Addressing the Root Causes of Population Health in Central Appalachian Virginia.

Introduction: The Southwest Virginia Health Authority (SWVHA) recently commissioned a community health needs assessment (CHNA) to reduce the high rate of preventable health problems in Virginia's (VA) Appalachian Region. The CHNA took place over a two-year period from 2023 - 2025.

Purpose: This iterative, mixed-method CHNA informed the development of a new iteration of the regional Blueprint for Health Improvement and Health-Enabled Prosperity identifying and prioritizing health issues and develop strategic planning to address them in VA's three westernmost regional health districts.

Methods: The CHNA followed a sequential mixed methods design to assess the regional health status, the contextual factors associated with any health disparities identified, and the development of a participatory community health improvement plan to modify those contextual factors. The sequential approach involved three phases: in Phase 1, the study team collected and compiled primarily quantitative secondary data from local and regional sources. These data informed the subsequent collection and analysis of quantitative and qualitative data in Phase 2, and the data from Phase 2 informed development of a collaborative community-based strategic implementation plan in Phase 3.

Results: The all-cause mortality rate for the region is roughly double the state average. Residents are dying at a higher rate, and at younger ages, due to inadequate access to quality health care, educational opportunities, income stability, and treatments for substance use disorder. Community stakeholders recommended interventions to address the combination of access to quality care and rurality, employment/income, trauma, and substance use disorder, and education and nutrition. Based on these priorities, seven local non-profit organizations were selected for implementation funding.

Implications: This iterative effort supported the development of integrated and community-based population health interventions in the region. Future regional community health assessments will apply similar methods to evaluate progress on these projects and recalibrate regional efforts in response to evolving local needs and priorities.