1. v`v
Southernmost
Illinois
Minority Health Disparities
in Rural Areas
Mike Bularz
Fall 2012
Public Health 330
Dr. Richard Barret

3. 3
Southernmost Illinois:
Health Disparities in Minority Populations
If you ever get a chance to beeline South through Illinois from Chicago, you will probably
experience vast expanses of the great plains of America’s heartland, interspersed with single-
intersection towns, a few aging rustbelt cities, and the college towns. Follow this path for upwards
of 5 to 6 hours, and the view will start to change as you arrive in the rockier and forested landscape
of the southern tip of Illinois. Here exists a paradox between the North and the South in a few
contexts: The area, referred to as Little Egypt because of the fertile plains fed by the confluence of
the Mississippi and Ohio rivers,1 was originally staked out to be the central hub of Illinois, Checagou2
was just a distant and impenetrable swamp at this time. The unexpected also emerges from the
environmental geography of the region: great expanses of plains end to yield rock formations and
hilly landscapes, this is due to the geological history of the shaping of Illinois: the flattening of the
entire state by glaciers during the ice age didn’t reach out this far, and receded to leave the flat
majority of the state, and more interesting topology in Southern and far Northwestern Illinois. 3 The
last contradiction arises in terms of demography in the area: several urbanized towns boast heavy
African-American and Hispanic populations, and are encumbered with poor socioeconomic status
across several indicators: income, uninsured, teen pregnancies, and a prevalence of several chronic
diseases.
Interestingly enough, the distribution of these two minority populations does not exactly
mirror the distributions found in more urbanized northern counterparts. The spatial patterns of
the populations differ somewhat in rural towns: African – Americans are further from city center,
Hispanics further than African-Americans, and Whites at the center and far out in the country.
The origins of these populations and their concentrations are the outcome of different economic
factors transplanting or attracting different minority populations over time, and are the subject of
speculation based on history. The causes of the population distributions are speculated in this paper,
but it is imperative to first give an overall account of Illinois settlement patterns.
Remnants of Un-
derground Railroad
1 Musgrave, John. “Egypt.” Egypt. American Weekend, 13 July 1996. Web. 12 Dec. 2012.
2 Original Native-American term, meaning “stinking onion”. It referred to the odorous and
muddy landscape where the city was founded, and was eventually changed to “Chicago”.
3 Testa, Adam. “Our History: How Southern Illinois Came to Be.” Thesouthern.com. The
Southern, 13 Oct. 2011. Web. 12 Dec. 2012.

4. 4
Early River Barge Early Illinois Settlement Patterns
Exploration
The earliest settlement of Illinois (not including Native Americans) was
by French explorers and fur and hide traders. The confluence of the
Ohio and Mississippi rivers made the area an ideal trading post, and
the French king even staked out a large buffalo hide tanning operation
in the area between Grand Chain and Mound City. Settlement also
occurred in Kaskasia, but the area was eventually wiped out by a
flooding of the river which wiped out the town.4 Cairo, founded at
the southernmost tip of Illinois on a peninsula shaped like a crescent, was strategic for trade and future military
operations.5 The War of 1812 established the port for takeover by English settlers, and the Civil War boosted the
economy at the strategic location by providing medical services on the Red Rover hospital ship.6
Shift in Transportation and Rise of Industry
Hubs came and went in Illinois, the southern tip at Cairo being essentially the first in relation to others: St. Louis
and Chicago overtook the spotlight as a canal was dredged through the muddy banks of Chicago, and was primed
to be the new center of the Midwest. This all changed with the advent of rail, and boosters and speculators
investing in Chicago, such as William B. Ogden, who purchased development rights door to door, and secured rail
transport from Galena to Chicago.7 The industrial boon in Galena was mining for materials needed for Chicago’s
construction, and similar economies thrived in Southern and Central Illinois, and were eventually connected with
the Illinois Central Railroad. Southern Illinois enjoyed industries around coal, mining, and salt mines such as the one
in Equality, IL.8
Settlement by Race, Early and Industrial Era Illinois
The majority of white settlement occurred from land speculators at this time traveling westward, as well as
Appalachian whites who migrated from Kentucky and Virginia.9 Cairo and Equality garnered a large black population
from the underground railroad routes by which slaves from the south traversed north to Chicago and Canada,10 the
former being a safe rest-stop and the latter being a capture point by night hunters re-capturing escaped slaves to
work in Equality’s salt mines.11 Urbanized areas attracted populations to work, including minority populations, as
industrial processes demanded labor. This was particularly true in what is deemed the “Great Migration” of blacks
in the 1950’s during the war, when mostly whites were abroad fighting, and the war itself generated a demand for
4 Keller, Fred. “Cairo-Kaskaskia - Southernmost Illinois History.” Southernmost Illinois History. N.p., n.d. Web. 12 Dec.
2012.
5 Keller, Fred. “Cairo History - Southernmost Illinois History.” Southernmost Illinois History. N.p., n.d. Web. 12 Dec.
2012.
6 Keller, Fred. “Red Rover Hospital Ship - Southernmost Illinois History.” Southernmost Illinois History. N.p., n.d. Web.
12 Dec. 2012.
7 History of Chicago – William B ogden, St. Louis Canal
8 Musgrave, John. “Black Kidnappings in Southeastern Illinois.” Black Kidnappings in Southeastern Illinois. N.p., Apr. 1996. Web. 12 Dec.
2012
9 Harris, Jesse W. “Dialect of Appalachia in Southern Illinois.” JSTOR. N.p., n.d. Web. 12 Dec. 2012.
10 ”The Underground Railroad in Illinois, Freedom Trails: 2 Legacies of Hope.” The Underground Railroad in Illinois, Freedom Trails: 2
Legacies of Hope. N.p., n.d. Web. 12 Dec. 2012.
11 Taylor, Troy. “The Old Slave House.” The Old Slave House. N.p., 2008. Web. 12 Dec. 2012.

