Advancing an Age-Friendly Ecosystem in Mississippi

Abstract

Over the past 4 years, a partnership between the Mississippi State Department of Health (MSDH), the Mississippi Public Health Association (MPHA), and AARP Mississippi has been systematically and intentionally building an age-friendly ecosystem for Mississippi. Using the Collective Impact Model and the Age-Friendly Ecosystem framework, Mississippi has implemented evidence-based activities and strategies to advance and strengthen systems and policies related to healthy aging. A movement is growing to include all sectors such as healthcare, education, faith-based communities, cities/counties, public health, nonprofits, and community-based services, with a goal of making Mississippi, the state with the lowest life expectancy, an age-friendly state.

Key Words

age-friendly, public health, collective impact, ecosystem, multisectoral collaboration, aging, and community

In 2024, the Centers for Disease Control & Prevention (CDC) reports indicated that Mississippi’s life expectancy is the lowest in the United States, ranking 51 among 50 states and the District of Columbia, with an average life expectancy at birth of 71.9 years in 2020. This demonstrated a decline from 2019, when the state’s average life expectancy at birth was 74.4 (Arias et al., 2022). While life expectancy declined nationwide, Mississippi is especially affected by economic instability, limited education access and quality, and inadequate healthcare access and quality. Variable neighborhood and built environments and overall social and community challenges are the major driving factors in the state’s decreased life expectancy (U.S. Department of Health and Human Services, n.d.).

Concrete examples of these challenges include the percentage of people (19.2) in the state who live below the federal poverty level, second only to the neighboring state of Louisiana. The leading cause of death in Mississippi is heart disease, followed by cancer and chronic conditions that disproportionately affect older adults (Mississippi State Department of Health, 2023a).

Finally, Mississippi has the highest firearm injury death rate of 33.9 per 100,000 people, with firearm suicide rates highest among adults ages 75 and older. The state also has the highest homicide death rate in the nation, of 20.7 deaths per 100,000, more than 11 times the nation’s lowest rate of 1.8 deaths per 100,000 in New Hampshire (CDC, 2022). Following on the heels of COVID-related deaths, these challenges affect people of all ages.

These stark realities, along with an increase in the older adult population from 12% in 2000 to 17% in 2022 (White et al., 2024), are a call to action for the state to ensure it is dedicated to improving the life expectancy of all Mississippians, while making aging as healthy as possible. The call to action to promote healthy aging requires all sectors’ attention in the Age-Friendly Ecosystem. With this backdrop, Mississippi leaders began a body of work to ensure the state’s older adult population is front and center in longevity discussions.

Over the past 4 years, a partnership between the Mississippi State Department of Health (MSDH), the Mississippi Public Health Association (MPHA), and AARP Mississippi has worked to systematically and intentionally build an age-friendly ecosystem for Mississippi. The foundational work began with a vision from a public health leader in the state and grew into the current work ensuring that Mississippi is an age-friendly state, as evidenced by ongoing and dedicated commitment to the sectors described in the Age-Friendly Ecosystem model developed by The John A. Hartford Foundation—healthcare systems, public health systems, employers and businesses, universities, cities/communities/states, and home- and community-based services (The John A. Hartford Foundation, n.d.). A graphic illustration of the ecosystem can be viewed at https://www.johnahartford.org/grants-strategy/current-strategies/age-friendly/age-friendly-ecosystem.

Hearing from Different Voices Using the Collective Impact Model

The Collective Impact Model was chosen to guide the multi-year phases of Mississippi’s age-friendly work, because it created “a network of community members, organizations, and institutions who advance equity by learning together, aligning, and integrating their actions to achieve population and systems level change” (Collective Impact Forum, n.d.)

There are five components to the Collective Impact Model, with equity serving as a key piece, as it permeates all work done under this framework. According to Collective Impact Model recommendations, Mississippi has embedded equity by grounding the work in data and context, and targeting solutions (specifically examining disparities); focusing on systems change, in addition to programs and services (the sectors in many ways represent the systems); shifting power within the collaborative; listening to and acting with each sector; and building equity leadership and mutual accountability for long-term sustainability.

