Appalachian Folk Culture: Health Care Differences and Disparities
The concept of culture is all the characteristics a person has such as language, beliefs, values, behaviors and norms. It is the objects we hold dear and pass from one generation to the next. It is every aspect of who and what we are.
When we are born we have no knowledge of whom or what we are. We have no language, no values, no religion, and no morality. We lack the fundamental orientations that we take for granted and are very important to who we are.
These are all learned traits that we usually share within the core group of our family. It is through the learning of our culture that we understand and give meaning to everything around us and if someone challenges us on our beliefs it usually upsets the individual that has been challenged.
This cultural make-up is what defines each person as individual. We use our culture to sometimes judge others and sometimes this can be negative or this can be positive.
As health practitioners must keep in mind that when dealing with others cultures you must remember the framework of that culture and view it from that framework. Being raised in a different culture gives individuals a different perspective of normal than what most Americans believe.
The Appalachian region has several diseases that affect them. Cancer will be the focus of this paper even though it is all of the conditions combined that have affected the Appalachian culture and to some degree have banded them together as a whole. In this region health care and disease prevention has been a hot topic for sometime and has been overlooked by the nation.
Frustration among this population only reinforces their distrust of health care professionals as well as governmental aid. Reforming how health care is delivered is now needed to help with bringing this region up to the standards the majority of the nation already has for health care.
The entire region of the Appalachian covers from southern New York State to the northern part of Mississippi and covers over 13 states. There is a high percentage of poverty, low income higher than average high school drop out rate, infant mortality rate and a steady migration moving out of the region.
Because of the terrain being very hilly basic community infrastructure is difficult and costly. Per capita income in 1993 for the region was just a little over $15,000 with the poverty in the region, when compared to the nation, shows that 4 out of 10 countries with the highest rates are located within this region.
It isn’t uncommon for counties in the region to show unemployment rates of 11 to 15%. Mining jobs in West Virginia, just in recent times have been eliminated and have placed a great strain in this region. 86% of the counties in the region have been given the distinction of being areas where shortages of health care professional are present and inadequate with insurance coverage.
This is shown with higher than the national average, for example, heart disease at 19%, lung disease at 22% and the death rate at 12%. Education statistics in this region shows that 12% of the adult population only has an education up to the 9th grade and according to The Appalachian Regional Commission this is three times the national average.
Another interesting disparity that should be noted is the education since this affects health and how health care is handled. For example in the Ohio region of the Appalachian spending on students in the region by Ohio in 1991 was only $2,822 per student, while the average for the whole state was $4390.
Living conditions are also noted while looking at the health care disparities in the region. Statistics show that more than 15% of homes are substandard when compared to the nation (http://census.gov & http://healthypeople.gov) .
How Appalachian culture is viewed has great bearing on how health care is approached in this region. Certain myths and stereotyping of these people probably had a direct cause as to how this culture views health care and the system. Many see this culture as different, than what it really is. And many haven’t even heard of the plight in this region in the United States.
“Today’s mainstream media still routinely depicts “hillbillies” as ignorant, lazy, close-minded and violent rubes, given to “feuding and fussing” when not handling snakes, brewing moonshine, or fathering children with their cousins” (Noe, 2002, p.1).
Kenneth W. Noe a professor at Auburn University wrote that class consciousness seemed to propel this culture into a “tradition of resistance” (Noe, 2002, p.3). The region and its people had become exploited causing a general disillusionment for business and government. In today’s terms business and government is the health care system.
So that belief alone would definitely hamper how individuals in this region use and get health care. In their culture distrust of both is passed down in family beliefs and it seems to be a very difficult cycle to break or change.
Many health care practitioners find that it is difficult to overcome the social class barriers that have been built up against this culture. “Ohmans, Garrett, and Treichel (1996) recognize that social class can be a significant barrier, particularly for new immigrants whose social status or class distinction may have radically been altered…” (Huff & Kline, 1999, p.16).
This social class is best described in terms of the conflict theory, or how upper classes used their power and privilege to exploit those below them.
Through generations of belief and the general neglect of this region and culture this behavior is seen as a problem for health practitioners in this area. The Appalachian culture has a basic mistrust of physicians and of modern health care practices.