5. 5
labor as outputs increased.12
Modern Settlement Patterns by Race
Hispanics
Research by the USDA – ERS (Economic Research Service)
reveals a growing trend in Hispanic migrants settling in rural
areas of the country, as opposed to the traditional migration
pattern of Hispanics into southwestern states. Currently,
more than half of Hispanics are settling in non-metro areas.13
The Carsey Institute attributes this trend to new migrants
being recruited to work in rural meat-processing plants
and other agricultural operations.14 Research into Central
Salt Mining Illinois distributions of Hispanics further assesses barriers of
integrating into existing communities, discrimination, language
barriers, and access to schools and health care.15
Figure 8
Year of U.S. arrival for all foreign-born Hispanics
Percent
45
40 High-growth Hispanic
Established Hispanic
35 Other nonmetro
30 Metro
25
20
15
10
5
0
pre 1 965 65-6 9 70-74 75-7 9 80-84 85-8 9 90-94 95-2000
Source: Calculated by ERS using data from Census 2000, SF3 files.
12 Great Migration – History of Chicago
13 Kandel, Willam, and John Cromartie. New Patterns of Hispanic Settlement in Rural America. Rep. no. 99. N.p.:
United States Department of Agriculture - Economic Research Service, 2010. Print.
14 Jensen, Leif. New Immigration Settlements in Rural America: Problems, Prospects, Policies. Rep. Durham, New
Hamspshire: Carsey Institute, 2006. Print.
15 Rafaelli, Marcella. “Challenges and Strengths of Immigrant Latino Families in the Rural Midwest.” Journal of
Family Issues (2012): n. pag. Print.

6. Figure 4a
6 Hispanic share of total county population, 1990
Less than 1 percent
1-9 percent
10 percent or higher
Metro
Source: Calculated by ERS using data from the U.S. Census Bureau.
Figure 4b
Hispanic share of total county population, 2000
Less than 1 percent
1-9 percent
10 percent or higher
Metro
Source: Calculated by ERS using data from the U.S. Census Bureau.
12
New Patterns of Hispanic Settlement in Rural America/RDRR-99
Economic Research Service/USDA

7. 7
Blacks
There is increasing evidence of of what is deemed “black flight” of African-Americans from northern to
southern states, and from urban to more rural and suburban areas. A few trends are speculated to contribute
to this pattern of migration: 1) Decrease of industry and jobs in urban areas making it less attractive to live
in cities for the urban poor is speculated to be causing blacks and other minorities to seek out jobs in rural
areas and processing plants.16 2) Increasing gentrification of areas within cities is pushing the urban poor and
minorities out into suburban and rural areas, and suburban areas are abundant in cheap housing options as
property owners scramble to sell or attract tenants after the housing crisis.17 3) On a positive note, blacks are
seeing an increase in social mobility with higher educational attainment and are populating the farther suburbs
of cities, such as Chicago’s southern suburbs.18 4) Decreased racial tensions in urban areas in the southern
states are attracting more blacks than whites.19 These several factors, whether contributing to lower-class
African-Americans or higher class, are in general perceived to be causing a reversal of the Great Migration.
Figure 1. Black Net Migration, U.S. Regions, 1965–2000
1965–70 1975–80 1985–90 1995–2000
400,000
300,000
200,000
100,000
0
-100,000
-200,000
-300,000
-400,000
South Northeast Midwest West
Source: Author’s analysis of 1970, 1980, 1990 and 2000 decennial censuses.
16 Godfrey Ukpong, Onoyom. Yankee Migration: Causes and Reverse Trends in Urbanization. Rep. Louisiana:
Southern University, n.d. Print.
17 Greene, Richard P., Mark Jansen. Bouman, and Dennis Grammenos. Chicago’s Geographies: Metropolis for
the 21st Century. Washington D.C.: AAG, Association of American Geographers, 2006. Print.
18Greene, Richard P., Mark Jansen. Bouman, and Dennis Grammenos. Chicago’s Geographies: Metropolis for
the 21st Century. Washington D.C.: AAG, Association of American Geographers, 2006. Print.
19 Frey, William H. The New Great Migration: Black Americans’ Return to the South. Rep. Washington D.C.:
Brookings Institute, 2004. Print.

