Project EARTH: Lessons from 10 Years of Teaching Public Health Skills for Resource-Limited Settings.

The College of Public Health at East Tennessee State University started a program in 2011 to teach the skills needed to protect and promote health and well-being in resource-limited settings. The need to provide public health services in resource-limited settings exists in both wilderness and isolated settings and when a disaster disrupts basic societal infrastructure. In these settings, lives may depend on the ability to provide water, sanitation, hygiene, shelter, first aid, and other basic services. Over the last decade, the college expanded the program considerably into what is now known as Project EARTH (Employing Available Resources to Transform Health) that now includes several different academic courses as well as programs designed to develop innovative solutions to address the needs of people in resource-limited settings. Working in a resource-limited setting requires effectively utilizing locally available resources to improve and protect people's health and well-being. Project EARTH focuses on teaching students to design and create specific products for these situations while progressively honing those cross-cutting skills necessary to work effectively in these settings-notably teamwork, creativity, and resilience. To this end, Project EARTH implements a sequential learning process that includes significant hands-on training and simulated experiences with debriefing opportunities at the end of each activity. Project EARTH may serve as a useful model for others considering a similar training program.

Poverty and Health in Tennessee.

OBJECTIVES: Understanding the impact of poverty on health can inform efforts to target social programs and regional economic development. This study examined the effects of poverty on health among the 95 counties of Tennessee. METHODS: All of the counties of Tennessee were ranked by 5-year median household income, from the wealthiest to the poorest. The counties were divided into quintiles, from wealthiest to poorest, to reflect the general impact of wealth on health. Next, the five wealthiest counties and the five poorest counties were identified, allowing for examination of the extremes of poverty and wealth within Tennessee. Comparisons of quintiles and five wealthiest and poorest counties on key measures were performed using the independent t test. RESULTS: People living in the wealthiest quintile lived on average 2.5 to 4 years longer and had lower rates of all health behaviors and health outcomes investigated compared with those in the poorest quintile. This disparity was even more pronounced when comparing the wealthiest five counties to the poorest five. The five poorest counties, for example, had twice the years of potential life lost and were overwhelmingly rural in character, with similar accompanying disparities such as median income, high unemployment, and a more aged population. CONCLUSIONS: This study highlights the fact that lower income is associated with significantly worse health outcomes in Tennessee and reinforces the importance of economic development, specifically, and addresses the social determinants, more generally, in helping to improve Tennessee's overall health statistics.

Health and Social Conditions of the Poorest Versus Wealthiest Counties in the United States.

OBJECTIVES: To more clearly articulate, and more graphically demonstrate, the impact of poverty on various health outcomes and social conditions by comparing the poorest counties to the richest counties in the United States and to other countries in the world. METHODS: We used 5-year averages for median household income to form the 3141 US counties into 50 new "states"-each representing 2% of the counties in the United States (62 or 63 counties each). We compared the poorest and wealthiest "states." RESULTS: We documented dramatic and statistically significant differences in life expectancy, smoking rates, obesity rates, and almost every other measure of health and well-being between the wealthiest and poorest "states" in the country. The populations of more than half the countries in the world have a longer life expectancy than do US persons living in the poorest "state." CONCLUSIONS: This analysis graphically demonstrates the true impact of the extreme socioeconomic disparities that exist in the United States. These differences can be obscured when one looks only at state data, and suggest that practitioners and policymakers should increasingly focus interventions to address the needs of the poorest citizens in the United States.

The Ninth Myth of Appalachia.

Many stereotypes afflict our much-maligned region, and the Jonesborough-Washington County History Museum displays eight of these "myths of Appalachia." Here, our Editor-in-Chief suggests a ninth-that the people of Appalachia "do not care" about their health-and argues that regional health disparities result not from apathy but from a confluence of socioeconomic factors.

We Welcome Findings from Further Afield.

For the past five years, the Journal of Appalachian Health has published timely, high-quality research from within Appalachia. We also welcome submissions from those working outside of Appalachia who produce quality research of direct relevance to our region.

Potential approaches to address the undergraduate public health training needs for working professionals: a case study of one rural area.

The leadership of several health districts in the rural Appalachian region of northeast Tennessee and southwest Virginia has expressed interest in addressing the educational needs of their employees. The majority of these workers have not completed an undergraduate degree, but they desire to further their education. The College of Public Health at East Tennessee State University has begun preliminary discussions with these leaders to identify potential approaches to address these needs. There appear to be four approaches that should be explored by regions facing similar challenges: on-line or on-line/on-site degree completion programs; course clusters provided for academic credit; partnerships with community colleges; and training programs offered for nonacademic credit.

New developments in undergraduate education in public health: implications for health education and health promotion.

The article provides an overview of efforts to improve public health and health education training and on the potential use of Critical Component Elements (CCEs) for undergraduate health education programs toward more consistent quality assurance across programs. Considered in the context of the Galway Consensus Conference, the authors discuss the need for consistency in health education and public health quality assurance and curricular development. They discuss emerging quality assurance trends in relation to newly approved CCEs by the Association of Schools of Public Health after being developed by the Framing the Future Task Force: The Second 100 Years for Public Health. The CCE development process is discussed including its consideration as a tool program, which can be used to develop or refine undergraduate health education professional preparation programs. The authors suggest that CCEs should be "cross-walked" against existing health education undergraduate-level competencies. The authors conclude that CCEs may serve the long-term health education goal of accreditation for undergraduate health education and promote the tradition of strong undergraduate health education within a broader framework of public health and health promotion.