Known as the “Peach State”, Georgia has a diverse and growing population, robust political landscape, and a slow growing health care environment. The distinct health care environments in rural Georgia and the urban metropolitan area are a unique challenge for the Title V program.  

Geographic Description 
Georgia is on the southeastern Atlantic coast and its terrain spans coastal beaches, farmland, and mountains. The state is bordered on the south by Florida; on the east by the Atlantic Ocean and South Carolina; on the west by Alabama; and on the north by Tennessee and North Carolina. The main geographical features include mountains such as the Ridge-and-valley Appalachians in the northwest, the Blue Ridge Mountains in the northeast, the Piedmont plateau in the central portion of the state and Coastal Plain in the south. Georgia has fourteen barrier islands off its coast and include Saint Simons Island and Jekyll Island, both popular tourist destinations. Georgia is vulnerable to hurricanes, though the coast rarely experiences a direct hurricane strike due to its location and shorter coastline. With elevations ranging from sea level to more than 4,700 feet the ecology of Georgia is widely varied with a diverse geological base and many different soil types.1 Georgia is ranked 24th in the nation in terms of land size and is the largest state geographically east of the Mississippi River.2 Georgia has over nine million acres of prime farmland and both the agricultural areas and the waters of Georgia have created a thriving environment for hunting, fishing and game.3,4 

Urban and Rural Counties 
Georgia has 535 incorporated municipalities in 159 counties with 13 congressional districts.5 Of Georgia’s 159 counties, there are both urban and rural counties located throughout the state. The Census Bureau defines two types of urban areas; urbanized areas of 50,000 people or more, and urban clusters between 2,500 people and 50,000 people. All other counties are considered rural. Of the 159 counties, 120 are designated as rural and 21% of the state’s population lives in a rural area as of the 2020 census, which is less than 25% from the 2010 census.6 Most of the state’s rural counties are in the southern half of the state. According to projections based on the 2020 census data, rural counties in the southern part of Georgia are expected to continue to decline in population, while rural counties in the northern part of Georgia are expected to increase in population.6 The largely rural makeup of the state provides many challenges, and opportunities, to offering adequate health and social services to all Georgia residents. Due to the large number of counties being designated as rural, access to health care services is challenging, and as such it is essential for DPH to accommodate the needs of the rural population. DPH provides an alternative approach in meeting the needs of Georgia’s rural citizens through innovative strategies such as telehealth services in all 159 counties that increase access to health care providers and services. 

According to the 2020 census data, there are 14 Metropolitan Statistical Areas in Georgia: Atlanta-Sandy Springs-Roswell, Augusta (GA-SC), Savannah, Columbus (GA-AL), Macon, Athens, Gainesville, Warner Robins, Albany, Valdosta, Dalton, Brunswick, Rome, and Hinesville.5 Georgia’s population growth from 2010-2020 was primarily due to an increase in population in urban counties.6   

The following map generated by the US Census Bureau based on population data for 2020 depicts the population density in Georgia.7 

Figure 1: Population Density in Georgia Counties: 2020 

Population 
Georgia’s population reached 10.7 million, gaining a million new residents from 2010 to 2020, up 10.6%, making Georgia the eighth most populous state in the nation.7 Georgia is the 12th fastest growing state in the country.8 This growth has resulted in a fundamental shift in Georgia’s population changing the state from a largely rural area with urban centers to an urban state with rural areas. Rural Georgians have health experiences that contrast their urban counterparts including, travelling longer distances to seek medical care and higher rates of chronic health conditions. It is estimated that Georgia’s population will increase to 11.8 million by 2030.9 As with any population growth, there are increasing demands on state and local governments to provide necessary services, including health and social services. 

Georgia is growing more urban and diverse with 2020 Census figures showing a continued shift in population toward metro Atlanta and away from the rural areas that were once the backbone of the state. The state’s fastest-growing areas remain in the suburbs of Atlanta, Savannah, and Augusta. Bryan County, just south of Savannah, grew by 48% over the decade, making it the sixth-fastest-growing county in the nation. Forsyth County, located north of Atlanta is the 13th-fastest-growing county nationally due to its 43% growth.10 Sixty-seven of Georgia’s 159 counties, most of them smaller and rural, lost population, as part of a nationwide trend.7 

