Appalachian Health: More OD’s, Fewer MD’s
A region-wide health study shows that the gap between Appalachia and the rest of the U.S. is widening for health indicators such as infant mortality, cancer deaths, and poverty.
Appalachians are sicker and die younger from conditions like heart disease, cancer, and drug overdoses than the rest of the nation, according to a study released today by a government agency and private charities.
Health problems are worst in the 13-state region’s most rural and economically distressed areas, according to a joint press release from the Appalachian Regional Commission and the Foundation for a Healthy Kentucky. The Robert Wood Johnson Foundation was also part of the research.
The study reviews 41 population and public health indicators to provide a comprehensive overview of the health of the 25 million people living in the Appalachian region, federally defined as 420 counties stretching from northern Mississippi to the southern tier of New York.
Key findings include:
- Appalachia has higher mortality rates than the nation in seven of America’s leading causes of death, including heart disease, cancer, chronic obstructive pulmonary disease (COPD), injury, stroke, diabetes, and suicide. These rates are dramatically higher in Appalachia’s rural areas and in counties experiencing economic distress.
- Mortality due to poisoning—which includes drug overdoses—is markedly higher in the region than in the nation as a whole, especially in the region’s rural and economically distressed areas.
- The Appalachian region has lower supplies of health care professionals per 100,000 population when compared to the nation as a whole. These include primary care physicians, mental health providers, specialty physicians, and dentists. The supply of specialty physicians per 100,000 population is 65 percent lower in Central Appalachia than in the nation as a whole.
- Obesity, smoking, and physical inactivity—risk factors for a number of health issues—are all more prevalent in Appalachia than in the nation overall. Nearly 25 percent of adults in Appalachia’s economically distressed counties are smokers, as compared with just over 16.3 percent of adults in the nation as a whole.
- In several measures, including incidence of chlamydia, prevalence of HIV, student-teacher ratio, diabetes monitoring among Medicare patients, and the social association rate, Appalachia is doing better than the nation as a whole.
“This report begins to identify key health challenges confronting Appalachia,” said ARC Federal Co-Chair Earl F. Gohl. “Now we need to understand the implications these findings have for Appalachia’s economy so we can continue working towards a brighter future for the region.”
The report also examines 20-year trends for selected indicators. While the region and the country have made improvements on many health measures, the improvements made by the nation overall frequently outpace those made by the region, resulting in widening disparities. For instance:
- During the 1989–1995 period, the cancer mortality rate in Appalachia was only 1 percent higher than the rate in the United States overall, but by 2008–2014, the rate in the region was 10 percent higher than the national rate.
- During the 1989–1995 period, the infant mortality rate in Appalachia was only 4 percent higher than the rate in the United States overall, but by 2008–2014, the rate in the region was 16 percent higher than the national rate.
- In 1995, the household poverty rate in Appalachia was only 0.6 percentage points higher than the rate in the United States overall. By 2014, the poverty rate in the region was 1.6 percentage points higher than the national rate.
“These data bring attention to the growing health gap between Appalachia and the rest of the country,” said Hilary Heishman, senior program officer, Robert Wood Johnson Foundation. “The U.S. can’t be healthy as a whole if we are leaving whole regions behind. Both taking on the challenges and building on the assets that counties in Appalachia have will be essential to building a Culture of Health.”
Health Disparities in Appalachia is part of Creating a Culture of Health in Appalachia: Disparities and Bright Spots, a multi-part health research project conducted by ARC in partnership with the Foundation for a Healthy Kentucky with funding from the Robert Wood Johnson Foundation. The research team was led by PDA, Inc., of Raleigh, North Carolina, in collaboration with the University of North Carolina’s Cecil G. Sheps Center for Health Services Research and Wake Forest School of Medicine.
Data sets used in this report included county-level data compiled from numerous sources, such as County Health Rankings and Roadmaps; Centers for Disease Control and Prevention; Centers for Medicare & Medicaid Services; Area Health Resource Files; and the American Community Survey.
“In measure after measure, the Central Appalachian region—including Eastern Kentucky—faces greater health challenges, and gaps are widening at a faster rate, than in the rest of Appalachia and the nation,” said Ben Chandler, president and CEO of the Foundation for a Healthy Kentucky. “Appalachia’s economic livelihood is absolutely dependent on improving these health measures. The foundation believes that the single most effective step we can take toward that end is to reduce our high smoking rates.”