Geography doesn’t have to be destiny

Donna Arnett
Donna Arnett

The drive down the Mountain Parkway from Lexington to Campton is only about an hour. It’s a beautiful drive, as the mountains of Kentucky come into view as you leave the Bluegrass. But hidden behind those beautiful views is one of our state’s most serious problems — profound differences in health, with disparities that are striking from the mountains to the Bluegrass.

These differences are starkly shown by a map released today by the Robert Wood Johnson Foundation and their colleagues at Virginia Commonwealth University. The map shows life expectancy for Lexington in Fayette County is 78 years, but in Wolfe County, where Campton is, it is only 70 years of age.

How can this be?

The easy thing to do is to question the behavior of those who live in Appalachia and wonder why they don’t make healthier choices. But that is the wrong way to go about it and the wrong question to ask.

We know that place shapes health and people’s choices are a result of their environment. These are communities with schools that suffer from poverty and inadequate support. These are communities with the highest high-school dropout rates. These are communities that may not have access to grocery stores with fresh fruits and vegetables so that a nutritious diet is possible. These are the communities with Kentucky’s highest unemployment rates and poorest citizens.

These problems didn’t arise overnight and the life expectancy disparities on the map will continue until the basic needs of Appalachia are addressed. We must recognize that health is more than individual behavior: It is a part of where we live, work, play and pray. The good news is that we are now seeing some of the leadership of Eastern Kentucky come forward to address the larger community factors that impact health.

Groups like SOAR and the Eastern Kentucky Leadership Foundation are working to create a stronger, healthier Appalachia. Here are a few illustrations of efforts to address the underlying community problems:

▪  The increased number of Appalachia K-12 schools that are recognized for their excellence.

▪  Programs that support the use of SNAP and WIC vouchers to encourage farmers’ market use.

▪  A recent Kentucky Appalachia Development Fund grant to develop farmers’ markets.

▪  The advent of broadband access and technology training so the unemployed miner can find work.

These efforts are promising and we know it is possible to do better. The success of Williamsburg, a coal mining community in West Virginia, in receiving a Robert Wood Johnson Foundation “Culture of Health Award” is solid evidence we can succeed too.

However, there is a long way to go.

Kentucky’s policies and politics must reflect the need for public-private partnerships in Appalachia. We must provide more excellent educational opportunities for the kids of the hills, we must identify additional mechanisms to replace the coal-mining jobs that have been lost and provide meaningful jobs to the hard-working citizens of Appalachia. The people of Appalachia are smart and don’t mind working hard. They just need a chance to do it.

There have been numerous attempts to address Appalachia’s problems by outsiders. But Appalachia’s problems can’t be solved by non-Appalachia folks alone. Appalachia must rely on its own citizens and their community assets, create collaborations across numerous sectors in their communities, and work with others from state and federal organizations and agencies to address the challenges.

Who can follow the lead of folks who live in these beautiful hills? Many already have. Certainly the administrative and legislative branches of government, local, state and federal are among those, our chambers of commerce, and our educational establishment, including K-12 education administrators, higher education, both public and private.

We need the help of foundations, local, state and federal organizations together with those in the mountains to successfully meet the needs of their citizens. We need to help provide the infrastructure on which to hang the dreams of Appalachia’s citizens.

Only with the leadership of those from the mountains and with the support of all of the commonwealth will we change the monotonous map of Kentucky that always shows the problems of Appalachia and not its wonder.

F. Douglas Scutchfield, M.D., is the Bosomworth Professor of Health Services Research and Policy and Donna Arnett is dean and professor of epidemiology at the University of Kentucky College of Public Health.