Access to Health Care in Appalachia: Perception and Reality.

Introduction: Health disparities such as cancer and diabetes are well documented in Appalachia. These disparities contribute to health status, and by many indicators, Appalachian people are less healthy than those who live in other parts of the country. Access to health care is one factor that contributes to health disparities. Access to care is complex and involves both intrinsic and extrinsic aspects, including satisfaction with quality of care. This research sought to compare Appalachian to non-Appalachian communities in terms of perceptions of access to care. Methods: We implemented a statewide survey to quantify perceptions of multiple components of access to care, including satisfaction with quality of care. We compared survey results to quantitative data from the County Health Rankings to document consistency with perceptions of access to care. We used chi-square analysis to compare Appalachian with non-Appalachian respondents. Results: More than 600 people completed the survey. Results of the survey identify significant differences between Appalachian and non-Appalachian residents' perceptions of access to care and their satisfaction with health care. Specifically, Appalachian residents are less satisfied with convenience, information, quality, and courtesy of health care. They perceive providers relying on stereotypes when communicating with patients. Implications: Examining and documenting perceptions of health care is important because it could lead to improving access by focusing on cultural competency in addition to more resource intensive strategies. Health disparities in Appalachia might be minimized by being more compassionate and understanding of people who live here.

The Nuclear Legacy in Appalachia.

Nestled in the rolling hills of Appalachia Ohio is a reminder of the role that the region played in winning the Cold War. For more than 40 years in rural Pike County, the 3,700-acre Portsmouth Gaseous Diffusion Plant (PORTS), or the "A-Plant" as the locals refer to it, enriched uranium for use in nuclear weapons. While the facility produced nuclear fuel for national security, it simultaneously exposed plant workers to chemicals and radiation and discharged pollution into the surrounding community. The A-Plant is now being demolished and the site repurposed. However, the site continues to affect the community as, for example, a middle school near it was closed in late spring of 2019 due to alarming levels of radiation detected in the building.

Development and application of a rubric to compare strategies for improving access to health care in rural communities in the United States.

Rural areas are underserved in terms of the availability of and access to health care services. According to Healthy People 2020, access to health care continues to be the most frequently identified rural health priority in the United States. PURPOSE: The purpose was to develop an efficient approach for standardizing and prioritizing strategies to improve access to health care in rural areas across the United States. The rubric provides a quantitative metric of the effectiveness of each strategy in terms of impact and feasibility and allows community health departments and other access to care groups to compare strategies and facilitate discussion of various strategies' ability to meet the needs of diverse communities. FRAMEWORK: The Plan, Do, Check, Act (PDCA) cycle was used to create the rubric. The research team constructed a plan for creating a rubric to measure each strategy's impact and feasibility. We checked the rubric by applying it to selected access to care improvement strategies evaluated by the Robert Wood Johnson Foundation (RWJF). Members of a rural community Access to Care Workgroup applied the rubric to several RWJF What Works for Health strategies. The final step was to compare the results of the application phase through facilitated conversations with the goal of determining which strategy or strategies would best meet the needs of the rural community. DISCUSSION: A rubric is a valuable tool to facilitate assessment and discussion and for assisting community members in determining access to care priorities. After applying the rubric in a community setting, we identified two important tactics: 1) the rubric is best applied to strategies when they are summarized consistently and cohesively; and 2) it is important to involve community stakeholders early in the process of identifying strategies for evaluation. The next step is to apply the rubric to similar strategies in other rural communities to further validate the rubric's effectiveness.

From Cancer to Diarrhea: The Moving Target of Public Concern about Environmental Health Risks.

Public concern about the environment can be unpredictable because it is influenced by numerous factors. Environmental health issues often emerge as important because the public is worried about their health especially when it comes to cancer. Public fear of cancer from environmental exposures is reinforced by many of the US regulations that set pollutant limits based on reducing the risk of cancers rather than other health outcomes. While fear of cancer will never dissipate, recent foodborne outbreaks are contributing to raising public awareness of the health effects from microbes. This paper adds to the dialogue about the challenges of enhancing public understanding of environmental health issues. Internal factors, such as worry, that contribute to public outrage are sometimes more important than external factors such as the media. In addition, relying on the media to inform the public about imminent public health risks may be an ineffective approach to enhancing understanding. In the end, scientists and risk communicators are forced to compete with politicians who are often very effective at manipulating public understanding of risk.

Creating effective messages about environmental health.

The Centers for Disease Control and Prevention supported research coordinated by the Association of Environmental Health Academic Programs (AEHAP) for the purpose of developing effective messages about environmental health. The purpose of these messages would be to increase the visibility of the environmental health profession and improve the public's awareness and understanding of the role played by the profession in protecting the public's health. To accomplish this task, AEHAP first collaborated with a marketing team to develop initial test messages. The core message revolved around five major themes: effects of pollution, susceptible populations, economics and prevention, homeland security, and specific environmental health issues. The draft messages were tested in three focus group settings: 1) policy makers, 2) environmental health professionals, and 3) the general public. This paper reports a finding that there is a perceptual gap among environmental health professionals, policy makers, and the public. This gap is part of why there is a compelling need for the environmental health community to develop and disseminate more effective messages about the profession.

Health education and food safety behavior in the university setting.

Health education in colleges and universities offers an opportunity to reach a captive audience of young people in order to promote a lifetime of healthy behavior. University health education typically focuses on topics such as alcohol and substance abuse, sexual behavior, and nutrition. Environmental health issues are not a prominent component of university health education, even though an understanding of a healthy environment is critical to promoting overall health. Food safety is an environmental health issue of particular concern in universities since many young adults prepare their own meals for the first time there. Food safety questions from the Centers for Disease Control and Prevention's Behavioral Risk Factor Surveillance Survey were used to assess the behaviors of 354 upper-level undergraduate students. Findings from the survey indicate that students are engaging in risky food consumption and handling behaviors and that the educational techniques mandated by the federal government are ineffective in reaching college students.

Skills and abilities needed by environmental health science and protection professionals in the public sector.

The National Environmental Health Science and Protection Accreditation Council (EHAC) accredits undergraduate academic environmental health science programs in the United States. The guidelines used by EHAC include core and technical courses that students should take in order to graduate with a bachelor of science degree in environmental health science. As part of a review of the accreditation guidelines, the research reported in this paper was undertaken with support from the Centers for Disease Control and Prevention. To identify the skills and abilities needed by entry-level environmental health professionals in the public sector, the research 1) examined existing environmental health priorities in public-health agencies, 2) reviewed entry-level job postings, and 3) surveyed more than 120 public-health professionals across the country. The results suggest that students who graduate from accredited programs must be skilled interpersonal communicators with a broad base of technical knowledge.