As applied to advancing an age-friendly ecosystem in Mississippi, the components and strategies include:

• A common agenda developed to ensure Mississippi becomes an age-friendly state, guided by an advisory council of multisectoral leaders and organizations with a mission to support individuals as they age and their caregivers. This agenda acknowledges disparities in the state and recognizes assets that local communities can bring to the table.
• Established shared measurement by developing a work plan that is reviewed annually, as well as a partnership between the MSDH and the University of Massachusetts at Boston that resulted in developing a Mississippi Healthy Aging Data Report (Mississippi State Department of Health, 2023b). This report provides information about older Mississippians’ health, including 82 county profiles with 125 indicators for each county and 125 ranked and alphabetized maps showing community rates for each indicator. Hard copies of these data reports have been distributed to each elected official at the county and city level throughout the state. This component helps to ground the work in data and provide context.
• Mutually reinforcing activities have been identified so work with engaged leaders in each of the sectors can occur simultaneously. Sectors continue to be developed and to mature, but early adopters have collaborated with statewide efforts and the workplan to ensure their activities address their communities’ needs and contribute to the success of the comprehensive statewide work.
• Continuous communications are planned to strengthen relationships and bolster trust among sectors. These communications are mutually implemented by the MSDH, AARP MS, and the MPHA, and have included annual summits, webinars, regional meetings, and email communications. The communications work also includes listening and encouraging local decision-making.
• A strong backbone organization is the MSDH Office of Community Health Improvement. This office is kept informed by an Advisory Council representing a cross-sectoral collaboration from public health, healthcare systems, aging services, community-based organizations, transportation, education, faith communities, libraries, and others dedicated to the advancement of the health and well-being of older adults.

Call to Action from Cross-Sectoral Partners

Using the Age-Friendly Ecosystem Model described earlier, Mississippi strategically plans events and activities to engage all cross-sectoral partners. An Annual Healthy Aging Summit, which began in May 2023, is held during Older Americans Month, and focuses on the roles of various sectors in the age-friendly ecosystem. These summits educate those who may be new to this work, provide best and emerging practices from representatives of the sectors of focus for each summit, and offer networking opportunities to facilitate new partnerships among sectors. Each summit ends with an update to the statewide work plan and calls to action for desired next steps. Examples from the past 2 years of Healthy Aging Summits illustrating this component of the work include:

• The inaugural Healthy Aging Summit on May 4, 2023, focused on educating leaders and those working with older adults in the state on the meaning of the term “age-friendly” and how to incorporate their passion for older adults into making Mississippi an age-friendly state. Speakers from Trust for America’s Health (TFAH) and The John A. Hartford Foundation provided a national perspective, encouragement, and tools for Mississippi to use in developing the work. The state’s first Healthy Aging Report and County-Level Data Profiles, as developed by the University of Massachusetts Boston, were spotlighted, and participants engaged in an interactive process to learn how to access and utilize the data. Breakout sessions focused on the clinical community, faith community, and education and outreach. Notes from the summit were used to update the state’s age-friendly public health system work plan (Age-Friendly Public Health System for Mississippi, 2023).
• The second annual Healthy Aging Summit on May 2, 2024, zeroed in on equitable age-friendly communities and AARP’s model of healthy aging, walkability, and livability. A panel on policy included mayors from age-friendly cities and communities, the Mississippi Center for Rural Health, and the Mississippi Municipal League. This panel discussed ways in which age-friendly strategies are being implemented in local communities and best-practice strategies for success in rural areas. Another panel on the Age-Friendly Ecosystem included representatives from an age-friendly university, an age-friendly community in the Mississippi Delta, an age-friendly health system, home- and community-based services, and community health workers who discussed each of their sectors’ journeys to date.

Additional initiatives in Mississippi include the development of a Healthy Aging Champions program in which volunteers learn about healthy aging topics and share that information with their families, churches, and local communities. Healthy Aging Champions bring important and accurate information to local communities across Mississippi, and they network with each other to share best practices. At the writing of this article, Mississippi has 55 volunteer Healthy Aging Champions.

