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Appalachian Health and Well-Being

Appalachian Health and Well-Being

Robert L. Ludke
Phillip J. Obermiller
Foreword by Richard A. Couto
Copyright Date: 2012
Pages: 400
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  • Book Info
    Appalachian Health and Well-Being
    Book Description:

    Appalachians have been characterized as a population with numerous disparities in health and limited access to medical services and infrastructures, leading to inaccurate generalizations that inhibit their healthcare progress. Appalachians face significant challenges in obtaining effective care, and the public lacks information about both their healthcare needs and about the resources communities have developed to meet those needs.

    In Appalachian Health and Well-Being, editors Robert L. Ludke and Phillip J. Obermiller bring together leading researchers and practitioners to provide a much-needed compilation of data- and research-driven perspectives, broadening our understanding of strategies to decrease the health inequalities affecting both rural and urban Appalachians. The contributors propose specific recommendations for necessary research, suggest practical solutions for health policy, and present best practices models for effective health intervention. This in-depth analysis offers new insights for students, health practitioners, and policy makers, promoting a greater understanding of the factors affecting Appalachian health and effective responses to those needs.

    eISBN: 978-0-8131-3587-8
    Subjects: History, Public Health

Table of Contents

  1. Front Matter
    (pp. i-vi)
  2. Table of Contents
    (pp. vii-viii)
  3. List of Illustrations
    (pp. ix-x)
  4. Foreword
    (pp. xi-xvi)
    Richard A. Couto

    As director of the Center for Health Services at Vanderbilt University from 1975 to 1988, I had the professionally and personally enriching experience of working with community leaders in rural, low-income communities in and around Tennessee. Our work, like the chapters of this book, addressed all the factors that promote health and well-being, including economic, political, psychological, environmental, and social ones. From these community leaders I learned to put health and health care in a socioeconomic and political context. I recall in particular Square Mormon, an African American farmer in predominantly black Fayette County in West Tennessee. He and his...

  5. Introduction
    (pp. 1-24)

    The story of Appalachian health and health care is one of complexity and paradox. At various times and in different places throughout the region’s history, health care has been the province of herbalists, granny women, missionaries, company doctors, nurse practitioners, labor unions, church groups, community-based organizations, private practitioners, and state and federal governments. At various times and places, the region has experienced a shortage of physicians, dentists, nurses, health educators, clinics, and hospitals. At times, the region has been a repository of underqualified and unqualified health practitioners, and it remains an area where a few unethical pharmacists and physicians trade...

  6. Part I. Appalachian Health Determinants

    • 1 Genetic Contributions to Health
      (pp. 27-46)
      Melanie F. Myers and Carol S. Baugh

      Genetic factors are well-recognized contributors to the overall health of populations; however, their contribution to the incidence and prevalence of health conditions in the Appalachian population has not been systematically studied. This dearth of information may be due to the underrecognition of genetic conditions owing to the absence of systematic health surveillance systems in Appalachia; limited access to health care services and, specifically, to genetic specialists; lack of education among health professionals about genetic conditions; and limited investment in social capital, resulting in restricted resources and competing health and other priorities.1, 2The economic and demographic diversity in Appalachia compounds...

    • 2 Health and the Physical Environment
      (pp. 47-66)
      Michael S. Hendryx

      Appalachia is known for its mountains and rivers, its forests, hills, and streams. It is known for its music and its heritage. It also includes large cities (Birmingham, Chattanooga, Pittsburgh), major industries, and, perhaps most centrally, coal. The complex interplay of historical, geographic, geologic, social, economic, and anthropogenic forces affects the health of the Appalachian population in profound ways. This chapter explores these influences, documents their impacts, and recommends policies and programs to restore the Appalachian physical environment for the promotion of public health. Because Appalachia suffers from major health disparities relative to the nation,1–3and because Appalachia is...

    • 3 The Quest for an Appalachian Health Lifestyle
      (pp. 67-88)
      Evelyn A. Knight

      Is there a distinctive Appalachian health lifestyle? This chapter explores the concept of health lifestyles and how research on this concept has been applied to the Appalachian region. It concludes with recommendations for researchers and practitioners engaged in addressing health issues from a lifestyle perspective.

      Although there is no universal definition of the termlifestyleas it is applied to health research, in the most general sense, it refers to the behaviors and life course choices individuals and groups of individuals make that have the potential to impact their health status. Based on extensive epidemiological study over the past sixty...