8. 8
Physical Health
Disparities in Rural Areas in America
Focus Area - Nutrition and Physical Health
The focus of this work is the physical health – and inficators
manifested in prevalence of chronic diseases such as Obesity,
Diabetes, and diseases of the heart, incidence of deaths from
stroke, complications from diabetes or obesity, as well as
hospitalizations attributed to these diseases. I also examine
southern Illinois in terms of indicators linked as contributors to
these chronic diseases. Indicators, referred to as “risk factors”,
examined at the level of individuals and populations include
the availability of healthy food sources and level of physical
activity and exercise. Community and environment-level
factors examined include availability of preventive, emergency,
and supplemental (government-sponsored community health
centers) care, as well as broader socio-economic status
and indicators by race categories, such as income, poverty,
insurance coverage, and ability to drive.
Differences between Urban and Rural Health
The health problems of rural minorities often mirror the
problem of those of urban areas, but are not necessarily of the
same causation. For example, poor nutritional environment
is may not be because of an abundance of cheaper, high
calorie “meals” like in urban areas, but more likely caused by
general dearth of grocery outlets and options in less-densely
populated areas. Examining the issue in southern Illinois
requires understanding rural health disparity patterns, as well
as urban ones as there are both, urban and rural areas in this
part of the state.
Prevalence of Chronic Diseases
In general, health disparities are markedly higher in rural areas than
in urban areas. African-Americans have higher prevalence of self
reported fair or poor health (determined through National Health
Interview Survey asking to rank themselves as on average, very good health, good, fair, poor), and hispanics rank the
highest.
Diabetes in Rural America
Certain chronic disease categories has significant variation by race in rural and urban areas. Diabetes affected African-
Americans significantly higher than Whites, Hispanics, and Asians as a percentage of population. The number was
significantly higher in areas classified “small-adjacent rural” meaning rural areas adjacent to an urban area; 12.6%
of urban blacks had diabetes, while 15.1% of all rural blacks had diabetes. Within the rural category, 17.2% or “small
adjacent rural” blacks had diabetes. Probable cause for this pattern may be the settlement of blacks near urban centers
or micropolitan areas as opposed to far rural areas.20
20 Van Nostrand, Joan, DPA. Health Disparities: A Rural-Urban Chartbook. Rep. Columbia, SC: South
Carolina Rural Health Research Center, 2010. Print.

9. 9
Obesity in Rural America
A similar distribution occurred for blacks and
hispanics in the distribution of obesity rates among
rural versus urban classifications, with some minor
differences. Overall, blacks were more obese than
Whites and Hispanics, and obesity was higher in rural
America in general. Hispanics had higher obesity
rates within the micropolitan rural and small-adjacent
rural areas. This was true for blacks as well, but
obesity among blacks increased out into remote rural
areas as well, whereas remote rural hispanics were
significantly less obese.21
Access to Care and Quality of Care
Availability and Quality of Care Facilities
The base economics of low density population
hamper rural access to various necessary care
facilities: Doctors need density of patients, Hospitals
need patients and a labor force, and it is difficult
to blanket large regions with community health
centers and preventive services as well. Further, it is
challenging to maintain a high standard of care with limited training and resources.22
Barriers from the Individual’s End
To complicate things, most rural residents don’t have insurance, as well as money or time to seek proper health
care.23 Barriers exist in the larger community as well, as individuals’ inner and outer circles, as well as broader
community do not promote proper health.24 Contributing factors to health disparity exist in the built environment
as well, with limited availability of quality produce, and oversaturation with convenient and unhealthy meal
options (“food swamps”).
Environment, Community, and Culture
Nutrition in Rural America
Surprisingly, rural residents have poor food choices like their urban counterparts. This is particularly true in
micropolitan areas and small-adjacent rural areas, where there are significant low-income populations either not
attracting healthy food options due to financial constraint or healthy food options are limited due to particular
cultural choices.25 USDA - Economic Research Service mapping of income and distance to grocery stores posits that
21 Van Nostrand, Joan, DPA. Health Disparities: A Rural-Urban Chartbook. Rep. Columbia, SC: South
Carolina Rural Health Research Center, 2010. Print.
22 Maripuri, Saugar, and Martin MacDowell. Addressing Rural Health Disparities in Illinois. Rep. N.p.:
University of Illinois at Rockford, n.d. Print.
23 Ziller, Erika, and Jennifer Lenardson. Rural-Urban Differences in Health Care Access Vary Across
Measures. Rep. N.p.: Maine Rural Health Research Center, n.d. Print.
24 Reardon, Kenneth M. “Enhancing the Capacity of Community-Based Organizations in East St.
Louis.” Enhancing the Capacity of Community-Based Organizations in East St. Louis. N.p., n.d. Web. 12
Dec. 2012.
25 Smith, Chery, and Lois W. Morton. “Rural Food Deserts: Low-income Perspectives on Food Access

