Health disparities in Appalachia are growing

The 25 million people who live in the Appalachian mountains are in worse health than all other Americans in almost every way possible, a new study shows.

Public health experts and politicians in the area have said the new data underlines the growing disparity in the region compared to the rest of the country.  

The report shows that the 13-state region, which includes Kentucky, North Carolina and West Virginia, lags behind the rest of the country in 33 out of 41 population health indicators.

Among those are seven of the 10 leading causes of death in the United States. 

The study was conducted by the Foundation for a Healthy Kentucky, the Appalachian Regional Commission, and the Robert Wood Johnson Foundation. 

Public health experts and politicians in the area have said the new data underlines the growing disparity in the 13-state region among the Appalachian mountains compared to the rest of the country. The map shows the region, outlined in orange, and the years of potential life lost per 100,000, which is particularly high in Appalachia compared to the rest of the country

Deaths by poisoning, which include drug overdoses, were 37 percent higher than the rest of the country – a testament to the opioid addiction crisis that has gripped the area for years.   

Central Appalachia, which mostly consists of the eastern portion Kentucky, was the worst of the worst.

It led all other regions of Appalachia in deaths from heart disease, cancer, lung disease, injuries and diabetes. 

In the category of ‘years of potential life lost,’ a measure of premature deaths, central Appalachia lost more than 11,200 years from 2011 to 2013. No other Appalachian region was above 9,200.

‘I think it’s a wakeup call,’ said Ben Chandler, president and CEO of the foundation. 

‘We are dealing with real challenges in Appalachian Kentucky and the health of the entire state, both economically and physically.’


Infant mortality has surged and life expectancy has plummeted in Appalachia compared with the rest of the country. 

A study conducted earlier this month by the Health Resources and Services Administration chronicles the ongoing health crisis in the 13-state region, which includes West Virginia and Kentucky.

It puts a lot of the blame for the disparity on high rates of tobacco use, particularly during pregnancy. 

Researchers compared infant mortality and life expectancy rates – two key indicators of ‘a nation’s health and well-being’ – in Appalachia with the rest of the United States between 1990 and 2013.

They found that while the rates were similar in the 1990s, by 2013 infant mortality across Appalachia was 16 percent higher than the rest of the country, and life expectancy for adults was 2.4 years shorter. 

While the region has been the focus of the opioid epidemic in recent years, the study found one of the biggest culprits was likely the prevalence of smoking and the region’s tendency to be ‘more accepting of tobacco use as a social norm.’ 

Nearly 20 percent of women in the region also reported smoking during pregnancy, compared with just eight percent in the rest of the country, according to co-author and senior health equity adviser with the HRSA Gopal K Singh.

‘Smoking takes a tremendous toll on the health of Appalachians,’ the authors wrote.

A spokeswoman for Kentucky Governor Matt Bevin (R) said the report highlights why states ‘need flexibility to tailor programs like Medicaid to the unique needs of their populations.’

Bevin has asked the federal government for permission to change the state’s Medicaid program by charging premiums to some beneficiaries and requiring some to have jobs in order to keep their benefits. 

He said such changes would encourage people to be healthy, while critics said it would make it harder for poor people to obtain health coverage.

The report showed the health of the regions’ residents has improved over the years, but it has not kept up with gains elsewhere in the country. 

The result is a widening national disparity that leaders worry is affecting the region’s economic potential as it struggles to recover from the decline of the once dominant coal industry.

‘I’m picturing county commission battles and, you know, town meetings and high school football games and the things that make up life in a small town in Appalachia,’ said Hilary Heishman, senior program officer with the Robert Wood Jonson Foundation and a native of West Virginia. 

‘I read this and I feel, I can’t say I feel it more than other people, but I feel a certain weight to it. It’s not just numbers to me.’

Though the area has some of the worst health problems, it has the fewest doctors and medical staff when compared to what’s available in the rest of the country. 

The region’s suicide rate is 17 percent higher than the national population and depression among Medicare beneficiaries is 16.7 more frequent than any other part of the country. 

Despite that, Appalachia has 35 percent fewer mental health providers than everywhere else in the US. 

But the report wasn’t all bad. 

It showed Appalachian residents did better than the rest of the country in areas of HIV and chlamydia prevalence, excessive drinking, student-teacher ratios and the percentage of the population under age 65 that is uninsured. 

Later this year, the advocacy groups plan to release a second report titled, ‘Bright Spots.’ 

That report will highlight 10 Appalachian counties that are bucking the regions’ trends and what can be learned from them.

‘I would say the report really gives us some work to do,’ said Earl Gohl, the federal co-chair of the Appalachian Regional Commission.