Noxubee County, Mississippi

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I think the camaraderie and care for another is probably our greatest asset. 

—Dr. Velma Jenkins, Mayor of Shuqualak, Mississippi

Located near the southernmost point of the Appalachian Region, Noxubee County is quiet and sparsely 

populated, with 100 churches and no stoplights. Of the 565 farms in the county, one in five is 500 acres or 

larger. There is a strong emphasis on farming that carries over to individual homeowners. Many families 

grow vegetable gardens, and there are a variety of roadside farm stands where local farmers sell fruits and 

vegetables from the back of their pickup trucks. 

 

Noxubee County has few chain restaurants. Residents turn instead to local places such as the Wagon 

Wheel—a classic Southern “meat-and-three” (a daily selection of meat and choices of side dishes)

restaurant that’s also the cafeteria for Trail Boss Trailers, a local business. But despite an emphasis on 

growing and consuming local food, it is not readily available to all. The county has at least six centers that 

provide summer and after-school meals to children who qualify for free school lunches. In some schools, 

that includes most of the students. 

The vast majority of the county is rural—farms, commercial forests, or undeveloped land. Yet, only 13 

percent of the jobs here are farm jobs. Timbering, logging, catfish farming, and trucking are the main 

economic activities. The big employers are the hospital and the school system, as well as local businesses 

such as the Shuqualak Lumber Company, one of the South’s largest privately owned independent 

producers of southern yellow pine lumber. The company produces over 100 million board feet of lumber 

annually. Still, many workers must commute 60 to 80 miles (round trip) to jobs in another county.

Shuqualak, Mississippi, is one of three sizable communities in Noxubee County.

© Kim Cross 
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Noxubee County is a place of dichotomies where basic utilities may not reach outside city limits, yet 

residents have access to a network of clinics and around-the-clock emergency care. Despite severe 

funding challenges, Noxubee has three health clinics and a robust hospital system with a wound care 

clinic and an infusion clinic. At the same time, many county roads are still unpaved, and some homes lack 

running water and, in the poorest districts, sewage treatment of any kind.

Yet, community leaders and residents are engaged in making Noxubee County a good place to live.

Noxubee County is among the ten percent of Appalachian counties—and one of four counties in

Appalachian Mississippi—identified as a Bright Spot, performing better than expected across 16 of 19 

health outcome measures. Most notably, Noxubee County performed better than expected on the 

following five measures:

 COPD mortality: 56 percent better than expected 

 Heart disease hospitalizations: 44 percent better than expected

 Poisoning mortality: 38 percent better than expected

 Opioid prescriptions as a percentage of Medicare Part D claims: 37 percent better than expected

 Injury mortality: 32 percent better than expected

These better-than-expected results are likely influenced by local conditions and initiatives in the county 

that aim to improve overall well-being. For example, field research indicates that local leaders are coming 

together to address some of the key drivers of health, such as having affordable housing and places to 

play and exercise. Additionally, hospitals, schools and the faith community play a critical role in health 

education and promotion. 

Noxubee County’s classification as a Bright Spot means that, on average, the county performed better 

than expected on a number of health outcome measures, given its characteristics and resources—that is, 

the socioeconomics, demographics, behaviors, health care facilities, and other factors that influence health 

outcomes. It does not mean that all residents here enjoy excellent health. In fact, the county still lags 

behind the rest of the nation on many health indicators. Like other counties with limited resources, Bright 

Spot counties face challenges to attaining good health outcomes. Noxubee County’s performance, 

however, indicates that certain county conditions or programs may be helping generate better-thanexpected outcomes—and that other resource-challenged Appalachian counties may benefit from adopting 

similar initiatives.

1

 

 1 See Table 18 in the data appendix at the end of this case study for a full list of actual health outcomes for Noxubee

County compared with predicted outcomes. For details on the outcome measures, see the data files accompanying 

the report Identifying Bright Spots in Appalachian Health: Statistical Analysis.
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COUNTY OVERVIEW 

Figure 8: Map - Bright Spot Community Noxubee County, Mississippi 

Noxubee County represents a nonmetropolitan county in Southern Appalachia. It is 

one of four Bright Spot counties in Appalachian Mississippi. 

