Community Context

The city of Natchez, named for the Indigenous mound-building tribe that initially inhabited the land, is the county seat and is home to nearly half of the county’s residents. It is the oldest town along the Mississippi River and is well-known for its historic mansions and growing cultural tourism industry. 

For many years, there was little mention of the history and experiences of Adams County’s Black population, but more recently, this information has been incorporated into local tours as the community continues to grapple with its difficult history within the slave trade. Some community members have taken steps to reconcile the history of Adams County and its role in the slave trade, but tensions between the Black and White populations remain. 

There are stark inequities in poverty rates in Natchez, with nearly 37 percent of Black residents living in poverty compared to roughly 19 percent of White residents. Natchez’s recent Democratic mayors have committed to addressing issues of inequity, with some consideration of addressing the region’s past. This has represented some evolution of who is included in leadership and a more expansive set of voices in the discussion of community needs. Darryl Grennell, a former county supervisor and former professor at Alcorn University, served as mayor beginning in 2016 with the aim of rebuilding the economy and bringing jobs to the community. In July 2020, Dan Gibson was elected mayor and has worked to carry on a similar mission to address economic inequities and build stronger community ties between the county’s Black and White populations. 

Adams County has been working to uplift a struggling public education system and outcomes for youth, yet with low graduation rates and limited opportunities for employment, little has changed over the past five years. Adams County residents also face high rates of diabetes, smoking, infant mortality, and obesity. In addition, there has long been a shortage in healthcare professionals in the county, which was spotlighted as a barrier in the county’s attempt to provide vaccinations to residents during the COVID-19 pandemic, impeding the community’s ability to vaccinate the population at a swift pace.

Adams County’s Journey to Promote Health, Well-Being, and Equity

Across Adams County, individuals and organizations are actively focused on creating a healthier future.

Five years into the Sentinel Communities Surveillance Project, Adams County’s capacity to address health and well-being remains anchored by its main hospital, Merit Health Natchez, and supported by a network of small federally qualified health centers (FQHCs). In the past, Adams County benefited from external funding and initiatives that allowed the community to address chronic health conditions. Though many of those resources have come to an end, there remains a strong focus on economic revitalization of the county. Over the past five years, there have been slight shifts in how people think about and approach health, though long-held cultural norms about health and healthcare being the same continue to influence beliefs and behaviors around health. Though there have been some efforts to summarize health equity issues via the HIA and conversations to acknowledge the racial legacy issues of the region, the county has not achieved greater progress in terms of collaboration and action around health equity to influence policy and systems change.

Lessons Learned: Where is Adams County Five Years Later?

Despite some challenges, there are areas of optimism, particularly as it relates to positive change in the county’s interest to address longstanding racial dynamics and discuss the history of the slave trade. Coupled with optimism about new political leadership, this could provide an opening for connecting racism to health equity, though not yet realized. 

Adams County will need to tackle this lack of holism when it comes to health, given its reliance on an individualistic and personal responsibility framework, potentially impeding a broader commitment to shared, community-wide health investments. 

Going forward, it will be important to track how Adams County is or is not making the connection between racial history and health inequity, and the extent to which the county begins to assume a social determinants of health-centric approach rather than a healthcare-centric approach. This will require collaborations among the healthcare system, local government, and community-based organizations, which has not been sustained yet in many notable ways. 

As Adams County contends with these challenges, other communities facing similar difficulties can learn what happens to the health narrative and investment in places with entrenched views of health issues, limited resources, and a slower pace to advance health equity. 

Future research could consider what it takes to make progress in communities, which prioritize economic development, and how health can be a more explicit part of that focus.

Efforts to promote health and well-being have generally been guided by external funding and a segment of motivated community members who are dedicated to improving the quality of life for Adams County residents. Yet with little political will, limited resources, and a need for increased data capacity, Adams County continues to face challenges in making significant impacts in health and health equity. 


  • Experienced community champions have the expertise to bring in external funding 

  • New leadership and greater input by community members has led to some movement in changing power structures

  • Leveraging the historic preservation community has fostered important dialogue


  • Some community members remain uncomfortable discussing race relations 

  • Lack of political will is a challenge to make health a shared value 

  • There is a strong need for increased and robust data