Intergenerational Health and Children’s Health
The concept of fatalism falls into the morass of Appalchian character that Ohio-born writer J.D. Vance captured in his memoir, Hillbilly Elegy; a spirit of stubbornness, independence, and isolationism has a strong hold in this part of the country. In her 2011 article, “Self Control, Fatalism and Health in Appalachia,” Wendy Welch argues that fatalism can appear in Appalachia as, “Faith-based; distrust; pride covering poverty; apathy or unwillingness to change; or based on ignorance of potential health outcomes.”6 Welch’s notion of Appalachian fatalism corroborates Dr. Sisler’s stories of parents who believe obesity is purely genetic, or who refuse to vaccinate their children.
Welch writes: “Mistrust of medical professionals is a serious issue in southwest Virginia. This could include the overprescribing of drugs, the indigenous belief that rural areas are served by less competent professionals, or the ubiquitous mistrust of any self-reliant population on knowledge they do not themselves possess.” If a family possesses information to perform a home remedy, but lacks credible information on medical treatment, they will be more likely to trust their own self-reliance. This historic self-reliance, when armed with the Internet, can further deter patients from heading to the doctor. “The Internet, and the freedom of access to misinformation, is really stunting our patients,” says Dr. Sisler. “If I were a young, uneducated mom and I were on Facebook, and I just want to do right by my kid, I can’t say that I wouldn’t question my physician.”
Vaccine-hesitancy has reached a crisis level in the U.S., and health care providers are cited as the most important resource for improving vaccination trends.8 But, like Dr. Sisler, many providers have reported challenges with mitigating the fears of vaccine-hesitant parents, including lack of perceived trust in the provider, or lack of time for explanation during children’s visits.7 These issues all come back to relationships between providers and patient; the building of trust that Dr. Sisler names as essential improving children’s health. “If a colleague of mine treated someone as a child, they’re more open to me treating their child,” Dr. Sisler explains. “In the county committee, we review foster care cases together, and it’s amazing to see people who’ve worked in the county for years recall the parents of our patients when they were foster care kids.”
Dr. Sisler hypothesizes that intergenerational health issues are more prevalent in rural communities versus urban. “We see a lot of broken households here— a lot of single parents, with one of the highest rates of teenage pregnancy in the state of Maryland,” she says. “We see a lot of young mothers who are living with their mothers, and so on.” In fact, the largest demographic of people living in poverty in Garrett County is women between the ages of 25-359: the young mothers that Dr. Sisler described. The Appalachian Regional Commission (ARC) reports that, with a rate for 38.2 births per females ages 15-19, teen births are 10% higher in Appalachia than in the U.S. as a whole. This statistic contains a polarity between urban and rural areas, with “rural, economically distressed counties” reported closer to 59 births per 1,000 teenage girls.
High teen birth rates are a medical issue, but the issue is compounded by economic instability. “We have several patients with housing issues; there aren’t a lot of resources here in terms of affordable housing, day care, or career centers,” says Dr. Sisler. The ARC claims that, “The children of teenage mothers are more likely to have lower school achievement, drop out, have more health problems, be incarcerated during adolescence, and give birth as a teenager.” These incidences can all be described as Adverse Childhood Experiences (ACEs), and require practitioners to take a trauma-informed approach to care.