Noxubee has three sizable communities—Macon, Brooksville and Shuqualak—and each has a distinct 

personality. Macon is the county seat and the location of the hospital. Brooksville has a strong Mennonite 

presence, and Shuqualak is a center of lumber production. Eleven unincorporated communities also dot 

the rural landscape. 

Of Noxubee’s 11,240 residents, 71.4 percent are black, and 27.2 percent are white. Nearly 44 percent of 

adults have at least some college education, compared with 63.3 percent nationally. The median 2014 

household income was $28,730, half the national median of $56,135. Unemployment in 2014 was 12.4 

percent, compared with 6.5 percent regionally and 6.2 percent nationally. Just over 30 percent of residents 

live in poverty, compared with 15.6 percent nationally.2

 

 

2

 Table 16 in the Noxubee County data appendix at the end of this case study provides a quantitative profile of 

county characteristics. 

GEORGIA

SOUTH 

CAROLINA

NORTH CAROLINA

ALABAMA

MISSISSIPPI

TENNESSEE

KENTUCKY

OHIO PENNSYLVANIA

MARYLAND

VIRGINIA

NEW YORK

WEST

VIRGINIA

Noxubee County, MS

Northern

Southern

Central

South Central

North Central

0 100 50

Miles
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A DEEPER LOOK AT NOXUBEE COUNTY: COMMUNITY STRENGTHS

As in the other Bright Spot communities explored in this report, people in Noxubee County are making 

the most of available resources and harnessing their collective power to create better-than-expected health 

outcomes. 

Field work helped identify local practices that appear to be contributing to overall health, document 

effective practices that could be replicated in other counties, and identify promising practices and 

strategies that should be explored further.3 Specifically, the research identified these features in Noxubee 

County:

 Community engagement and collaboration: Informal groups—including local leaders, schools, 

and faith groups—collaborate to address nutrition, physical activity, and housing issues. 

 Integration of health services and systems: The medical complex, mental health clinic, and 

general hospital—including its branch clinics—work together to provide vulnerable residents the 

opportunity to access a continuum of preventive and curative care.

 Making health a shared value: Relationships among and between individuals and organizations 

develop and strengthen community values and actions related to good health. Local coalitions and 

religious groups are notable for influencing community culture. Intergenerational discussions 

about good health are common. 

 Resourcefulness: Leaders, churches, and volunteers in this county work hard to continually 

improve the quality of life in Noxubee with a view towards making Noxubee County a good 

place to call home.

Like other Bright Spot counties, Noxubee County has programs and activities in place that fall into four 

overarching categories: leadership, resource sharing, local providers committed to public health, and an 

active faith community.

Community Leaders Engaged in Health Initiatives

In Noxubee County, leaders come from all walks of life, from 

elected officials to faith leaders, and they are both paid and 

volunteer. These important community figures are influencers 

who care deeply about their community. Their propensity for 

resourcefulness enables a community with severely limited 

resources to do a lot with a little. Strong community bonds and 

generosity fill gaps in social services. 

Local leaders focus on the core determinants of health. For 

example, the Noxubee County supervisor and the county’s three

town mayors are collaborating to attract jobs. They are vigilant in 

pursuit of grants. The mayors want to see people buy homes, but 

the lack of resources to build infrastructure and provide 

municipal services limits the supply of good housing. All three 

towns enforce smoke-free ordinances. 

 3 For a full explanation of the methodology, see Appendix B: Research Approach. For a list of key informants 

interviewed for this county, see Table 17 in the data appendix at the end of this case study.

© Kim Cross 

Bob Boykin, mayor of Macon, Mississippi 
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County Supervisor Bo Oliver values educating people about healthy behaviors and exercise. Macon 

Mayor Bob Boykin responded to a community request for a sports complex by developing one that the 

high school shares. Boykin is also actively engaged in efforts to increase participation in the county-run 

farmers’ market. 

Shuqualak Mayor Velma Jenkins is committed to increasing access to affordable housing and housing 

with complete plumbing facilities. Her efforts have resulted in the construction of approximately nine 

brick homes secured through the U.S. Department of Housing and Urban Development’s HOME 

Investment Partnership Program. 

Noxubee County also benefits from other leadership. The county’s 

extension office is relatively new, but one of its first initiatives is 

working to improve obesity rates. Mississippi Homemaker 

Volunteers (MHV) is an all-women’s program of the Noxubee 

County (Mississippi State University) Extension Service with a 

mission “to strengthen families through education and community 

involvement.” MVH clubs have 10–20 members who participate in 

leadership training before volunteering in their local communities. 

They learn about nutrition, diet, exercise, health care, food safety, 

and other health issues, and share this knowledge with their local 

communities. They also sew pillowcases for children with cancer 

and quilts for the Children’s Hospital of Mississippi. Similarly, the 

4H Club puts on programs to raise well-rounded individuals. An 

Alzheimer’s group supports caretakers. A statewide health 

department diabetes collaborative benefits from the insights of a 

leader who has lived in the community all her life. The diabetes coalition, led by Katherine Mickens and 

other key players, works with the extension office to engage the community in discussions on health, 

reaching out through social media, community projects, and health fairs. 

Noxubee County’s black fraternities and sororities also have strong commitments to community 

improvement. For example, Black Ice is a group of men who provide books, supplies, and healthy snacks 

at school. Members also visit classes to discuss the importance of not smoking and of exercising 

regularly.

Resource Sharing 

Noxubee County has a core group of people who are deeply committed to the community. They use and 

combine available resources to share funding, launch local health initiatives, and disseminate information 

about health widely. 

Mayors, schools, small businesses, churches, and food programs tackle the problem of basic nutrition 

together. Mayors pursue and maintain community walking paths, clean water, and affordable housing. 

Schools collaborate with churches to distribute information about health and health programs. The 

hospital also collaborates with churches and schools to sponsor monthly health fairs. The fairs, which 

provide free health screenings for residents, are reportedly popular and well attended. But, as noted in 

other case studies, the fairs do something more critical than providing preventive screenings and health 

information: They convey the message that health is important. When multiple organizational actors 

cooperate to put on a health fair, they nurture the idea that health is something that everyone should value.

Noxubee County middle schools and high schools took advantage of a grant program to develop a 

curriculum that focuses on healthy living. Woven into the regular school day activities, the curriculum

© Kim Cross 

Katherine Mickens, social worker for 

Noxubee General Hospital
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conveyed messages about healthy behaviors and covered topics from eating and physical activity to 

sexually transmitted diseases and the impact of substance use on physical performance. Focus group 

feedback suggested that, while the grant lasted, the program was effective. Unfortunately, after five years, 

local budget cuts meant Noxubee County schools could not sustain the program. 

Resource sharing is particularly evident among the county’s churches and its female leaders. Their

resourcefulness enables a community with severely limited resources to do a lot with a little. Strong 

community bonds and generosity often fill vast gaps in social services. 

Information is another community resource that is shared broadly, including across generations. Children 

share with older generations the information about good health habits they learn in school, and elders 

teach children with both words and examples about living healthfully so as to prevent chronic disease. 

Local Providers Committed to Public Health 

The local health department provides a range of services, including preventive care for low-income 

residents, communicable disease control, and diabetes education. Additionally, the Mississippi 

Department of Health sponsors multiple community initiatives to promote and improve health.

With a staff of 170 full-time and part-time employees, the Noxubee Medical Complex has a strong 

community presence, providing services across five facilities: Noxubee General (a critical access 

hospital); a nursing home located adjacent to the hospital; a primary care clinic also adjacent to the 

hospital; and two other clinics in the county. 

Because the hospital also owns the adjacent health clinic, emergency room (ER) staff can redirect noncritical ER patients there, reducing costs for both the patients and the hospital. Patients pay according to a 

sliding fee scale. And for those who can’t pay, it is less costly to provide care through the clinic than the 

ER.

On days that aren’t busy, hospital administrator Danny McKay 

sends hospital staff to a public place such as the grocery store to 

offer free blood pressure checks for the community. “It helps 

them, and it helps us, too,” he said. The hospital’s next focus is 

on chronic care management.

According to McKay, health behaviors are largely reactive—

conversations and actions are usually in response to an illness or 

ailment. Interviews also showed that, in Noxubee, family values 

and strong intergenerational ties play a major role in determining 

what happens around health decisions. Some rely on the head of 

the household to make decisions, while others turn to female 

family members, and others said they hold a family council to 

make decisions. For the most part, preventive care comes in the 

form of health screenings, which are well attended, and often 

provided free of charge.

The Noxubee Medical Complex describes itself as a “comprehensive health care system” that strives to 

provide diversified services, including primary care, some specialty services (radiology, speech therapy, 

occupational therapy), and skilled nursing for short-term rehabilitation. Physician rotations through 

Noxubee General Hospital provide opportunities for patients to consult specialists in cardiology and 

podiatry. 

© Kim Cross 

Danny McKay, administrator of Noxubee 

General Hospital
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As McKay put it, “The basic rule is, if there is anything that goes on in this community in regard to health 

care, and we are not involved, then we are missing the boat; we try to be very engaged and involved in 

anything that has to do with health care.” 

Another noteworthy feature of the hospital is its local reputation as a homegrown institution. Beverly 

Clark, the hospital’s director of nurses and a Noxubee native, spoke of the connection between the 

hospital and the community: “I was born in this hospital and raised 15 miles from here . . . when I walk 

into this place, it is like walking into my house. This hospital is home.” 

The county has three primary care medical clinics associated with the hospital, one in Brooksville and 

two in Macon. The clinics associated with the hospital provide urgent care, even on holidays. When 

inpatient care is slow, the hospital diverts inpatient staff to the clinics for preventive care.

What blew my mind is that [the clinics] are actually open on holidays. That would give a 

person access to health care seven days a week, 24 hours a day. Again, I’m not a health 

care expert. I didn’t think we needed a new clinic . . . little did I know that health clinic has 

been the salvation and the savior for our hospital. – Macon Mayor Bob Boykin

The state’s decision not to expand Medicaid limits what the hospital can do. It strains to stay financially 

strong while serving many working poor who need but cannot afford services. During field research, key 

interviewees spoke highly of the hospital and the clinics, hoping to see them grow. 

Reaching beyond inpatient, outpatient, and 

emergency care, Noxubee General Hospital has an 

infusion center and a wound center. The hospital 

does not offer obstetrical care because it cannot 

meet the requirements to cover 24/7 calls. It 

supports an Alzheimer’s group and a nutrition 

clinic. The Noxubee Medical Complex self-funds 

employee health insurance and charges higher 

premiums to smokers. When the hospital 

encouraged a walk-a-thon, the whole community in 

Macon was out walking. Still, the hospital finds 

preventive care challenging. Its diabetes prevention 

class struggles; while 50 to 60 people may sign up,

only about five graduate.

Clark also notes that she spends so much time taking care of people who are sick that there is little time to 

think about or plan preventive programs to keep people healthy:

You want to keep people healthy . . . but then you spend so much time taking care of them 

that it is hard to reach out into the community and do prevention. I think now we are taking 

a lot of steps to try to keep people healthy—calling the patients and reminding them of 

appointments and making sure they get their health screenings and making sure they went 

and picked up their medicines at the pharmacy. Staying healthy is the main thing.

–Beverly Clark, director of nurses, Noxubee General Hospital

Noxubee County’s better-than-expected Medicare depression rates may be, in part, attributable to 

Noxubee General’s therapeutic daycare programs for senior adults, the county’s senior centers, and the 

high proportion of seniors who are active in local civic organizations. It may also reflect what appears to 

be a high degree of intergenerational extended families in Noxubee. Further, Noxubee’s mental health 

© Kim Cross 

The Noxubee County courthouse
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program, Region 7 Community Counseling Services, has been around for more than 25 years and 

provides counseling for residents of all ages, from young children to seniors. Many interviewees had high 

praise for its counseling service work with the schools. Headquarters for the services, the Region 7 

Community Mental Health Center, are state funded and located outside Noxubee County in West Point. 

During field work for this report, similarly strong ties were observed between nonprofit hospitals and 

local communities in other Bright Spot counties, including Madison, Wirt, Grant, Potter, and Hale. In 

each case, the hospital was strongly identified with the community. From the hospital side, this meant 

prioritizing local health needs over the economic interests of distant shareholders. From the patient side, it 

meant patients have feelings of trust and familiarity, which can reduce barriers to seeking care. This sense 

of identification with a major care provider, and the trust it engenders, are elements of a culture of health 

that warrant deeper exploration in future research.

