Lost in the Black Belt South: health outcomes and transportation infrastructure.

The importance of transportation infrastructure to health outcomes has been increasingly recognized. However, the relationship between transportation and health is underexplored in rural areas. This study fills the gap by investigating rural health outcomes in association with two transportation infrastructures-highways and airports-in the Black Belt counties of the USA, a region characterized as predominantly rural and black and as having high poverty and unemployment. Spatial regression models are applied to analyze the 2010 data. The results suggest Black Belt counties have poorer health outcomes than their non-Black Belt counterparts, and the difference increases as the percentage of blacks increases. The results also show that the higher accessibility to an airport a county has, the better its health outcomes. Highways, however, do not have a statistically significant association with health outcomes. The poor health outcomes in the Black Belt counties are also influenced by poverty, rurality, unemployment, and low educational attainment. This research was the first to study transportation, especially airports, in the rural US South with relation to health outcomes. Our findings shed new light on removing the health disadvantages accumulated in the Black Belt.