states with population increases of 1 percent or greater. Alabama falls into a third tier, with growth under 1 percent. Alabama’s population increased an estimated 0.3 percent increase. Eight states, including Mississippi and Louisiana, in the Southeast, lost population in 2018, according to the Census estimates.

To estimate population change, Census tracks births and deaths in a state and estimates the number of people moving in and moving out. According to the 2018 estimates, these are estimated totals for Alabama:

Alabama 2018 Components of Change	Values
Births	57,216
Deaths	53,425
Net Natural Increase	3,791
Net Domestic Migration	5,718
Net International Migration	3,344
Net Migration	9,062
Net Population Change in 2018	12,751

To be able to compare those numbers to other states, it is necessary to compute a rate for each measure. The Census expresses rates as a number per 1,000 residents. For example, Alabama had a death rate of 10.9, that’s 10.9 deaths for every 1,000 residents. Alabama’s death rate has been consistently high according to Census estimates, which are based on population estimates and death records collected by public health agencies. Alabama’s population is older than the average state. That effects population in two ways. Older residents are more likely to die, and younger people are more likely to have children. In addition, Alabama residents, by many measures are less healthy than residents in other states and have a shorter life expectancy than residents of most other states. Alabama’s high death rate ultimately depresses the state’s rate of natural increase, which ranks 43 among U.S. states.

Rates of Change, by Components	Rate of change per 1,000	Rate's Rank among U.S. States
Death Rate	10.9	2
Birth Rate	11.7	28
Natural Increase Rate	0.8	43
Domestic Migration Rate	1.2	19
International Migration Rate	0.7	47
Net Migration Rate	1.9	24

The other way states grow or shrink is residents leaving or new residents moving in. Alabama has a positive rate of domestic migration, netting 5,718 new residents that moved to Alabama from other U.S. states. However, Alabama doesn’t attract many transplants from other countries. Alabama ranked 47th in its international migration rate, adding only 3,344 new residents from other countries. That left the state’s overall migration rate in the midrange of U.S. states.

According to the estimates, Alabama continues to be outpaced in population growth by South Carolina, a demographically similar state that was smaller than Alabama at the time of the 2010 Census. Since 2018, South Carolina’s population growth has accelerated, particularly in terms of domestic migration. Since 2010, South Carolina has surpassed Alabama in population, adding more than 450,000 new residents, while Alabama has added just over 100,000.  The interactive maps and charts below allow you to explore the data and make your own comparisons of numeric change, percentage change and rates of change. Expand the display by clicking on the full screen icon on the bottom left of the graphic.

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 2^nd 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 47^th 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.

 

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 4^th 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 11^th 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 41^st, 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 27^th in overall adult mental health and 28^th in overall youth mental health. Looking at individual components, Alabama ranked:

• 30^th in the number of adults suffering from any mental illness;
• 18^th in the number of adults suffering from acute suicidal ideation;
• 9^th in the number of youth suffering from a major depressive episode in the previous year;
• 42^nd in the number of adults diagnosed with any mental illness without insurance, representing 20.8% of the adult population; and
• 48^th 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 34^th 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

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 5^th 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 6^th 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 39^th among U.S. states in per student spending.[6]
• Expanded student and family support for students in Pre-K through 12^th
• 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 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)

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 7^th 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 8^th 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 14^th 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 9^th 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 3^rd 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 20^th in the nation. When compared to Southeastern states, the state ranked 3^rd 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

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 9^th 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:

• 42^nd in child-well being[1]
• schools rank 42^nd in the nation[2]
• #3 in speed-related deaths[3]
• #1 for fast-food restaurants per capita[4]
• 41^st in places to start a business[5]
• 40^th in children’s health[6]
• 49^th 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 (9^th) than for policy professionals (16^th). 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

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.