10. 10
the distribution of food deserts (defined by census tracts with 33% low income bracket individuals with less than 5
grocery stores within driving distance of 5 miles) are not primarily urban, contrary to popular belief and the focus of
most studies. Although I was not able to calculate percentage Urban Vs. Rural populations for the U.S., for Illinois, 89%
of the population living in food desert tracts is Urban, whereas 11% is Rural. This indicates that, although food deserts
are located mostly in urban areas, there is still more than 1/10 of the population in food deserts is rural, in Illinois. (See
Illinois Health section)
Exercise & Fitness in Rural America
Rural populations face similar disparities in terms of exercise and physical fitness26, it is likely that the near-urban and
rural environments require a car to get to around in general, and the ability to walk places, accompanied by availability
of parks and recreation opportunities is limited. Studies show that a portion of rural and near-urban work is shifting to
less labor-intensive jobs,27 but the connection between labor intensive jobs and fitness is not necessarily comparable,
in fact, many would argue that labor intensive jobs are a cause of poor health.28 Rural populations have very close
numbers to urban populations in terms of general exercise: 45% of Urban Residents met moderate or vigorous exercise
guidelines, while 44 % of rural did the same.29 Hispanics in urban adjacent areas showed higher activity than Hispanics
in other categories, while Blacks showed higher in far-rural areas.
Access to Care
A key obstacle for good health in rural residents is access to adequate medical care. Many rural residents do not
produce enough of a draw to attract hospitals, doctors, and other wellness / preventive services. Often, rural residents
will need to rely on social safety nets – nonprofit and government sponsored community health centers. The locations
of these are often not sufficient to meet the needs of rural and near-urban residents, as the centers are located
primarily in urbanized areas.30
in Minnesota and Iowa.” Journal of Nutrition Education and Behavior 41.3 (2009): 176-87. Print.
26 Van Nostrand, Joan, DPA. Health Disparities: A Rural-Urban Chartbook. Rep. Columbia, SC: South Carolina
Rural Health Research Center, 2010. Print.
27 ibid
28 “Labor Intensive Industry.” EconoWatch. N.p., June 2010. Web. 12 Dec. 2012.
29 Van Nostrand, Joan, DPA. Health Disparities: A Rural-Urban Chartbook. Rep. Columbia, SC: South Carolina
Rural Health Research Center, 2010. Print.v
30 Removing Barriers to Care: Community Health Centers in Rural Areas. Rep. N.p.: National Association
of Community Health Centers, 2011. Print

11. 11
Illinois “Southern Seven” Diabetes Risk Factors:
Indirect Contributing Factors
Poor school lunch programs
Direct Contributing Factor
Limited availability of fruits /
Low income neighborhoods
vegetables
Lack of Farmer’s Markets in all counties
Indirect Contributing Factors
Cultural / Family norms
Direct Contributing Factor
High fat diet Abundant Fast Food Restaurants
Risk Factor Low income level
Poor Diet Indirect Contributing Factors
Large serving sizes at restaurants
Direct Contributing Factor
Portion Sizes Lack of education
Cultural / Family norms
Indirect Contributing Factors
High soda intake
Excessive intake of simple sugars /
Cultural / Family norms / High poverty
caffeine
Abundant fast food restaurants
Indirect Contributing Factors
Lack of self motivation
Direct Contributing Factor
Sedentary lifestyle Lack of time / resources
Nature of employment/physical
limitations
Indirect Contributing Factors
Community Finances
Risk Factor Direct Contributing Factor
Obesity / Diabetes Lack of Physical Walking Routes / Safety / other City Council leaders without health
Type II Activity venues focus
Crime in the community
Indirect Contributing Factors
Direct Contributing Factor
Inadequate / Lack of incentives
Lack of Motivation / Time
Lack of understanding / education
Indirect Contributing Factors
Incomplete records
Direct Contributing Factor
Lack of Family History Knowledge Lack of communication
Lack of genetic testing
Indirect Contributing Factors
Chemical exposures
Direct Contributing Factor
Genetic Mutation Radiation exposures
Risk Factor
Genetics Indirect Contributing Factors
Direct Contributing Factor
Parents
Indirect Contributing Factors
Direct Contributing Factor
Race / Ethnicity

