Appalachian Health and Well-Being

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. Robert L. Ludke is a professor of family and community medicine at the University of Cincinnati. He is also a member of the Board of the Urban Appalachian Council. Phillip J. Obermiller is a Senior Visiting Scholar in the School of Planning at the University of Cincinnati and a past president of the Appalachian Studies Association. This volume pulls together an enormous amount of information that has been scattered in obscure publications in diverse fields. It synthesizes that information, puts it in context, and makes it available to the anyone interested in general health issues. It should be in the library of every postsecondary education institution with an Appalachian constituency. -- Wayne Meyers, M.D. A well-written, insightful work that encompasses the breadth of this important topic. -- Baretta R. Casey, M.D., M.P.H. Ludke and Obermiller\u27s work goes far beyond the borders of Appalachia to document the relationship between health and economic status. It particularly emphasizes the long-term effects of poverty on health. Its usefulness is not limited to Appalachia but to all those who believe that the opportunity for good health should not be defined by income and wealth. -- William W. Philliber, author of Appalachian Migrants in Urban America An important and much-needed book. Mountaineers, both those inside the region as well as those beyond it, will receive better care from health-care providers and more humane treatment by policy makers if both read carefully the multidisciplinary perspectives contained in this timely volume. -- Chad Berry, author of Southern Migrants, Northern Exiles An excellent introduction to the persisting health challenges of Appalachia, where health disparities are one of the continuing markers of inequality. In this volume some of the region\u27s leading health researchers examine the economic, environmental, behavioral and systemic causes of those disparities. -- Ronald D Eller, Distinguished Professor of History, author of Uneven Ground: Appalachia since 1945 Brings together researchers who present data addressing health disparities affecting urban and rural Appalachians and offers possible solutions. -- Kentucky Enquirer Ludke and Obermiller summarize the state of Appalachian health. . . . An important addition to the body of work documenting the state of Appalachia. -- Kentucky Libraries A truly exemplary book. . . . Surveys nine areas of health in the region and concludes with policy recommendations. -- Apalachian Heritage An important addition to the body of work documenting the state of Appalachia. -- Kentucky Libraries This medical text, the first of its kind, focuses on health of the region’s inhabitants as well as those who have moved away. -- Library Journal While the idea of geographically-based health disparities is still evolving, this engaging resource has greatly expanded the concept in what is a remarkable volume of well-organized, well-written, evidence-based studies on health in Appalachia presented from a host of critical perspectives. This book should become required reading for policy makers, health care providers, community activists, and students everywhere. -- Elke Jones Zschaebitz, David C. Gordon, Family and Community Health Appalachian Health and Well-being develops an enriched analytical framework for health care and creates a new, comprehensive source of knowledge that will benefit multidirectional efforts to improve Appalachian health. Authors offer informed recommendations for assessing and preventing disease and promoting health. This compilation is a pioneering work that will inform and guide readers and serve as a model for future Appalachian health research. -- Journal of Appalachian Studieshttps://uknowledge.uky.edu/upk_medicine_and_health_sciences/1013/thumbnail.jp

Engaging Rural and Urban Appalachians in Research using a Community-Based Participatory Research Approach

Appalachians are particularly vulnerable to chronic diseases as documented by recent national studies that have identified disproportionally higher rates of cancer, diabetes, heart disease and premature mortality for this population. Evidence-based interventions to reduce rates of diabetes and obesity among adults and children have been ineffective among Appalachians where multiple factors including poor living conditions, limited health information, lifestyle behaviors, and lack of access to health care interact to increase the prevalence of these problems. However, there is growing evidence that Community-Based Participatory Research (CBPR) conducted through community-academic partnerships can lead to significant health and social impact in communities faced with seemingly intractable health disparities. Framed in the guiding principles of the CBPR approach, this paper describes the development of two academic-community partnerships that took root in Appalachian communities, one urban and one rural. Both partnerships aimed to identify community health needs, develop a community-led intervention to promote positive health outcomes, and evaluate that work iteratively. Although the initial focus for each community was to address obesity and diabetes risk, adherence to the CBPR approach led to different community identified prioritized needs and different pilot projects. The CBPR approach resulted in strong partnerships, each with improved capacity to address Appalachian health disparities in their communities

