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Appalachian Health and Well-Being

edited by Robert L. Ludke and Phillip J. Obermiller

Publication Year: 2012

Appalachians have been characterized as a population with numerous disparities in health and limited access to medical services and infrastructures, leading to inaccurate generalizations that inhibit their healthcare progress. Appalachians face significant challenges in obtaining effective care, and the public lacks information about both their healthcare needs and about the resources communities have developed to meet those needs.

In Appalachian Health and Well-Being, editors Robert L. Ludke and Phillip J. Obermiller bring together leading researchers and practitioners to provide a much-needed compilation of data- and research-driven perspectives, broadening our understanding of strategies to decrease the health inequalities affecting both rural and urban Appalachians. The contributors propose specific recommendations for necessary research, suggest practical solutions for health policy, and present best practices models for effective health intervention. This in-depth analysis offers new insights for students, health practitioners, and policy makers, promoting a greater understanding of the factors affecting Appalachian health and effective responses to those needs.

Published by: The University Press of Kentucky

Front Cover

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Title Page

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Copyright Page

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List of Illustrations

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pp. ix-x

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pp. xi-xv

As director of the Center for Health Services at Vanderbilt University from 1975 to 1988, I had the professionally and personally enriching experience of working with community leaders in rural, low-income communities in and around Tennessee. ...

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pp. 1-24

The story of Appalachian health and health care is one of complexity and paradox. At various times and in different places throughout the region’s history, health care has been the province of herbalists, granny women, missionaries, company doctors, nurse practitioners, labor unions, church groups...

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Part I: Appalachian Health Determinants

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pp. 25

To better understand the background factors affecting the health of the region’s population, this part examines some of the most misunderstood aspects of Appalachian health, including genetic predisposition, individual lifestyle behaviors, and the social and cultural dimensions of health. ...

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1. Genetic Contributions to Health

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pp. 27-46

Genetic factors are well-recognized contributors to the overall health of populations; however, their contribution to the incidence and prevalence of health conditions in the Appalachian population has not been systematically studied. This dearth of information may be due to the underrecognition of genetic conditions...

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2. Health and the Physical Environment

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pp. 47-66

Appalachia is known for its mountains and rivers, its forests, hills, and streams. It is known for its music and its heritage. It also includes large cities (Birmingham, Chattanooga, Pittsburgh), major industries, and, perhaps most centrally, coal. The complex interplay of historical, geographic, geologic, social, economic...

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3. The Quest for an Appalachian Health Lifestyle

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pp. 67-88

Is there a distinctive Appalachian health lifestyle? This chapter explores the concept of health lifestyles and how research on this concept has been applied to the Appalachian region. It concludes with recommendations for researchers and practitioners engaged in addressing health issues from a lifestyle perspective. ...

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4. Health Care Systems

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pp. 89-108

Scholars are engaged in active discussion about the underlying causes of poor health outcomes in the Appalachian region. One view is that cultural factors and traditions maintained over generations lead to unhealthy lifestyles and the inappropriate use or underuse of health services.1 ...

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Part II: Appalachian Health Status

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pp. 109

This part discusses the nature, prevalence, interconnections, and implications of various health conditions in the region. The issue of health disparities both in the region as a whole and in the states with Appalachian counties underlies the following chapters. ...

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5. The Heart of Appalachia

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pp. 111-130

Heart disease,a the leading cause of death of both men and women in the United States, costs an estimated $475 billion for health care services, medications, and lost productivity in 2009.1 Among adults over 20 years of age, some 80 million Americans, or 38 percent of men and 34 percent of women, are currently living with one or more types of cardiovascular disease. ...

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6. Diabetes and Its Management

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pp. 131-148

According to the Centers for Disease Control and Prevention,1 25.8 million children and adults in the United States, or 8.3 percent of the nation’s population, have been diagnosed with diabetes, a figure that has more than doubled since 1980. ...

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7. Obesity and Food Insecurity

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pp. 149-166

Obesity has increased dramatically in the United States since 1980.1 It is now the second leading cause of preventable death, contributing to more than 100,000 deaths annually.2 The health effects of obesity are well documented, including increased rates of cancer, diabetes, and heart disease. ...

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8. Cancer-Related Disparities

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pp. 167-186

This chapter describes disparities in cancer incidence, prevalence, and mortality in Appalachia, as well as differences in contributing factors such as cancer screening behaviors (e.g., mammography) and cancer-related behaviors (e.g., tobacco use). ...

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9. Chronic Kidney Disease—A Hidden Illness

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pp. 187-207

Many Americans are attentive to the widespread problems of heart disease, high cholesterol, and accelerating rates of obesity in the United States but are far less aware of chronic kidney disease (CKD).1 Yet CKD (formerly called chronic renal failure) is widespread, affecting approximately one in nine adults...

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10. Trauma

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pp. 209-222

This chapter addresses the problem of injury in rural areas of Appalachia, including the role of trauma systems in caring for the injured and the inadequacies of these systems in rural areas. Because systems for collecting data on injury are fragmented and limited in scope...

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11. Mental Health

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pp. 223-250

Appalachia presents striking challenges for the field of mental health. Multiple social and economic stressors, including high rates of unemployment and poverty, low levels of education and health insurance coverage, long travel distances to services, few institutional resources, and cultural differences,a...

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12. Substance Abuse

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pp. 251-274

Substance abuse has become a major health concern in Appalachia. In pockets of rural Appalachia, poor economic prospects, high unemployment rates, limited transportation networks, long distances to medical facilities, and a scarcity of treatment facilities and service organizations...

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13. Oral Health

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pp. 275-294

Oral health is a sentinel marker of overall health status. In Appalachia, it serves as a mirror reflecting health and well-being in the region. Whereas dental health involves a singular focus on dentition (teeth), oral health is a more comprehensive concept that includes the well-being of the oral cavity and areas of the head and neck...

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Part III: Urban Appalachian Health

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pp. 295

There is little information about the health of the millions of Appalachians who have migrated to urban areas outside the region. Many of these migrants and their descendants may be experiencing health disparities similar to those of their counterparts in the region. ...

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14. Identifying Appalachians Outside the Region

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pp. 297-313

Since the time of the Great Migration, when millions of Appalachians moved to urban centers outside the Appalachian region, questions have been raised about the status of those migrants and their descendants. How are these people faring in the cities? ...

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15. The Health Status and Health Determinants of Urban Appalachian Adults and Children

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pp. 315-338

The health status of urban Appalachians—those who have migrated out of the region to urban areas such as Cincinnati, Columbus, Chicago, Baltimore, and Detroit—is largely unknown. What is known is tentative due to a greater emphasis on health care delivery than on health status...

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16. Community-Based Participatory Health Research in an Urban Appalachian Neighborhood

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pp. 339-360

Community-based participatory research (CBPR) is an appropriate and effective research methodology for areas that are underserved or completely missed by health data-collection protocols that typically operate at the federal, state, county, or metropolitan level.1 ...


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pp. 361

Selected Bibliography

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pp. 363-366


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pp. 367-370


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pp. 371-386

E-ISBN-13: 9780813135878
Print-ISBN-13: 9780813135861

Publication Year: 2012