CHARLESTON, W.Va. - Doctors, lawmakers and specialists are launching a large-scale public health network to change one of the stark facts of Appalachian life: residents here are 20 percent more likely to die from heart disease than the rest of the country.
The goal is to focus attention and money on preventing cardiovascular disease in the 13 Appalachian states, especially their poor, rural and underserved areas.
The task won't be easy. States in Appalachia lead the country in heart disease risk factors like smoking, obesity and lack of exercise. Those factors could partly come from long-held cultural practices and beliefs.
That's why a two-day cardiovascular health conference that began Thursday in Charleston isn't just aimed at doctors and specialists. It's also targeted at lawmakers and even historians, who can explain the unique characteristics of the region and how a public health network could be created here.
Ultimately, the federal Centers for Disease Control and Prevention - one of the conference's organizers - sees a pan-Appalachian effort focused on improving the overall rates in America by focusing on the region where heart disease is most severe.
The CDC estimates heart disease will cost the United States roughly $248 billion this year, said Dr. Darwin Labarthe, the head of the agency's Division for Heart Disease and Stroke Prevention. He wants to see resources directed at stopping heart disease early.
"The drop in the bucket is what's being invested now in prevention," he said.
The Appalachian region stretches from Mississippi into upstate New York, including parts of Pennsylvania, Maryland, Ohio, Kentucky, Virginia, Tennessee, North Carolina, South Carolina, Georgia, Alabama and all of West Virginia.
Four of the five states with the highest rates of common heart conditions are in Appalachia, according to the CDC. West Virginia's rate is the highest in the country, with about 10.4 percent of adults reporting a common heart condition such as coronary heart disease, compared to a national average of about 6.5 percent.
Four Appalachian states also rank in the top five for the highest rate of cardiovascular disease-related deaths, according to the American Heart Association, which also sponsored the conference.
While researchers have known that for years, they still don't have a good explanation for it.
Dr. Tom Pearson, chairman of the Department of Community and Prevention Medicine at the University of Rochester in New York, said likely factors include the region's lower economic status and a lack of access to health care.
But Pearson also said the traditional rural diet - high in fat and calories - has persisted, even as rural labor has become less strenuous because of mechanization.
Heart disease rates in rural areas were always lower than in urban areas until around 1979, he said. As a boy, Pearson lived on a farm in Wisconsin and remembered the hard, sweaty work of cutting hay by hand.
"Now we're sitting in our tractors with our headphones on listening to the Grateful Dead, and that's basically the physical activity of the day," he said.
It can be misleading to look for a single cause in the culture of such a large region, though, said John Williams, a historian at Appalachian State University in North Carolina. Even though there are similarities in rural living, he said, the culture in New York State is much different than in Mississippi.
What's more, some of the common risk factors in Appalachia may have less to do with traditional culture than with trends that can be seen nationwide, he said.
"Does the higher incidence of obesity come from the traditional Appalachian Sunday dinner, or is it from the spread of convenience stores and fast food in the last 25 years?" he asked.
The conference is intended to result in the creation of the Appalachian Cardiovascular Health Network, which will be dedicated to ongoing efforts to improve the heart health of the region.