12. 12
Illinois Health Disparity Patterns
Prevalence of Chronic Diseases
Obesity
Obesity and Nurtition disparities are significant in Illinois, especially when examining rural communities. Illinois
ranks at 61.7% obese (gauged by BMI) as compared to the national average of 61.1%. Obesity rates (percentage
or population obese) are actually higher in rural communities than urban ones.31 The highest obesity rates are in
southern counties, and counties by the St. Louis / East St. Louis metro area.
Obesity and the Environment in Illinois
The distribution of obesity patterns in Illinois is somewhat correlated with risk factors such as availability of
healthy food outlets, consumption of fruits and vegetables, and physical activity / inactivity, this is especially true
when comparing in terms of North vs. West vs. South.
Other risk factors include access to healthy food. The USDA Food Desert locator highlights a majority of food
deserts around St. Louis metro area, far southern Illinois, and parts of Chicago and Rockford.
A further complication is the ability for residents to drive in these areas. Examining data from the American
Community Survey, there are pockets where people walk to work. This could indicate inability to afford a car.
Diabetes
Diabetes distributions in Illinois seem to mirror the patterns seen in Obesity and Nutrition distributions. This
isn’t surprising as the Diabetes is often associated with poor diet habits. Diabetes can be closely tied to most
of the same risk factors: Physical Inactivity, Poor Diet (Limited Furits and Vegetables, High-fat Diets), Genetics,
as well as contributing factors (ex. Crime and a neighborhood’s walkability, and the amount of physical activity
of individuals. See Figure on Next page). Diabetes, and diabetes risk factors are concentrated in Southern and
Southwestern Illinois similarly to obesity.
White Population Black Population Asians Hispanic - All Races Mexican
Puerto Rican Cuban American Indian or Alaskan Native Single Mothers New Single Mothers 2011
(Under Poverty Line)
31 Arnold, Damon T. Illinois Strategic Plan: Promoting Healthy Eating and Physical Activity to
Prevent and Control Obesity 2007 – 2013. Rep. Springfield, IL: Illinois Department of Public Health,
2012. Print.

13. 13
Overall Illinois Health: National Health Interview Survey participants were
asked: On an average day, is you health Very good, Good, Fair, or Poor?
Maps show fair or poor health
Fair or Poor Health, 2002 Fair or Poor Health, 2003 Fair or Poor Health, 2004 Fair or Poor Health, 2005 Fair or Poor Health, 2006
Fair Poor Health 2007 Fair or Poor Health, 2008 Fair or Poor Health, 2009 Fair or Poor Health, 2010 Fair or Poor Health,
2004 to 2010
All Obese Hospitalizations White Obese Hispanic Obese Black Obese All Diabetes Hospitalizations
Incidences of
Hospitalizations
from Diabetes or
Obesity Compli-
cations, by Race
or Ethnicity
White Diabetes Hisp Diabetes Uninsured, All Uninsured,
Under Poverty Line

14. 14
Obesity Prevalence, NHIS:
Figure 11: Percentage of Adults Reporting Cardiovascular Disease Risk Factors, Illinois, 2003 and
2004 Figure 6: 2006 Illinois Adult Weight Prevalence by Region
77.4
Poor Nutrition*
45
77.4 42.4
40.8
39.0
59.8 38.3 38.3
Physical Activity* 36.2 36.2 36.3 36.6 36.0 36.6
34.6
52.6
CVD Risk Factors
22.1
Obesity** 28.8
23.2
30
27.3
24.7 25.5
Percentage
6.1
Diabetes** 7.0 21.0 21.3
22.2
Smoking**
20.8
15
25.9
High Blood Pressure 24.8
34.1
High Cholesterol 33.1
0
0 20 40 60 80
Illlinois Chicago Suburban Collar Urban Rural
Percentage Total Cook Counties Counties Counties
2003 2004
underweight/normal overweight obese
U. S. Centers for Disease Control and Prevention Behavioral Risk Factor Surveillance
Data Source:
System; Illinois Department of Public Health BRFSS; *2003, **2004
Data Source: Illinois Behavioral Risk Factor Surveillance System, 2006
Risk Factors to Health
There are several risk factors to consider in assessing risk and prevalence of populations for Obesity, Diabetes, and Heart
Disease. Several of these risk factors are prevalent in Illinois rural areas, particularly south and southwest: BMI and
overweight rates are higher in rural areas, poor nutrition is higher in rural areas and rural adjacent to small urban.
Food Deserts Rurality of
Illinoisans
Rural
11%
Another risk factor to consider is access to food; the USDA Economic
Research Service publishes data from their “Food Desert Locator”, living in Food
which tracks areas in the US which have low income populations that Urban
Deserts:
are far away from a healthy food source such as a grocery store. This
Rural
data, combined with the ability to drive to a store (car ownership)
11% Rural
highlights the issue further - residents in southern and western
89% Urban
Urban
89%
Illinois need to drive to the majority of destinations, but cannot do
so because they don’t own a vehicle and public transportation is
often limited, if an option at all.

