Overview:

Living in a rural county, I have often felt the isolation many Tennesseans are forced to face when it comes to accessing medical care. While my family's average drive time ranges from 30 minutes to over an hour to access healthcare, many Tennesseans living in more remote counties are forced drive several times farther.

The story map, "Standing Alone," follows three individuals who have each been differently affected by the disparity in rural Tennessee healthcare. Through their stories, I wanted to peel back the layers of the Tennessee healthcare crisis with geospatial analysis, highlighting underserved counties and advocating for healthcare reform. When it comes to healthcare, no one deserves to be standing alone.

Methods:

Map Showing Rural and Urban Areas: The “USA Urban Areas” and the “USA Counties” layers, both feature layers created by Esri, were added to the map from the Living Atlas. The USA Counties layered was filtered to only counties inside Tennessee. The Derive New Locations analysis tool was then used to find “USA Urban Areas” that intersect the filtered “USA Counties” layer, producing the “Tennessee Urban Areas” layer. Additionally, the Derive New Locations analysis tool was used to find “USA Counties” that do not intersect “USA Urban Areas,” creating the “Tennessee Rural Areas” layer. Custom pop-ups were formatted for the layers. Map Showing Life Expectancy per Tennessee County: The layer, “County Health Rankings 2021” by esri_demographics, was added from the Living Atlas and filtered to show only Tennessee counties. The layer was styled with “Counts and Amounts (Color)” style to show the average life expectancy in years for individuals living in each Tennessee county. The layer “Tennessee Urban Areas”, mentioned above, was also added to the map, and custom pop-ups were created for both layers. Map Showing Percent of Population Living Below the Poverty Level: The layer, “ACS Poverty Status Variables – Boundaries, created by Esri, was added from the Living Atlas and filtered to show only Tennessee counties. This layer was then joined with the Life Expectancy layer created for the Map Showing Life Expectancy per Tennessee county using the Join Features analysis tool, and the resulting layer was styled using “Counts and Amounts (Color)” style to show the percent of population whose income in the past 12 months is below the poverty level. Lastly, the “Tennessee Urban Areas” layer was added to the map, and custom pop-ups were configured for the layers. Map Showing Dr. Copeland’s Office and the Cumberland River Hospital: Addresses and labels for each location were added to an ArcGIS StoryMaps Express Map. Map Showing Rural Counties with Medically Underserved Populations: Using data from the Health Resources Administration’s Find MUA/P (Medically Underserved Area/Population) tool, data showing rural counties with medically underserved populations was inserted in a custom .csv layer and uploaded as a layer. This layer was joined to “USA Counties” using the Join Features analysis tool, and the resulting layer was styled using the “Location (Single symbol)” style. Custom pop-ups were also added to this layer. Maps Showing Ms. Crouch’s Search for Emergency Medical Services: These maps were created by inserting addresses or cities of each location into an ArcGIS StoryMaps Express Map. Map Showing Fentress County Ambulance Station: This map was created by inserting the address of Fentress County Ambulance Service and the location of each city into an ArcGIS StoryMaps Express Map. Map Showing Sum of Ambulance Units per County: Using data from the Tennessee Health Department, a custom .csv layer with the total number of ambulances per EMS station was created and uploaded as a layer. This layer was joined to the “USA Counties Layer” using the Join Features analysis tool, and the resulting layer was styled using the “Counts and Amounts (Size)” style to show the sum of ambulances in each county. Custom pop-ups were added for this layer. Map Showing Hospitals That Have Closed Since 2010: A custom .csv file was created using data from a Tennessee Healthcare Campaign report, and this data was uploaded as a layer showing the location of each hospital that has closed since 2010. The “Tennessee Urban Areas” layer and the “Tennessee Rural Areas” layer were also added to this map. Lastly, custom pop-ups were configured for these layers. Map Showing Drive Time Areas to Trauma Hospitals: Using data from the Tennessee Health Department, a custom .csv file was uploaded as a layer showing the locations of Tennessee trauma hospitals. A drive time buffer was created using the Create Drive-Time Areas analysis tool to map locations 15, 30, 45, and 60 minutes away from a trauma hospital. The “USA Counties” layer was added from the Living Atlas, and the Derive New Locations analysis tool was used to find locations over 60 minutes away from a trauma hospital. Finally, custom pop-ups were added to the layers. Map Showing COVID-19 Case Rate per Hundred Thousand for Each State: Using data from the Centers for Disease Control, a custom .csv file was created and uploaded as a layer, which was joined to “USA Counties” using the Join Features analysis tool. The resulting layer was styled using the “Counts and Amounts (Color)” style to display the case rate per hundred thousand, and customized pop-ups were made for the layer. Map Showing COVID-19 Death Rate per Hundred Thousand for Each State: Using the same layer created in for the Map Showing COVID-19 Case Rate per Hundred Thousand for Each State, the layer was changed to show the death rate per hundred. Customized pop-ups were also added. Map Showing Percent of Deadly COVID-19 Cases in Tennessee: Using data from the Tennessee Health Department, a custom .csv was created, and the percentage of deadly COVID-19 was calculated. This file was uploaded as a layer, which was joined to “USA Counties” using the Join Features analysis tool and styled using “Counts and Amounts (Color)”. Finally, customized pop-ups were added to the map. Map Showing Percent Difference Between National Vaccination Average and County Rates: Using the same data as the Map Showing Percent of Deadly COVID-19 Cases in Tennessee, a custom attribute was created to show the percent difference between county vaccination rates and the national average. The map was styled using the “Counts and Amounts (Color)”, and customized pop-ups were created for the map.

