Paper on Improving Access to Health In The Appalachia: Public Health


The assessment of the access to health services in the Appalachian Region is of the essence. The Appalachia is a vast region encompassing in an excess of 13 states and 410 counties including sections of New York and Virginia in the US with a population in excess of 25 million inhabitants. It is a multicultural and cosmopolitan society whose main ethnic groups are the immigrant whites from Europe, blacks, Indians and some Hispanics.  At the core of the culture of the inhabitants of the Appalachia is their attachment to family, social events, religion etc. it is also of notable concern, their distrust towards wanderers and their hostility towards conventional healthcare practice (Bruce , 2009).

The Appalachia community is faced with a myriad of challenges in the health sector. Some of which are systemic while others are cultural. These challenges have been responsible for the high mortality rate in this region compared to other regions in the US with rural areas as the most affected. This region brings to the fore the effects of culture, poverty, illiteracy and poor infrastructure on the access health services.

Effects of poverty, illiteracy and poor infrastructure on health outcomes in the Appalachia Region


Research was conducted among 700 residents in the 13 counties of the Appalachian region. Phone calls were made at random during the day to the respondents in the Appalachia. The survey was approved by the Institutional Review Board for the Social and Behavioral Sciences at the University of Virginia. Survey included anyone aged above 18 years with access to a phone and consented. All information was voluntary and there were no forms of coercion. Bias in the study  could have emanated from the time the survey was carried out limited the survey to only those who were close to their phones, mostly those not at work and those without daytime jobs. Phone interviews were carried out by professionals.


The respondents in the survey were majorly a random sample. Calls were made based on a random list representative of the population demographics. Special attention was paid to the sample representation with respect to race/ ethnicity, and total income. Prior notification was made to the households with known addresses. Phone interviews lasted between 5 minutes and 15 minutes. Participants are selected randomly but commensurate with the demographics of the region. Most respondents were men and women aged between 18 years years and 90 years mostly in the rural and suburban areas of the Appalachia (Springer .Co. Limited, 2011). The respondents were interviewed on issues to do with:

  1. What are the barriers to healthcare access in the region?
  2. Where do you go when you feel unwell?
  3. What can be done to improve healthcare outcomes in the region?

The interview questionnaire used for the survey was custom made specifically for this survey. Tools and variables for the survey were tested and refined. Survey was based on socio-demographic parameters including age, state, gender race, education level etc,

Results and Findings

20% of the respondents replied that cultural barriers constrained them from accessing medical care, while 45% indicated that they shy away because they have no information on how to access these services. 15% indicated that they had no money to enable them access healthcare services. When asked where they got medical services, 60 % indicated that they bought over the counter medication from the chemist, 20% indicated they subscribed to holistic and cultural ways of treatment. The remaining 20% couldn’t comprehend what the question needed of them. 15 % believed nothing could be done to improve heath outcomes in the region while 22 % indicated sourcing for more healthcare professionals would remedy the situation. 20% infrastructure improvement, 30% believe civic education and empowerment is key.


Most of the populace of rural Appalachia includes men and women above 60 years. They experience different health requirements compared to those in urban cities. Due to constraints relating to poverty, illiteracy they tend to shy away from healthcare facilities. This then leads to loss of life. Cultural expectations were reported including subscription to unconventional and untested methods of healing. Consumption of medication from local drug stores based on symptoms.

Due to long periods of exclusion and marginalization, the Appalachian populace tends to be rather coy and unresponsive to new ideas. They would therefore accept sparingly or reject in totality modern healthcare practices, including vaccination, dietary changes to reduce occurrence of disease, subscription to medication for terminal illnesses etc. Prevention and treatment of disease through early warning systems practiced in modern medicine would greatly reduce mortality rates in this region (Bruce , 2009).

Healthcare acceptance in the Appalachia is low perhaps due to poverty and or lack of medical insurance. Total unavailability of cultural competent medical practices by practitioners’ are some of the barriers experienced in this region.

Risk factors associated with the Appalachia region are:

  • Most middle aged and young persons smoke cigarettes that predispose them to lung infections, ventilation difficulties etc.
  • Obesity is rife in the Appalachia due to over indulgence in the consumption of processed. Junk food


Bruce , B. (2009, 05 04). Special Challenges and Issues in Appalachian Communities.       Retrieved from special challenge and o:            registry/Special_Challenges_in_Appalachia.pdf

Springer .co. (2011, 06). Health Disparities between Appalachian and non appalabirn . Jounal       of American medicine , 348-356.