Public Health in Appalachia

Essays from the Clinic and the Field


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About the Book

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.

About the Author(s)

Wendy Welch is the executive director of the Graduate Medical Education Consortium of Southwest Virginia and an associate editor for the Journal of Appalachian Studies. She lives in Big Stone Gap, Virginia.

Bibliographic Details

Edited by Wendy Welch
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

Table of Contents

Table of Contents

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

Book Reviews & Awards

“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.