Understanding the Challenges of Reducing Cancer in Appalachia: Addressing a Place-Based Health Disparity Population

The Appalachian region of the United States has long been recognized for its poor economic and social indicators. Only during the past decade have multi-state data become more accessible to describe the regions’ poor health status and resulting outcomes. A recent community-based participatory study engaged rural Appalachians to describe “what makes Appalachia different?” from other geographic areas and cultural groups in the United States and identify those characteristics that influence the region’s health. This article summarizes the community interpretation of these findings

BMQ

BMQ: Boston Medical Quarterly was published from 1950-1966 by the Boston University School of Medicine and the Massachusetts Memorial Hospitals

Lésions pré-cancéreuses de la vessie

La pathogénie du carcinome vésical, comme celle du cancer du col utérin, se caractérise par une évolution depuis les structures histologiques normales jusqu'au développement d'un épithélium malin. Le cancer invasif survient généralement sur, ou en association avec un cancer in-situ, lequel à son tour est associé à des modifications pré-cancéreuses de l'épithélium vésical. Les frontières histopathologiques entre lésions biologiquement bénihnes et épithélium malin ne peuvent être fournies avec certitude, mais les données de recherches récentes par microscopie optique, microscope à balayage et études sur cytologie exfoliatrice sont contributives

EDITORIAL Appalachia: Where Place Matters in Health

Facts about health in the mountains of Appalachia have been slow to emerge. The formation of the Appalachian Regional Commission in the 1960s led to increased efforts to combat known precursors to poor health (e.g., low income, limited education, geographic isolation) (1). From New York’s southern counties to the foothills of Mississippi, mountain counties were eligible to participate in various federal health programs because of their poor economic status. Critical private investments in health care occurred infrequently during the 1960s and still lag because of Appalachia’s low population density and high percentage of residents without health insurance or with high-deductible plans. Health care is largely organized, funded, and monitored through political channels. Public health programs

Health Care Systems

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 A different perspective points to a structural basis; that is, the roots of Appalachia\u27s health problems lie in systemic characteristics, particularly those related to power and how- and by whom-decisions are made. At the same time, this view recognizes that population and social factors play a role.2 Poverty, lack of jobs, illiteracy, inadequate education, poor housing, lack of public transportation, and lack of social support contribute to poor health in the region.3