Exposes Education and Health Inequities in the South

In June, The Annie E. Casey Foundation released its 2020 KIDS COUNT Data Book assessing children’s well-being in the United States. The report provides a helpful snapshot of both the recent improvement and remaining disparities in children’s economic well-being, health, education, and the well-being of their families and communities that state policymakers need to consider in crafting legislation and policy. We examined the performance of southern states in the areas of Education and Health.


Driven by pronounced achievement gaps between Black students and White students, southern states displayed many of the same dismal Education rankings in 2020 as they did in 2019. The KIDS COUNT project used 2019 National Assessment for Educational Progress (NAEP) Mathematics and Reading data in calculating states’ Education ranking. SEF’s independent analysis of 2019 NAEP data found that on average, Black students in all 17 Southern states scored 25 points lower on the 2019 NAEP fourth grade Reading assessment than their White peers, and 28.6 points lower on the 2019 NAEP eighth grade Math assessment. South Carolina had the greatest fourth grade Reading score disparity between Black and White students: White students scored 30 points higher (229) than Black students (199). West Virginia had the smallest fourth grade Reading score disparity between Black and White students, where White students (214) scored 14 points higher than their Black peers (200).

The persistent achievement gaps between Black and White students in the South are a function of many southern states failing to prioritize equity in public education policies. In the 2020 KIDS COUNT rankings, six southern states – Alabama, Louisiana, Mississippi, Oklahoma, South Carolina and West Virginia – are in the bottom quartile of the Education ranking, while 12 southern states – Arkansas, Delaware, Georgia, Kentucky, Tennessee and Texas, in addition to the previous six – are in the bottom half of the nationwide 2020 Education ranking. In contrast, only three southern states – Florida, Maryland and Virginia – are in the top 20 states nationally for education. Between 2010 and 2017, ArkansasGeorgiaLouisiana and Mississippi made noticeable improvements in key Education indicators such as fourth grade reading proficiency and four-year high school graduation rate. The low rankings of most southern states are a symptom of their ongoing failure to allocate sufficient parity funding for their most vulnerable students. Another key indicator comprising southern states’ Education ranking, the percentage of 3- and 4-year-olds in school, also is cause for alarm.

While SEF’s work is primarily focused on equity solutions for K-12 students, one of our policy priorities is expanding access to high quality and affordable pre-primary programs. We know that introducing students to school environments where they practice vital social and emotional skills and receive instruction that is fundamental to future learning is crucial to closing the opportunity gap. Research consistently shows that children who do not attend Pre-K are more likely to need special education services, repeat a grade, be arrested and be involved in a violent crime. Later in life, they are less likely to be employed, earn more than $20,000 a year, have a savings account, own a home, graduate high school and/or attend a four-year college.

In light of these alarming statistics and the current national conversation around when, how and whether childcare facilities should reopen, we focused on the percentages of young children not in school disaggregated by race and state. In 14 southern states – Alabama, Arkansas, Delaware, Georgia, Kentucky, Louisiana, Maryland, Mississippi, North Carolina, South Carolina, Tennessee, Texas, Virginia and West Virginia the percentage of 3- and 4-year-olds not in school increased or stayed the same.  In 12 southern states, at least half of all 3- and 4-year-olds are not in school (AL, AR, DE, GA, KY, MD, NC, SC, TN, TX, VA, and WV). Unfortunately, this is more common for children of color. The data cited in KIDS COUNT for these 12 states shows 39 to 58 percent of Black 3- and 4-year-olds and 58 to 71 percent of Latinx 3- and 4-year-olds in a given state are not in a pre-primary program. In North Carolina, 54 percent of Asian American/Pacific Islander (AAPI) children between the ages of 3 and 4 are not in school, and in West Virginia, no Native and Indigenous children in this age group are in school. The fact that the majority of children of color in most southern states do not have access to high quality, affordable early childhood education constitutes a state of emergency.

While disparate access to childcare and early childhood education is troubling in its own right, this problem is being exacerbated by an increase in the number of childcare deserts and children’s exposure to COVID-19 in childcare environments. Defined as a census tract with more than three children under age 5 for every licensed childcare slot, childcare deserts are prevalent throughout the South. As the National Association for the Education of Young Children reported in March, only 11 percent of childcare programs were confident they could survive extended closure without support. Revealingly, most of the areas lacking sufficient childcare supply were low and middle income neighborhoods and predominantly Latinx communities. Many of those same areas are also the hardest hit by rising unemployment and COVID infection rates. Even for families capable of enrolling their child in an available program, the health risk associated with doing so remains high, especially in the South. In early July, Texas – where 54 percent of Black and 62 percent of Latinx 3- and 4-year-olds are not in school –  reported more than 1,000 new coronavirus cases resulting directly from childcare. This could be a result of the exposure inherent in a childcare environment or the high risk categories most childcare providers fall into. Regardless of antecedent, there must be a significant public and political focus on what this means about the health and education of very young children of color, now and in years to come.

