Place Effects and Chronic Disease Rates in a Rural State: Evidence from a Triangulation of Methods

Abstract

High rates of chronic diseases and increasing nutritional polarization between different income groups in the United States are issues of concern to policymakers and public health officials. Spatial differences in access to food are mainly blamed as the cause for these nutritional inequalities. This study first detected hot and cold spots of food providers in West Virginia and then used those places in a quasi-experimental method (entropy balancing) to study the effects of those places on diabetes and obesity rates. We found that although hot spots have lower rates of chronic diseases than non-hot spots and cold spots have higher rates of chronic diseases than non-cold spots—the situation is complicated. With the findings of income induced chronic disease rates in urban areas, where most hot spots are located, there is evidence of another case for "food swamps." However, in cold spots which are located mainly in rural areas, higher rates of chronic diseases are attributed to a combination of access to food providers along with lacking the means (i.e., income for low-income households) to form healthier habits.

Community-Based Efforts Aim to Improve the Food Environment within a Highly Obese Rural Appalachian County

“…Spanning 13 states from New York to Mississippi, one quarter of the counties that make up this region are classified as rural, the majority of which are found in eastern Kentucky, where the current study takes place [ 12 ]. Research reveals the deep-rooted connection between the scope of specific food outlets—traditional versus nontraditional—and population health [ 9 ], thus supporting the idea that greater obesity prevalence may be influenced by the rural food environment [ 13 ]. Additionally, all 54 counties located in the Appalachian region of Kentucky are classified as rural [ 14 ] and most are economically distressed [ 15 ], thereby limiting the variety and depth of accessibility of healthy food items in these communities.…”