Context: Scholars have called on public health to more commonly and more effectively learn from political science to understand the political determinants of health. They argue that policy decisions affecting health cannot be understood without appreciating the political dynamics shaping key institutions. As the least healthy place in the United States, the Mississippi Delta provides valuable insights on the connections between power, political participation, and health.

Methods: This case study relies on historical analysis, a review of the literature, and descriptive analysis of a unique data set examining every law introduced in the Mississippi legislature during the 2017 legislative session.

Findings: Legislators from the Delta have comparatively little influence in state-level policy making in Mississippi. This lack of power has deep historical roots but persists today.

Conclusions: This examination of power in the Mississippi Delta raises questions about the ability of the political process to achieve health equity. Systemic barriers to power, including structural racism, suggest that policies that would advance health equity cannot happen without the support of white residents, particularly those living in other parts of the state. In other words, health equity is not likely to be achieved without buy-in from leaders outside the area with the greatest need.

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