PEOPLE OF APPALACHIAN

HERITAGE
OVERVIEW, INHABITED LOCALITIES,
AND TOPOGRAPHY

• Appalachia, a region rich in coal, timber, and natural beauty, comprises 406 counties in 13 states—14-15
Georgia, Alabama, Mississippi, Virginia, West Virginia, North Carolina, South Carolina, Kentucky,
Tennessee, Ohio, Maryland, New York, and Pennsylvania. In addition, the region is divided into Southern
Appalachia, Central Appalachia, and Northern Appalachia. West Virginia is the only state entirely within
Appalachia.
• Appalachians generally characterize themselves according to their family name and by their country of
origin, such as German, Scotch-Irish, Welsh, French, or British, the primary groups who settled the
region between the 17th and 19th centuries. Most Appalachians can identify a family link with Native
Americans who populated the area before them.
• People came to Appalachia for religious freedom, space for themselves, and personal control over
interactions with the outside world. As mining and timber resources were depleted and farmland
eroded
• Appalachians migrated to larger urban areas seeking employment.
• Education beyond elementary levels is not considered important by some Appalachians because it is
not viewed as necessary to earning a living in their traditional occupations.
COMMUNICATION

• The dominant language of the Appalachian region is English, with many words derived from 16th-
century Saxon and Gaelic.
• Some insular groups in Appalachia speak Elizabethan English, which has its own distinct vocabulary and
syntax; this can cause communication difficulties with practitioners who are not familiar with the dialect
• Four dominant themes affect communication patterns in the Appalachian culture: 10-13
• (1) avoiding aggression and assertiveness,
• (2) not interfering with others’ lives unless asked to do so,
• (3) avoiding dominance over others, and
• (4) avoiding arguments and seeking agreement
• Appalachians are private people who do not want to offend others; nor do they easily trust or share
their thoughts and feelings with outsiders.
• Appalachians may be sensitive to direct questions about personal issues.
• Because traditional Appalachians like personal space, they are more likely to stand at a distance when
talking with people in both social and health-care situations.
• To communicate effectively with Appalachian clients, nonverbal behavior must be assessed within the
contextual framework of the culture. Many Appalachians are comfortable with silence, and when
talking with health-care providers who are outsiders, they are likely to speak without emotion, facial
expression, or gestures and avoid telling unpleasant news to avoid hurting someone’s feelings.
• The traditional Appalachian culture is “being”- oriented (i.e., living for today) as compared with “doing”-
oriented (i.e., planning for the future).
• For the traditional Appalachian, life is unhurried and body rhythms control activities, not the clock.
• Although the format for names in Appalachia follows the standard given name plus family name,
individuals address nonfamily members by their last name.
• To communicate effectively with traditional Appalachians, health-care providers must not ignore speech
patterns; they must clarify any differences in word meanings, translate medical terminology into
everyday language using concrete terms, explain not only what is to be done but also why, and ask
clients to repeat instructions to assure understanding.
FAMILY ROLES AND ORGANIZATION

• Men were supposed to do physical work, to support the family financially, and to provide
transportation. Women took care of the house and assumed responsibility for child rearing. Self-made
individuals and families were idealized.
• Children are important to the Appalachian culture. Large families are common, and children are usually
accepted regardless of their negative behaviors in school or with authority figures
• Same-sex couples and families living together are accepted, but rarely discussed. 9
WORKFORCE ISSUES

• Because many Appalachians value family, reporting to work may become less of a priority when a family
member is ill or other family obligations are pressing.
BIOCULTURAL ECOLOGY

• Some individuals can trace their heritage to a mixture of white ancestry and Cherokee or Apalachee
Indian. A few blacks, a distinct minority 7-8
• increased risk for respiratory diseases such as black lung, brown lung, emphysema, and tuberculosis
• Children are at greater risk for sudden infant death syndrome, congenital malformations, and infections
• Appalachians are less concerned about their overall health and risks associated with smoking
A 10-STEP PATTERN OF HEALTH-SEEKING BEHAVIORS
HAS BEEN IDENTIFIED AMONG APPALACHIANS.

• 1 At the onset of symptoms, Appalachians typically implement self-care practices that are usually learned from
mothers.
• 2 When the symptoms persist, they call their mother, if she is available.
• 3 If the mother is unavailable, they call the female in their kin network who is perceived as knowledgeable
regarding health. If a nurse is available, they may seek the nurse’s advice.
• 4 If relief is not achieved, they use over-the-counter (OTC) medicine they have seen advertised on television for
symptoms that most closely match their own.
• 5 If that is ineffective, they use some of “Mable’s medicine” (she lives down the road, had similar symptoms, and
did not finish her medicine).
• 6 Next, they ask the local pharmacist for a recommendation; this usually marks
the first encounter with a professional health provider. (Of course, they usually
do not tell the pharmacist that they tried Mable’s medicine.) The pharmacist may
strongly suggest that they see a health-care provider; however, on their
insistence, the pharmacist may recommend another OTC medication.
• 7 When no relief is achieved, they seek a local health-care provider, who may or
may not speak understandable English. The provider treats them to the best of
his or her ability.
• 8 If the condition does not resolve itself, the local health-care provider refers
them to a specialist in the area.
• 9 The specialist treats the condition to the best of his or her ability.
• 10 If unsuccessful, the specialist refers them to the closest tertiary medical
center.
NUTRITION

• Wealth means having plenty of food for family, friends, and social gatherings. One should drink plenty
of fluids and eat plenty to have a strong body. A strong body is a healthy body. 6
• Many believe that the sooner a baby can take food other than milk, the healthier it will be. Babies from
the first month are fed grease, sugar, and coffee to promote hardiness.
• deficiencies in vitamin A, iron, and calcium.
PREGNANCY AND CHILDBEARING
PRACTICES

• Contraceptive practices of Appalachians follow the general pattern of the U.S. population. Methods
include birth control pills, condoms, and tubal ligation; abortion is an individual choice.
• A popular belief among many is that taking laxatives facilitates an abortion.
• A disproportionate number of teenage pregnancies occur at a younger age among Appalachians
compared with non Appalachians.
• Some newborns wear a band around the abdomen to prevent umbilical hernias 5
DEATH RITUALS

• Deaths in Ohio are frequently published in West Virginia newspapers with a notice that the individual
will be returned to the mountains for burial.
• The deceased is usually buried in his or her best clothes. 4
SPIRITUALITY

• Appalachia were mostly Protestant and Episcopalian. 2-3

• fatalism comes the belief that what happens to the individual is largely a result of God’s will.
Appalachians may not seek health care until symptoms of illness are well advanced
HEALTH-CARE PRACTICES

• Appalachians are derived from concepts such as family, fatalism, traditionalism, self-reliance,
individualism, and the ethic of neutrality.
• The primary focus on health for many Appalachians is self-care. Self-care is primarily perceived as an
individual responsibility, and care is focused within the family rather than within the community. 1
BARRIERS TO HEALTH CARE

• accessibility,
• affordability,
• adaptability,
• acceptability,
• appropriateness,
• and awareness.