CMSA Today - Issue 7, 2016 - 21

Culture and Health OVERVIEW Appalachia is a beautiful region of rugged wooded hills, narrow valleys and winding streams that follows the Appalachian Mountain range. "Appalachia" is a Native American word that means "endless mountain range." The region stretches through 13 states: Mississippi, Alabama, Georgia, South Carolina, North Carolina, Tennessee, Kentucky, West Virginia, Virginia, Maryland, Ohio, Pennsylvania and New York. It covers 200,000 square miles, with a population of approximately 23 million people and includes some of the poorest counties in the United States. In 1965, the Appalachian Regional Development Act (ARDA) made it a legally designated area (Appalachian Regional Commission, 2009). Residents of this region do not usually refer to themselves as "Appalachian." Instead, they are referred to as "Mountaineers," "Mountain People," or "Hillbillies." A UNIQUE CULTURE The Appalachian culture is unique for several reasons. The original pioneers in the region were Native American, Irish, English, Scottish, German and Polish. Most came to Appalachia to escape persecution and find a better life. They brought with them an emphasis on family and strong religious beliefs that became the core of the culture. Appalachia has a long history of isolation and exploitation. The rocky, inaccessible mountain terrain contributed to Appalachia's isolation from the rest of the country. The area is extremely rich in natural resources, which have been exploited by outsiders. The profits from these natural resources were not shared with residents of the region. In addition, outsiders have constantly tried to change the culture. All of these factors have contributed to the mistrust of outsiders and development of a distinctive culture. Appalachian culture has been preserved mostly by families and churches. Culture and religion are interwoven. The culture is revealed through its arts and crafts, music, foods, customs, traditions and language. Arts and crafts include tool making, basket weaving, quilting, wood working, knitting, crochet, canning, needlework and a multitude of homemade items. Music is played on a banjo, fiddle, dulcimer or homemade instruments. Singing is an essential part of religion and storytelling. Traditional dancing includes clogging and flat-foot dancing. Greens, potatoes, beans with cornbread, fried chicken, and biscuits and gravy are traditional foods. Traditions include storytelling, group games, large family gatherings and formation of informal musical groups. Appalachian language is a unique blend of Scottish and Elizabethan English that is directly related to the early pioneers. Although most continue to live in the Appalachian region, there is a substantial population in many urban Midwestern areas such as Cincinnati, Cleveland and Detroit. Those "Urban Appalachians" often retain their original culture and are proud of their strong family ties, self-reliance, values, heritage and community involvement. Assimilation into a new community can be difficult and stressful. Returning "home" for visits is a regular occurrence. In order to understand the Appalachian culture, it is important for case managers to recognize five distinctive groups. One group consists of descendants of the original pioneers. They are usually landowners, politicians and business people who are stable with strong family ties, self-reliant, independent, and hardworking. A second group is composed of hardworking coal miners, loggers or factory workers. The average worker has a large family, little education, few skills, no wealth and few choices for a vocation. Another group is composed of professionals and their families who have moved to Appalachia related to job opportunities. This group includes bankers, lawyers, teachers, ministers, and physicians. Members of this group are usually not readily accepted by Appalachians. The fourth group includes professional individuals born, raised and educated in Appalachia. They have chosen to stay in Appalachia and raise their families. Members of this group include nurses, teachers, physicians and ministers. The remaining group consists of returning Appalachians. They grew up in the mountains, moved away and have returned. Many of them find it difficult to adjust to the lifestyle they left years before. HEALTH IN APPALACHIA Appalachians have a high rate of diabetes, heart disease and stroke. Death rates related to heart disease, cancer and strokes exceed national averages. Health in Appalachia is influenced by many environmental factors including toxic waste, unclean air, poor water quality and occupational hazards. Depression is a major issue. Self-medication is common and has led to an increase in substance abuse. The most common substances abused are nicotine and opioids. Barriers to healthcare include a shortage of physicians, limited access to healthcare, poverty, unhealthy lifestyle, low education TO LEARN MORE ABOUT THE APPALACHIAN CULTURE MOVIES: * "The Appalachians"-A film (DVD) on the history and culture of Appalachians that features Johnny Cash, Rosanne Cash, Loretta Lynn, Little Jimmy Dickens, Marty Stuart, Ricky Skaggs and others. * "Mountain Talk" -A unique portrait of the language and life of the Southern Appalachian Mountains. * "October Sky" -A young boy in Coalwood, West Virginia, embarks on a mission to build and launch his own homemade rockets with the help of his loyal band of friends. Though their frequent mistakes nearly get them shut down, their successes inspire the whole town to believe that miracles can happen and there's nothing wrong with shooting for the stars. BOOKS: Yesterday's People: Life in Contemporary Appalachia by Jack E. Weller and published by The University Press of Kentucky, Lexington, KY. Websites: www.ARC.gov (Appalachian Regional Commission) Issue 7 * 2016 * DIGITAL CMSA TODAY 21 http://www.ARC.gov

