Facts about health in the mountains of Appalachia have been slow to emerge. The formation of the Appalachian Regional Commission in the 1960s led to increased efforts to combat known precursors to poor health (e.g., low income, limited education, geographic isolation) (1). From New York's southern counties to the foothills of Mississippi, mountain counties were eligible to participate in various federal health programs because of their poor economic status. Critical private investments in health care occurred infrequently during the 1960s and still lag because of Appalachia's low population density and high percentage of residents without health insurance or with high-deductible plans.
Health care is largely organized, funded, and monitored through political channels. Public health programs, Medicaid funding, and vital statistics reports are organized by state. Health care service boundaries and health outcome patterns are not as clearly defined. Attempts to organize health status data across state lines within the formal boundaries of Appalachia proved to be a logistical and statistical nightmare (2). It was not until the National Center for Health Statistics (NCHS) produced national maps to display mortality rates that the truth about Appalachia's health status emerged (3). The maps proved statistically what residents knew intuitively: Appalachia, the place they called home, suffered disparately poor health compared with the rest of the nation.
The national computerization of health statistics and free Internet access to national and multistate databases have spurred additional exploration of health disparities in Appalachia. Recent studies have identified higher rates of cancer (4) and, in particular, cervical cancer (5); heart disease (6); and premature mortality (7) in the Appalachian regional population that spans state boundaries.
The articles in this issue of Preventing Chronic Disease (PCD) represent a new wave of studies that explore community-based explanations for Appalachian cancer issues by gathering and considering community perspectives on health and illness. The authors of these articles also share an implicit understanding of the relationship among people's health, their behavior, and their environment. This collection of research provides a view of some dilemmas faced by Appalachian health practitioners and advocates.