The Appalachian Region
The Appalachian region is a 205,000-square-mile region that follows the spine of the Appalachian Mountains from southern New York to northern Mississippi, and is home to 24.8 million people. It includes all of West Virginia and parts of 12 other states: Alabama, Georgia, Kentucky, Maryland, Mississippi, New York, North Carolina, Ohio, Pennsylvania, South Carolina, Tennessee, and Virginia. Forty-two percent of the region's population is rural, compared with 20% of the national population.
Appalachians have a rich cultural tradition, but also face severe socioeconomic and public health challenges. Despite recent progress, Appalachia still does not enjoy the same economic vitality as the rest of the nation. Central Appalachia in particular still battles economic distress, with concentrated areas of high poverty, unemployment, poor health, and severe educational disparities. And recent economic data show that the region has fared far worse in the current recession than the rest of the nation.
West Virginia (WV) is the only state that lies entirely within Appalachia. The state is characterized by its rural and rugged terrain, ranking as one of the most rural states in the country and possessing extremely uneven topography, ranging from 240 to 4,860 ft above sea level. Two-thirds of the 1.8 million West Virginians live in counties with less than 30,000 people. Additionally, 60% of West Virginia’s counties have full or partial designation as Health Professions Shortage Areas, and 49 of WV’s 55 counties are wholly or partially designated as Medically Underserved Areas by the Health Resource and Services Administration.
With 17.7% of the population living below the poverty level, WV ranked as the sixth lowest state for poverty status in 2009. For those workers who are employed, work is often labor intensive, such as that required in underground mining, family farming, timber harvesting and other rural occupations. These factors contribute to an injury fatality rate that far exceeds the national rate.
Demographic factors also play an important role in the health status of West Virginians. West Virginia ranks second (behind Florida) as the state with the largest proportion of the total population who are 65 years of age and over.
These regional, demographic, and economic factors noted above all contribute to producing high injury mortality rates among West Virginians. According to data available from the CDC, from 2003 to 2007, West Virginia had the fifth highest overall injury death rate in the United States with an average annual rate (83.3 per 100,000 population) that was 42% above the U.S. rate (58.6 per 100,000 population). Unintentional injuries are the leading cause of death for West Virginians one to 44 years of age and WV has the fifth highest unintentional injury death rate in the U.S. During the period from 1999 – 2007, the injury death rate in WV has increased 29%, while the U.S. rate increased 10%.
The leading mechanisms of deaths due to injury in WV are: 1) motor vehicle crashes (MVCs), 2) poisonings, particularly drug overdoses, 3) firearm injuries, and 4) falls. Between 1999 and 2007, drug overdose fatalities increased four-fold, while fall deaths increased 19%, MVCs 9%, and firearm deaths stayed relatively unchanged. With the rapid increase in prescription drug overdose deaths, between 2003 and 2007 WV surpassed all other states except New Mexico in the rate of fatal drug overdose poisonings.
The need for a comprehensive interdisciplinary program dedicated to reducing injury disparities in the Appalachian region is clearly evident. By utilizing the public health approach, with dedicated activities in injury surveillance, research discovery and knowledge translation, the WVU ICRC is optimally poised to have a direct and sustained impact in this region, and, by extension, the entire nation. As an academic research center, the Center emphasizes and stimulates high quality innovative research that builds the scientific basis for the prevention and control of injuries. In addition to the continued research emphasis, Center educational activities are creating a cadre of skilled practitioners and researchers who will build capacity and continue to address regional and national concerns in the years ahead. Our outreach, collaboration, and technical assistance activities are designed to improve the capacity and capabilities of local programs. ICRC works with policymakers to inform the development (or strengthening) of regional and national policies. Collectively, these Center activities and outputs are contributing to the prevention and reduction of the consequences of violence and unintentional injuries, resulting in changes in morbidity and mortality at the population level. Our evaluation methods and injury surveillance activities will document this progress in the years ahead.
for a list of Appalachian State Injury Programs and Surveillance Reports
Sources for the information on this page include: