The United Health Foundation places Arkansas 49th among the 50 states in overall health and 43rd when it comes to premature deaths. In an effort to better understand the challenges facing Arkansans, a new University of Arkansas dashboard can help us understand the numbers and trends behind health. The dashboard is fueled by the Arkansas Health Survey. Lead researcher for that survey is Michael Niño, an associate professor of sociology and criminology at the University of Arkansas. He says his role as a medical sociologist and social demographer led him to the project.
Niño: When I first started to really think about what it would look like to meaningfully understand and address health disparities in the state, it became very clear to me that we didn't have the public health data infrastructure to really do that. So we embarked on this effort of sending out 70,000 invitations to adult Arkansans in all 75 counties and asked them to participate in the Arkansas Health Survey. And that process resulted in a final sample of 9,932 adults in all 75 counties. Those are complete responses, and they're weighted to the adult population, making it the largest population health survey in the state's history. Because the invitations that we sent out were mailed, when folks completed the survey, they confirmed their address on the front end. So all of our responses are geolocated. And so we can use those geolocated responses and anchor them with data from the U.S. Census to create representative and reliable estimates at both the county and census tract levels. Census tract levels function like neighborhoods. Approximately 2,000 people live in a census tract. And they're much more meaningful than zip codes, because that's how we actually distribute federal and state resources. You'll often hear where you live matters, your zip code matters, when we look at this from a federal-state kind of policy-making perspective. Census tracts matter much more to legislators. And so that's why we decided to use census tracts rather than zip codes when looking at stuff on the dashboard.
Kellams: Sure, a zip code could have one person who lives within a quarter mile of a grocery store and, especially in rural Arkansas, someone who lives more than 10 miles from a grocery store.
Niño: Yes, absolutely. The same is also true for a census tract. The important thing to note about zip codes is that they overlap across counties. So you could live in a zip code that is in both, say, just as an example, Madison and Benton County, whereas census tracts are just within counties. And so most people, when they're looking at planning and programming, they're thinking about counties. And so if you wanted to look within them, the best way to do it is census tracts.
Kellams: Some of the information that has come through that survey is tobacco use, dangerous alcohol use, drug overdoses. I was going through some of these maps, and I end up with more questions than answers from this.
Niño: Yeah, absolutely. I think that's why we really wanted to put together a project that allowed us to look at the variation across the state. We know that these patterns are unequally distributed in different areas, and depending on the outcome that we're looking at, you might see more prevalence in one region rather than another. So if you begin to look at the maps, even at the county level, you'll see much higher prevalence of hazardous alcohol use in Northwest Arkansas, in central Arkansas.
Kellams: It was around the urban areas.
Niño: Totally. And then if you start to look at things like cardiometabolic risks — so these are things like obesity, hypertension, diabetes, high blood sugar — we see high concentrations in the Delta region. We also see some higher concentrations in certain pockets of central Arkansas. So what the survey and the dashboard help us do is really begin to understand where prevalence is concentrated, so we can really begin to think about where do we need to put resources and what kinds of interventions and programs we need to put in place.
Kellams: People who can use the dashboard seem to go from health officials, policy makers, journalists.
Niño: Absolutely. We would like everyone to use it. To me, this helps us tell the story of Arkansas, both good and bad. Where anyone — a concerned citizen — may want to say, well, what's going on in my particular county? What's going on with obesity? What's going on with depression? What's going on with tobacco use? To begin to think of, well, how can I also advocate for my community? Even outside of legislators and nonprofits and foundations that have been doing this work for decades, just individual residents in Arkansas — to begin to provide them with the evidence to advocate for themselves in their own communities. So as the dashboard gets rolled out throughout the state, what we hope to do is provide workshops to people, all people, so that they can really begin to think: how could they use this for themselves and their communities? Because what we know is that they really know what they need. And so we can help people understand where prevalence is concentrated. But outside of that, really going into these communities and not assuming what they need, but going in there and saying, OK, now we know there's a high prevalence of depression in this area. What is it that you think you need, and what do your community members need in order to actually make marked improvements in depression?
Kellams: Yeah, the questions that come up — there's one North Arkansas county where, with the tobacco use, the majority of that county is about what you would call the Arkansas average, and then there's one census tract, just one at the top of that county, that is heavy tobacco use. And I just want to go there and say what?
Niño: Yeah. And what the dashboard can help us understand is when you go into that particular county and you click on that particular tract, you can compare that tract to three other tracts. And when you do that, it will give you all sorts of estimates — outside of tobacco — depression, alcohol use, hypertension, diabetes, but also poverty, SNAP benefits, Medicaid, single-family households. So all of the potential underlying social mechanisms that might potentially explain some of these patterns are also in the dashboard. So what it helps us do is begin to organize a story around who lives in this particular region, and why is it so different than the tract right next to it. And this really is just kind of the beginning, because what we can do — because these data are geolocated — is we can overlay other types of data on top of it. So if you wanted to know, say, for instance, where all the grocery stores are in an area, or where all the hospitals or the community clinics — anything that has an address attached to it, we can overlay those data — so that we can really begin to provide communities with very granular, nuanced information about the social support networks, access to care and other resources folks might need to actually improve their health.
Kellams: In an announcement about the dashboard's unveiling, what I thought was a stunning figure: Arkansas loses an estimated 11,384 years of potential life annually for every 100,000 residents under age 75.
