New Health Blueprint for Southwest Virginia highlights grave health challenges

A sweeping new Health Blueprint for Southwest Virginia highlights the grave health challenges that grip the rural region but also proposes solutions to help residents live longer, healthier lives.

The Blueprint was assembled by the University of Virginia College at Wise's Healthy Appalachia Institute, the Southwest Virginia Health Authority, UVA Health's Center for Telehealth and a coalition of residents and regional healthcare providers. The document identifies priority health concerns for the three health districts in the southwestern corner of Virginia: Lenowisco, Cumberland Plateau and Mount Rogers. These are areas with some of the highest mortality rates in the state, and, in some cases, the nation.

Some of the challenges identified in the new report:

• High rates of health risks such as smoking, high blood pressure, diabetes and obesity. For example, 22.1% of residents identified as smokers compared with only 13.6% for the rest of the state.
• High rates of adverse childhood events. The area is home to only 6% of Virginia's population but is the source of 24% of the state's 3,161 cases of child abuse and neglect that were deemed "founded" after investigation in 2022.
• Lack of health insurance. Approximately 10% of adults under age 65 reported not having health insurance in the 2020 Census.

The top five causes of the death in the region, the report finds, were heart disease, cancer, COVID-19, chronic respiratory diseases (including black lung) and unintentional injuries. The ranking mostly aligns with the leading causes of death nationally, except for the unusually high placement of death from chronic respiratory diseases. Southwest Virginia residents are nearly three times more likely to die from chronic lower respiratory disease than other state residents, the document notes; coal mining and tobacco growing were major employment and income sources in the region for many years.

While the order of the ranking largely aligns with the top causes of the death for the country overall, the actual mortality rates tend to skew much higher than elsewhere. For example, Southwest Virginia's cancer mortality rate was 315.5 per 100,000 people in 2021, compared with the statewide rate of 181.9.

COVID-19 also has taken a disproportionate toll: The mortality rate from the virus was 94.5% higher than elsewhere in the state. And accidental deaths are much higher as well, with a death rate of 97.4 per 100,000 compared with the state's rate of only 62 per 100,000.

In these pages, residents of the region describe how the health disparities they experience are directly associated with key inequities, including inequitable access to educational opportunities, safe jobs and quality health care and other social services. It is our hope that this and future Blueprints will align regional health and social services with local needs and priorities to build a stronger and healthier future for Virginia's Appalachian communities."

David Driscoll, PhD, Director of the Healthy Appalachia Institute

In assembling the new report, Driscoll and the UVA team worked closely with the region's residents and local health leaders, including the Health Wagon, Tri-Area Community Health and Ballad Health. Notably, residents participating in community discussions expressed a strong preference for terms such as "root causes" of regional health issues rather "health determinants," a descriptor commonly used in health research. "Some study participants described this as recognizing that residents have some degree of control over these factors, and thus that their health was not predetermined," the new report notes.

Participants ranked the top three health problems for the area's residents as diabetes (20%), cancer (18%) and either heart disease or substance overdose (17%). The report notes that diabetes is the sixth-leading cause of death for the region, suggesting that diabetes and its management weigh heavily on residents' lives. 

The most cited health concern for the region was the combination of "income/poverty," "substance use" and "traumatic stress" (44%). Coming in second was "access to quality health care" and "geographic distance and other barriers to services," at 37%. "Diet/nutrition/exercise" and "education" came in third at 15%.

In terms of programs that could improve health in the region, survey participants most often suggested "partnerships providing substance-use treatment" (15%), while "mental health treatment using video visits" and "partnerships providing health services for children and families" tied at 13%. "Informing people about how to prevent and manage diabetes" came in next, at 12%.

Based on the survey results and additional research, the new Blueprint offers three primary recommendations:

• Increase healthcare access using screening programs, telehealth and remote monitoring. This includes establishing telehealth access points at libraries, community centers, EMS units, senior centers and pharmacies, as well as providing school-based health services. 
• Reduce substance use, trauma and poverty by offering integrated mental and behavioral health services, including medication management, trauma treatment and child abuse and neglect services, both in person and via telehealth. 
• Promote healthy eating and exercise through nutrition management and physical activity education, including diabetes management, both in person and through telehealth.

Those recommendations, the report notes, represent the "intersection of goals that are of importance to the community with evidence-based programs that have high feasibility for rapid implementation." 

The recommendations reflect the growing importance of telehealth both for the region and more generally as rural hospitals close around the nation. "While not a panacea, telemedicine helps to improve access to care, addresses and mitigates health workforce disparities and improves patient outcomes," said UVA Health's Karen Rheuban, MD, director of the UVA Center for Telehealth. "Partnerships such as those developed through this grant consortium will enable us to begin to tackle some of the major challenges faced by residents and providers across the Southwest region of the Commonwealth. Federal investments in our state broadband infrastructure and additional state investments in innovative solutions will help us to achieve the goals identified in the Blueprint."

The new Blueprint, available on the Healthy Appalachia Institute's site, is the first update of a document originally created in 2009. The update was made possible by a $5.1 million grant Rheuban received from the U.S Department of Agriculture to expand Southwest Virginia's access to care. 

Improving care and increasing care access across Virginia is a primary mission of UVA Health, as outlined in its first-ever 10-year strategic plan.