Atlanta, the state capital, is the economic, cultural, and demographic center of Georgia. Located in DeKalb and Fulton counties, Atlanta has a population 490,270.11 It is the largest city in Georgia and the 39th largest city in the U.S according to 2023 population estimates.11 Atlanta is currently growing at a rate of -1.86% annually as people migrate to the surrounding suburbs.11 Spanning over 135 miles, Atlanta has a population density of 3,685 people per square mile.11  

The Atlanta metropolitan area includes 29 counties and is home to 5.6 million people, making it the ninth largest metropolitan area in the U.S.11 Metro-Atlanta contains about 57 % of Georgia's entire population.12 In Georgia, approximately 5% of residents are under age five, 17.4% are under the age of 18 and 11.6 % are over age 65.13 Atlanta has the 19th largest number of LGBTQ adults in a large metropolitan statistical area and is the second largest majority Black metro area in the country.11   

Diversity 

The state's population is 51.9% White, 31% Black, 10.5% Hispanic or Latino, and 4.5% Asian.7 Close to 7% of the population identify as two or more races.7 Georgia grew substantially more diverse over the last ten years as its Black, Hispanic and Asian populations increased and its number of White residents slightly decreased.14 Statewide, the number of Black Georgians increased by 13%, while the White population dropped by 1%. The state’s Asian population increased by 53% and its Hispanic population increased by 32%.14  The growth in diversity and population necessitates the availability of culturally competent health care, education, and human services.  

Age 
According to the 2020 US Census Bureau, 23% of the state’s population is under 18 years of age.15 In 2020, the population of women ages 15-44 was 2,197,385.16 The median age in Georgia is 37.5 years according to 2021 estimates.17 

Immigration 
Georgia’s population is continually evolving with the immigration of foreign-born individuals that add to the racially and ethnically diverse population of Georgia. According to 2019 data, approximately 1.1 million immigrants (foreign-born individuals) comprise 10.2% of the population.18 Among the foreign-born population, 5.5% are aged 0-15 and 83.3% are aged 16-64.18 There are 70,852 foreign-born children in Georgia.18 The top countries of origin for immigrants are Mexico (22 %), India (9 %), Vietnam (5%), Jamaica (4%), and Guatemala (3.8%).18 Among foreign-born immigrants, 25% have less than a high school education, 38.7% have high school and some college, 19.7% have a bachelor’s degree, and 16.5% have a graduate degree.18 

There are 352,643 undocumented immigrants in Georgia.18 Immigrants who are “qualified non-citizens” are generally eligible for coverage through Medicaid and the Children's Health Insurance Program (CHIP).19 Non-qualified adult immigrants or undocumented adult immigrants may be eligible for emergency medical services only that includes the cost of labor and delivery.19 Emergency medical assistance is not an ongoing coverage plan and applicants must apply for this service as a medical hardship is incurred.19  

Language Proficiency 
According to the US Census Bureau’s American Community Survey, over 14% of Georgia residents, ages five years and older, speak a language other than English.15 Of the other languages spoken, Spanish is the most spoken language at approximately 7.9% of the state’s population.9 According to Kids Count Data, 53% of children in immigrant families have resident parents who have difficult speaking English.20 These factors can have implications on the services offered to residents and may necessitate investment in interpretation and culturally competent approaches to health care delivery. 

Family Household Type  

Children growing up in single-parent families typically do not have the same economic or human resources available as those growing up in two-parent families. According to the 2021 Kids Count Data, 38% of Georgia’s children lived in single-parent families.21 The percentage of children under age 18 who live in families with income below the federal poverty level decreased from 26.3% in 2014 to 19.5% in 2020.22   

Educational Attainment 
Public schools are the primary source of education in Georgia. In 2021, 49.1% of four-year-old children were enrolled in a public pre-kindergarten program.23 According to the Kids Count Data, 32% of fourth graders and 31% of eighth graders were at or above proficient in reading in 2022.24 Additionally, 34% of fourth graders and 24% of eighth graders were at or above proficiency in math in 2022.24 High school students not graduating on time reduced to 16% in 2019-2020 from 28% in 2013-2014.25 

Georgia's high school graduation rate continues to rise and has increased by 14.4% since 2012.26 In 2022, Georgia's high school graduation rate rose to 84.1%, an all-time high since the state began using the adjusted cohort calculation now required by federal law.26  

The University System of Georgia awarded an all-time high of 74,446 degrees in fiscal year 2022 which was a 2.1% annual increase over fiscal year 2022.27 The state has approximately 70 public institutions and specialized schools, and over 45 private universities for higher education which include 10 Historically Black Colleges and Universities. The flagship research institution, University of Georgia, is the oldest public school in the country.  

