A view of the French Broad River. Photo courtesy of RiverLink.

By Taylor Knopf, NC Health News

Rural Appalachian counties are known to struggle to keep up with the rest of the United States, especially when it comes to health outcomes.

Infant mortality is 16 percent higher in Appalachia than other areas of America. There are higher rates of diabetes and child poverty.

In general, rural North Carolina has higher rates of drug and alcohol use, suicide, years in productive life lost, injury, teen births, uninsured patients and preventable hospitalizations. And the list goes on.

But there are great health care efforts happening across rural Appalachia as well.

Some counties have better health outcomes than expected considering their lack of resources, poverty and unemployment rates and other factors, according to new research and reports from the Appalachian Regional Commission (ARC), the Robert Wood Johnson Foundation (RWJF), and the Foundation for a Healthy Kentucky.

The reports label these counties as “bright spots.” Three North Carolina counties made the list: Alleghany, Henderson and Madison.

The foundations also launched a new website HealthinAppalachia.org, which has data on the region’s health challenges, outcomes and potential solutions.

“These data and research reports change our understanding of what is possible for health in Appalachia and other rural places,” CEO of the Foundation for a Healthy Kentucky Ben Chandler said in a press release. “These communities are resilient and have incredible assets, including strong social connections, and volunteer networks for things like delivering meals to the elderly and providing transportation.”

‘Madison County: Jewel of the Blue Ridge’

The report researchers profiled 10 Appalachian counties with creative health initiatives and local collaborations that are making a difference for their communities, including the small mountain community of Madison County, located just west of Asheville.

Madison County scored better than expected on 13 of the 19 health outcomes researchers used to measure county bright spots.

For example, the county scored 25 percent better than expected in the category “years of potential life lost,” an attempt to quantify the potential and the promise lost when someone dies prematurely.

In a county that’s been dubbed the “Jewel of the Blue Ridge” there are also fewer adults with obesity and diabetes than expected, as well as fewer heart disease hospitalizations.

“It does not mean that all Madison County residents enjoy excellent health,” study authors wrote. “In fact, Madison County lags behind the rest of the nation on many health outcome measures.

“But Madison County’s performance does indicate that certain county conditions or programs may be helping generate better-than-expected outcomes—and that other resource-challenged Appalachian counties may benefit from adopting similar initiatives,” the authors concluded.

The report notes that one of Madison County’s top strengths is its focus on primary care, which is mainly provided by the Hot Springs Health Program (HSHP).

HSHP has four locations throughout the county with extended evening and weekend hours of operation. While the clinics technically focus on primary care, the health care providers in them also treat many urgent needs.

Madison County’s rate of potentially preventable readmissions to the emergency department is 54 percent lower than expected, according to Community Care of Western North Carolina.

“For them to come to us rather than go to (Asheville’s Mission) hospital is a big piece of it,” Hot Springs Health Program Director Teresa Strom told NC Health News last year.

“A lot of counties have patients that go straight to the emergency room for their strep throat and all those things,” Strom added at the time. “So that generates all these claims. For us, we must have less claims of people that go there.”

Primary care providers at HSHP see everything from broken limbs and chest pain to pneumonia and cuts needing stitches. The physicians also have access to a lab for immediate testing, an X-ray machine and IV hydration capabilities, which are all rarities for the many primary care facilities.

Hot Springs Health Program provides pediatric and family care, all the way to hospice services.

“Our home health, hospice, pharmacies and outpatient physical therapy help insure we can handle most all of the health care needs for our community,” Strom said after the “Bright Spot” report was published.

“Several of our staff members are residents of Madison County. They love taking care of their family and friends. That is why I work with the HSHP, I want to help take care of my community,” she said.

Partnerships are key

Madison County also has a robust health department that has been tackling opioid-related issues such as the increased number of Hepatitis C cases. The health department is also screening for the contagious virus in the county jail and has a good working relationship with the local sheriff.

The report highlights other good work and partnerships in Madison County.

For example, the local Mars Hill Baptist Church started a nonprofit called the Lord’s Harvest, which aims to help the 30 percent of county children who are food insecure. Most of the county is considered a food desert.

The church received grants from other churches throughout the state and collects donations from the community to feed kids in need. The nonprofit provides 1,790 families each month with 4,100 pounds of potatoes, 1,000 pounds of cornmeal, and 1,000 pounds of pinto beans, according to the report.

“Mars Hill Baptist Church Pastor Tommy Justus pieced together supplies from the regional food bank, human capital from the faith-based community, and a packing site in his church basement, but he lacked a way to get the food to the schools that serve as the three distribution sites across Madison County,” study authors wrote.

“So the sheriff volunteered his deputies to courier the food to the schools.”

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