Growing Care: How Local Initiatives are Combating Health Problems in Appalachia

Sheila Ingraham is the current psychology coordinator for Hocking County Behavioral Health. Since 2001, she has specialized in substance abuse issues of the region, citing opiate use, overdoses and an increase in fentanyl presence in drugs as significant issues of the region that require medical care. For Ingraham, becoming trained as a community health worker was about expanding her knowledge of her community’s needs.   

Ingraham says the three specific target populations of high vulnerability in the Appalachian region are: 

  • Those suffering from chronic illnesses  
  • Individuals with substance abuse problems 
  • Older adults 

Melissa Kimmel, executive in residence and aging lead of the OHIO Alliance for Population Health, helped identify these populations. Working with the alliance since 2019, Kimmel also founded the Southeastern Ohio Older Adult Coalition.   

“We picked those target areas because it is specific to community resiliency for COVID and other types of illnesses,” Kimmel says.   

The OHIO Alliance for Population Health of Ohio University’s College of Health Sciences and Professions dates back to 2017 and aims to tackle local health needs and create partnerships to address them. Through the alliance, the Jackson County Health Department was awarded a $4.5 million grant from the Centers for Disease Control and Prevention, Kimmel says. This grant has allowed for 13 community health workers to be trained and stationed in various counties in Southeast Ohio.   

Other factors that contribute to the state of public health in Southeast Ohio and Appalachia as a whole:    

  • A lack of resources 
  • Access to information 
  • Transportation issues 
  • Poverty  

At the OHIO Alliance for Population Health, community health worker lead Kerri Shaw oversees the training of the region’s community health workers.   

“We are under-resourced, and we don’t have the access to the same level of health care as more urban areas around the state,” Shaw says. “I think what we see is chronic diseases that go undiagnosed or untreated for a longer period of time, cancer rates that are high and some vaccine hesitancy that is affecting COVID rates, which is part of the reason that we have this CDC grant to address these things.”  

Though Appalachia experiences novel health concerns related to the geography and culture of the region, its uniqueness encourages communities to be innovative when it comes to finding health solutions.   

“I think relationships are a factor when it comes to health resiliency,” Shaw says. “There’s a lot of opportunity to grow our health in ways that also align with Appalachian values. Because we’re under-resourced in a lot of ways, we have a lot of creative organizations that are figuring out how to make people healthier through mobile health clinics, mobile produce delivery and programs like that. I think community health workers serve as that soft tissue of getting those things all connected to the people that they want to be serving.”   

Rooted in the community   

Shaw says community health workers are “frontline workers” who are trusted by the people they’re treating because they look and talk like them. 

“[They’re] just getting a feel for what the health issues are in the community from the perspective of the community — kind of the eyes and ears,” Shaw says.  

The relational nature of the position allows workers not to have excessively large caseloads. This ensures that they can spend quality time working with and getting to know patients in the places they serve. 

“Having someone who is really going to listen to you and help figure out what you need and how to get to that point is huge — and that’s something that people are lacking,” Shaw says. 

Shanda Lewis of Athens County Integrated Services for Behavioral Health is currently undergoing her community health worker certification. She believes the area needs more people pursuing this type of work. 

“It just bridges a gap between what’s going on in doctors’ offices and what’s going on in actual homes in our community,” Lewis says,  

Another program that aims to locally elevate health care is the addition of a bachelor’s in nursing program at OHIO Eastern. Increased access to a nursing degree in Southeast Ohio gives students the opportunity to live and work in their own communities. 

Jenna Cunningham of St. Clairsville is a current junior studying nursing at OHIO Eastern. She feels that public health is often overlooked within the area due to a lack of awareness. Most issues involving health care often get referred to other states for supplementary treatment. 

“Advances in technology and health care education would be a great asset to the area and would help promote overall health and management of one’s health,” Cunningham says.  

Her intimate perspective on health issues of her region will give Cunningham a better understanding of the region she will serve upon completing her nursing degree.   

“This has inspired me to advocate for better nurse-to-patient ratios,” Cunningham says. “It can improve outcomes and give a better overall quality in health care. Having a sufficient amount of staff and health care resources can help improve public health.”