Urban Appalachian Community Coalition is committed to the health and well-being of the urban Appalachian people of greater Cincinnati. The Urban Appalachian Council’s environmental justice activities and key events such as the explosion and fire of the Queen City Barrel Company have long made health issues of critical importance in research and advocacy for the best interest of Appalachian people in greater Cincinnati. New work by UACC Core members and student intern researchers updates what we know about the state of health issues within the urban Appalachian communities and neighborhoods. 

In the days of the Urban Appalachian Council, early studies showed disparities in the health of urban Appalachian populations in greater Cincinnati as compared to other groups in the region. Those working with and within Appalachian communities found that rural attitudes toward healthcare conditioned the ways urban Appalachians viewed medical issues. The idea that healthcare was a simple “one-shot” solution, for example, was one of the main issues. Further studies conducted in 1990s showed that the disparities in health among urban Appalachians remained even as we were following second generation urban Appalachians. Many of these studies are summarized in the Urban Appalachian Council’s Working Paper 18, Appalachian Health Status in Greater Cincinnati: A Research Overview by Phillip Obermiller and Katie Brown (2002). The definitive work on Appalachian health, Appalachian Health and Well-Being (2012), is authored by Robert Ludke and Philip Obermiller, members of UACC, and is available at UACC’s Frank Foster Memorial Library.

Now, a new research project, UACC Generations Health Study, led by UACC Core members Michael Maloney and Maureen Sullivan, and Research Committee Chair Roberta Campbell, with the help of student intern researchers Natasha Rodriguez, Nikita Sawant Dessai and Nathan A. Squillante, has begun to determine how health disparities between the urban Appalachian populations and other populations persist and how to approach these issues. As we now consider 3rd, 4th, and 5th generation urban Appalachians, the questions of health disparities appear to stubbornly persist, and this new research is designed to pinpoint the causes of these disparities.

A combination of research techniques such as story circles, focus groups and detailed questionnaires have found some of the key issues at the heart of the health disparities that characterize the urban Appalachian communities. These include the rising cost of healthcare and the inability of some urban Appalachians to navigate online resources either because of no access to internet or the challenge of navigating health care websites. Socio-economic status, too, tends to lock people into certain precarious positions in relation to healthcare. The socio-economic status of urban Appalachians is also bound up with older attitudes toward healthcare that go back to rural life where people learned about health issues primarily from family rather than from official sources.

According to Mike Maloney, the UACC Generations Health Study has so far emphasized the fact that “the [urban Appalachian] community needs… improved access to medical advice, consultations, nutrition, healthy eating programs, and immunization and disease prevention efforts,” among many other things. The simple fact of access to information seems to be one of the primary engines of the health disparities between urban Appalachian communities and the rest of the population. People in Lower Price Hill and East Price Hill specifically made it clear that healthcare services in their areas were both inadequate and/or inaccessible. These are issues that go back to the earliest studies in the late 1970s which reveal a pattern of negligence toward urban Appalachian neighborhoods and communities.

More specific issues that pertain to things like the Covid-19 pandemic reveal similar problems and disparities. The City of Cincinnati was “slow to set up testing sites in their [historically urban Appalachian] neighborhoods.” There was confusion among people in these neighborhoods about where to go to get tested, and many people experienced difficulties getting to testing sites. These problems tended to reinforce old attitudes of mistrust toward government and medical services, thus further complicating efforts to get people immunized against Covid-19.

Some of the more distressing findings in this research so far indicates a marked increase in drug use among urban Appalachians. Violence, particularly toward women has increased, and attempts to address these issues have been met with outright medical negligence. Much of these findings are anecdotal, coming from focus groups and direct discussions with participants. These discussions also show an increased awareness within the urban Appalachian communities toward these issues and therefore increased vigilance. Participants also have told us that women’s health issues are more in the open than they used to be, and people are much more aware of the importance of mental health issues.

The research is already compiled into several reports, and what is presented here is only the barest summary of these findings. While health issues and conditions in urban Appalachian communities have improved over the decades, many of the barriers to healthcare that impacted urban Appalachians decades ago appear to persist, and for similar reasons. A simple lack of access to healthcare services creates an overall barrier to healthy populations. This in turn tends to perpetuate mistrust on the part of people within the urban Appalachian communities toward official healthcare services which aggravates these problems.

The Urban Appalachian Community Coalition’s research recommends continued efforts to raise awareness of health issues and access points for health care, increased availability of transportation to and from healthcare services, and a great emphasis on education on healthcare issues to reduce the stigma that surrounds seeking healthcare, especially mental healthcare. There is a long list of recommendations contained in these reports. These will be added to the UACC website under the Research tab in the coming weeks. A summary by Michael Maloney of the earlier 2021 research will also be made available. 

The Urban Appalachian Community Coalition has always put health issues at the forefront of with work of advocacy on behalf of urban Appalachian people. One of the most important ways this kind of work is done is with continued research on public health issues, particularly as they impact our urban Appalachian neighborhoods, and these studies provide powerful insights into how we proceed in working to overcome health disparities between our urban Appalachian communities and the greater Cincinnati community in general.

Mike Templeton is a writer, independent scholar, barista, cook, guitar player, and accidental jack-of-all-trades. He is the author of The Chief of Birds: A Memoir, available from Erratum Press, and Impossible to Believe, forthcoming from Iff Books. Check out his profile in UACC’s new Cultural Directory. He lives in West Milton, Ohio with his wife who is a talented photographer. They spend their free time walking around the city and the country snapping photos. She looks up at the grandeur above, while Mike always seems to be staring at the ground.

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