Brighter Futures Begin with HOPE.

Standing in the Need of Care

April 1st, 2020

Nearly half of all Deep South counties do not have an Intensive Care Unit
or no hospital at all

While all eyes are on New York as the epicenter of the COVID-19 crisis, Deep South states are bracing for the coming storm.  Due to a long history of extraction and underinvestment in our region, individuals, communities, and institutions in the Deep South are already struggling to maintain sound financial footing. COVID-19 will exacerbate existing challenges, particularly for low-income, rural communities of color.

We begin by looking at availability of health care in the Deep South.  The lack of access to a robust health care system, which is already the reality in our region, will be a driving factor in COVID-19’s impact on our communities. In the coming days, additional blogs will dig deeper into these issues around labor market, state government responses, financial security, and more.

Twenty-seven rural hospitals have closed across Alabama, Arkansas, Mississippi, Louisiana, and Tennessee since 2010.[1] Even hospitals that do exist are cash-strapped, particularly as states like, Mississippi, Tennessee, and Alabama have failed to expand Medicaid despite high rates of uninsured people.[2] This disinvestment contributes to disproportionate adverse health outcomes, particularly for communities of color — such as obesity, asthma, heart disease, and diabetes[3] — which then increase their vulnerability to the current pandemic.[4]

Based on HOPE’s analysis of data from Kaiser Health News, nearly half (188) of all Deep South counties (383) do not have an Intensive Care Unit or do not have a hospital at all.[5]  These counties are home to more than 3.6 million people.  Mississippi has the greatest number of counties without ICU beds (40). Arkansas leads with the greatest number of counties without any hospital at all (24), and has the fewest number of ICU beds for its residents.  See Table 1.

Table 1:  Counties with Hospitals and ICU Beds in the Deep South

Taking a deeper look, a significant number (72) of the 188 Deep South counties without neither a hospital, nor an ICU bed, are counties that have been in deep poverty for more than 30 years.[7] See Figure 1. All 72 of these counties in are rural areas. They are home to more than 1 million people, about 50% of whom are Black, 45% of whom are white, 2.3% Latino, and 1% Native American.  Due to a long history of exclusionary and extractive policies by race and place, persistently poverty areas experience higher rates of other challenges, such as lower overall health outcomes, higher unemployment rates, and higher incidences of predatory lending.[8]  These are all challenges which will are already existing barriers to surviving and recovering from COVID-19.

Figure 1:  Presence of Hospitals and ICU beds in Persistent Poverty Counties

Seeking to fill the gap of the health care needs of Deep South communities even before this crisis, HOPE has made more than 30 loans to healthcare providers and helped these providers access an additional $50 million in financing.  Even so, more is needed.

What all of this means now is that we need a robust public health and financial response to ensure the people, community, and institutions in the Deep South can both survive and recover from this pandemic. This includes support for our health care infrastructure and its workers, as well as support to ensure people can stay safe while staying home, and prevent long-lasting financial devastation as result of doing so.  Now is the time to look to the Deep South to understand the depth of what is needed to keep our communities and our country safe.



[1] Cecil G. Sheps Center for Health Services Research. (2020). 170 Rural Hospital Closures: January 2005 – Present (128 since 2010). Retrieved from

[2] Richard Read, “Cash-strapped rural hospitals face ‘imminent closure’ as coronavirus bears down,” L.A. Times, Mar. 25, 2020,; and Olivia Paschal, “COVID-19 exposes the precarious state of rural health care in the South,” Facing South, Mar. 19, 2020,

[3] Samantha Artiga and Kendal Orgera, Key Facts on Health and Health Care by Race and Ethnicity, (Washington, DC: KFF, November 2019),

[4] Centers for Disease Control. (2020). Coronavirus Disease (COVID-19). Frequently Asked Questions. Retrieved from

[5] Data analyzed by HOPE is available by county from Kaiser Health News, based on hospital cost reports filed to the Centers for Medicare & Medicaid Services, available at Data updated as of March 30, 2020.

[6] For each state, we divide the total state population by the total number of ICU beds in the state.

[7] HOPE analysis of counties designated as persistent poverty counties by the U.S. Treasury CDFI Fund, which is a county that has experienced poverty rates of 20% or more for 30 years in a row.

[8] Transforming Persistent Poverty in America: How Community Development Financial Institutions  Drive Economic Opportunity. Partners for Rural Transformation. November 2019.



Diane-Standaert-500x626 - 04 Policy Analyst


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