ETSU public health dean discusses poverty, poor health outcomes in Central Appalachia

Brandon Paykamian • Oct 21, 2018 at 6:19 PM

Education and economic development ties into some of the most pressing health and mental health issues here in Central Appalachia, according to Randy Wykoff, the founding dean of the East Tennessee State University College of Public Health. 

On Thursday, Wykoff kicked off a conference titled, “Promoting Mental Health in Central Appalachia.” The event, hosted by the ETSU College of Public Health and American Psychiatric Association at the Millennium Center, featured over a dozen mental health and health care experts discussing the root causes of health issues in the region. 

One major focus of Wykoff’s presentation, “Social Determinants of Health and Mental Health,” was the opioid crisis, an epidemic he said has been “exploding” since 1999. Today at Niswonger Children’s Hospital alone, about 30 percent of infants in the neonatal intensive care unit are living with neonatal abstinence syndrome, a number indicative of the scope of the problem.

“Our rate is 66 percent worse than the national rate,” Wykoff said of drug overdoses. “Our worst counties are much worse than the worst counties in the rest of the country, and I think that’s because the epidemic is longer-standing here.

“The epicenter is right here in Central Appalachia.” 

When it comes to poor health behaviors such as substance abuse and smoking, Wykoff said there are multiple factors that play into the numbers: Poverty, racial and ethnic disparities, community cohesion, housing, income, early life experiences, work and education. 

“If we were having this conversation 20 years ago, this is where I would stop. I would say, ‘Folks, we’ve got to make sure people have access to health care, but we also have to make sure we change behaviors related to smoking, diet and exercise and substance abuse,’” he said. “And that is still completely true, but it is not truly complete because we are coming to understand that there’s a whole other set of factors that impact health that are especially relevant here in Appalachia.

“The idea behind the social determinants of health is that we are all born with a genetic predisposition, good or bad, and we can impact that by access to health care and dramatically with our behaviors, but there’s a whole other set of factors outside of ourselves that have a dramatic impact.”

Lack of access to health care is just one major concern, accounting for about 10 percent of early deaths. 

“This means that if all Americans had access to the very best health care — which they don’t — we would reduce our early death rate by a tenth,” he pointed out. 

But one of the biggest determinants, according to Wykoff, is education. About 75 percent of Central Appalachian counties fall below the national average for college education. 

“Education is a tremendous predictor and it has a tremendous relationship with health outcomes,” he said. “By the time you’re 25, based on your education level, there is a five- to seven-year difference for life expectancy between men and women — the difference between a high school dropout and college graduate. That’s a huge difference.”

Wykoff said poverty, in general, is a “tremendous predictor of poor health” as well. Many of the poorest counties in the country are right here in Central Appalachia. 

“I want to point out that we have counties (throughout the country) where less than 5 percent of kids are living in poverty all the way up to 50 percent living in poverty,” he said. 

“A poor American is three times more likely to die before the age of 65 than a rich American,” he later pointed out. 

Wykoff said improving mental and health outcomes — and alleviating the opioid crisis — requires a multidisciplinary approach across all professions outside of health care. 

“We won’t be effective at improving health unless we start working with the business community, with the Chambers of Commerce, with economic development folks — things we don’t traditionally think of ourselves doing. But if we want to be successful, we’ve got to start working across lines,” he said. “We have to work together and recognize that all of our efforts across all of our disciplines are necessary to improve health in the region.”

The story is the same elsewhere in the country, according to American Psychiatric Association President Altha Stewart, who is from Memphis. 

“Poverty begins a process that leads to poor health outcomes. This is something we share, whether we live in the west or eastern part of the state,” she said.


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