The inaction of many states on updating their education funding formulas to accurately reflect the needs of an economically and ethnically diverse student population drives inequity and diminishes opportunities for educational success for the states’ most vulnerable students. Southern states continue to spend the least nationwide per-pupil, despite extensive and conclusive research showing that increased education spending, particularly for students of color and students from low-income families, directly contributes to improved academic outcomes. Those states now face a bleak outlook as a precipitous drop in state expenditures and revenues looms as a consequence of the COVID-19 economic crisis. In this moment of racial, economic, and health-related unrest, states’ commitment and constitutional prerogative to adequately and fairly fund public education and high-quality childcare programs is only greater.


As with children’s education, many states’ insufficient attention to their healthcare systems has decisively put the South in the bottom of the nation’s Health ranking in the 2020 KIDS COUNT report. The Health ranking is based on four key indicators: low birth-weight babies, children without health insurance, child and teen deaths per 100,000 and children and teens ages 10-17 who are overweight or obese. Sixteen of 17 southern states are in the bottom half of the Health ranking. The one exception – Virginia – is ranked 24th out of 50 and generally outperformed every other southern state in each ranking. Twelve of the bottom 13 states for healthcare are southern states, with Georgia, Alabama, Tennessee, Oklahoma and Mississippi comprising the bottom five. Similar to the Education, Economic Well-Being, and Family and Community rankings, the Health ranking exposes stark racial disparities in health outcomes and healthcare access. Throughout the South, Latinx children are the least likely to have access to healthcare; this disparity is starkest in Georgia, where 18 percent of Latinx children lack health insurance, compared with 7 percent of White children.

The healthcare inequities plaguing the South are especially dangerous in light of COVID-19, as many states in the region have consistently been hotspots for the novel coronavirus and are seeing significant spikes in COVID-19 cases. In states with race-related COVID-19 data available, it has become clear that Black, Latinx and Native people are disproportionately infected with and dying from the virus. Nationally, people of color are overrepresented among workers deemed essential, as Black and Latinx workers represent nearly 30 percent of postal workers, 37 percent of workers in leisure and hospitality, 41 percent of food service workers, and 30 percent of retail workers. Southern states’ rush to reopen their economies has placed Black and Latinx essential workers and their families at a disproportionately higher risk for contracting COVID-19, and the relatively low access to healthcare for low-income people and people of color in the South makes matters worse. Additionally, 10 out of 17 southern states have not expanded Medicaid, a federally-funded program that has closed coverage gaps for vulnerable populations. Failure to expand this program has left vulnerable populations, particularly many low-income, Black and Latinx families, without access to any form of preventive care.

For children of color and children from low-income families, healthcare and education are inextricably linked, and much like education, healthcare throughout the South is extremely underfunded. Malnutrition, limited access to preventive care and mental health professionals, and environmental hazards that contribute to underlying health conditions in children and families directly affect academic performance and cognitive development. A global pandemic that is claiming lives and livelihoods and decimating the well-being of our region’s most vulnerable children has solidified the connection between access to healthcare and positive education outcomes. School closures during the pandemic have severely limited students’ ability to learn due to low device and internet access, particularly for Black students. Given the renewed challenges COVID-19 poses for students, addressing health and education issues related to COVID-19 will involve developing and implementing a whole child approach that includes wraparound services, services such as COVID-19 testing, telehealth access points, and access to WiFi and devices.

Recommendations and Next Steps

Informed by SEF’s policy positions and an analysis of 2020 KIDS COUNT data, the following recommendations warrant consideration to catalyze improved outcomes for students across the South.

  1. Implement equitable funding formulas that account for the needs of students from low-income families, students of color and other underserved student populations.
  2. Expand and fully fund high-quality, safe pre-primary programs to ensure children develop essential learning and social skills.
  3. Expand and fully fund access to mental health resources for students and families as communities continue to grapple with the changes, loss and trauma of a global pandemic and social reckoning on antiracism.

Sujith Cherukumilli is SEF’s Legislative and Research Analyst. Keonnie Igwe is a Leadership for Educational Equity (LEE) Summer Fellow with SEF.