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In the 1960s after the Appalachian Regional Commission was formed, there was an increase in the efforts put to fight known causes of poor health in the Appalachian region which included limited education, geographic isolation and low income. The release of the national maps by the National Center for Health Statistics (NCHS) displayed the mortality rates within the Appalachia region bringing into light the health status of Appalachia’s (Behringer, B and Friedell, G. H. 2006).
Culture and mode of life
Appalachians put into consideration faith in God and medical care benefits when seeking for cure. Faith has not been found as a barrier when seeking health care and for people with cancer its used as a consoling factor. Recent surveys have shown higher rates of cancer especially cervical cancer, premature mortality and heart disease in the Appalachian population (Huttlinger, K., 2003). Studies in the urban Appalachia region have found out that 50% of patients in the primary care are associated with production, use or sales of tobacco.
The region has a history of inadequate health professionals which coupled to the referral centers long distances from rural centers has limited availability of patient care.
Environmental influence on the Appalachians health can not be underestimated. Of importance include unclean air; toxic waste; occupational exposures, farm effluents, factories and mines that contaminate water.
Private, proud and desiring to “take care of their own” are some of the Appalachian characteristics. Health professionals thus face a great challenge of understanding the personal characteristics of Appalachians and utilizing them to create a two-way communication on cancer preventive measures. Poor communication between the health experts and their patients results into a barrier for the patients to pursue screening, diagnoses as well as treatment. High rates of unemployment hamper individual’s ability to cater for health care bills either directly or from job-related benefits.
Mortality rates have been shown to differ with the eastern Kentuckians dieing younger as compared to the central and western Kentuckains. Infant deaths in this region have been on the higher side as compared to the state average (Obermiller, P. J and Brown, M. K. 2002).
America has constantly experienced Appalachian mountain migration since the year 1820. Earlier migrations were from the west to the rural areas while the later ones after the Civil War had an urban focus. During the Great Appalachian Migration in the twentieth century (1940-1960), migrants settled in the industrialized Midwest and Northeast region. The migrations later switched on to the South as well as the West regions of metropolitan area. Cities surrounding the Appalachian region in 1970s became the principal host of the Appalachian migrants. Today Cincinnati city and its environs hosts a large population of Appalachian migrants as well as their descendants and it continues to receive a significant number of new Applachian migrants (Obermiller, P. J and Brown, M. K. 2002).
Appalachian Health Issues
Early studies in the 1960s to 1980s noted that health services were mostly got on a crisis basis. These early studies noted the importance of folk medicine, home remedies, as well as faith healing from the migrant’s history. Although there was knowledge of modern medicine in the mountains it was difficult to get it. There were few opportunities to educate people on their nutrition and health care preventive measures that they can adopt.
Most of the medical interventions that were done during an emergency were impersonal, drastic and ineffective. This was an unfortunate situation that was further aggravated by the bureaucratic procedures that had to be followed. The result was fear, contempt, and suspicion from the Appalachians for their health workers, attributes that persisted even after migration to the urban environments. Some of these perceptions still do persist in certain Appalachian urban population, (Huttlinger, K., 2003).
A research interview by John Friedl in 1983 found out that the experiences Appalachians migrants had within rural health care workers determined their expectations on the health care providers from the urban area. There were sharp differences between the health services in the rural areas and those in the urban areas. Due to the fewer staffs, rural physicians exercised more contacts directly to their patients. Due to cost and time there were few referrals to specialist and the Appalachian physicians did more of “one-shot” treatment where drugs were administered more during treatment rather than by prescriptions.
Since payments to third party were less in rural areas and payment schedule more flexible, fees were less. (Obermiller, P. J and Brown, M. K. 2002).These sharp differences between the urban and the rural health systems that Appalachian patients were used to led to negative stereotypes, distrust and confusion between the urban medical workers and the Appalachian patients.
Appalachian religion shows a strong association between health status and the will of God. Different studies in the early 1990s showed that Appalachians are less likely to believe that their health status is affected by exercise or good nutrition but almost two thirds believed it influenced by God. Both the white and the black Appalachian respondents did show high levels of health concern. The African American had more visits to the hospital emergency centre than the white Appalachians who had less physician contacts as compared to the black cohort.
The family provided an important source of health information to the Urban Appalachian whites while in contrast the urban blacks gained similar information mostly from the church. However it was noted that both groups considered television and the radio as more important sources of health information than the magazines and the newspapers (Behringer, B and Friedell, G. H. 2006).
Age, race, demographic and economic variations among other social factors affecting health have been shown to influence health status of the Appalachian population.
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- White Appalachians with low income have generally low health status than the non-Appalachians white or blacks of the same economic level.
- Over the age of 45, white Appalachians experience a better health status comparable to non-Appalachians white and better in comparison to that of blacks.
- Appalachians white have higher chances of chronic physical illnesses as compared to non-Appalachians although likely to have multiple conditions as blacks.
- White Appalachians have higher chances compared to non-Appalachian whites of being professionally diagnosed with cancer, allergies as well as chronic digestive illnesses.
- over the age of 45, white Appalachians have higher chances of reporting a professional diagnoses of heart trouble/angina, cancer, and allergies compared to blacks and the non-Applachian whites.
Health care services in the Appalachia mountain region is a real problem that has been aggravated by poverty, unemployment, low education as well as the religious local beliefs. (Huttlinger, K,.2003).All these act as barriers that prevent the people from accessing medical care. ER patients within the Appalachian culture will thus continue to face the problem of accessing primary care from the physicians due to their strong cultural background poverty and their religious beliefs.
- Behringer, B and Friedell, G. H. (2006). Appalachia: Where place matters in Health. Prey Chronic Dis. 3(4): A113
- Huttlinger, K. Schaller-Ayers., Lawson, T. and Ayers, J. (2003). Suffering it out: meeting the needs of health care delivery in a rural area. Journal of Rural Nursing and Health Care. 3 : ( 2).
- Obermiller, P. J and Brown, M. K. (2002).Appalachian Health Status in Greater Cincinnati: A Research Overview. Urban Appalachian Council Working Paper No. 18.