Although the qualitative field work conducted for this report makes causal inferences impossible, 

Noxubee’s better-than-expected poisoning and injury mortality rates may be associated with the 24/7/365 

availability of emergency medical services provided by Noxubee General Hospital. First-response help is 

also available at Noxubee’s Brooksville clinic, at the Greater Meridian Health Clinic in nearby 

Lauderdale County, and, until recently, at the Shuqualak-Noxubee Health Center, a Federally Qualified 

Health Center that benefits from annual federal operating grants and offers a sliding fee scale for 

medications.

Active Faith Community

Well, it’s a lot of faith-based, a lot of church-based, organizations. Because everybody

knows everybody . . . and so it is sort of like the family ties. Even though it’s not family, it’s 

still like one huge family. – Macon Mayor Bob Boykin

Churches are among the county’s most important organizations. They serve not only as places of worship, 

but also as civic centers; sources of financial, social, and emotional support; political mobilizers; and 

disseminators of information. Most of Noxubee County’s 100 churches are small, but they pitch in when 

a situation requires pooled resources. Churches attract significant regular attendance, and they band 

together, organize, and take action through an interfaith organization in which pastors collaborate to work 

on community issues. Because they are hubs of social engagement and connectedness, they are also a 

means of communication for community initiatives.

I think that most people look to their church for information and guidance. Some churches 

have newsletters; some churches have clerks. But most of it is word of mouth from 

announcing clerks—a person in the congregation who is responsible for getting all of those 

announcements together and to the church. – Josephine Tate, state extension agent

Noxubee County has at least half a dozen locations, at churches and community centers in the three large 

towns and in rural communities, where low-income children can find a nutritious meal. The churches 

provide after-school food programs, and there are in-home food services for families with more than six 

children. Churches also provide support for seniors.

Noxubee County is also very volunteer-minded, a culture that is shared and exemplified by the area’s 

Mennonites. Mississippi has the third-largest Mennonite population in the nation, and there are about 600 

Mennonite households in the greater Macon, Brooksville, and nearby Geiger (Alabama) area. 
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Mennonites were attracted to the rich farmland in the 1950s. They are community minded, bring 

a strong work ethic, and engage in economic development, including the catfish farm, tomato

house, and farmers’ market. Mennonites now represent thousands in the population. 

–Danny McKay, administrator, Noxubee General Hospital

As a matter of religious teaching, Mennonites generally abstain from smoking and drinking. They 

cultivate an agriculture-based lifestyle that emphasizes physical work and consumption of a natural diet. 

The church also embraces the belief that caring for the health of others, especially the most vulnerable, is 

a shared responsibility. The Mennonites have a distinct culture of health of their own. Given their 

considerable presence in Noxubee County, they may be affecting health outcome measures at the 

population level.

CREATING A CULTURE OF HEALTH IN NOXUBEE COUNTY 

Noxubee County’s actions indicate that county leaders and residents place a high value on health, as 

reflected in the wide range of health education programs available and the appreciation for health 

education and health care services shown by county residents. Elected officials and a strong network of 

faith leaders, in particular, seek to share information about and encourage good health practices. 

Strong leadership has helped Noxubee focus on the core determinants of health. For example, public 

officials are collaborating to attract jobs and promote homeownership, despite a lack of resources. 

Noxubee County has a core group of people who work with the range of available resources to improve 

health countywide. Participation in community life stems from strong individual relationships and social 

connections that people form with one another; these connections lead people to participate in 

volunteering, collaborating, and coalition building.

This persistent struggle toward a better life is a defining trait in Noxubee County. It harnesses its 

collective strengths, from the resilience and spirit of its residents to the dedication and engagement of its 

leaders, to ensure that limited resources are stretched as far as they can go, that creative solutions are 

found when resources run out, and that a focus on health and well-being remains a priority for all.
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REFERENCES

Agency for Healthcare Research and Quality. 2011. “Chapter 9: Access to Health Care, 2011 National 

Healthcare Quality Report.” Agency for Healthcare Research and Quality.

https://www.ahrq.gov/research/findings/nhqrdr/nhqr11/chap9.html

Holmes, G. Mark, Nancy M. Lane, Thomas A. Arcury, Michael L. Schawlbe, Randy Randolph, John 

Frank, Sharita Thomas, et. al. 2018. Identifying Bright Spots in Appalachian Health: Statistical Analysis. 