Table of Contents for the Digital Edition of CMSA Today - Issue 7, 2016

PRESIDENT’S LETTER
ASSOCIATION NEWS
CMSA CORPORATE PARTNERS
Are You Culturally Competent?
Return to Culture – Return to Healing
Appalachian Culture: A Guide for Case Managers
Professional Case Management’s Ethical Quartet for 2017: Part 1, Workplace Bullying and End of Life Care
Diversity of Role Reversal: When the Case Manager Becomes the Patient
INDEX OF ADVERTISERS
CMSA Today - Issue 7, 2016 - cover1
CMSA Today - Issue 7, 2016 - cover2
CMSA Today - Issue 7, 2016 - 3
CMSA Today - Issue 7, 2016 - 4
CMSA Today - Issue 7, 2016 - 5
CMSA Today - Issue 7, 2016 - PRESIDENT’S LETTER
CMSA Today - Issue 7, 2016 - 7
CMSA Today - Issue 7, 2016 - 8
CMSA Today - Issue 7, 2016 - 9
CMSA Today - Issue 7, 2016 - ASSOCIATION NEWS
CMSA Today - Issue 7, 2016 - 11
CMSA Today - Issue 7, 2016 - CMSA CORPORATE PARTNERS
CMSA Today - Issue 7, 2016 - 13
CMSA Today - Issue 7, 2016 - Are You Culturally Competent?
CMSA Today - Issue 7, 2016 - 15
CMSA Today - Issue 7, 2016 - Return to Culture – Return to Healing
CMSA Today - Issue 7, 2016 - 17
CMSA Today - Issue 7, 2016 - 18
CMSA Today - Issue 7, 2016 - 19
CMSA Today - Issue 7, 2016 - Appalachian Culture: A Guide for Case Managers
CMSA Today - Issue 7, 2016 - 21
CMSA Today - Issue 7, 2016 - 22
CMSA Today - Issue 7, 2016 - Professional Case Management’s Ethical Quartet for 2017: Part 1, Workplace Bullying and End of Life Care
CMSA Today - Issue 7, 2016 - 24
CMSA Today - Issue 7, 2016 - 25
CMSA Today - Issue 7, 2016 - 26
CMSA Today - Issue 7, 2016 - 27
CMSA Today - Issue 7, 2016 - Diversity of Role Reversal: When the Case Manager Becomes the Patient
CMSA Today - Issue 7, 2016 - 29
CMSA Today - Issue 7, 2016 - 30
CMSA Today - Issue 7, 2016 - 31
CMSA Today - Issue 7, 2016 - 32
CMSA Today - Issue 7, 2016 - 33
CMSA Today - Issue 7, 2016 - INDEX OF ADVERTISERS
CMSA Today - Issue 7, 2016 - cover3
CMSA Today - Issue 7, 2016 - cover4
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http://www.nxtbook.com/nxtbooks/naylor/CMSQ0212
http://www.nxtbook.com/nxtbooks/naylor/CMSQ1212
http://www.nxtbook.com/nxtbooks/naylor/CMSQ0112
http://www.nxtbook.com/nxtbooks/naylor/CMSQ1112
http://www.nxtbook.com/nxtbooks/naylor/CMSQ0411
http://www.nxtbook.com/nxtbooks/naylor/CMSQ1411
http://www.nxtbook.com/nxtbooks/naylor/CMSQ0311
http://www.nxtbook.com/nxtbooks/naylor/CMSQ1311
http://www.nxtbook.com/nxtbooks/naylor/CMSQ0211
http://www.nxtbook.com/nxtbooks/naylor/CMSQ1211
http://www.nxtbook.com/nxtbooks/naylor/CMSQ0111
http://www.nxtbook.com/nxtbooks/naylor/CMSQ1111
http://www.nxtbookMEDIA.com