The contribution of hospitals to a local economy: a case study in Iowa and Illinois

This study assessed the importance of the hospital sector to a regional economy by examining the estimated effects of direct and indirect hospital spending on the income and employment of a metropolitan region in Iowa and Illinois. The evaluation included the role of hospital services as a regional export. In addition, the stabilizing impact of hospital spending during business cycles was examined. Results of the study indicated that the hospitals played a vital role in the economic stability and growth of the local community

Health services management manpower and education: outlook for the future

There is much concern about administrative costs in health care. But little has been written on the market for health managers. This article discusses Bureau of Labor Statistics data estimating a total of 362,500 health managers in the United States in 1990 and projections showing an increase to 517,800 in 2005. The article further discusses the composition of health care employment in terms of settings and functions, and evaluates the implications of a rapidly changing market for health administrators. The authors conclude that sufficient demand exists for AUPHA programs to produce more graduates, but that curriculum should be revised and should place greater emphasis on efficient production of health services. This will provide qualitative differentiation and give health management training a competitive advantage over business and other educational backgrounds

Health services management manpower and education: outlook for the future

There is much concern about administrative costs in health care. But little has been written on the market for health managers. This article discusses Bureau of Labor Statistics data estimating a total of 362,500 health managers in the United States in 1990 and projections showing an increase to 517,800 in 2005. The article further discusses the composition of health care employment in terms of settings and functions, and evaluates the implications of a rapidly changing market for health administrators. The authors conclude that sufficient demand exists for AUPHA programs to produce more graduates, but that curriculum should be revised and should place greater emphasis on efficient production of health services. This will provide qualitative differentiation and give health management training a competitive advantage over business and other educational backgrounds

Geographic variation in primary care visits in Iowa

Objective. This study investigates the determinants of primary care office visit rates. Data Sources. Blue Cross and Blue Shield of Iowa subscriber information was sorted by residence into geographic health service areas. Cost-sharing information was also obtained from Blue Cross. Physician supply data were obtained from The University of Iowa, Office of Community-Based Programs. Hospital data were reported by the Iowa Hospital Association. Study Design. Cases were classified into ambulatory care groups (ACGs). Use rates were computed for each group in each service area. Ordinary least squares regression models were developed to model geographic variation in each ACG- specific primary care visit rate. Principal Findings. Regression models were not significant for five out of eleven ACGs studied. Out-of-pocket expense significantly affected utilization in three out of six. The number of primary care practices per capita had a significant effect on utilization in two ACGs. The supply of hospital outpatient services was significant in one ACG. Conclusions. Study findings reveal that some ACGs are price sensitive and some are not. Policies aimed at changing levels of primary care use should take into account whether varying cost sharing will influence consumer behavior in the desired direction

An Urban Appalachian Neighborhood\u27s Response to Diabetes

The Appalachian community in the Lower Price Hill (LPH) neighborhood of Cincinnati, Ohio, used community-based participatory principles and methods to develop, implement, and evaluate an on-going initiative to address the high prevalence of diabetes among its residents. Led by the Urban Appalachian Council in partnership with a number of academic and community organizations, the initiative conducted town hall meetings of LPH residents to identify diabetes-related areas that needed to be addressed and to select an initial pilot intervention. The result was a Community Health Advocate (CHA) program which trained neighborhood residents to canvass households to conduct diabetes risk assessments and provide education on diabetes prevention, schedule follow up diabetes screenings at a wellness site established by the community, and conduct follow-up telephone calls to ensure wellness site participation. The extensive case-finding effort by the CHAs led to the identification of a substantial number of previously undiagnosed residents as high risk for diabetes. This effort also resulted in the confirmation of the community\u27s perceptions of other diabetes-related need areas which are being addressed through subsequent interventions. The success and acceptance of the program demonstrates that an Appalachian community can use existing resources to enhance its own capacity to address its health issues