    • 4 Health Care Systems
      (pp. 89-108)
      Joel A. Halverson, Gilbert H. Friedell, Eleanor Sue Cantrell and Bruce A. Behringer

      Scholars are engaged in active discussion about the underlying causes of poor health outcomes in the Appalachian region. One view is that cultural factors and traditions maintained over generations lead to unhealthy lifestyles and the inappropriate use or underuse of health services.¹ A different perspective points to a structural basis; that is, the roots of Appalachia’s health problems lie in systemic characteristics, particularly those related to power and how—and by whom—decisions are made. At the same time, this view recognizes that population and social factors play a role.² Poverty, lack of jobs, illiteracy, inadequate education, poor housing, lack...

  7. Part II. Appalachian Health Status

    • 5 The Heart of Appalachia
      (pp. 111-130)
      Ann L. McCracken and E. Kelly Firesheets

      Heart disease,athe leading cause of death of both men and women in the United States, costs an estimated $475 billion for health care services, medications, and lost productivity in 2009.¹ Among adults over 20 years of age, some 80 million Americans, or 38 percent of men and 34 percent of women, are currently living with one or more types of cardiovascular disease. This form of heart disease affects the heart itself or the blood vessel system, especially the veins and arteries leading to and from the heart. Nationally, more than 830,000 people die of cardiovascular-related conditions every year.²


    • 6 Diabetes and Its Management
      (pp. 131-148)
      Sharon A. Denham

      According to the Centers for Disease Control and Prevention,¹ 25.8 million children and adults in the United States, or 8.3 percent of the nation’s population, have been diagnosed with diabetes, a figure that has more than doubled since 1980. In addition, an estimated 7 million people are unaware that they have the disease, and as many as 79 million people may have pre-diabetes. It is important to note, however, that these estimates may understate diabetes’ prevalence. For example, death certificates are likely to state the immediate cause of death and ignore diabetes, which may be a contributing factor. Diabetes is...

    • 7 Obesity and Food Insecurity
      (pp. 149-166)
      Jennifer Chubinski and Mark A. Carrozza

      Obesity has increased dramatically in the United States since 1980.¹ It is now the second leading cause of preventable death, contributing to more than 100,000 deaths annually.² The health effects of obesity are well documented, including increased rates of cancer, diabetes, and heart disease. These conditions lead to greater health care spending, disability, and death.3–7Because obesity is not distributed randomly across the population, certain groups are more likely than others to be obese.⁸ Minorities, women, the poor, and the less educated generally have a higher risk of being obese.8, 9In addition, rural Americans tend to have higher...

    • 8 Cancer-Related Disparities
      (pp. 167-186)
      James L. Fisher, John M. McLaughlin, Mira L. Katz, Mary Ellen Wewers, Mark B. Dignan and Electra D. Paskett

      This chapter describes disparities in cancer incidence, prevalence, and mortality in Appalachia, as well as differences in contributing factors such as cancer screening behaviors (e.g., mammography) and cancer-related behaviors (e.g., tobacco use). It focuses on the four leading anatomic sites of cancer (lung/bronchus, colon/rectum, female breast, and prostate) and the two cancers (cancer of the cervix and cancer of the oral cavity/pharynx) for which screening tests are available and for which data sources exist on potential disparities in Appalachia. Information on these disparities is drawn from published literature as well as from rates and proportions determined from six state-based central...

    • 9 Chronic Kidney Disease—A Hidden Illness
      (pp. 187-208)
      Barbara B. Weaner and Rebecca J. Schmidt

      Many Americans are attentive to the widespread problems of heart disease, high cholesterol, and accelerating rates of obesity in the United States but are far less aware of chronic kidney disease (CKD).¹ Yet CKD (formerly called chronic renal failure) is widespread, affecting approximately one in nine adults in the United States.² It is estimated that 20 million American adults are currently affected by CKD, with another 20 million at risk for developing it.2–4Some 80,000 adults are diagnosed with CKD annually in the United States, where it is the ninth leading cause of death.⁵ In addition, patients with kidney...

    • 10 Trauma
      (pp. 209-222)
      Levi D. Procter, Andrew C. Bernard, Paul A. Kearney and Julia F. Costich

      This chapter addresses the problem of injury in rural areas of Appalachia, including the role of trauma systems in caring for the injured and the inadequacies of these systems in rural areas. Because systems for collecting data on injury are fragmented and limited in scope, the precise analysis of injury data in Appalachia remains impossible, even in the twenty-first century. Therefore, injury data from three Appalachian states are used as a surrogate for other rural areas in Appalachia. This chapter outlines specific deficiencies and concludes with recommendations for future research and policy initiatives.