Niño: That's a big number. Our state ranking in terms of premature death is 43. It has been that for a very long time. I think the folks that have been working in these areas for decades have become frustrated knowing that they have invested time and effort into really trying to make marked improvements in overall health in the state, and we continue to see this ranking near or at the bottom. Underneath that number of over 11,000 years of potential life loss — these are years of life lost with the people that we love, years of life lost with our neighbors, years of life lost contributing to the workforce, contributing civically and socially to communities. That's really, at least for me on a personal level, why I decided to embark on this effort. I grew up in the Texas Panhandle, working-class family. My parents were the first in their families to graduate from high school. My grandparents had a less than third-grade education, and the people around me as I was growing up were living with and dying from chronic diseases that were preventable, and they were dying much sooner than they should. And so you can go around the state and ask people, do you know people who died much sooner than they should? And did they die from a disease that was largely preventable? And in most cases, people will say yes. And so to me, it's about trying to figure out where is there high prevalence of these preventable diseases or behavioral health conditions that also contribute to these preventable diseases, and finding ways to actually reduce these particular chronic conditions, so ultimately we can actually improve that premature death ranking.
Kellams: The health survey is great. You need software to put something like this together. Where do you get the software? How does that exist?
Niño: We worked with a company, CAP Index. CAP Index is a global company that works on risk and loss prevention for Fortune 500 companies. So you can think of a Walmart or a Target or any kind of large retailer. And when they're thinking about risk assessments or thinking about the built environment and what might be driving theft in an area, or just kind of keeping an area secure so people can go in and feel safe — they build these wonderful interactive dashboards. And so we partnered with them, provided them with all of the data and worked really closely with their developers to build this dashboard that is now free and publicly available.
Kellams: You mentioned you want everyone to use it, and there will be workshops through the summer. May 30, there's a webinar that can help people get started.
Niño: Yes. May 30, we will provide a webinar through our communications office through Fulbright College, so that if folks are interested in understanding how to log in, how to begin to play with it, and then really begin to think of, well, what are the questions that are most important to me, and how could I use this to answer them? And then from there, begin to think about what's next. Now that I know this information, what do I do with it? What do I do with it?
Kellams: I mean, the work is not done.
Niño: No, it's just the beginning.
Kellams: I imagine there are going to be people using this over the rest of 2026 saying, hey, what about this, or could you do this? And there will be people saying, whenever the next survey comes, I want you to ask about that.
Niño: So that's what we hope — that it leads to more questions, more pressure on public officials, more organizing. To me, the dashboard can help us organize ourselves around particular issues. If we know that cardiovascular disease is the No. 1 killer in the state, and we know there's high prevalence of cardiometabolic conditions in a particular region, how can we organize coalitions around this, knowing where high prevalence is concentrated and what is necessary in order to make meaningful reductions in prevalence for those conditions? That's really the real value of the dashboard.
Kellams: I was looking at it thinking, I'd like to know about oral health and access to dentists. I'd like to know about all sorts of things.
Niño: So that's actually great. We received a grant from the Delta Dental Foundation for year two. And so we will include an oral health module in the survey. What we also plan to do is expand the maternal health module. We included a maternal health module in year one — it's not in the dashboard, but we will expand it. And if you combine responses from year one of the Arkansas Health Survey with year two, we can create a separate dashboard just on women's and maternal health. So we'll be the first state in all of the United States to have a dashboard that's very similar to this one, but focused purely on women's and maternal health.
Kellams: And I remember when the health survey was first coming into fruition — we were one of the very few states that did something this vast.
Niño: California is the only state in the U.S. to have something this vast until we started. So we're the second in all of the U.S. to have a continuous health monitoring survey of this magnitude. What separates us from California is that the dashboard we've provided gives much more nuanced data to the public. We combine 26 different indicators from the Arkansas Health Survey with 10 different indicators from the American Community Survey — those data are from the U.S. Census — and bring them all into one place. A key feature of the dashboard that I haven't mentioned is that you can look at the relationship between two indicators spatially. So if I wanted to look at the relationship between tobacco use and cancer, I can actually look at that relationship at both the county level and census tract level to see where the highest prevalence of those two indicators meet spatially. Beginning to really think about — is there a connection between, say, gender and depression in a particular area? You could do that. Or poverty or food insecurity and any other kind of health indicator. The dashboard will allow you to do that.
Kellams: Over time, will this give us metrics on how we're doing?
Niño: Yes. We plan to administer the Arkansas Health Survey every year, and we can update the dashboard as we go. So you can imagine we'll have year one estimates, year two estimates, year three estimates, and we can track whether or not improvements are being made. And because the dashboard was built by CAP Index using an open-access software, everything is modular. We can just add different boxes to it, add different components to it. It's kind of endless.
Kellams: You can go to uaheal.uark.edu to see some of these maps we've talked about and learn more.
Niño: Yes. If you go to my lab's website — the Arkansas Health Equity and Access Lab — there are different links at the top: one to the Arkansas Health Survey, which will give you more information about the survey and how we collected the data and the survey instrument itself. And then if you go to AR-COMPASS, it will take you to the landing page, give you information about the dashboard and its features, how to log in, and then give you several opportunities to actually go to the dashboard and start to play around.
Kellams: This is a sort of project that you can become completely immersed in. Some people could become obsessed with it. Can you back away? Can you take some time off?
Niño: No. To me, this is probably the privilege of a lifetime. I have the opportunity every week to speak to people who have been working on the ground in their communities, trying to improve the health and well-being of people throughout the state. There's a lot of suffering in this state, but there are also a lot of really wonderful, deeply committed, very smart Arkansans getting up every single day to do this. And we're going to help them. This is what I'll spend the rest of my career doing.
Kellams: Michael, thanks for your time.
Niño: Yeah, absolutely. Thank you.
Michael Niño is an associate professor and chair of the Department of Sociology and Criminology at the University of Arkansas and lead researcher for the Arkansas Health Survey. More about the survey and the dashboard can be found at uaheal.uark.edu. Our conversation took place yesterday.
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