Public Health in Appalachia

The Appalachian region of the United States sees hunger, poverty, disability, preventable illness and premature death in disproportionally high numbers. Yet, Appalachia also knows the quiet strength of people working together to lift one another up as a community. In this collection of essays, health professionals explore how clinics and communities address the barriers to healthcare that continue to plague this underserved region and discuss theoretical perspectives about Appalachian healthcare. Topics include regional dental care, cancer and diabetes treatment, the integration of primary care and behavioral health, telehealth, the importance of “patient responsibility,” and the effects of faith, fatalism and family dynamics on the health of Appalachian youth. Avoiding simplification and stereotype while presenting data, analysis and anecdotes, this volume gives a detailed picture of Appalachia’s complex and multi-faceted public health challenges. Instructors considering this book for use in a course may request an examination copy here.

Wendy Welch is the executive director of the Graduate Medical Education Consortium of Southwest Virginia where she advocates for social justice and policy planning in equal measure. She lives in Wytheville, Virginia.

Edited by Wendy Welch

Foreword by John Dreyzehner

Foreword by John J. Dreyzehner

Format: softcover (6 x 9)
Pages: 216
Bibliographic Info: bibliographies, index
Copyright Date: 2014
pISBN: 978-0-7864-9414-9
eISBN: 978-1-4766-1603-2
Imprint: McFarland
Series: Contributions to Southern Appalachian Studies

Foreword by John J. Dreyzehner 1
Introduction 3

Part One: Health Issues
No Reason to Smile: Dental Care in Rural Appalachia (Sarah Raskin and A. Carole Pratt, DDS) 9
Cancer in Appalachia (Morgan Fields, Gretchen E. Ely and Mark Dignan) 29
The Growing Problem of Diabetes in Appalachia (Carl J. Greever, MD, Rachel Ward and Christian L. Williams) 46
When OxyContin Struck, and How the Community Struck Back: One Woman Remembers (Sue Ella Kobak) 65

Part Two: Culturally Appropriate Healthcare Delivery Systems
Blending Primary Care and Behavioral Health: An Ideal Model for the Diverse Cultures of Appalachia (Bob Franko) 81
Telehealth in Appalachia (Steve North, MD) 105
Mountain Empire Older Citizens, Inc., and Economic Development in Southwest Virginia: From ­Home-­Delivered Meals to ­All-­Inclusive Care for the Elderly (Marilyn Pace Maxwell and Tony Lawson) 130

Part Three: Cultural Theory and Clinical Policy
The Elephant on the Examining Table: “Patient Responsibility” Examined as a Construct of Public Health and Clinical Health Care
(Wendy Welch and Esther Thatcher, RN) 153
The Effects of Fatalism, Faith and Family Dynamics on Health Among Appalachian Youth (Tauna Gulley, RN) 167
Finding the Spark: Enabling Community Participation in Research, Planning and Delivery (Tom Plaut) 179

About the Contributors 195
Index 199

• “The collective authors of this work deliver a thought provoking, inspiring presentation of the challenges of health care in Appalachia…highly recommended”—Choice
• “Sophisticated and compassionate analyses of health problems in the region…an important contribution to the field”—Appalachian Journal