      Trauma is the number-one cause of death...

    • 11 Mental Health
      (pp. 223-250)
      Susan E. Keefe and Lisa Curtin

      Appalachia presents striking challenges for the field of mental health. Multiple social and economic stressors, including high rates of unemployment and poverty, low levels of education and health insurance coverage, long travel distances to services, few institutional resources, and cultural differences,acreate the conditions for a high prevalence of mental and emotional problems. Yet some types of mental health services tend to be unavailable in the region and, if available, underutilized.

      This chapter argues that mental health researchers and practitioners must be familiar with both biomedical and ethnomedical models to create and deliver appropriate mental health services for Appalachians. Medical...

    • 12 Substance Abuse
      (pp. 251-274)
      Michael S. Dunn, Bruce A. Behringer and Kristine Harper Bowers

      Substance abuse has become a major health concern in Appalachia. In pockets of rural Appalachia, poor economic prospects, high unemployment rates, limited transportation networks, long distances to medical facilities, and a scarcity of treatment facilities and service organizations influence a community’s ability to cope with the production, distribution, and use of drugs, illicit and otherwise. Data for the region indicate that the substances of choice include alcohol, tobacco, prescription drugs, methamphetamine, marijuana, and newer versions of drugs as they become available.1, 2Anecdotal evidence also indicates the presence of rolling addictions in Appalachia, such as from OxyContin to hydrocodone to...

    • 13 Oral Health
      (pp. 275-294)
      Daniel W. McNeil, Richard J. Crout and Mary L. Marazita

      Oral health is a sentinel marker of overall health status. In Appalachia, it serves as a mirror reflecting health and well-being in the region. Whereasdental healthinvolves a singular focus on dentition (teeth),oral healthis a more comprehensive concept that includes the well-being of the oral cavity and areas of the head and neck, including aspects of function and appearance. Important health factors related to oral health but not typically considered part of dental health include diet, tobacco use, psychological functioning, pregnancy, cardiovascular disease, and head and neck cancer. Like other areas of health, oral health is not...

  8. Part III: Urban Appalachian Health

    • 14 Identifying Appalachians Outside the Region
      (pp. 297-314)
      Robert L. Ludke, Phillip J. Obermiller, Eric W. Rademacher and Shiloh K. Turner

      Since the time of the Great Migration, when millions of Appalachians moved to urban centers outside the Appalachian region, questions have been raised about the status of those migrants and their descendants. How are these people faring in the cities? How do they compare with other urban groups on key social indicators? Do they show signs of economic and social assimilation? What are their social, economic, educational, and health needs, if any, and what programs and services might be required to meet those needs?

      It has been difficult to answer these questions definitively, in large part because urban Appalachians are...

    • 15 The Health Status and Health Determinants of Urban Appalachian Adults and Children
      (pp. 315-338)
      Robert L. Ludke, Phillip J. Obermiller and Ronnie D. Horner

      The health status of urban Appalachians—those who have migrated out of the region to urban areas such as Cincinnati, Columbus, Chicago, Baltimore, and Detroit—is largely unknown. What is known is tentative due to a greater emphasis on health care delivery than on health status and due to a heavy focus on Appalachian migrant populations in central and southwestern Ohio.1–6Beginning in the early 1990s, a number of studies sought to more fully describe the health status of urban Appalachians, although this literature retained its focus on Appalachians residing in Greater Cincinnati. Several interesting patterns began to emerge...

    • 16 Community-Based Participatory Health Research in an Urban Appalachian Neighborhood
      (pp. 339-360)
      M. Kathryn Brown

      Community-based participatory research (CBPR) is an appropriate and effective research methodology for areas that are underserved or completely missed by health data-collection protocols that typically operate at the federal, state, county, or metropolitan level.¹ In this research paradigm, communities identify their health issues of concern and then systematically collect local data to better understand those issues so that practical intervention and prevention strategies can be developed and implemented. CBPR is no less scientific or accurate than conventional investigator-initiated research models. When done right, CBPR is a rigorous research methodology that builds capacity and generates reliable data for improving health.


  9. Acknowledgments
    (pp. 361-362)
  10. Selected Bibliography
    (pp. 363-366)
  11. List of Contributors
    (pp. 367-370)
  12. Index
    (pp. 371-386)