Big study finds Appalachia falling behind rest of the nation in health; rural areas often worse off

This county-by-county map of premature deaths, from the report, outlines in red the Appalachian region, where the rate is 25 percent higher than in the nation as a whole.

By Melissa Patrick
Institute for Rural Journalism and Community Issues

When it comes to health, Appalachia is falling farther behind the rest of the nation. So says a comprehensive report from the Appalachian Regional Commission, the Robert Wood Johnson Foundation and a Kentucky foundation, looking at a range of health measures in Appalachia.

"We can't underestimate the importance of accurate and timely data in understanding the issues that lead to the health disparities in Appalachia," said Ben Chandler, president and CEO of the Foundation for a Healthy Kentucky, which co-sponsored the study.

The report, “Health Disparities in Appalachia,” not only paints a grim picture of the region's health status, but also shows that even in the areas of improvement, the region hasn't kept up with the rest of the nation, and continues to fall behind.

The researchers found that over the last two decades, Appalachia and the rest of the U.S. saw improvements in seven of the eight health measures examined: deaths from heart disease, cancer and stroke; infant mortality, the supply of primary-care doctors, education levels and years of potential life lost. Poverty was the only measure that increased.

But when compared to the rest of the nation, Appalachia's improvements lagged behind in all but one of those measures: the number of primary-care physicians.

The greatest gap was in life expectancy, the most fundamental measure of a place's health. The report measured it in "years of potential life lost." Over the last two decades, the U.S. saw a 24 percent decrease in premature deaths, while the Appalachian region only saw an 8 percent decrease. The Appalachian rate was 25 percent higher than the nation as a whole.

A news release about the study noted that the nation's improvements have often outpaced those in Appalachia.

For example, in the 1990s, the cancer death rate in Appalachia was only 1 percent higher than the rest of the nation, but more recently it is 10 percent higher. The infant mortality rates were 4 percent higher in Appalachia in the '90s, but are now 16 percent higher.

“These data bring attention to the growing health gap between Appalachia and the rest of the country,” Hilary Heishman, senior program officer of the Robert Wood Johnson Foundation, said in the release. “The U.S. can’t be healthy as a whole if we are leaving whole regions behind.”

The report also analyzed 41 health indicators and how the 420 Appalachian counties compared to the rest of the nation in those measures, as well as how parts of the region compared to one another. The data is also broken down by state.

One of the greatest differences between Appalachia and the rest of the nation is the number of deaths caused by injury, which are 33 percent higher in the region. Injury deaths include things like motor vehicle accidents, falls and drug overdoses.

Injury deaths were more than twice the national rate in Central Appalachia – 81.4 injury deaths per 100,000 people compared to 39.5 nationally. Central Appalachia is the most rural sub-region as defined by the Appalachian commission.

Poisoning mortality rates in Appalachia
(Boundaries of sub-regions are in red.)

The overdose, or poisoning, deaths were a whopping 146 percent higher in Central Appalachia and 79 percent higher in North Central Appalachia than in the nation as a whole.

The premature death rate in Central Appalachia was much higher than the other sub-regions, 69 percent higher than the national average.

Appalachian suicide rates were also higher than the national rates by 17 percent, and were 31 percent higher in Central Appalachia.

“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,” Chandler said in the news release. “Appalachia’s economic livelihood is absolutely dependent on improving these health measures."

The report also notes that Appalachia's rural counties have higher death rates than the region's large metro counties for each of the mortality measures, "signifying a stark rural-urban divide in the region": in rural counties, heart disease is 27 percent higher, cancer is 15 percent higher, COPD is 55 percent higher, injury is 47 percent higher, stroke is 8 percent higher; suicide is 21 percent higher, and diabetes is 36 percent higher. Premature death rates are 40 percent higher in rural Appalachia.

It comes as no surprise that many of the risk factors for poor health are also more prevalent in the Appalachian region, including fewer health care providers, higher rates of diabetes and obesity, higher rates of physical inactivity and higher smoking rates. The region also has lower incomes, higher poverty rates, more people on disability and lower shares of residents with some college education.

One bright spot is the Appalachian region's high rate of social associations, at 33 percent. This is a measure of the number of social organizations available and may very well end up being part of the solution to improving the region's health. "Greater levels of social relationships and interaction positively affect a number of outcomes, included those associated with both mental and physical health,” the report says.

The region also has lower incidence of chlamydia, lower prevalence of HIV, higher student-teacher ratios, and better diabetes monitoring among Medicare patients than the rest of the nation as a whole.

“This report begins to identify key health challenges confronting Appalachia,” ARC Federal Co-Chair Earl F. Gohl said in the release. “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.”

This report is part of multi-part research project titled “Creating a Culture of Health in Appalachia: Disparities and Bright Spots.” The next report will explore “bright spots,” Appalachian communities that have better-than-expected health outcomes given their resources, with the goal of identifying activities, programs or policies that other struggling communities could replicate.