HEALTH

Report: Appalachians' health 'dramatically' poorer than the US as a whole

Heart disease, cancer, chronic obstructive pulmonary disease, drug overdose, diabetes, stroke and suicide – they’re all killing Appalachians at a higher rate than the rest of the country as a whole.

On Thursday, the Appalachian Regional Commission, Robert Wood Johnson Foundation and the Foundation for a Healthy Kentucky issued a report, “Health Disparities in Appalachia,” outlining what it called “dramatic disparities” in both health issues and outcomes in the 420-county Appalachian Region, compared to nationwide numbers.

The report, which included work from the Cecil B. Sheps Center for Health Services Research at the University of North Carolina at Chapel Hill, is the first in a series of planned reports looking at health issues in Appalachia, which encompasses some 25 million Americans in parts of 13 states — including Tennessee — from northern Mississippi to the southern tier of New York.

Higher death rates, fewer providers

It indicates significantly high mortality rates in seven of America’s leading causes of death, with rates even higher in rural areas and low-income counties. It notes higher-than-average rates of obesity, smoking and physical activity among Appalachians, compared to the national rate. Nearly a quarter of Appalachian adults smoke, compared to 16 percent of Americans overall.

And the region also faces a shortage of primary-care and mental-health providers as well as specialty physicians and dentists. There are 65 percent fewer specialists per 100,000 residents in Central Appalachia than nationwide.

Appalachia is doing better than the nation as a whole in some areas: lower incidences of chlamydia and HIV infection, better monitoring of diabetes among patients with Medicare, and lower student-teacher ratios in school, for example.

But the report says trends indicate other disparities are widening. The cancer mortality rate, 1 percent higher in Appalachia than nationwide from 1989-1995, was 10 percent higher during 2008-2014. Infant mortality jumped from 4 percent higher in Appalachia during 1989-1995 to 16 percent in 2008-2014.

More:Read the full report

“These data bring attention to the growing health gap between Appalachia and the rest of the country,” said Hillary Heishman, senior program officer for the Robert Wood Johnson Foundation. “The U.S. can’t be healthy as a whole if we are leaving whole regions behind.”

The report is one piece of a multi-part health research program, “Creating a Culture of Health in Appalachia: Disparities and Bright Spots,” that aims to find ways to reduce some of those disparities, using and building on assets that are already there when possible. The ARD and Foundation for a Healthy Kentucky are leading the project, which is funded by the Robert Wood Johnson Foundation.

Disparities even within state

Fifty-two of Tennessee’s 95 counties lie in the Appalachian region, and the report breaks down some disparities between “Appalachian Tennessee” and the rest of the state:

In Appalachian counties in Tennessee, the number of people who die from chronic pulmonary obstructive disorder is 38 percent higher than the national average and 20 percent higher than non-Appalachian Tennessee.

The number of Appalachian Tennesseans who die of injuries — including drug overdose — is 48 percent higher than the national average and 16 percent higher than non-Appalachian Tennessee. Poisoning deaths, which include drug overdoses, is 54 percent higher in Appalachian Tennessee than nationally and 46 percent higher than the rest of the state.

The number of Appalachian Tennesseans who die of stroke is 18 percent higher than the national average but 9 percent lower than non-Appalachian Tennessee.

The rate of cancer death in Tennessee is the same statewide but still 14 percent higher than the national average; the rate of heart disease deaths is the same statewide but still 21 percent higher than the national average.

On average, Appalachian Tennesseans report feeling physically unhealthy 31 percent more days than Americans as a whole and 7 percent more days than non-Appalachian Tennesseans; for mental health, it’s 28 percent more days than the national average and 5 percent more days than non-Appalachian Tennesseans.

Appalachian Tennessee has a suicide rate 32 percent higher than the nation and 22 percent higher than the rest of the state.

But Appalachian Tennessee’s HIV rate is 60 percent lower than the national average and 67 percent lower than the rest of the state. And the percentage of adults who report drinking excessively is lower than both the rest of the state and the rest of the country.

In Appalachian Tennessee, 18.6 of households live in poverty, compared to 7.6 percent nationally and 18.1 percent in the rest of the state; 7.6 receive disability benefits, compared to 5.1 percent nationally and 5.8 percent in the rest of the state.