In Georgia, 33% of adults aged 25 and over have a bachelor’s degree or above.15 Eighty-eight percent have a high school graduate degree or higher.15  

Household Income and Poverty 

According to the 2022 American Community Survey of the U.S. Census Bureau, the median household income for Georgia is $65,030.15 Compared to the median U.S. household income of $70,784, Georgia’s median household income is lower.28  

According to the 2021 American Community Survey of the U.S. Census Bureau, Georgia has the 14th highest poverty rate in the U.S. with 14% of Georgians living below the federal poverty line, compared with 11.6% for the United States overall.15 According to the 2021 Kids Count Data, 30% of children live below 150% of the federal poverty level and 41% live below 200% of the federal poverty level.29 Poverty disproportionately affects race and ethnicity in Georgia. 

Health Equity and Social Determinates of Health (SDOH) Disparities 

According to the 2023 Kids Count Data Book, Georgia ranked 37th in overall child well-being.30 The ranking is based on the state’s wealth and other resources, policy choices and investments in the state in which the child is born and raised. The annual Kids Count Data Book uses 16 indicators to rank each state across four domains that include health, education, economic well-being, and family and community that represent what children need the most to thrive. Georgia ranked 35th in economic well-being, 31st in education, 43rd in health, and 29th in family and community.30  
 

There are consistent disparities by race/ethnicity in Georgia for health outcomes. Georgia’s pregnancy-related mortality ratio shows that non-Hispanic Black women are over 2 times more likely to die of pregnancy-related causes than non-Hispanic White women, primarily driven by differences in outcomes related to cardiac conditions. In 2020, racial disparities were also seen in infant mortality rates with a rate of 9.6 in Black, non-Hispanic or Latino infant deaths compared to a rate of 5.1 in White, non-Hispanic or Latino infant deaths under one year of age.31 The percentage for Black, non-Hispanic or Latino low birth weight infants was 14.5% compared to 7.2% for low-birth-weight White, non-Hispanic or Latino infants.31 Premature births in 2020 occurred at 14.4% in Black, non-Hispanic women compared to 10% in White, non-Hispanic women.31  

Economy  

Six U.S. interstates, with over 1,200 miles of highway, connect Georgia to neighboring states and the rest of the nation and help move workers from their homes to places of employment in the major cities. Three of the interstate highways converge in Atlanta, making it, along with Hartsfield-Jackson Atlanta International Airport, the transportation hub of the southeast. These advantages have led to 9 Fortune 500 companies on Fortune’s 2023 list to be headquartered in Georgia. All but two of these are based in metro Atlanta.  

According to the Georgia Department of Transportation’s (GDOT) 2020 Statewide Airport Economic Impact Study, Hartsfield-Jackson Atlanta International contributes $66.8 billion in annual economic benefits, which accounts for 90% of all economic activity among the state’s 103 public airports.32 Together, the airports support 15% of Georgia’s GDP and 13% of all statewide jobs.32  

The film and television industry are other industries elevating Georgia’s economy. Georgia offers lucrative tax incentives for television and movies making the state a popular site for filming and production, stimulating further growth. The tax credit that allows productions to collect a credit of up to 30% of its budget, enabling studios to save money or increase their budgets. The amount of the annual credit doubled between 2013 and 2019. The state’s generally lower prices compared with California or New York and the geographic diversity with cities such as Atlanta and many rural locations offer a variety of settings. In 2021, Georgia’s film production exceeded its pre-pandemic pace, setting a record of $4.4 billion in direct spend in production in the state in 2022.33 Georgia has more than 3 million square feet in purpose-built space in 2022, and this is planned to more than double in the next two years.33  

Georgia has a rich, varied, and ongoing tradition of producing quality sports teams that enhance the economy. Atlanta is home to several professional sports franchises, including the Braves (Major League Baseball), Hawks (National Basketball Association), Falcons (National Football League), Dream (Women’s National Basketball Association), and Atlanta United (Major League Soccer). In 2020, an additional professional sports league (Major League Rugby) was established in Georgia with the Rugby ATL. Atlanta was home to NFL Superbowl LIII with more than 500,000 attending and more than 150,000 out-of-state visitors. In addition to Atlanta’s major league sports teams, minor league franchises are hosted by several Georgia cities. Augusta, Georgia is home to the Masters, professional golf’s most famous and prestigious event. Atlanta Motor Speedway hosts NASCAR’s Sprint Cup Series Race each Labor Day weekend. Sports provide an economic boost for the city and remain a key revenue-generator within the tourism industry. 