15. 15
Illinois Food Deserts, with darker values representing percentage of
population under poverty with no vehicle. Southern Illinois and the St.
Louis metro have the highest number of people with difficulty accessing
healthy food options.

16. 16
Access to Rural Health Centers
Key potential for attacking the issue of disparities lies in strengthening the effectiveness of our Rural Health
Centers. The current distribution of health centers is primarily in urban areas. An analysis of populations within
5, 10, 15, and 20 mile driving distances revealed the following:
• Almost no populations under the poverty level live within 5 miles of a community health center
• The majority of the poverty population was within the 15 and 20 mile range
• Poor Blacks lived primarily within 15 mile, and 20 mile driving distances, whereas Hispanics live in further
reaches (20 miles or more)
It is evident that siting health centers in small municipalities may be convenient for running the centers, but is
highly incovenient for the rural populations needing the most care. Offering a shuttle service, or working with
the public transportation system may offer a solution other than siting centers in more rural areas. Looking for
clusters of low-income individuals may be an option for siting satellite offices, or small scale health centers.
Race / Ethnicity by Distance Class
Population in Poverty Population per square mile, under poverty line 7000000
by 5, 10, 15, and 20 mile 6000000
(American Community Surevy Estimates)
5000000
driving distances to 4000000
IDPH Rural Health Centers 3000000
2000000
Illinois coverage by 1000000
Dubuque
Rural Health Centers Road
Sycamore
Dekalb
Clinton
Sterling
Population by
Distance interval
Ottawa Low
Kewanee
Kankakee Bradley
Galesburg
Pontiac
Bourbonnais
5 10 15 20
High Health miles
Canton Morton Pekin Center
Normal
Keokuk Macomb Peoria
Bloomington
Rantoul
Distance from IDPH Rural Health Center
Lincoln Champaign Danville
Urbana
Quincy
Springfield Decatur
Hannibal Jacksonville
Population under poverty, by distance from IDPH Rural Health Center
Taylorville Mattoon Terre Haute by Race / Ethnicity
Charleston
4500000
Effingham
Godfrey
Alton 4000000
Glen Carbon
Collinsville Vincennes
Population per square mile, under poverty line
Edwardsville Centralia 3500000
Population by Mount Vernon
(American Community Surevy Estimates)
Distance interval
3000000
Low
Murphysboro Marion Herrin
2500000
Carbondale
Whites in Poverty
High
2000000 Blacks in Poverty
Hispanic in Poverty
Paducah
1500000
1000000
500000
0
5 10 15 20
Distance from Rural Health Center (miles)

