Combating Heart Disease in Appalachia

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As we learned in the Health Disparities Report, the leading cause of death in the United States is heart disease—and Appalachia’s mortality rate for the disease is even higher than the rate for the country as a whole. Looking more closely at the report’s data, which cover the 2008–2014 period, we see that the heart disease mortality rate in Appalachia was 204 per 100,000 population, which was 17 percent higher than the national rate of 175 per 100,000 population. Within the Region, disparities exist based on a county’s metro designation and rurality status: rural counties have a mortality rate 27 percent higher than the Region’s large metro counties, and distressed counties have a rate 29 percent higher than non-distressed counties.

Without some context, it might be difficult to appreciate just how significant the problem is. Take the following: according to the Centers for Disease Control and Prevention, approximately 1 in every 4 deaths in the United States is the result of some form of heart disease. (Using 2016 data, the American Heart Association estimates this to be even higher: approximately 1 of every 3 deaths.) And the disease does not discriminate, affecting both men and women—it’s the leading cause of death for both sexes—across all race and ethnic groups.

Using data from the CDC, The Heart Foundation notes that in the United States:

  • Someone suffers from a heart attack every 40 seconds
  • One person dies from a heart-disease related event every 60 seconds
  • 720,000 new heart attacks take place every year, as well as 335,000 recurrent attacks

Whether you’re considering a minute, a month, or a year, someone in the country is affected by heart disease. But while it may be the leading cause of death in the United States, it’s also one of the most preventable.

Risk factors

Many changeable behaviors are found among the risk factors for heart disease, including the following:

  • Smoking
  • Obesity
  • Diabetes
  • Physical inactivity

Two of these risk factors—smoking and obesity—were recently highlighted by blog posts found here and here. Troubling from an Appalachian perspective is that the disparities among these measures—between the Region and the United States as a whole—may at least partially explain the disparity in heart disease mortality rates. Consider the following:

  • Nearly 20 percent of adults in the Region report being cigarette smokers, compared to the 16 percent for the United States as a whole
  • Almost one-third of adults in the Region are considered obese: 31.0 percent, compared to 27.4 percent for the United States as a whole
  • The prevalence of diabetes in Appalachia is 11.9 percent, compared to 9.8 percent in the country overall
  • In Appalachia, 28.1 percent of adults over age 20 report being physically inactive, compared to 23.1 percent for the country overall

According to the American Heart Association, additional risk factors include poor nutrition, high cholesterol levels, and high blood pressure.

What communities can do

Because many forms of the disease are preventable, it makes it one of the more promising areas for improving individual and population health. By providing the resources necessary to help people change their behaviors—most of which are related to the risk factors noted above—communities are capable of bringing about significant changes to the health of their residents.

Let’s consider some findings from a few of the Bright Spot case studies, where research teams visited ten communities throughout the Region and explored why each of the places was experiencing better-than-expected health outcomes.

Take the Sequatchie County, TN case study, where we learn about how the school district partners with a food bank so that kids are able to take home free fruits and vegetables to share with their families. Not only does this contribute to a healthier diet among the community’s residents, it also helps kids develop healthy eating habits at an early age. The local school district in Sequatchie also contributes to its employees’ heart and overall health by offering exercise and stress-reduction classes—a risk factor for high blood pressure—to all employees.

Also consider the case of Grant County, WV, where a student-led program discourages unhealthy behaviors among peers, including such things as smoking and alcohol and drug use. The school system also offers a class on healthy eating to students. But the education is not limited to the school system in Grant County, as the community hospital provides a monthly “Healthy Saturdays” health fair. At these fairs, not only are blood panel workups performed by staff and volunteers—where cholesterol and other indicators can be checked—but specific health information is provided to residents on various topics, such as congestive heart failure.

In Tioga County, NY, organizations and volunteers come together to help solve the community’s health issues, one of which is food insecurity. With limited options in terms of stores and markets in the region, local farms and community gardens offer fresh, healthy produce at farmers’ markets, and many of these markets accept SNAP benefits, making healthy food an option for low-income residents.

Consider also the interviews from Madison County, NC, a county that had lower-than-expected obesity, diabetes, and heart disease hospitalization rates. Residents here attributed these findings to a minimal number of fast-food restaurants, as well as community members’ desire to grow and raise their own food.

There are also examples in the other six case studies of individuals and organizations working together in their communities to improve heart health, whether it be directly or indirectly.

As is the case with so many health issues, one of the first steps is educating people—both those at risk for the disease as well as community stakeholders—about how they might be able to improve their heart health. The second is then providing the resources necessary to bring about these changes, which can include things as simple as healthy eating classes, smoking cessation programs, and opportunities for exercise.

One of the great things about Appalachia is that its residents know how to make a little go a long way. The same can be said for heart health: change some behaviors, even small ones, and your likelihood of suffering a heart attack or developing heart disease may drop substantially.