The following methods were used to create the graphics in this story map.

Thumbnail of Clay County: This thumbnail was created using the "Blank White Vector Basemap" by j_nelson. Two copies of the "USA Counties" layer by Esri were added to the map, with one layer outlining all the counties in Tennessee and the other layer highlighting Clay County. A screen shot of this map was uploaded to the story map as an image.Thumbnail of Fentress County: This thumbnail was also created using the "Blank White Vector Basemap" by j_nelson. Two copies of the "USA Counties" layer by Esri were added to the map, with one layer outlining all the counties in Tennessee and the other layer highlighting Fentress County. Finally, a screen shot of this map was uploaded to the story map as an image.

All remaining graphics were custom images created in Microsoft PowerPoint.

Sources and Acknowledgements:

This map was created for the 2022 ArcGIS Online Competition for US High Schools.

I would like to give special thanks to my geomentor and my parents, whose help and guidance were invaluable during the creation of this story map.All sources for information, data, and photographs are included as links throughout the story map.

This raster map depicts outdoor settings (closely related to human land-use) for the counties surrounding the Oak Ridge Reservation (Anderson, Blount, Loudon, Knox, Monroe, and Roane). This data layer is a 90 meter grid subset of the setting map created as part of the SAMAB (Southern Appalachian Man and the Biosphere Program) SAA (Southern Appalachian Assessment). It identifies portions of the region which were coded as one of the several Settings by the team that assessed outdoor recreation settings. The data set was created by combining maps of land cover, roads, utility corridors, and protected areas such as Wilderness and National Parks. The land cover map was converted to a map of existing land use categories such as 'forested' and 'sub-urban'. Information about roads, utility corridors, and protected areas was then used to refine these themes into composite setting descriptors. The areas of different setting descriptors were compiled by ecological sections and were compared to existing maps of management designations and recreational features. All of the maps used in this study were part of a standard geographic database which was prepared for the Southern Appalachian Assessment. counties.

 A map depicting human land use can be created by aggregating the preceding classes into rural, urban, sub-urban, and transitional. 

Setting legend categories include the following: 1 Rural - pastoral/agricultural 2 Rural - partially forested 3 Semi-primitive - natural appearing 4 Roaded - natural appearing 5 Rural - forested 6 Transitional 7 Sub-urban 8 Urban 9 Water 10 Unknown 11 Primitive - naturally evolving 12 Semi-primitive - naturally evolving 13 Roaded - naturally evolving

The Road Segment table describes the administration and ownership of the segment of road. It contains tabular polyline data showing the log miles/measures, road name, functional class, government control, and U.S. Routes. Road names are derived from visual surveys by field crew or official GIS maps. Functional class is set by the Federal Highway Administration (FHWA). All other categories are determined by state and local agencies. This dataset is updated weekly. County – County in Tennessee where associated features and attributes are located.Route Number – Route in Tennessee with corresponding attributes.Special Case – Route designator for non-standard routes such as By-Pass.00 None01 Spur - S02 Alternate - A03 State Connector - C04 Bypass - BP05 Business Route - BR06 Northbound - N07 Southbound - S08 Eastbound - E09 Westbound - WCounty Sequence – This number indicates the sequential number of times a route enters and leaves the county, begins with zero (0).Beginning Log Mile (BLM) – The beginning log mile (measure) for the route segment.Ending Log Mile (ELM) - The ending log mile (measure) for the route segment.Functional Classification – These codes, set by the FHWA, provide a statewide highway functional classification in rural and urban areas to determine functional usage of the existing roads and streets.01 Rural Interstate02 Rural Other Principal Arterial03 Rural Freeway or Expressway06 Rural Minor Arterial07 Rural Major Collector08 Rural Minor Collector09 Rural Local11 Urban Interstate12 Urban Freeway or Expressway14 Urban Other Principal Arterial16 Urban Minor Arterial17 Urban Collector19 Urban LocalGovernment Control – These codes determine ownership and maintenance responsibility.01 State Highway Agency02 County04 Municipal11 State Park12 Local Park21 Other State Agency25 Other Local Agency26 Private27 Railroad40 Other Public60 Other Federal Agency63 US Fish and Wildlife64 US Forest Service66 National Park Service67 TVA68 Bureau of Land Management70 Corps of Engineers (Civil)72 Air Force73 Navy or Marines74 Army80 OtherUS Route Number – US Route Number assigned to roadway segment.