Washington, D.C.: Appalachian Regional Commission.

Marshall, Julie L., Logan Thomas, Nancy M. Lane, G. Mark Holmes, Thomas A. Arcury, Randy 

Randolph, Pam Silberman, et al. 2017. Health Disparities in Appalachia. Washington, D.C.: Appalachian 

Regional Commission. 

Noxubee County Economic and Community Development Alliance. 2017. Noxubee County History.

February 14. Accessed 2017. 

http://noxubeealliance.com/ 
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APPENDIX: NOXUBEE COUNTY DATA

Table 16: Noxubee County Characteristics 

Characteristic Noxubee County United States

Population, 2010–2014 11,240 314,107,084

Percent population change, 2010–2015 -4.3% 4.1%

Median age, 2015 36.6 37.8

Percent of persons over age 65, 2015 16.0% 14.9%

Median household income, 2014 $28,730 $56,135

Per capita income in past 12 months, (in 2015 

dollars), 2011–2015 $14,450 $28,930

Unemployment rate, 2014 12.4% 6.2%

Percent persons in poverty, 2014 31.3% 15.6%

Percent white alone, 2015 27.2% 77.1%

Percent black alone, 2015 71.4% 13.3%

Percent adults with at least some college, 2010–

2014 43.79% 63.27%

Distance to nearest large population center from 

county center Columbus – 27.3 miles N/A

ARC designations, fiscal year 2017 Distressed

Southern Appalachia N/A

Source: These data are compiled from the U.S. Bureau of Labor Statistics, Local Area Unemployment Statistics, 

2014, and the U.S. Census Bureau American Community Survey Selected Social Characteristics, General Economic 

Characteristics, Demographic and Housing Characteristics, and Educational Attainment Tables for years 2010–2014 

and 2011–2015.
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Table 17: Noxubee County Key Informants

Name Location Title Organization Interview 

Date

Bob Boykin Mayor’s Office, 

Macon Mayor of Macon Town of Macon 9/15/16

Velma Jenkins Courthouse Macon Mayor of Shuqualak Town of Shuqualak 9/19/16

Bo Oliver Supervisor’s Office County Supervisor Noxubee County 9/19/16

Josephine Tate Office

State Extension 

Agent, Health 

Education

USDA Extension 9/19/16

Beverly Clark Noxubee General 

Hospital Director of Nurses Noxubee General Hospital 9/20/16

Danny McKay Noxubee General 

Hospital Administrator Noxubee General Hospital 9/20/16

Katherine Mickens Noxubee General 

Hospital Social Worker Noxubee General Hospital 9/20/16

Reecy Dixon Mississippi State 

Extension Office

Former State 

Legislator Retired 9/15/16

Les Decker Mississippi State 

Extension Office

Organic Farmer, 

Baker Self Employed 9/15/16

Walden Peasler Mississippi State 

Extension Office Aquaculture Self Employed 9/15/16

Dordil Stuart Mississippi State 

Extension Office Principal Noxubee County High School 9/15/16
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Table 18: Noxubee County Health Outcomes – Actual vs. Predicted

Outcome Measure Actual Predicted

Percentage 

Difference

(negative = 

better)

