The hospital here, the only one in the county, is planning to close this month.
The 9,000 or so people who are seen in Lakeland Community’s emergency room each year will have to go dozens of miles to Jasper or Russellville or Winfield. Eighty-seven people will need new jobs. Businesses are worried about their workers’ compensation premiums rising and how this city of about 4,100 people will attract anyone without a hospital to help them once they are here.
“It’s a dire situation if that hospital closes,” said Holly Watkins, a real estate agent who was shopping on a downtown block dotted by empty storefronts. “The hospital closing is the No. 1 issue.”
But during the U.S. Senate race that will culminate Tuesday, the sensational has overshadowed the myriad problems in one of the nation’s poorest states. And as voters prepare to cast their ballots, they often lament the issues that have fallen outside the spotlight’s glare during the nationally watched campaign between Doug Jones and Roy S. Moore.
Those issues are still haunting Alabama in a race that has revolved almost entirely around Moore’s extreme views and the allegations against him of improper behavior with young girls.
Polls suggest that about half the voters believe that the accusations of sexual misconduct against Moore, the Republican nominee, are not the most important issue in the race. For every voter who calls the allegations crucial, there is another who worries more about education, health care, job creation, same-sex marriage, race relations or the state’s roads and bridges. (Moore has denied the charges.)
“Alabama voters do care about infrastructure, health care, the military,” said Paul DeMarco, who was a Republican state legislator until 2014. “Those issues are important, but they’ve gotten drowned out with the headlines of the past 30 days.”
The state is so often stellar in football, residents say ruefully, and not much else, a consequence of generations of bitter fights, political turbulence and eternal divides over race and class.
About 17 percent of Alabamians live in poverty — the fifth-highest rate in the country — and the state’s violence-wracked prisons are jammed to 159 percent of their intended capacity. With budget troubles a chronic fact of life, spending on Medicaid, which has not been expanded, lags. Standardized test scores are among the nation’s lowest. Heart disease and diabetes are endemic.
Last year, Marion, a rural city in central Alabama, suffered a tuberculosis outbreak so severe that its incidence rate was worse than that of many developing countries.
The infant mortality rate for 2016 rose to 9.1 deaths per 1,000 live births, the highest rate the state has seen since 2008. (The national rate was 5.9 deaths per 1,000 live births in 2015, the most recent year for which federal data is available.) The mortality rate was more than twice as high for black infants as white ones, and in some parts of the state, like Perry or Pickens counties, the rate was 25.6 and 30.3.
“I think we really don’t know why it’s going up,” said Grace Thomas, the assistant state health officer for family health services with the state’s Department of Public Health, who called the rates a “key indicator of a health care system’s effectiveness” and said black, Hispanic and poor women were less likely to get the care they need.
Paris Daves, 24, said it took her several months after she found out she was pregnant last year to get on Medicaid, though she has since drawn support from an organization called Gift of Life, which works to prevent infant mortality in Montgomery. But as a young, single parent, there are other problems, too, like unreliable public transportation and low wages.
“Minimum wage here is $7.25,” said Daves, who earns a dollar more than that as a shift manager at McDonald’s. “That’s not enough to pay my rent or take care of my son.”
In Haleyville, northwest of Birmingham, the coming shutdown of the hospital looms over the city where, in 1968, the country’s first 911 call was made.
But you can pick anyplace in Alabama and find issues that feel somewhere between daunting and suffocating. In the Black Belt, named for its rich topsoil but now a region of widespread rural poverty, people still wonder whether once-plentiful jobs will ever come back.
Along the Black Warrior River in Tuscaloosa, professionals and university professors worry about Alabama’s reputation and whether companies with money to spend might look elsewhere. Indeed, many fear that the ultimate fallout from the race will be yet another hit to the state’s reputation and attractiveness as a place to do business.
Huntsville cares about federal spending that helps power an economy that depends on rockets and missiles.
National reporters flocked to a town hall last month in Gadsden hoping for animated discussion of Moore and the Senate race. Instead, most of the conversation was about opioids, economic development and the extension of Interstate 759.
People here know that no single senator can fix all of Alabama’s ills. Many of the state’s troubles, residents acknowledge, must be solved at the State House in Montgomery, not in Washington. But as the campaign for a rare open Senate seat droops to an end that just about everyone here says cannot come soon enough, there is no shortage of regret that the tawdry overtook the tangible and topics of statewide concern got little hearing.
“There’s really no other way to put it than a missed opportunity,” said Will Walker, a bank president in Haleyville, the largest city in a county where President Donald Trump won 90 percent of the vote last year. “We’ve had so little discussion about issues, it’s disappointing.”
The state, like its neighbors in the South, is desperate to preserve the economic lifeboats that have emerged in recent decades: big-name foreign manufacturers who put down stakes in exchange for cheap labor, low taxes and lavish incentive packages.
The economic model has created a strange dichotomy: While Alabama often generates headlines about culture-war battles that outsiders view as hopelessly provincial, the flavor of commerce is increasingly, and proudly, international.
Airbus, a French company, assembles jets at a state-of-the-art, $600 million factory in Mobile, working with pieces assembled in Spain, Wales, France and Germany. Mercedes-Benz produces luxury SUVs and sedans along Interstate 20 in Tuscaloosa County. Hyundai has been producing vehicles in Alabama since 2005; Honda, since 2001.
But the strategy only works so well. In 1999, according to census figures, Alabama’s median household income lagged the national median by about $7,800. Today, Alabama lags behind the national median by more than $11,000.
Samuel N. Addy, an economist at the University of Alabama, said the state still has glaring public sector needs in education, infrastructure, health and prisons.
“Those are our four major ones,” said Addy, “and all of them require raising revenues to meet the needs here. But I don’t think the climate is such that we are open to raising revenues much.”
The poor quality of public education, in particular, has long been a concern in a state where the gap between rich and poor residents — and white and black ones — remains a nagging reality.
The concerns have only seemed to mount with the realization that 21st century manufacturing jobs often require advanced understanding of computer systems: Building a jet is just not the same as running a loom. A year ago, then-Gov. Robert Bentley, a former church deacon not prone to strong language, at least in public, put the matter in shockingly blunt terms: “Our education system in this state sucks.”
In Escambia County, near the Florida border and the site of Alabama’s death row, Laurine Gentry, 37, said she, too, worried about the state’s schools. This year, she said, the area voted to consolidatesome schools, and she worries about her kindergartner, who she says has to ride the bus with high schoolers.
“He hears and sees things that maybe he shouldn’t,” she said.
Gentry, who said her husband is serving a prison term elsewhere in Alabama, also described the state’s deteriorating prisons. Her husband, she knows, can take care of himself behind bars, but she said the strain on the system is obvious to her family.
“My husband’s last probation officer told me he’s sorry he failed me and my children, because he’s got 70 guys to look after, because it’s hard,” Gentry said.
Indeed, Escambia County is but one place that struggles. Even with the state’s vast presence and a nearby casino, Main Street is sprinkled with shuttered businesses.
“We are 49th or 50th in too many categories,” said Robbie Drummond, 63, a pharmacist. “In Alabama, we always say, ‘Thank God for Mississippi.’ I know they say the same about us.”