Appalachian Health and Well-Being

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

315 15 The Health Status and Health Determinants of Urban Appalachian Adults and Children Robert L. Ludke, Phillip J. Obermiller, and Ronnie D. Horner 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 and due to a heavy focus on Appalachian migrant populations in central and southwestern Ohio.1–6 Beginning in the early 1990s, a number of studies sought to more fully describe the health status of urban Appalachians, although this literature retained its focus on Appalachians residing in Greater Cincinnati. Several interesting patterns began to emerge from this work. For example, Obermiller and Oldendick7 found that, similar to urban blacks, white Appalachians’ major health concerns included heart attack, stroke, emotional or mental illness, and serious accidental injury. In a follow-up report two years later, Obermiller and Handy8 added information on black urban Appalachians, whose health concerns were similar to those of white urban Appalachians. Based on interviews and case records obtained in the late 1990s, Halperin and Reiter-Purtill9 documented that urban Appalachian women who had migrated to Cincinnati experienced more severe symptoms of “nerves” than did rural Appalachian women. As health issues among Appalachians became more urgent, the Appalachian community responded by initiating research and advocacy groups 316 Ludke, Obermiller, and Horner to address its health problems. Foremost among these groups was the task force formed by Cincinnati’s Urban Appalachian Council to study the health status of children in one of the city’s Appalachian neighborhoods.10 The work of this task force and of two community-based groups is discussed in chapter 16. The dearth of health status information on Appalachians in Cincinnati proved to be a formidable barrier to designing interventions to address the health problems of the community. Local data gathered by the urban Appalachian groups, though important in documenting health problems among Appalachian residents of the city, did not permit the large-scale assessment required to devise effective interventions.a Subsequently, the Health Improvement Collaborative of Greater Cincinnati and the Health Foundation of Greater Cincinnati initiated the Greater Cincinnati Community Health Status Survey in 1996.b This survey was complemented by the Child Well-Being Survey conducted by the Child Health Policy Research Center at Cincinnati Children’s Hospital Medical Center in partnership with the Health Foundation of Greater Cincinnati and the United Way of Greater Cincinnati.c These community surveys are the data sources used in this chapter to illustrate the health status of Appalachian migrants and their descendants residing in the Greater Cincinnati metropolitan area and to examine some of the potential determinants of their health.d Appalachian migrants pose some interesting challenges,in that they are a dynamic population comprising both first-generation migrants (those born in Appalachia) and second-generation migrants (individuals born and raised in Cincinnati). First-generation migrants may have a “health heritage” that is a more important contributor to their current health status than their more immediate surroundings. The health status of secondgeneration individuals is likely influenced more by the local environment. The first section of this chapter looks at changes in the health status and health determinants of first-generation white Appalachian adults between 1999 and 2005. The second section examines changes in the health status and health determinants of first- and second-generation Appalachian children between 2000 and 2005. The chapter concludes with recommendations for further research to improve our current understanding of the health of Appalachian migrants and their descendants and the policy initiatives emanating from this work. The Health Status and Health Determinants of Urban Appalachians 317 First-Generation White Appalachian Adults The term first generation refers to individuals who were born in the Appalachian region and subsequently migrated to the Cincinnati area. In a sense, their health experience is informative in much the same way as that of international immigrants. Unfortunately, this discussion is restricted to white respondents simply because there were insufficient nonwhite respondents in the Greater Cincinnati Community Health Status surveys. Regrettably, it is unknown when during their lives the immigrant Appalachians migrated, because length of time in the new location influences the extent to which the local environment impacts health status. The comparison group consisted of non-Appalachian white survey respondents. HealthStatus.Healthstatuswasexaminedinthreedimensions:healthrelated...