People who live in rural Appalachia, which includes six South Carolina counties, generally suffer from poorer health than other Americans, according to a new report.
The 400-page report, which was released last month by the Robert Wood Johnson Foundation, Foundation for a Healthy Kentucky, and Appalachian Regional Commission outlines “dramatic disparities” in both health issues and outcomes between the 13-state Appalachian region and nationwide figures.
It shows the region, which encompasses 25 million Americans from Mississippi to New York, has higher rates than the rest of the country in seven of the 10 leading causes of death, including heart disease and cancer. Disparities were most severe in rural areas and low-income counties, according to the report.
Hilary Heishman, senior program officer at the Robert Wood Johnson Foundation, said the data brings attention to the growing health gap between Appalachia and the rest of the country. “The U.S. can’t be healthy as a whole if we are leaving whole regions behind,” she said.
The Appalachian portion of South Carolina, which includes Greenville, Anderson, Pickens, Oconee, Spartanburg, and Cherokee counties, fares far worse than the rest of the nation when it comes to stroke, cancer, diabetes, heart disease, and other health measures, according to the report.
For example, the number of people who die from chronic obstructive pulmonary disease in the six-county region is 28 percent higher than the national average. Among other findings in the report:
• The cancer mortality rate in Appalachian South Carolina is 5 percent higher than the national average.
• Appalachian South Carolina also has among the highest rates of deaths related to injuries, 32 percent higher than the national average.
• The number of people who die from strokes in the six-county region is 22 percent higher than the rest of country.
• The heart disease rate is 3 percent higher in Appalachian South Carolina than the national average.
• Appalachian South Carolina has one of the highest rates of deaths related to suicide, 30 percent higher than the national average.
The reasons for the disparities include everything from high rates of smoking and physical inactivity to fewer grocery stores and physicians, according to Dr. Shaniece Criss, an assistant professor of health science at Furman University.
She also noted that incomes in Appalachia have not kept up with the cost of living. “The employed population makes significantly lower amounts of money, which can affect diet and a variety of other health factors,” Criss said.
For example, she said, people who use food stamps usually purchase cheaper foods that are packed with calories and saturated fats yet lack nutrition. That can lead to various health issues, including diabetes and heart disease.
“It’s really difficult to eat healthy on a limited budget,” she said. “And many people actually lack the time and skills to prepare healthier meals.”
Poverty can also create chronic stress, which can lead to poor health decisions such as smoking. “Many people smoke to relieve stress,” Criss said. “I think that could be one of the factors behind the higher rates of chronic obstructive pulmonary disease.”
She added that Appalachian residents in South Carolina would likely benefit from more mental health providers. The rate of mental health providers across the region is 33 percent lower than the national average, according to the report.
“Many people are dealing with hard life circumstances,” she said. “They really need more access to counselors so they can talk about those struggles.”
Criss also said solutions must focus on improving community services and health education across the region. “There isn’t a silver bullet to solve all of our issues, but I think more collaboration from our community is a step in the right direction.”
The opioid crisis
One health discrepancy that will require special attention is the region’s poisoning deaths, according to Criss. Deaths by poisoning, which include accidental drug overdoses, are 13 percent higher than the national rate.
The increasing rate of poisonings is likely a result of the opioid addiction crisis that has gripped the area for years, according to Criss. “It’s become a really big problem across the entire state,” she said. “But it’s much worse in the Appalachia area.”
Since 2011, more than 3,000 South Carolinians have died from prescription opioid overdoses. In 2015, 71 people died in Greenville County from opioid overdoses, rivaling the number of lives lost in car accidents. The year before, 65 people died from overdoses, according to the Greenville County Coroner’s Office.
Criss said the region’s opioid crisis has likely been fueled by the sudden emergence of fentanyl, a synthetic opioid that’s 50 times stronger than heroin and 100 times stronger than morphine. In recent years, illegal manufacturing of fentanyl has skyrocketed and led to an alarming increase in opioid overdose deaths across the U.S.
In Greenville County, there were 33 fentanyl-related deaths in 2015, the last year data is available. That’s more than five times the number of fentanyl-related deaths in 2013, according to Greenville County Deputy Coroner Jeff Fowler.
“There are law enforcement initiatives happening across the state to address opioid addiction, but it’s not going away anytime soon,” Criss said. “Many dealers are now mixing heroin with fentanyl.”
The good news
But the news for Appalachia residents isn’t all that bad, according to the report.
The region is doing better than the nation in several measures, including the incidence of chlamydia, prevalence of HIV, and student-teacher ratio.
“This report begins to identify key health challenges confronting Appalachia,” said Earl Gohl, the federal co-chair of the Appalachian Regional Commission. “Now we need to understand the implications these findings have for Appalachia’s economy so we can continue working towards a brighter future for the region.”
Later this year, the groups will release the results of a second study, “Bright Spots,” that highlights 10 Appalachian counties that are defying the region’s trends and what can be learned from them.