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A Grim Portrait of Public Health in Appalachia

A coal miner walks through the morning fog in Welch, W.Va. in May of 2016.

A coal miner walks through the morning fog in Welch, W.Va. in May of 2016. (AP Photo/David Goldman)

 

Connecting state and local government leaders

New research finds the region is lagging in dozens of health metrics, including mortality rates caused by ailments like heart disease, cancer and stroke.

People in Appalachia are experiencing a wide range of bleak health outcomes and conditions compared to the rest of the nation, according to research released this week.

The region performed worse than the country as a whole across 33 health indicators, including leading causes of death. These findings were presented as part of a research project known as Creating a Culture of Health in Appalachia: Disparities and Bright Spots.

An initial report released as part of the initiative offers an assessment of 41 health metrics for people living in the Appalachian region, which includes 420 counties, about 25 million people, and extends from New York’s Southern Tier in the north, to northern Mississippi in the south.

“These data bring attention to the growing health gap between Appalachia and the rest of the country,” Hilary Heishman, senior program officer for the Robert Wood Johnson Foundation, one of the groups sponsoring the research initiative, said in a statement.

Mortality rates in the region are higher than the rest of the country for seven of 10 of the nation’s leading causes of death. These fatal conditions include heart disease, cancer, chronic obstructive pulmonary disease, injury, stroke, diabetes and suicide.

The same is true for poisoning deaths, which include drug overdoses.

“Years of potential life lost,” a broad measure of premature mortality, is 25 percent higher in Appalachia than in the rest of the U.S.

Click the map to expand it in a new window. This chart can be found on page 77 of the report. (Creating a Culture of Health in Appalachia: Disparities and Bright Spots)

There are other negative findings as well.

The number of physically and mentally unhealthy days for people in the region, and the prevalence of depression, obesity and smoking also exceed national rates.

And while some health-related metrics have improved in recent decades, progress has often lagged compared to the rest of the country.

Outcomes in places throughout the region vary.

For instance, the rate for years of potential life lost is higher in central Appalachia than in other parts of the region, exceeding the national benchmark by 69 percent. Rates are also higher in rural areas compared to those that are urban, and in economically distressed areas.

Click on the chart to expand it in a new window. The chart shows the distribution of years of potential life lost rates by geography and economic status. Shaded boxes show the middle 50 percent of all values for each group, with dots representing especially high or low values. The gray line stretching across the width of the graph indicates the national average, and the black lines inside the shaded boxes indicate the median for each group. This chart can be found on page 78 of the report. (Creating a Culture of Health in Appalachia: Disparities and Bright Spots)

There are eight indicators examined in the report where Appalachia performed better than other parts of the country.

These included: HIV prevalence, travel time to work, excessive drinking, student-to-teacher ratios, chlamydia prevalence, portion of the population under age 65 that is uninsured, diabetes monitoring among Medicare patients and the social association rate.

The diabetes monitoring metric assesses the percentage of diabetic, fee-for-service Medicare patients who are 65 to 75 years-old and have tested their glycated hemoglobin levels in the past year.

Social association rates looks at the number of social organizations per 10,000 people. These include organizations like fitness centers, sports teams and civic and religious groups.

Joining the Robert Wood Johnson Foundation in sponsoring the research is the Appalachian Regional Commission, an independent federal agency that President Trump proposed closing down in the budget proposal he sent to Congress earlier this year.

Foundation for a Healthy Kentucky is administering the research initiative.

The 382-page report released this week is the first in a series. Future research conducted as part of the initiative will seek to identify Appalachian communities where health outcomes are better than expected, and to explore these places with in-depth case studies.

Ben Chandler, president and CEO of the Foundation for a Healthy Kentucky said reducing smoking rates is one important step that could improve public health in the region.

“Appalachia’s economic livelihood is absolutely dependent on improving these health measures,” he added.

A full copy of the report can be found here.

Bill Lucia is a Senior Reporter for Government Executive’s Route Fifty and is based in Washington, D.C.

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