Experts Co-Edit Book to Educate, Squelch Myths Associated with Appalachians
Health disparities exist for most sub-groups in America, but by acknowledging these issues and educating people about them, those gaps are gradually closing.
When it comes to the Appalachian community, there are still many hurdles to overcome, and in Cincinnati, there are still a number of health issues affecting a community known as "Urban Appalachia.”
To bring these problems to light and to squelch some of the myths associated with Appalachians, Robert Ludke, PhD, a professor in UC’s department of family and community medicine, and Phillip Obermiller, PhD, a senior visiting scholar in the School of Planning within UC’s College of Design, Architecture, Art, and Planning (DAAP), have co-edited a book, titled Appalachian Health and Well-Being. The volume brings together leading researchers who present data addressing health disparities affecting both urban and rural Appalachians and offers possible solutions.
"Having nearly 40 contributors, most of them Appalachian, is an indicator of the scholarly capabilities and research skills that Appalachians themselves bring to this topic,” says Obermiller.
The book will officially debut at the Appalachian Studies Conference, March 23-25, 2012, in Indiana, Pennsylvania. As a follow-up, Ludke and Obermiller will present the book’s implications for urban and rural health planning to faculty and students in the School of Planning on Tuesday, April 10, in DAAP 5401 from 12:30 to 2 p.m.. The presentation is open to the campus community.
"This book was compiled as a resource to those studying public health or to help researchers who are investigating this population further,” Ludke says. "However, I think the general population as well as politicians and city representatives need to know this information to improve the health of this group of individuals.”
"I also see it as a useful tool to local groups who want to develop their own health promotion and education programs, to conduct community-based research on local health concerns or to include quantitative data in their grant applications,” Obermiller adds. "The book includes examples of Appalachian organizations successfully addressing local health needs as best-practice models for others.”
Urban Appalachians in Cincinnati
Urban Appalachians are people of Appalachian heritage who live in metropolitan areas outside of the region. Migration to cities began in the early 1900s and peaked after World War II when the coal industry declined and thousands of mining jobs were lost.
Ludke, a second-generation Appalachian himself, says that during this time period, an estimated 3 million people from Appalachia migrated into newer industrial areas of the region, like Chicago, Detroit, Cincinnati and other Midwestern urban areas, looking for better employment opportunities.
"The Cincinnati urban Appalachian population has assimilated less than the others in the country,” he says, noting that many continue to live in Appalachian enclaves such as Lower Price Hill, which is where the offices of the Urban Appalachian Council are located. "Nearly 90 percent of Price Hill residents are of Appalachian heritage and are affected by poverty, drug use and a high incidence of obesity, diabetes and cancer—all issues that affect the majority of Appalachian communities.”
Ludke first became involved with this work in 1993 through the Health Collaborative of Greater Cincinnati’s efforts to look at an unrelated public health issue—cost rates for inpatient hospital procedures. Shortly thereafter, he chaired a task force created by the collaborative to monitor the health and health behaviors of individuals living in the Greater Cincinnati area.
This led to the implementation of the Greater Cincinnati Community Health Status Survey, a telephone survey of the health status of over 2,000 individuals in the area. The survey, conducted every three to five years since 1996, was funded primarily by the Health Foundation of Greater Cincinnati.
"The data showed that a sub-group of individuals—white, urban Appalachians—had the lowest health status of everyone surveyed,” he says. "We were intrigued, and we wanted to know why this group had such a poor health status.”
From there, Ludke got involved with the Urban Appalachian Council—where he and Obermiller are members of the council’s research committee—and found that there was not much health information available about the Appalachian population, especially urban Appalachians living in the region.
"I applied for a sabbatical to pull together literature and data about this group and invited Phil to become my co-editor on this project,” Ludke says.
Their newbook includes 17 chapters from various authors across the nation and touches on everything from genetic contribution to health in Appalachia to major health issues and available health care resources in these areas.
"There are three major sections covered in the book: underlying determinants of health, specific health conditions that are prevalent in the region and health issues related to urban Appalachians,” Ludke says. "When you look at the region as a whole—which is made up of 420 counties—it is a highly rural area. There are a lot of issues in terms of health care delivery, and the region has always had areas of deep poverty.
"There are also a lot of negative stereotypes about Appalachians—that they are ‘stupid’, ‘backward,’ ‘inbred.’ These are all myths. For example, there is not a higher level of genetic-related disease in an Appalachian community than in any other community. We hope in promoting this book, we will educate people to stop using stereotypes and build support for this group.”
Obermiller adds that understanding Appalachia and its people can also lead to overall improvement in the health care system.
"There’s a lot of active involvement among Appalachians—grassroots groups and organizations showing health care providers how they can be much more effective in serving low-income rural and urban patients,” he says.
Interventions in Place for Local Appalachian Communities
In addition to the book, Ludke is involved in several diabetes-related initiatives in Lower Price Hill to educate individuals in that community and to get them to actively participate in the betterment of their own health care.
"As part of a grant by UC’s Center for Clinical and Translational Science and Training, we trained ‘community health advocates’—individuals who live in the Urban Appalachian community—to follow up with residents of Price Hill who have been identified as high-risk for type 2 diabetes onset,” Ludke explains, adding that this is a follow-up study of a door-to-door health assessment study funded by the Ohio State Center for Clinical and Translational Science. "The hope is that these individuals seek assistance at a wellness site, where a volunteer nurse or health care professional will conduct a free screening.”
Ludke says Phase 2 of the study, which is now under way, is to see if the individuals who were identified as being at high risk for diabetes access the necessary medical services to be properly diagnosed and treated.
He adds that they are beginning to talk about ways to address the substance abuse problem in that area of the city as well.
"These are just a few interventions locally, but there is a need to help this population nationally, which is why our book is so helpful for health care advocates everywhere,” Ludke says. "My hope is that this is the first step in making a difference for this population.”