Of course, not everyone who lives in an inner-city neighborhood or a backwoods tract is poor, uneducated, or unhealthy. And before we can gain a better understanding of the healthcare challenges that face many inhabitants of Appalachia, Ludke says, we must first get past the hillbilly stereotypes that have plagued the region for decades.
"The Appalachian culture in many respects is no different from other cultures. These aren't people that follow those stereotypes. They are people like you and me in many respects," he says. "What we try to do in the book is to raise the questions about what is underpinning the health of the people living within the Appalachian region as well as those individuals who have migrated to the region to urban areas such as Cincinnati, Detroit, Chicago, Pittsburgh, Cleveland, and Indianapolis."
For example, when it comes to access to care, Ludke says, the challenges in Appalachia as a region are about the same as anywhere else in the country, and that is not necessarily a good thing.
"When you look at it more carefully, you see that about half of the Appalachian region is rural and what you see which is comparable to other rural areas in the country is that those are the areas where there are limited healthcare services," he says.