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Saturday, September 02, 2017

Talking about poor health as an obstacle to progress in Appalachia, and what to do about it

By Melissa Patrick
Institute for Rural Journalism and Community Issues

JOHNSON CITY, Tenn. -- Appalachia faces many hurdles when it comes to economic development and creating a healthy workforce, including education barriers, addiction issues, stigma and overall poor health.

Those were the conclusions of a 13-member panel convened to discuss the findings of two new Appalachian Regional Commission reports that found Appalachian health continues to fall behind the rest of the nation, and how that affects economic development.

"Without a healthy workforce, the economic prospects in the region are greatly diminished," declared Julie Marshall, an ARC economist and a principal investigator for the "Health Disparities in Appalachia" report.

The second report, "Diseases of Despair," looked at deaths from overdose, suicide and alcohol-related liver diseases in Appalachian and found them to be 37 percent higher than the rest of the nation: Overdose deaths were 65 percent higher, suicide deaths were 20 percent higher, and alcoholic liver-disease deaths were 8 percent higher.

Michael Meit, lead author of the study, reminded the panel that it's important to look beyond poverty as the only reason for these high rates, pointing out that some Appalachian states, like Mississippi and Georgia, have high poverty levels, but lower death rates for these measures.

Meeting in Johnson City, Tenn., the panel said addiction -- to opioids, alcohol, methamphetamine and cocaine -- is a major workforce issue in the region.

Dan Eldridge, the mayor of surrounding Washington County, said he had recently talked to a company looking to bring more than 600 jobs to his area, and spent most of the time talking about the region's workforce. And when he asked why, they told him that among other things, one of their selection criteria was access to a drug-free workforce and "this region of the country does not have a good reputation."

Eldridge said he thought one contributor to the problem is that high-school students who aren't college-bound don't have any plans for the future, and their drug use seems to increase after they graduate.

Randy Wykoff, dean of the East Tennessee State University College of Public Health, said it's time to bring people together from different sectors -- health-care providers, the criminal-justice system, advocacy groups and people with substance-use disorders --  to "rethink this whole thing." He said it's time to quit putting people in jails who need rehabilitation and treatment.

Successes and strategies

Eldridge said his county has a program that teaches employees how to recognize personal or work-related problems and encourages employers to implement employee-assistance programs to address them.

Mike Caudill, CEO of the Mountain Comprehensive Health Corp., a federally qualified health center in Whitesburg, Ky., pointed to its "Farmacy" program as one of their many successes.

The grant-funded program gives qualifying individuals a "prescription" for fresh fruits and vegetables at their local farmers' market. Caudill noted that one of their participants lowered his A1C, a test for blood sugar, from 14 to 6.2 in just eight months. A normal A1C is between 4 and 5.6.

"In the midst of all this bad news, somebody has to speak life into what is possible," said Jared Arnett, executive director of Shaping Our Appalachian Region, a bipartisan effort to revitalize and diversify Eastern Kentucky's economy.

Arnett said technology can open doors for new economic opportunities, expand entrepreneurship, provide access to health-care specialists through telemedicine, and offer more opportunities for education and workforce training.

Other ideas to improve the workforce included creating multi-sector partnerships, involving community members in decision making, taking advantage of the region's high rate of social associations, including health considerations in all government policies, and better coordinating local educational systems with the region's workforce needs.

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