Current Public Health Challenges in the South
By Sam MacArthur

The Southern U.S. is constantly in the news for rural public health issues. With a high proportion of rural and low-income communities, and the legacy of Jim Crow and segregation, rates of obesity, heart disease, pulmonary issues, substance abuse and more are cause for alarm when it comes to health concerns in the Southern U.S. Rural public health issues are the result of many different influencing factors, but there’s no denying the impact they have on the average resident in the South.

Fortunately, the South is also home to some of the most influential and dedicated public health schools, researching and working to make positive change in a vulnerable region.

Following is a look at rural health concerns and what a health professional can expect when working in the region:

Substance Abuse 

The opioid epidemic in the form of prescription pain killers was a scandal that affected the entire U.S. However, the South was hit especially hard due to its concentration of poverty and prevalence of heavy labor jobs that take their toll on the body. The cessation of the prescription drugs drew people into using illegal drugs for pain and to feed addictions. The South was experiencing an increase in substance abuse prior to the opioid epidemic due to a loss of gainful employment and little support from government at all levels. Addiction is one of the biggest rural health concerns, and health workers in the South face the mental and physical toll that addiction exacts from users.  

Black Lung Disease

One of the major sources of employment in the U.S. South is coal mining. With coal mining comes a respiratory disease known as black lung. It’s caused by the inhalation of coal dust which blackens the lungs and makes breathing difficult. Even though coal mining is on the decline, black lung disease is on the increase and is affecting public health in rural areas. The disease is preventable, but prevention relies on working respiratory equipment, awareness, and health screening to catch the condition before it becomes more problematic. Health officials on the state and federal level are committed to eliminating black lung disease, but until then, it’s a major health concern in the Southern U.S. 

Chronic Respiratory Disease

Chronic respiratory disease covers all other lung issues outside of black lung disease. Smoking is a common habit in the South due to its tobacco growing heritage and heavy industries contribute to poor air quality for residents. Exposure to poor air quality over time tends to result in respiratory conditions such as COPD and asthma. Lung scarring and damage is impossible to reverse and requires medical intervention in the form of medication and regular checkups. Prevention education is difficult due to generational attitudes towards tobacco use and pollutants from heavy industry and is a common issue with rural public health.


Obesity is a major problem in the South. The reasons vary from high-caloric diets that are a hold-over from the days of farming and heavy labor to food deserts that lack access to fresh groceries. Another cause is insufficient nutritional education from grades K-12. Residents in the South frequently don’t see the point in exercising to maintain their health and strength until it’s too late. Health conditions such as obesity, arthritic joint pain, respiratory distress and cardiovascular disease are all attributable to obesity, and all can be mostly avoided through diet and exercise. However, convincing a population about the importance of self-care is difficult and is a long-term challenge for the health professional. 

Cardiovascular Disease

Cardiovascular disease has multiple causes that range from genetics, drug and alcohol abuse, diabetes, poor dietary choices, and obesity. The South has a higher rate of these issues than other regions of the U.S. due to the aforementioned health conditions. Reducing the rates of cardiovascular disease in the Southeast has been difficult in part due to genetic issues and predispositions in certain racial populations. These racial populations have a higher concentration in the South which leads full-circle to the higher-than-average rates of cardiovascular disease. Education is key to reducing the rates, but reaching rural populations has its difficulties along with providing sufficient education and gaining the trust of a mistrustful populace. 


Cancer affects residents of the South in larger numbers than the rest of the U.S. due to tobacco use, poor diets and a lack of exercise. Lack of access to medical care for early detection is also an issue. Cancer patients frequently ignore their symptoms or fail to get adequate medical care before the cancer becomes a serious issue. Rural populations experience difficulty in reaching medical treatment. Patients in remote locations have to drive an average of 70 miles to reach a facility that provides adequate medical care. Cancer outreach organizations are working to improve outcomes for patients, but some difficulties, such as geography and ingrained habits, are going to take time to overcome. 

Unintentional Injury

Unintentional injury is a broad category that includes making decisions that are counter to one’s own safety, living in an unsafe home environment and using consumer products that aren’t safe. Residents in the South are more likely to drive without a seatbelt or ride a motorcycle without a helmet and thereby increasing their chances of a debilitating accident. It’s not unusual for people to modify consumer products and use them in a manner that’s unsafe. This is driven by a lack of funds to purchase the proper equipment. Abusive home environments are not always closely monitored by authorities and abusers feel free to do as they please. These issues all contribute to rural health concerns that medical professionals find themselves addressing.

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