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Appalachian, Urban Health Challenges Remarkably Similar

 |  By John Commins  
   May 23, 2012

We compartmentalize population health issues in this country. Perhaps it is because the challenges are vast and daunting and there are usually exceptions to any consensus. Therefore, using reams of data to carve national healthcare issues into smaller bits based on region, race, gender, or socioeconomic class makes issues seemingly more digestible and solvable.

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However, one of the unfortunate ironies of population health in the United States is that the people who live in the most remote sections of the country often face the same health and healthcare access issues that plague people in large cities. 

That notion is illustrated in new compilation of studies—Appalachian Health and Well-Being—that identify healthcare issues in the sprawling 13-state region.

Robert L. Ludke, PhD, a co-editor of the compilation and a professor of family and community medicine at the University of Cincinnati, told HealthLeaders Media that the "common denominators" for the poor health status of many people in Appalachian hollows and inner-city slums are "poor environment, low socioeconomic status, and lifestyles behaviors."

Ludke says Appalachian inhabitants from coal-producing regions, for example, would feel the ill effects of living in a contaminated environment, just as any urban inhabitant might suffer from living near an industrial complex, or from moldy and substandard housing.

There are lifestyle behaviors, particularly around high-fat diets and high incidences of tobacco use in Appalachia and among lower-income Americans regardless of their neighborhoods that contribute to health problems.

There is a high incidence of mental illness and substance abuse. Finally, there is the poverty—the grinding, stubborn and notorious pockets of blight that can be found in the shadows of mountains and sky scrapers.

"When you put together the environment, the lifestyle behaviors, the socio-economic status, and couple that with this overlay of the healthcare system and the difficulty to access services because of where they are located, they all contribute to the greater disparities," Ludke says.

He was talking specifically about Appalachia, but the words could apply to the health issues that are seen every day at urban safety net hospitals.

Of course, not everyone who lives in an inner-city neighborhood or a backwoods tract is poor, uneducated, or unhealthy. And before we can gain a better understanding of the healthcare challenges that face many inhabitants of Appalachia, Ludke says, we must first get past the hillbilly stereotypes that have plagued the region for decades.

"The Appalachian culture in many respects is no different from other cultures. These aren't people that follow those stereotypes. They are people like you and me in many respects," he says. "What we try to do in the book is to raise the questions about what is underpinning the health of the people living within the Appalachian region as well as those individuals who have migrated to the region to urban areas such as Cincinnati, Detroit, Chicago, Pittsburgh, Cleveland, and Indianapolis."

For example, when it comes to access to care, Ludke says, the challenges in Appalachia as a region are about the same as anywhere else in the country, and that is not necessarily a good thing.

"When you look at it more carefully, you see that about half of the Appalachian region is rural and what you see which is comparable to other rural areas in the country is that those are the areas where there are limited healthcare services," he says.

"Just like the country as a whole, it's not necessarily where we have shortages of healthcare professionals or facilities. What we have is a maldistribution issue where they are concentrated in the major population areas. Therefore, people who live away from those areas have a much more difficult time to try to get care."

One disturbing commonality between the urban and rural poor is the effect of stress on their health.  "It's not just thinking about stress as 'what kind of a day do you have?'" Ludke says. "There is clearly a body of literature out there that says that early in life, even before we are born, we are exposed to stress and it builds up over time to the point where it leads to the onset of disease."

Are people poor because they are stressed, or are they stressed because they are poor? It's a chicken-or-egg question. Regardless, Ludke says there is a link.

"People living in lower socioeconomic conditions are living in environments where there is a higher degree of negative environmental exposure," he says. "They are living under higher stress than people not living in those environments to the point where they would be more susceptible to disease."

Bottom line: No matter where you live, poverty isn't easy.

John Commins is a content specialist and online news editor for HealthLeaders, a Simplify Compliance brand.

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