Are you feeling okay, Appalachia? Judging by the recently-released County Health Rankings, no, you're not. The rankings, determined by the Robert Wood Johnson Foundation and the University of Wisconsin Population Health Institute, look at a number of health factors (like obesity, access to health care, sexually transmitted infections and teen births) and outcomes (premature death, number of poor health days) – to see how counties stack up against each other. And Appalachian counties are at the bottom.
In Kentucky, Appalachia accounts for 23 of the bottom 24 counties for both health outcomes and health factors. The rest of the region doesn't fare much better. Residents of Mingo County, WV reported an average of 8.2 out of the last 30 days in poor physical health, above the state average of 5 days (and well above the national benchmark of 2.6). In neighboring Logan County, it is 7 days; in McDowell, 7.6. 12,421 die prematurely in Buchanan County, VA, nearly double the Virginia average of 6,872. 23% of adults in Meigs County, OH report being in "poor or fair health," compared to 15% in the rest of the state. You can see the statewide maps below – in most of the states, the worst health tends to cluster in the most rural, mountainous areas.
The health rankings also include factors such as unemployment, poverty and education, which, sad to say, have been problems in Appalachia for decades. It is not difficult to understand how poor health goes hand-in-hand with an inability to find a job, to go to school, to earn a living.
It is also interesting to compare Appalachian counties with other rural counties outside the region. Why should Lawrence County, Ohio (ranked 88th out of 88 counties) with a population density of 137 people per square mile, fare so much worse than Shelby County, OH (ranked 19th) with a population density of 117 people per square mile? Is there something inherently unhealthy about Appalachian living? Or is it the pattern of decades neglect and disinvestment by elected officials at all levels of government? With state and federal budget cuts threatening health centers, health education and other programs to improve the health of underserved areas, how will we improve these factors?
What we can be sure of is that we can't continue to ignore these problems, and that we will need strong, innovative leadership to solve them.