New Research and Website Highlight Health in Appalachia

Ten “Bright Spot” Counties Where Health is Better than Expected, Suggest Practical Lessons for Other Communities

WASHINGTON, D.C., July 24, 2018—Three new resources released today by the Appalachian Regional Commission (ARC), the Robert Wood Johnson Foundation (RWJF), and the Foundation for a Healthy Kentucky offer a fresh approach to understanding health in Appalachia by focusing on community strengths and identifying local factors supporting a Culture of Health. These resources include case studies of ten “Bright Spot” counties, each defying predictions for health with better-than-expected outcomes; the performance-focused research methodology that helped identify these counties; and, a website that explores extensive county-level health data for the entire Appalachian Region.

A Closer Look at the Appalachian “Bright Spots”
Exploring Bright Spots in Appalachian Health: Case Studies describes the people and community-focused strategies, programs, and activities that are working to improve health in these ten Bright Spot counties:

Grant County, West Virginia
Hale County, Alabama
Madison County, North Carolina
McCreary County, Kentucky
Noxubee County, Mississippi
Potter County, Pennsylvania
Sequatchie County, Tennessee
Tioga County, New York
Wayne County, Kentucky
Wirt County, West Virginia

While each county developed its own approaches for addressing local health challenges, the researchers identified several cross-cutting themes:

  • Community leaders engaged in health initiatives
  • Cross-sector collaboration
  • A tradition of resource sharing
  • Local health care providers committed to public health
  • Active faith communities
  • Grassroots initiatives to combat substance abuse

Field research found that the greatest assets these Bright Spot counties have are their people, who generate collective pride and power through volunteerism, a steadfast commitment to community, and shared values for health. The Bright Spot counties also benefit from “anchor institutions” such as schools, businesses, churches, and hospitals that work to improve community health and the social factors that affect health.

“While Appalachia lags behind the rest of the nation on many key measures of health, this research offers evidence that local communities, even with modest resources, can influence in a positive way the health and well-being of their citizens,“ said ARC Federal Co-Chair Tim Thomas. “All the counties profiled in this research share a sense of strength and resiliency. They offer concrete examples for other communities that may be encouraged to similarly leverage their own available assets to advance health and quality of life.”

Identifying the Appalachian Bright Spots
An accompanying report, Identifying Bright Spots in Appalachian Health: Statistical Analysis, explores how each of the Region’s 420 counties performed on 19 health outcome measures. The goal of this analysis was to identify and examine counties with a wide range of characteristics and resource levels that had all managed to find a way to be healthier than expected, given their health drivers and resources.

Of the 42 top-performing counties, ten were chosen as a representative sample for in-depth case study exploration. These ten represent each of the five ARC Appalachian subregions, vary in economic status, and are equally distributed between metropolitan and non-metropolitan locations. Researchers went into these ten counties to identify networks, values, beliefs, programs, and processes that may have helped them achieve better-than-expected-health outcomes.

“These Appalachian ‘Bright Spots’ look a lot like other places—they don’t necessarily have extra resources or advantages to improve community health,” shared Hilary Heishman, a senior program officer at RWJF, who is proud to call Hardy County, West Virginia, her home. “What you find instead are community members who are committed to creating better opportunities for themselves and their neighbors to live the healthiest lives possible. You find leaders from all walks of life coming together and using the assets they have at hand to build a local Culture of Health.”

Data to Drive Community Health Solutions in Appalachia
The new website complements the Bright Spots research, offering regional data on mortality, morbidity, behavioral health, and social determinants, among other health domains. Local leaders, community members, public health officials, and policy makers can use it to explore health disparities and guide decisions on how to improve community health. draws on the August 2017 report Health Disparities in Appalachia to dive deeper into regional data on social association, smoking, physically unhealthy days, mentally unhealthy days, poisoning mortality, and other health measures. Of particular interest are the social association data (a proxy for social relationships and interaction in communities, through any type of business, civic, labor, political, professional, religious, or sports organizations), which reinforce the value of community connectedness. Appalachia’s social association rate is 33 percent higher than the U.S. rate.

“These data and research reports change our understanding of what is possible for health in Appalachia and other rural places. These communities are resilient and have incredible assets, including strong social connections, and volunteer networks for things like delivering meals to the elderly and providing transportation,” stated Ben Chandler, president and CEO of the Foundation for a Healthy Kentucky. “The Bright Spot communities show us that there’s always somewhere to start when working to improve health. Sometimes it can be as simple as giving your neighbor a ride to the clinic or passing out a breast cancer awareness pamphlet at church. No question: Health care resources and investment are important and continue to be critical needs for the Region. But just as valuable is the willingness to come together to meet needs beyond health care.”

There is no single “best” approach to improving community health. However, the Bright Spot communities illustrate solutions that may be combined and replicated in other communities to enhance health at little cost. A final report identifying practical activities and strategies from the “Creating a Culture of Health in Appalachia: Disparities and Bright Spots” research initiative will be released in late 2018.

About the Appalachian Regional Commission

The Appalachian Regional Commission (ARC) is an economic development agency of the federal government and 13 state governments focusing on 420 counties across the Appalachian Region. ARC’s mission is to innovate, partner, and invest to build community capacity and strengthen economic growth in Appalachia to help the Region achieve socioeconomic parity with the nation.

About the Robert Wood Johnson Foundation

For more than 45 years the Robert Wood Johnson Foundation has worked to improve health and health care. We are working alongside others to build a national Culture of Health that provides everyone in America a fair and just opportunity for health and well-being. For more information, visit Follow the Foundation on Twitter at or on Facebook at

About the Foundation for a Healthy Kentucky

Funded by an endowment, the mission of the nonpartisan Foundation for a Healthy Kentucky is to address the unmet health needs of Kentuckians by developing and influencing policy, improving access to care, reducing health risks and disparities, and promoting health equity. Since the Foundation opened its doors in 2001, it has invested more than $27 million in health policy research, advocacy, and demonstration project grants across the Commonwealth. Follow the Foundation on Twitter, Facebook, and YouTube, and visit our website at