Chronic Obstructive Pulmonary Disease and Social Determinants of Health: A Case of Marginalization in Rural Appalachia.

Chronic obstructive pulmonary disease remains a challenging epidemic across the United States. This serious illness impacts nearly twice as many individuals in the rural area compared with urban counterparts. As the disease progresses, the symptom burden and needs of the patient and caregivers escalate. Access gaps to services, such as hospice and palliative care, and the social determinants of health found in Appalachia may lead to marginalization and social injustice. Defined as the condition of being peripheralized based upon one's social margins of identity, associations, and/or environment, marginalization impacts health outcomes and quality of life. This article explores the triple threat of marginalization for patients with chronic obstructive pulmonary disease living in rural Appalachia. By recognizing marginalization and designing initiatives to reduce the impact, hospice and palliative care nurses serve as advocates and leaders to influence systemic change through partnerships with key policymakers and legislators.