Lessons Learned from the “Stroke Belt”

By Byron E. Conner, M.D.

“Whether therefore ye eat, or drink, or whatsoever ye do, do all to the glory of God”
– I Corinthians 10:31

Since the 1960’s it has been recognized that there is a region of America in which the incidence of stroke is much higher compared to the rest of the country. This region of the country is composed of 11 states in the southeastern United States, and includes: Alabama, Arkansas, Georgia, Indiana, Kentucky, Louisiana, Mississippi, North Carolina, South Carolina, Tennessee, and Virginia. This part of the country is referred to as the “Stroke Belt”.

There, both blacks as well as whites have higher stroke rates than people in the rest of the country. The stroke rates for blacks in all regions of the country are substantially higher, with African Americans facing a risk three to four times higher. Some observers have stated that it is a “mystery” as to why the Stroke Belt exists. It has been said that lifestyle factors do not account for a full explanation of the higher stroke rates in this area of the country. Some have even suggested that there are environmental factors such as things that may be in the soil, air and water.

People who move from the stroke belt take their increased risk of stroke with them! The realization of this public health problem led to some initiatives such as public service announcements, public health initiatives by government agencies and efforts to have churches participate in blood pressure screening and other types of health outreach. These efforts have not ended the ethnic disparities in stroke incidence.

Stroke is the third leading cause of death in America. 500,000 strokes occur each year and about 150,000 result in death. For those who survive strokes there may be permanent disability and tremendous financial loss. There are a number of significant risk factors for stroke as follows: high blood pressure, diabetes, smoking, abnormal cholesterol levels, obesity, lack of exercise, abnormal heart rhythm (atrial fibrillation), a sedentary lifestyle, illicit drugs( such as cocaine), poverty and advanced age.

Despite the fact that some may consider the excess incidence of stroke in the Stroke Belt a mystery, efforts should be unsparing to reduce the burden of suffering from this condition. If we do consider lifestyle factors, let’s just take a look at what is called “southern cooking”. In the traditional south, hog fat may be cooked and mixed with every food and served every meal. Vegetables may be boiled for a long time with large chunks of fat or fried in grease. Almost all meat is fried after dipping in batter and may be dripping with grease. Would you be willing to eat a concoction you may find in the South called a “hamdog”?

This creation consists of a hot dog wrapped by a beef patty that’s deep fried, covered with chili, cheese and onions and served on a hoagie bun. All of this meal is then topped with a fried egg and french fries! Imagine what that will do for your blood vessels! There is other dangerous southern fare such as fried chicken, fried seafood, fried green tomatoes, biscuits and gravy, and cornbread slathered in butter. There are, in fact healthier – but still tasty – food alternatives.

Another major health concern that we may find in the Stroke Belt is a sedentary lifestyle. Obesity is more prevalent in particular in Mississippi and in other states in the region. This may be a combination of diet and lack of exercise. The obesity epidemic could be helped by having the southern roads more heavily populated by walkers, runners, and bicyclists!

It has been found that churches may play a large role in helping to make lifestyle changes and interventions in the Stroke Belt, and elsewhere:

  • Promoting hypertension control: teaching people how to play a role in control and self-monitoring of blood pressure by use of simple blood pressure machines for home use
  • Promoting weight control: This would involve instruction on how to exercise and a diet low in fat, sugar, calories and rich in fruits, vegetables and whole grains.
  • Teaching diabetes self-management: Teaching those with diabetes to have good blood sugar control
  • Help with smoking cessation: Conduction classes on how to overcome smoking
  • Substance abuse counseling: Helping with overcoming addictions such as cocaine use as this may play a role in stroke even in young people
  • Screening for hypertension, diabetes, and high cholesterol

Let’s not consider the Stroke Belt a mystery, but something that needs intervention nationwide.

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