Health issues facing Appalachia, focus of CDC director's tour, could be a forewarning of where the country is heading

The chronic health issues of Appalachia, the focus of a recent tour by the head of the federal Centers for Disease Control and Prevention, are really no different than the chronic health issues the entire country faces; they are simply more concentrated in one area, Laura Ungar writes for The Courier-Journal and USA Today.

"It's about proportion and intensity rather than something unique that's happening there," Jesse Roman, chairman of the Department of Medicine at the University of Louisville, told Ungar. "The problem is larger and more visible there, but they're not alone."

Ungar describes the health challenges of one couple in Appalachia, 48-year-old Alisha Blankenbeckler and her husband, Tony. Alisha has diabetes, bowel and bladder problems and is on oxygen. Her condition makes it hard to take care of her husband who has heart disease and hip problems since being struck by lightening in 2010. He takes 11 pills a day; she takes 30.

"Dying is something I think about every day," Alisha told Ungar.

This story, Ungar reports, is common in the Appalachian region, which is considered one of the nation's unhealthiest regions.

Heart disease prevalence is 84 percent higher in the region than the national average, diabetes is 47 percent higher, and lung cancer kills at a rate 83 percent higher. The region has the highest-in-the-nation smoking rates, with nearly a third of adults smoking cigarettes, and Kentucky has the highest number of deaths caused by cancer.

"We're in the stroke belt, the diabetes belt, the coronary valley. We get all those labels," Fran Feltner, director of the University of Kentucky Center of Excellence in Rural Health at Hazard, told Ungar. "We're in a sad state here."

Some experts say Appalachia "may be a harbinger of where the country is headed if we don't rein in epidemics like obesity," Ungar writes. Obesity spawns "diabetes, heart disease and many cancers and spanning all socioeconomic levels/."

CDC Director Tom Frieden recently toured Eastern Kentucky to "find out more about the underlying causes of the region's ills and how to treat them -- and in the process gain traction against the rising burden of chronic disease that ails the nation," Ungar reports.

"The Appalachian region is just like the rest of the U.S. ? only more," Frieden said on the tour. "We want to help an entire community and a whole nation."

Ungar writes, "Appalachia, like some blighted urban areas and Native American reservations, mixes several ingredients of poor health: doctor shortages and access-to-care problems; stressful, unhealthy lifestyles; low education levels; and insidious poverty."

Alisha Blankenbeckler told Ungar that at times she has had to stretch her insulin by taking less than the prescribed amount and once needed to go to the hospital but didn't because she had no insurance or money to pay the bill. She recently got insurance through the state's Medicaid expansion, and her husband is on Medicare, but that doesn't guarantee access to all the care they need because of required Medicare co-payments, medical equipment that is not covered, and gas to get to the doctor. The couple gets disability benefits of $1,427 a month.

Though more than half a million Kentuckians have enrolled in health insurance through the Affordable Care Act, "access to health care is difficult in Appalachia," Roman told Ungar.  "And there seems to be something about culture ? a sense of fatalism, that whatever happens, happens."

Ungar writes that Friden and Benjamin Sommers, assistant professor of health policy and economics at the Harvard School of Public Health "say improving the health of Appalachia and like communities will not be easy, because it depends on changing seemingly intractable socioeconomic disparities and personal health habits."

Frieden said that while outreach and health education is crucial, he will "listen and take cues from local communities about how best to attack their particular health problems. If he finds an effective program, he said, he will replicate it and fit it to other communities."

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