Diabetes: A Family Matter

Appalachian Region

The Appalachian Region

This section of the website provides information and resources pertaining to the Appalachian region and concerns relevant to its people. You will find a variety of resources here that will likely be useful as health concerns of those residing in the Appalachian region are considered. More resources can be found under the subsections Videos about the Region, Appalachian Organizations, and Distressed Regions of Appalachia

Prior to the mid-1960s, an identified region called Appalachia did not exist. It was created when the federal government designated the Appalachian Regional Commission (ARC) with legislative powers to address the geographic region of approximately 205,000 square-miles that runs along the northern, central and southern Appalachian Mountain chain. About 24.8 million people live in the the Appalachian Region; 42% of the Region's population is rural, compared with 20% of the national population. The Appalachian region, as currently defined by legislation, includes 420 counties includes all of West Virginia and parts of 12 other states from New York to Mississippi. Appalachia includes some urban regions, but it is largely rural. People that live here appreciate its beauty and welcome the way of life offered.

The Appalachian Region

This region has made great advances over the past decades. Use of federal funds has improved transportation systems, education, health care, sanitation, and other essential services to help decrease the problems linked with poverty (Halverson, Ma, & Harner, 2004). However, many parts of the Appalachian region are still plagued by high unemployment, high poverty rates, and challenges in meeting resident’s educational needs. Other problems include things like higher rates of disease, lack of health professionals and specialists, fewer accessible health care services, and greater rates of uninsured or underinsured people.



When compared to non-Appalachian areas, Appalachia has greater health disparities and higher mortality rates from the leading causes of death. Risk factors appear to be highly localized, vary from one Appalachian area to another, and require interventions at the local level (Halverson, Ma, & Garner, 2004a). Links between socioeconomic stressors such as long-term poverty and unemployment are often better understood in terms of geographic region and cumulative effects on health outcomes over time (Brown et al., 2004). This is important because residents are largely a white or Caucasian population. While numbers of minority groups living in this area are smaller, many white people living here have had generations of low paying jobs, frequent problems with unemployment, and great stress resulting from years of poverty.


Challenges Linked with Health in Appalachian Communities

While the ideas listed here may differ from one geographic location to another, they are points that might need attention as local diabetes coalitions are developed, volunteer SUGAR Helpers recruited, and health promotion and disease prevention activities are implemented in Appalachian communities. Many of these ideas are based on empirical data, but others come from experiences gained through working with regional people and teaching.

  • No common way to describe Appalachian people or the communities where they live exists. Culture is described by the people of a geographic region which might include the idea of not being labeled as Appalachian due to negative stereotypes.
  • People and relationships are important in community, thus it is important to begin a dialogue with community prior to instituting plans or starting new activities. Obtaining buy-in and agreement of others is of primary concern for success. Reasons and issues for making changes need to be relevant to everyday lives and issues.
  • Economic concerns and lack of health insurance are important concerns for many residents in the Appalachian region. Finding local ways to address problems and be inclusive of those needing assistance is essential.
  • Many Appalachian communities are fighting battles with issues such as mental health concerns, substance abuse, and increased crime. Local people tend to be aware and concerned about these problems. Finding ways to tie these concerns with health promotion and disease prevention might be beneficial.
  • While levels of education for some community people may be lower than others in the nation, it does not mean that people are not anxious to learn new things. Lack of formal education does not imply a lack of willingness to gain new knowledge about things. Using caring methods of empowerment and skill-building can be important tools in mobilizing local efforts.
  • Outsiders are not necessarily unliked or unwanted, but it is important that trust-building, respect, and credibility are gained prior to assuming you know the answers. Many physicians and other health care providers are often of different race and ethnicity that the people in the rural communities of Appalachia. Time spent interacting and communicating is important. It is essential that language is clear and directions for actions to be taken are clear.
  • Many Appalachian people tend to delay seeking health care services and often do not seek medical care until serious problems are occurring. Thus, messages about prevention, screening, and the value of early detection of a problem like diabetes need to be clear messages that everyone understands.
  • Families are important to many of those living in the Appalachian region and can play important lives in the health and wellness of individuals. Take time to consult the Family Section of this website for many ideas and resources that could be important and useful in providing health care services and diabetes or health education.
  • Many people living in some geographic regions of Appalachia are Caucasian and thus do not qualify as minorities. However, diabetes, cardiac, stroke, cancer, oral care, and other health risks are often as high for many living here as for other national minority groups. Thus, it is important to keep track of the numbers of people with specific health concerns, the kinds of treatments provided, and the results that are achieved.
  • The importance of health risks such as obesity, alcohol, or tobacco use may be underestimated by those living in the region. It is important to be culturally sensitive as these problems are addressed.
  • Those living in rural regions of Appalachia may have fewer voices speaking for their needs at the state level. Thus, local people need to gain skills for speaking for themselves and learn ways to become involved in changing policies that impact their lives.
  • Geographic distances are important to people living in rural regions. Referral to specialists in distance places could mean that local people fail to seek that care. Thus, it is important that clinicians carefully explain the reasons for the care and those individuals understand its value and importance. Additionally, understanding whether resources are available for obtaining that care should be discussed.
  • Many people in the region have adopted family routines that include eating foods high in fat and carbohydrates and being less physically active. A reason for making changes needs to be understood and valued if healthy lifestyles are to be adopted. Thus, finding ways to rethink homestyle cooking so that recipes use healthier ingredients but retain the original flavors and appearance are needed. Media messages and health educators need to consider ways to address local needs as they suggest changes in diet and activity.
  • Consider ways to use existing groups as a way to address community health concerns. Encourage others to take an active role. Go to the Toolkit section of this website and view the Toolkit Activities for a variety of ideas that you might use in your community to address healthy lifestyles, diabetes prevention, and diabetes self-management.
  • Identify local partners to assist with meeting the needs of local people. Groups such as your local County Extension office, hospital, cancer or diabetes coalition, faith-based programs, senior center, elementary and secondary schools, local universities, health departments, and other local or neighborhood groups will be good places to find others interested in working towards a healthier community.