Stretching from Mississippi to New York and consisting of 428 counties in 13 states, Appalachia was dubbed “a region apart” in a report prepared by the Appalachian Regional Commission a half-century ago, thanks to its high rates of unemployment, low living standards, lack of urbanization and deficiencies in educational attainment.
Progress has been made in the last 50 years, but Appalachia remains “a region apart,” a status underscored by study findings released last week that found the region is falling behind the rest of the United States when it comes to life expectancy and infant mortality.
In recent years, we’ve been bombarded with headlines about how life expectancy is expanding and expanding, and how 100-year-olds will one day be more common thanks to continuing advances in health care and living conditions. Though we certainly see more people making it into their 80s and 90s than we once did, it must be emphasized that the added years are not being shared across all income levels. Lower-income Americans are generally leading shorter lives.
And the study published last week in the journal Health Affairs found that progress on infant mortality and life expectancy has stalled in Appalachia, which includes Washington and Greene counties and all of Southwest Pennsylvania.
In the early 1990s, the study found, the region was roughly on the same par as the rest of the country.
But in a four-year span extending from 2009 to 2013, the average American would live 2.4 years longer than the typical resident of Appalachia, according to the study. In that time, the infant mortality rate in Appalachia was also 16 percent higher than the rest of the country.
Given its devastating impact on the region, it would be natural to think that the opioid epidemic is the primary culprit behind Appalachia’s health woes. While it is a factor, it is not the only one. Smoking remains more socially acceptable in Appalachia than other parts of the country, leading to an increase in the number of cases of cancer and heart disease. Poverty also means diets are substandard, with inexpensive, calorie-dense foods leading to increased instances of obesity. Sometimes, residents of Appalachia also have to travel longer distances to get to hospitals or see doctors than their counterparts in other parts of the United States.
In an article in USA Today in 2014, Fran Feltner, director of the University of Kentucky Center of Excellence in Rural Health, said Appalachia was “the stroke belt, the diabetes belt, the coronary valley. We get all those labels. We’re in a sad state here.”
And then there are eminently preventable factors, like deaths on the roads due to drunken driving, speeding and not using seat belts, and spending too much time in front of screens rather than getting exercise.
Wendy Wasserman, a spokeswoman for the Appalachian Regional Commission, told The Washington Post that “the results are heartbreaking, but not unsurprising. We’re really interested in creating a healthy workforce, and all aspects of health are important to that.”
Economic development would certainly help Appalachia and its residents, as would increased education. Reducing income inequality would give the region a boost, as it would in every other corner of the country. Of course, individuals need to take responsibility for themselves, but a lifetime of habits can be hard to break.
But just as there are myriad causes for Appalachia’s health difficulties, there is unfortunately no one single cure.