What rural Appalachia eats -- and doesn't -- and why studying it matters

Kathryn Giglio (BSN `14) and Esther Thatcher (PhD `16)
Esther Thatcher (PhD `16) and Kathryn Giglio (BSN `14) study grocery store offerings.
Photo credit: Megan Spedden

(11-25-13) Very little salad. An overabundance of potatoes. Mountains of boxed starches, like rice and white bread, as well as dried beans, sweet potatoes, cornbread and collard greens.

But how does understanding what lines the grocery store shelves in rural Appalachia impact the way residents and public health nurses combat issues like diabetes and obesity?

That's the subject of School of Nursing doctoral student Esther Thatcher's dissertation, which aims to quantify and qualify food access in far southwestern Virginia (specifically Lee, Wise and Scott counties) by mapping what comestibles are available, how expensive they are and what's ultimately consumed – as well as how it’s cooked. With diabetes and obesity at epic proportions -- particularly in rural, impoverished regions in southwestern Virginia -- Thatcher's research aims to help identify the variety of food factors that public health nurses and others can potentially use to combat chronic health problems.

“There’s been a rapid shift from a labor force made up of jobs that entail hard, physical labor to jobs that are much more sedentary,” she explains, “but meals haven’t really changed. Food here is still defined by very strong traditions, and remains central to gatherings and cultural identity.”

Where West Virginia, Virginia, Kentucky and Tennessee converge in the Appalachian Mountains is a “hot spot” of obesity and diabetes. Life expectancy in these areas has gone down dramatically over the last three decades, and nutrition-related diseases are largely to blame, says Thatcher. One government-commissioned study from the Harvard School of Public Health found that the nation’s counties with the biggest decreases in life expectancy were all in southwestern Virginia where the drop in life expectancy was nearly six years for women and about two and a half years for men over the 16-year period studied.

And while these counties aren’t technically food “deserts” as defined by the USDA (given that most residents live within 10 miles of a food retail outlet), says Thatcher, the financial barriers to eating healthfully often mean that households face nutritional deficits even while healthy food lies tantalizingly close.

Just because the area isn’t a food “desert” as it’s strictly defined doesn’t mean something troubling’s not going on, Thatcher said.

“It’s not enough to install a supermarket in a rural place, and there’s no evidence that foods’ presence alone will change these chronic conditions,” she said.

While half of Thatcher’s study mapped food stores and their offerings, the other half involved nine one-on-one interviews, shopping trip “shadowing” and working individually with families to fill out questionnaires about its social composition, income, even the types of kitchen equipment they use. Together, the data and interviews enabled Thatcher to note sociological, economic and nutritional trends that offer a portrait of the gastronomical lives of especially poor women living in rural Appalachia.

During her research, Thatcher noted that many families pool resources and augment their pantries and freezers with huge, collective gardens. She noted that women employed thrifty techniques – like buying a large piece of meat and then divvying it into smaller portions – but heard repeatedly that fresh produce tended to be out of financial reach of many.

She also noted that in many rural areas, formal safety nets are thinner than in urban areas, so those informal ties – to family, friends and churches, for example – are critical means of support. Those who were better connected socially had better nutritional access; those less connected had a great deal more stress related to purchasing food, eating and cooking.

Thatcher noted too that over the last several decades, many girls haven’t been taught to cook.

Her advice?

Bring Home Economics back to schools. Make local food more available to people with fewer social connections through farmer’s markets and co-ops. Create community gardens and make them accessible to single parents by helping with childcare and transportation. Offer cooking classes for adults through the cooperative extension services to teach residents about food labels, mealtime-prep and healthy substitutes. Give especially women confidence and incentive to try things like brown rice, olive oil, whole wheat bread and pasta. And urge church leaders to offer healthier church suppers.

“There’s a lot of discussion about what Appalachia does not have,” said Thatcher. “There are a lot of wonderful resources and strengths there, and I’d like to approach interventions for healthcare from a strength-based perspective, rather than a needs-based one.”

“There is an amazing dedication I see to helping one another, despite one’s personal circumstances,” noted Thatcher. “That sense of nurturing and wanting to give is a huge asset – and that’s something we need to promote in these communities that may have fewer financial resources but that are rich in latent social capital.”

It often, she adds, begins with women.

“Women can do a lot of good,” Thatcher said.