Appalachian Health and Well-Being, by Robert L. Ludke and Phillip J. Obermiller. 2012. 386 pages, hardcover, University Press of Kentucky.

It is clear that when it comes to the health and well-being of Appalachians, place matters. The importance of this maxim is underscored in an extensive new compilation of studies on Appalachian health by Robert Ludke and Phillip Obermiller. While the idea of geographically-based health disparities is still evolving, this engaging resource has greatly expanded the concept in what is a remarkable volume of well-organized, well-written, evidence-based studies on health in Appalachia presented from a host of critical perspectives.

What is most striking about this exploration of the interplay of health and culture is that the writers do not resort to wearisome stereotypes of mountain folks and their ills; they replace myth with data and experience. Through the inclusion of exceptional authors from the region, provocative topics such as genetics, detailed research, and a consistent and systematic approach to the material, the editors provide a rich tapestry of the strengths, contradictions, challenges, and realities of health in the expansive region that is Appalachia. The methodology for the organization of the data in and of itself makes this work a very welcome addition to teaching Appalachian studies, population health, health education, and the sociology of the region. This work can become a valuable source for anyone seeking to understand the region and easily stands beside controversial works such as Harry Caudill's Night Comes to the Cumberlands or the more recently acclaimed The United States of Appalachia by Jeff Biggers.

The book adopts an approach that embraces the essential paradoxes of Appalachian health and well-being-examining strengths and weaknesses-and ensures a full exploration of the individual, how the individual functions within a unique culture, and the health consequences of social realities. Further research explores the Appalachian individual's access to health care, their physical environment, and what impact "being Appalachian" has on the native that travels beyond the borders of rural culture into urban settings and beyond.

The book is well organized into sections on health determinants (including rich explorations in genetics, environment, lifestyle, and systems), the consequences of these determinants (offering scholarly sections on chronic disease, trauma, substance abuse, and oral health), and an engaging section on urban Appalachian health (detailing the impact of moving beyond the boundaries of the steep mountain ridges and deep valleys into urban Appalachia as well as the effect of this identity on the diaspora of Appalachian peoples as they venture outside the region in search of opportunity).

The collective of authors assembled and the template provided by Ludke and Obermiller move the book from a simple reporting of generalizations about poor health to what is a thoughtful collection of best practice, community-based models within Appalachia and a remarkable glossary of well-defined concepts. The work then provides its most significant contribution: community-based solutions through suggestions for further research and a treasure trove of policy recommendations.

An old adage from the region is: To know the way up the mountain you have to ask the person who has traveled the road. The researchers, writers, and editors of Appalachian Health and Well-Being asked the traveler and have recognized that their experience, although particular to Appalachia, transcends borders. Their analysis of issues such as diabetes or obesity or substance abuse demonstrates that such realities of health care for Appalachians is a proverbial "canary in the coal mine" for the rest of the nation. In that regard, this book should become required reading for policy makers, health care providers, community activists, and students everywhere.

-Elke Jones Zschaebitz, MSN, RN, FNP-BC

Nurse Practitioner

Kenner Army Health Clinic

Ft Lee, Virginia

Special Needs Advisor

Exceptional Family Members Program

Ft Lee, Virginia

Faculty

Healthy Appalachia Institute

University of Virginia at Wise

-David C. Gordon, MDiv, MSW

Director

Office of Telemedicine

Director

Rural Network Development

Co-Director

Healthy Appalachia Institute

Instructor

Public Health Science & Nursing

University of Virginia

Charlottesville