17. !
Sycamore
Dekalb Sycamore
Dekalb
17
Sterling
Sterling !
!
!
Ottawa
Ottawa
Kewanee
Kewanee !
Kankakee Bradley !!
!
!
! Kankakee Bradley
Galesburg Bourbonnais
!
!
!
Pontiac Galesburg !
! Bourbonnais
! ! Pontiac
! !
East Peoria Peoria
East Peoria Peoria ! !
Canton Pekin
Normal
! ! ! ! ! ! ! !
Macomb Canton Pekin
Morton
Bloomington
!
Macomb
! ! Morton
Normal ! !
Bloomington
Rantoul
!
!
!
!
! !
! !Rantoul !
! !
Lincoln !
Champaign Urbana ! ! !
Lincoln !
Champaign Urbana
Quincy
Danville
! ! !
! !
!
!
! !
!
Quincy
Decatur ! ! Danville
!
!
Springfield !
!
!
Jacksonville Decatur
Springfield
Jacksonville ! !
!
! !
!
!
!
!
Taylorville Mattoon !
!
!!
Charleston !
Taylorville !
! Mattoon! !
Charleston
!
! !
!
! !
!
!
Effingham !
! ! !
!
!
!
!!
!
!
Godfrey ! ! Effingham
!
Alton ! !
! !!
!
!
Godfrey ! ! !
Alton !
!
!
Glen Carbon ! !
!
! !
!
Collinsville !
!
Glen Carbon
!
Centralia Collinsville
! ! !
! !!
!
!
!
!
! !
Centralia
Mount Vernon !
!! !
Poverty population ! Mount Vernon !
!
!
Percent Minority
!
by closest
!
!!
! !
!
within 20 Miles !
!
Rural health Center
!
!
Herrin
! !
!
!
0.000011 - 1.013780
!
! ! !
Marion !
!
!
Population in Poverty Carbondale !
!
!Herrin
Marion
! 1.013781 - 2.407460 !! Carbondale
! !! !
Black, up to 20 Miles
! !!! ! !!
! 2.407461 - 4.353350 !
Hispanic, up to 20 Miles ! 4.353351 - 7.076070 !
!
White, up to 20 Miles ! 7.076071 - 12.015400
!
!
! 12.015401 - 21.952801
! 21.952802 - 53.849602
Hispanic, in Poverty
White, in Poverty
Black, in poverty
Greenville Regional Hospital, Inc. - DBA Greenville Family…
Southern Illinois Medical Services NFP - DBA Logan…
HSHS Medical Group, Inc. - DBA HSHS Medical Group…
Mid-Illinois Medical Care Associates, LLC - DBA Drs.…
Hoopeston Community Memorial Hospital - DBA…
Steeleville Clinic
Medical Associates Of Jerseyville, Inc.
Lawrence P. Jennings, M.D., M.S.C.
Physicians Group Associates
IMH Gilman Clinic
Lincoln Family Care Specialists
Community Medical Clinic
SIU Care-A-Van
Mcfarlin Medical Clinic, SC
Southern OB/GYN - Highland
Elmer Hugh Taylor Clinic
Equality Family Practice
Family HealthCare of Gibson City
Kirby Medical Group
Mt. Olive Family Practice Center
Nokomis Rural Health Clinic
Clark County Family Medicine PC
Family Healthcare of Farmer City
Paxton Clinic, The
Comprehensive Health Center
Heartland Pediatric Clinic, LTD - DBA Heartland Pediatris
Cowden Medical Clinic LLC
Southern Illinois Immediate Care LLC
Hygienic Institute for LaSalle, Peru & Oglesby Inc
Jacksonville Family Practice
Watseka Family Practice
Confidence Medical Associates, Ltd.
Clinton County Rural Health - Germantown
Town & Country Rural Health Clinic
Carle Health Care - DBA Carle Physicians Group
CMH Palestine Rural Health
Marshall Clinic Effingham, S.C.

18. 18
ILLINOIS AND THE PPACA (Patient Protection and
Afforable Care Act)
Health Insurance Exhanges
The Future of Public Health Policy, especially for Southern Illinoisans, is due to change. WIth the passage
of the Patient Protection and Affordable Care Act (PPACA)a few years ago, there are two things that
will be occuring in the next three or so years: Illinois will set up centers referred to as Health Insurance
Exchanges (HIE’s) where private insurance companies will pool resources to provide coverage for many
residents who cannot currently afford health insurance, are uninsured, or have pre-existing conditions.
These new centers will give residents options for purchasing insurance. HIE purchasing for rural ans
small-urban periphery blacks, as well as rural Hispanics will greatly decrease the disease disparities faced
by these two minority groups in rural southern Illinois.
Increased Community Health Centers
Implementation of final stages of PPACA will create more community health centers as demand for
services grows. These centers, if placed optimally in rural areas, will ensure that populations in poverty
with low access to current centers receive better coverage. Increasing the amount of centers, as well as
existing center capacity will allow more preventative care and decrease mortality rates for diseases.
Percent Unin- White Unin- Black Unin-
sured, Under sured, Under sured, Under
Poverty Poverty Poverty

