A Systems Approach to Cancer Health Disparities in Appalachia

The rural area of Appalachia in the U. S. encompasses 13 states that extend along the spine of the Appalachian mountain range. For reasons that are still not fully understood, this region has some of the highest rates of cancer mortality in the U.S. The article discusses cancer as a complex, systemic disease with emergent properties that develops over time through interactions between genetic, biological and environmental factors. The term environment is used broadly to include social, behavioral and toxicological contributors. However, the common denominator uniting many of these factors is low socioeconomic status (SES). The article focuses on the complex pathways through which low SES contributes to cancer in this rural area, highlighting the need for multilevel treatment approaches. It also addresses the inadequacy of traditional statistical methods for interpreting either the multi factorial etiology of cancer or the short and long-term effects of multilevel interventions. To resolve these issues, it suggests greater utilization and development of analytic techniques that can incorporate temporal changes and nonlinear interactions in order to grapple with reducing the disparities. The methodological issues discussed are generalizable to other rural areas.