Where is This Place Called Appalachia?

The Appalachian region as defined by the Appalachian Regional Commission (ARC), extends from Northern Mississippi to Southern New York State. It roughly follows the Appalachian Mountain Range. Appalachia is a very large region containing all of the state of West Virginia and portions of 12 other states. There are more than 25 million people living in the Appalachian Region. In addition, the Appalachian region is divided into 5 regions. These are identified as Northern, North Central, Central, South Central, and Southern regions. The Appalachian region has the highest health disparities of any region in the United States. Appalachian Healthcare Training & Consulting is focused on improving health and human service outcomes and thereby decreasing health disparities in the South-Central Appalachian Region.

Health Disparities in Appalachia

A 2017 study by the ARC revealed that Appalachia ranks the highest in health disparities of any region in the nation. All chronic diseases such as, heart disease, diabetes, stroke, cancer, COPD, hypertension, obesity, and substance abuse are found at the highest levels in Appalachia. In addition, mental illness and suicide rates also have the highest occurrences. Furthermore, the cancer mortality rate in Appalachia is the highest of any region in the nation. Many times, a cancer diagnosis is not made until the disease has progressed quite far. Consequently, treatment may be ineffective, resulting in any possibility of a cure thus contributing to the high cancer mortality rate.

Contributing Factors to Health Disparities in Appalachia

There are many reasons for high health disparities in the Appalachian region. Social determinants such as: poverty, educational levels, transportation, and lack of insurance or inability to pay for healthcare are many of the contributing factors. Along with these reasons, is many people’s distrust of the healthcare system. The Appalachian region has a long and complicated history of exploitation by outsiders. Beginning in the late 1800’s, the vast amount of natural resources, especially timber and coal,  suffered exploitation by people who were not from the Appalachian region. Many people who had been in the Appalachian region during the Civil War realized there was much money to be made by extracting timber and coal from Appalachia. Unfortunately, most of the wealth did not stay in the Appalachian region. This allowed many people who did not live in Appalachia to become extremely wealthy, but did very little to improve the region.  Furthermore, during the War on Poverty in the 1960’s, many well-meaning people came from outside of the Appalachian region to try and improve poverty and other social issues that were occurring. Frequently, local people were not even asked what they thought were problems and what might help bring improvement. Subsequently, this contributed to this extreme distrust of outsiders which continues to greatly have a profound effect in the region.

What Can Be Done to Improve Health Outcomes and Decrease High Health Disparities?

The Appalachian region has long experienced economic, social, and high health disparities compared to the rest of the United States. While many factors underlie these disparities, one often over looked component is the cultural disconnect between health and human service provider and patient. In rural, underserved mountain areas, healthcare providers are often recruited from outside of the region or even outside of the country. Frequently, these providers are negatively influenced by the stereotypes concerning the people who live in the Appalachian region. Providing specific cultural competence training for health and human service  providers concerning the history, cultural values, beliefs, and communication issues of native Appalachian people would be  very helpful. This would improve communication and interactions  between health and human service providers and patients, thereby improving health outcomes which would decrease high health disparities.

Cultural Competence and Healthcare

As a young nurse in the 1950’s, Dr. Madeleine Leininger, PhD, RN, is credited with developing The Culture Care Theory. In the early 1950’s, Dr. Leininger recognized the need for greater understanding of cultural diversity, as she observed the globalization of the world. She remained active in the promotion of this theory until her death in 2012.  Leininger challenged nurses to learn as much as possible about not only worldwide cultures they would be providing nursing care for, but local cultures as well. Nurses who receive further training in cultural competency theory understand the relevance that it has for improving health care to their patients. Over the last sixty years, this area of study has grown tremendously and is being emphasized and taught in not only health care, but many different areas as well. Utilizing transcultural nursing concepts and providing culturally relevant care leads to an increase in patient satisfaction and improved health outcomes.

Improving Health Outcomes and Decreasing Disparities in South-Central Appalachia

Applying Madeline Leininger’s Culture Care Theory to health and human services in the Appalachian region, will improve communication between provider and patient. Research has shown that poor provider-patient communication is one of the causes of health disparities. Applying this theory to all health and human service professionals who provide care to Appalachian patients will result in improved health outcomes and a decrease in health disparities.