The COVID-19 pandemic impacted several industries in Georgia. Not including agriculture, over 531,000 jobs were initially lost. The hospitality industry experienced the greatest impact, initially losing over 223,000 jobs. Hospitality workers are disproportionately represented by people of color and typically perform “essential jobs” which include frontline, close-contact tasks. Economic development has improved with the unemployment rate remaining stable at 3.1% in 2023.34 In January 2023, Job numbers were up 3.4% over the previous year to 4,874,000, an all-time high.34  

Homelessness 

According to the Annual Homeless Assessment Report to Congress (AHAR), a Housing and Urban Development (HUD) report that provides estimates of homelessness, the total homelessness number in Georgia for 2022 was 10,689, including 1,785 individuals under age 18.35 The number of homeless individuals increased 4.4% from 2020.36   

Insurance 
In 2020, 13.7% of the total population were uninsured with the largest part of the population insured through employers.37 Approximately 36% of Georgians without health insurance are Black and 22% are Hispanic.38 According to the 2023 Kids Count Data Book, 7% of Georgia’s children, ages zero to 18, were uninsured, making it the 9th highest rate of uninsured children in the U.S in 2019.39  

Medicaid and PeachCare for Kids® provide access to affordable vital health services to nearly two million Georgians, including children, pregnant women, low-income seniors, and those with physical and developmental disabilities. Medicaid and PeachCare for Kids® covers 1.3 million Georgia children, which is nearly half of all children in Georgia. Private care management organizations (CMOs) operate in the state for families who do not meet Medicaid eligibility and allow families to select a health care plan at no cost to families for children under age six. Starting at age six, premiums are determined based on the federal poverty level and household size. CMOs operating in Georgia include Amerigroup Community Care, CareSource and Peach State Health Plan. In April 2022, the Georgia General Assembly passed Senate Bill 338, extending last postpartum coverage under Medicaid from six months to one year following the end of the pregnancy. 

 
The Affordable Care Act, signed in 2010, went into effect in 2014. Georgia does not participate in Medicaid expansion. For 2023 coverage, 879,084 individuals enrolled in health insurance plans through the Georgia exchange. Beginning in the fall of 2023, Georgia plans to run its own exchange platform.40  

Department of Public Health Priorities 

DPH is the lead agency in preventing disease, injury and disability; promoting health and well-being; and preparing for and responding to disasters from a health perspective. In 2011, the General Assembly restored DPH to its own state agency after more than 30 years of consolidation with other departments. At the state level, DPH functions through numerous divisions, sections, programs, and offices. Locally, DPH funds and collaborates with Georgia's 159 county health departments and 18 public health districts. Through the changes, the mission to protect the lives of all Georgians has remained constant. Today, DPH’s main functions include Women, Children, and Nursing Services, Infectious Disease and Immunization, Environmental Health, Epidemiology, Emergency Preparedness and Response, Emergency Medical Services, Pharmacy, Nursing, Volunteer Health Care, the Office of Health Equity, Vital Records, and the State Public Health Laboratory. 

In 2019, DPH achieved national accreditation through the Public Health Accreditation Board. The national accreditation program works to improve and protect the health of the public by advancing and transforming the quality and performance of health departments. Under the leadership of DPH Commissioner Dr. Kathleen Toomey, DPH continues its mission to prevent disease, injury and disability, promote health and well-being, and prepare for and respond to disasters.  

DPH’s workforce is guided by the following core values in carrying out public health work: 

People– We value our employees as professional colleagues. We treat our customers, clients, partners, and those we serve with respect by listening, understanding, and responding to needs.  

Excellence– Commitment, accountability, and transparency for optimal efficient, effective, and responsive performance.  

Partnership– Internal and external teamwork to solve problems, make decisions, and achieve common goals.  

Innovation– New approaches and progressive solutions to problems. Embracing change and accepting reasonable risk.  

Science– The application of the best available research, data, and analysis leading to improved outcomes.