Communication, education, and outreach also occur through various means such as webinars, in-person regional meetings, emails, and a special issue of the Journal of Public Health in the Deep South (JPHDS), the official journal of MPHA (https://scholarsjunction.msstate.edu/jphds). The JPHDS is a peer-reviewed, open-access, online journal focused on disseminating high quality research and/or effective applied techniques to academics, educators, and practitioners. JPHDS is the first publication to specifically focus on public health issues in this geographical space, with an appeal to research and applied public health professionals and educators. A special issue on Healthy Aging was published in August 2024.

Next Steps, Approaches, and Advice to Others

In addition to continuing to advance Mississippi’s Age-Friendly Ecosystem, leaders plan to expand into another key focus area this coming year. Because more than half of Mississippi residents live in rural communities, the annual Healthy Aging Summit planned for May 2025 will focus on the rural nature of our state and how healthy aging efforts can better support rural older adults and their families. The ongoing work plan will be updated, and accountability measures will be added or evaluated for all sectors identified in the ecosystem, resulting in a statewide Multisectoral Plan for Aging (MPA). Mississippi’s advice to others who are considering similar work includes the following:

• Be smart. Learn from what others have done and replicate it for your state. Mississippi gives a special thanks to Massachusetts, Florida, Washington, and Michigan, to name a few, for their leadership and peer collaborations.
• Be patient. Working to educate partners and stakeholders new to this body of research and listening to sector members before embarking on implementing strategies is a major element for success.
• Be intentional. Mississippi has learned that working on one or two sectors at the time, while building momentum in the next group of sectors, is a strong way to sustain work and to create leaders in those sectors who can ensure sustainability.
• Be accountable. Mississippi has conducted debriefings to identify strategies that are working and to make necessary changes in real time. To effectively reframe aging in Mississippi and develop sustainable goals, the collective impact framework is a transformative approach used to foster collaboration and continuous communication using a health equity lens.

Kina L. White, DrPH, MHSA, FACHE, is director of the Office of State Health Planning and Research in the Mississippi Center for Rural Health and Population Studies, at the Mississippi State Department of Health. She may be contacted at kina.white@msdh.ms.gov. Kaye Bender, PhD, RN, FAAN, is executive director at the Mississippi Public Health Association, both are in Jackson, MS. She may be contacted at execdir@mspha.org.

Photo caption: Oxford, Mississippi

Photo credit: Shutterstock/Jacque Manaugh

References

Age-Friendly Public Health System for Mississippi. (2023). Age-friendly public health system for Mississippi statewide work plan, January 2023. https://www.mspha.org/wp-content/uploads/2024/02/AFPHSMississippiRevisedWorkPlan_2023-Final.pdf

Arias, E., Xu, J., Tejada-Vera, B., & Bastian, B. (2022, February 10). U.S. state life tables, 2019. National Vital Statistics Reports, 70(18). https://www.cdc.gov/nchs/data/nvsr/nvsr70/NVSR70-18.pdf

Centers for Disease Control and Prevention. (2022). Firearm Mortality by State. https://www.cdc.gov/nchs/pressroom/sosmap/firearm_mortality/firearm.htm

Collective Impact Forum. (n.d.). Collective impact model. https://collectiveimpactforum.org/what-is-collective-impact/

The John A. Hartford Foundation. (n.d.) Working with partners to build an age-friendly ecosystem. https://www.johnahartford.org/grants-strategy/current-strategies/age-friendly/age-friendly-ecosystem

Mississippi State Department of Health. (2023a). Mississippi public health report card. https://msdh.ms.gov/page/29,27244,209.html

Mississippi State Department of Health. (2023b). Healthy aging data report: Highlights from Mississippi, 2023. https://msdh.ms.gov/page/resources/19858.pdf

U.S. Department of Health and Human Services. (n.d.) Healthy People 2030. https://odphp.health.gov/healthypeople/priority-areas/social-determinants-health

White, K., Wolfe, M., Kunkel, S., Carmody, J., & Auerbach, J. (2024). How Mississippi is changing public health [Commentary]. Journal of Public Health Management and Practice, 30(3).