19. 19
Works Cited
Arnold, Damon T. Illinois Strategic Plan: Promoting Healthy Eating and Physical Activity to Prevent and Control
Obesity 2007 – 2013. Rep. Springfield, IL: Illinois Department of Public Health, 2012. Print.
Ashton, Sarah, and Lauren McDonnel. Woody Biomass Desk Guide and Toolkit. Publication. N.p.: National
Association of Conservation Districts, n.d. Print.
“Black Kidnappings in Southeastern Illinois.” Black Kidnappings in Southeastern Illinois. N.p., n.d. Web. 12 Dec.
2012.
Frey, William H. The New Great Migration: Black Americans’ Return to the South. Rep. Washington D.C.:
Brookings Institute, 2004. Print.
Godfrey Ukpong, Onoyom. Yankee Migration: Causes and Reverse Trends in Urbanization. Rep. Louisiana:
Southern University, n.d. Print.
Greene, Richard P., Mark Jansen. Bouman, and Dennis Grammenos. Chicago’s Geographies: Metropolis for the
21st Century. Washington D.C.: AAG, Association of American Geographers, 2006. Print.
Harris, Jesse W. “Dialect of Appalachia in Southern Illinois.” JSTOR. N.p., n.d. Web. 12 Dec. 2012.
Harris, Jesse W. JSTOR. N.p., n.d. Web. 12 Dec. 2012.
Jensen, Leif. New Immigration Settlements in Rural America: Problems, Prospects, Policies. Rep. Durham, New
Hamspshire: Carsey Institute, 2006. Print.
Kandel, Willam, and John Cromartie. New Patterns of Hispanic Settlement in Rural America. Rep. no. 99. N.p.:
United States Department of Agriculture - Economic Research Service, 2010. Print.

20. 20
Keller, Fred. “Cairo History - Southernmost Illinois History.” Southernmost Illinois History. N.p., n.d. Web.
12 Dec. 2012.
Keller, Fred. “Cairo-Kaskaskia - Southernmost Illinois History.” Southernmost Illinois History. N.p., n.d.
Web. 12 Dec. 2012.
Keller, Fred. “Red Rover Hospital Ship - Southernmost Illinois History.” Southernmost Illinois History.
N.p., n.d. Web. 12 Dec. 2012.
“Labor Intensive Industry.” EconoWatch. N.p., June 2010. Web. 12 Dec. 2012.
The Law of Biomass Guide. Rep. Los Angeles: Stoel Rives Attorneys at Law, 2010. Print.
The Law of Biomass Guide. Rep. Los Angeles: Stoel Rives Attorneys at Law, 2010. Print.
Loomis, David, and Anthony Pagan. The Illinois RPS: Context, Structure, History, and Policy. Rep.
Bloomington, IL: Center for Renewable Energy - Illinois State University, 2011. Print.
Maripuri, Saugar, and Martin MacDowell. Addressing Rural Health Disparities in Illinois. Rep. N.p.:
University of Illinois at Rockford, n.d. Print.
Musgrave, John. “Black Kidnappings in Southeastern Illinois.” Black Kidnappings in Southeastern Illinois.
N.p., Apr. 1996. Web. 12 Dec. 2012.
Musgrave, John. “Egypt.” Egypt. American Weekend, 13 July 1996. Web. 12 Dec. 2012.
Rafaelli, Marcella. “Challenges and Strengths of Immigrant Latino Families in the Rural Midwest.”
Journal of Family Issues (2012): n. pag. Print.
Reardon, Kenneth M. “Enhancing the Capacity of Community-Based Organizations in East St. Louis.”
Enhancing the Capacity of Community-Based Organizations in East St. Louis. N.p., n.d. Web. 12
Dec. 2012.
Removing Barriers to Care: Community Health Centers in Rural Areas. Rep. N.p.: National Association of
Community Health Centers, 2011. Print.

21. 21
Smith, Chery, and Lois W. Morton. “Rural Food Deserts: Low-income Perspectives on Food Access in
Minnesota and Iowa.” Journal of Nutrition Education and Behavior 41.3 (2009): 176-87. Print.
Taylor, Troy. “The Old Slave House.” The Old Slave House. N.p., 2008. Web. 12 Dec. 2012.
Testa, Adam. “Our History: How Southern Illinois Came to Be.” Thesouthern.com. The Southern, 13 Oct.
2011. Web. 12 Dec. 2012.
Testa, Adam. “Subscribe Now!” The Southern. The Southern, 13 Oct. 2011. Web. 12 Dec. 2012.
“The Underground Railroad in Illinois, Freedom Trails: 2 Legacies of Hope.” The Underground Railroad
in Illinois, Freedom Trails: 2 Legacies of Hope. N.p., n.d. Web. 12 Dec. 2012.
Van Nostrand, Joan, DPA. Health Disparities: A Rural-Urban Chartbook. Rep. Columbia, SC: South
Carolina Rural Health Research Center, 2010. Print.
“Waste Management Introduces Fleet of CNG Trucks in Louisville.” Work Truck. N.p., 03 Aug. 2012. Web.
11 Dec. 2012.
Ziller, Erika, and Jennifer Lenardson. Rural-Urban Differences in Health Care Access Vary Across
Measures. Rep. N.p.: Maine Rural Health Research Center, n.d. Print.