A nonprofit publication of the Kentucky Center for Public Service Journalism

Roundtable says poor health a major obstacle to economic development in Appalachia

By Melissa Patrick
Kentucky Health News

Appalachia faces many hurdles when it comes to economic development and creating a healthy workforce, including education barriers, addiction issues, stigma and overall poor health.

Those were the conclusions of a 13-member panel convened to discuss the findings of two new Appalachian Regional Commission reports that found Appalachian health continues to fall behind the rest of the nation, and how that affects economic development.

“Without a healthy workforce, the economic prospects in the region are greatly diminished,” declared Julie Marshall, an ARC economist and a principal investigator for the “Health Disparities in Appalachia” report.

Appalachian Regional Commission roundtable on new health data and economic development in Appalachia. (ARC photo)

Marshall said the study found Appalachians feel unhealthy 12 more days a year than the average American if you account for physical and mental health, which results in more sick days, lower work productivity and more injuries, and “That is a significant hurdle to developing a healthy workforce.”

The second report, “Diseases of Despair,” looked at deaths from overdose, suicide and alcohol-related liver diseases in Appalachian and found them to be 37 percent higher than the rest of the nation: Overdose deaths were 65 percent higher, suicide deaths were 20 percent higher, and alcoholic liver-disease deaths were 8 percent higher.

Michael Meit, lead author of the study, reminded the panel that it’s important to look beyond poverty as the only reason for these high rates, pointing out that some Appalachian states, like Mississippi and Georgia, have high poverty levels, but lower death rates for these measures.

The report also notes that most people who die from an overdose in Appalachia are between the ages of 25 and 54, which are prime working years.

One surprise in the report, based on 2015 data, was that overdose deaths were higher in metropolitan counties than rural counties. The other report, using data through 2014, found overdoses were higher in rural Appalachia.

Meit, who is also the senior fellow for the NORC Walsh Center for Rural Health Analysis, said the difference may indicate a new trend.

Addiction is an economic issue

Meeting in Johnson City, Tenn., the panel said addiction — to opioids, alcohol, methamphetamine and cocaine — is a major workforce issue in the region.

Dan Eldridge, the mayor of surrounding Washington County, said he had recently talked to a company looking to bring more than 600 jobs to his area, and spent most of the time talking about the region’s workforce. And when he asked why, they told him that among other things, one of their selection criteria was access to a drug-free workforce and “this region of the country does not have a good reputation.”

Eldridge said he thought one contributor to the problem is that high-school students who aren’t college-bound don’t have any plans for the future, and their drug use seems to increase after they graduate.

“We have got to really help get our kids focused on a plan for success and career orientation . . . to make them ready for the workforce,” Eldridge said. “I think in doing that we are going to be able to avoid some of these issues that they slip into.”

Virginia Health Secretary William Hazel said a cultural change is needed in the workforce to provide help for people with addictions, noting that it is no longer plausible to simply “weed out the drug users.”

Mark Birdwhistell, vice president for Administration and External Affairs at the University of Kentucky, agreed and said it’s time to “eradicate the stigma of addiction.”

“Addiction is a clinical condition that needs to be addressed just like diabetes, asthma and any other medical condition,” Birdwhistell said. “And once you get to that point, it’s a lot easier to address many of the issues that we are talking about .”

Randy Wykoff, dean of the East Tennessee State University College of Public Health, said it’s time to bring people together from different sectors — health-care providers, the criminal-justice system, advocacy groups and people with substance-use disorders — to “rethink this whole thing.” He said it’s time to quit putting people in jails who need rehabilitation and treatment.


The panel stressed the importance of also sharing the success stories from the region. “These problems don’t define the region,” Meit said.

Eldridge said his county has a program that teaches employees how to recognize personal or work-related problems and encourages employers to implement employee-assistance programs to address them.

Tennessee now offers all high-school graduates tuition-free attendance to a Tennessee community or technical college, noted Ted Townsend, deputy commissioner and chief operating officer of the Tennessee Department of Economic and Community Development.

Wykoff reminded the panel that statistics are changeable, noting that Tennessee’s high-school graduation rate had moved from 49th in 2005 to a top 10 slot this year.

Mike Caudill, CEO of the Mountain Comprehensive Health Corp., a federally qualified health center in Letcher County, pointed to its “Farmacy” program as one of their many successes.

The grant-funded program gives qualifying individuals a “prescription” for fresh fruits and vegetables at their local farmers’ market. Caudill noted that one of their participants lowered his A1C, a test for blood sugar, from 14 to 6.2 in just eight months. A normal A1C is between 4 and 5.6.

What next?

“There is no plan without technology that fixes the problem,” said Jared Arnett, executive director of Shaping Our Appalachian Region, a bipartisan effort to revitalize and diversify Eastern Kentucky’s economy.

Arnett explained how technology opens doors for new economic opportunities, expands entrepreneurship, provides access to health-care specialists through telemedicine, and provides more opportunities for education and workforce training.

Other ideas to improve the workforce included creating multi-sector partnerships, involving community members in decision making, taking advantage of the region’s high rate of social associations, including health considerations in all government policies, and better coordinating local educational systems with the region’s workforce needs.

“For me, this discussion and the data that we are looking at is the story of human capital and where do we want to take human capital in this region,” said Jen Giovanutti, the regional community development manager for the Federal Reserve Bank of Richmond.

Arnett added: “In the midst of all this bad news, somebody has to speak life into what is possible.”

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