COPD mortality per 100,000 people, 2008–2014 26.70 60.40 -55.8%

Heart disease hospitalizations per 1,000 Medicare 

beneficiaries, 2012 28.50 51.00 -44.1%

Poisoning mortality per 100,000 people, 2008–2014 8.69 14.05 -38.1%

Opioid prescriptions as a percent of Part D claims, 

2013 3.97 6.31 -37.1%

Injury mortality per 100,000 people, 2008–2014 43.11 63.53 -32.1%

Percentage of Medicare beneficiaries w/ depression, 

2012 9.70% 13.42% -27.7%

Suicide mortality per 100,000 people, 2008–2014 10.91 14.02 -22.2%

Years of potential life lost, 2011–2013 10,274 12,284 -16.4%

Low-birth-weight births (<2,500g) per 1,000 births, 

2007–2013 11.96 13.18 -9.3%

Cancer mortality per 100,000 people, 2008–2014 206.84 224.57 -7.9%

Average Medicare condition score, 2013 0.905 0.979 -7.6%

Stroke mortality per 100,000 people, 2008–2014 52.86 56.29 -6.1%

Physically unhealthy days per month per person, 2014 5.00 5.22 -4.3%

Infant mortality per 1,000 births, 2008–2014 10.68 11.14 -4.1%

Mentally unhealthy days per month per person, 2014 4.60 4.66 -1.4%

Heart disease mortality per 100,000 people, 2008–

2014 296.45 292.61 1.3%

Percentage of excessive drinkers, 2014 10.20% 9.98% 2.2%

Percentage of obese adults (>30 BMI), 2012 41.8% 37.4% 11.7%

Percentage of adults with diabetes, 2012 19.00% 16.73% 13.6%

Notes:

Percentage Difference = 100 * [ (Actual / Predicted) – 1]

Green = County value was better than predicted

For details on the outcome measures, see the data files accompanying the report Identifying Bright Spots in 

Appalachian Health: Statistical Analysis.
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Table 19: Noxubee County Health Drivers vs. National Median

Driver Measure Lower is 

Better?

National 

Median

Noxubee 

County

Air pollution (average daily particulate matter 2.5), 

2011 Yes 11.87 12.63 

Average travel time to work in minutes, 2010–2014 Yes 22.82 27.21 

Chlamydia incidence rate per 100,000, 2013 Yes 287.16 891.42 

Dentists per 100,000 population, 2014 No 37.45 17.99 

Economic index, fiscal year 2017 Yes 108.79 201.84 

Full-service restaurants per 1,000, 2012 No 0.68 0.09 

Grocery stores per 1,000 residents, 2012 No 0.20 0.36 

Median household income, 2014 No $45,226.00 $28,730.00 

Mental health providers per 100,000 population, 2015 No 80.00 126.58 

Percentage of adults currently smoking, 2014 Yes 17.8% 24.4%

Percentage of adults not physically active, 2012 Yes 27.7% 39.7%

Percentage of adults with at least some college, 

2010–2014 No 56.3% 43.8%

Income inequality ratio,4 2010–2014 Yes 4.4% 5.1%

Percentage of diabetics with A1C testing, 2012 No 85.4% 92.9%

Percentage of doctors who e-prescribe, 2014 No 65.0% 77.0%

Percentage of eligibles enrolled in SNAP, 2014 No 78.0% 72.0%

Percentage of households with income below poverty, 

2014 Yes 15.8% 31.3%

Percentage of Medicare women with recent 

mammogram, 2013 No 61.0% 53.0%

Percentage of population with access to places for 

physical activity, 2011 and 2014 No 61.9% 35.7%

Percentage of total population in social assistant jobs, 

2013 N/A 0.01% --

Percentage receiving disability OASDI and/or SSI, 

2014 Yes 5.4% 14.7%

Percentage spending >30% of income on housing, 

2010–2014 Yes 29.0% 41.2%

Percentage w/ no car, low access, 2010–2014 Yes 19.7% 15.9%

Primary care physicians per 100,000 population, 2013 No 48.54 9.02 

Social associations per 10,000 population, 2013 No 12.68 13.53 

 4 Income inequality is the ratio of household income at the 80th percentile to that at the 20th percentile. A higher 

ratio reflects greater division between the top and the bottom of the income spectrum.
CREATING A CULTURE OF 

HEALTH IN APPALACHIA Noxubee County, Mississippi | CASE STUDIES

93

Driver Measure Lower is 

Better?

National 

Median

Noxubee 

County

Specialist physicians per 100,000 population, 2013 No 25.93 8.90 

Students per teacher, 2013–2014 Yes 14.13 --

Teenage births per 1,000, 2007–2013 Yes 39.96 71.55 

Uninsured rate for people under 65, 2013 Yes 17.24 23.99 

Notes:

Green = County value was better than national median

For details on the driver measures, see the data files accompanying the report Identifying Bright Spots in 

Appalachian Health: Statistical Analysis.