Story by Bill Kovarik

An alarming rise in new cases of black lung disease inspired new Mine Safety and Health Administration regulations announced this fall by the Obama Administration.

The new regulations come 15 years after occupational safety and disease control agencies recommended a tightening of standards. They also come seven years after the Bush administration loosened coal dust safety standards.

The regulations are designed to improve safety for 72,000 miners working in more than 400 underground mines and more than 1,100 surface mines. Technically, the regulations require coal mines to cut coal dust in half, to 1.0 mg/m3 (milligrams per cubic meter).

The regulations also require changes in sampling procedures, which have been a source of contention. Federal investigators have repeatedly caught mine operators falsifying coal dust samples, and the old system with a weeks-long delay in providing results will be replaced by real-time monitoring systems under the new regulations.

Although widely hailed, the regulations are a relatively small step in changing dangerous working conditions in coal mines. Especially troubling for public health advocates are the estimated 1,500 deaths per year from black lung disease. While most of these have been retired coal miners, the Centers for Disease Control recently found that cases of black lung disease had stopped falling and started rising again among younger, active coal miners.

Black lung disease is a centuries-old problem going back to the dawn of coal mining. The need for protection and compensation for miners inspired the 1969 Coal Mine Health and Safety Act, which set up a black lung payments system funded by a small tax on coal. But the system has been subject to corruption and abuse over the years, and most individual claims are still routinely fought by teams of coal industry doctors and lawyers.

Currently, only about 13 percent of initial black lung claims are approved, and three quarters of claims take three to six years to approve, according to a 2009 study by the Government Accountability Office.

Shirley Stewart Burns, author of Bringing Down the Mountains, hopes the new coal dust standards are enough to reduce black lung disease. “If these new standards keep even one other family from having to experience what my family has experienced, they will have an enormously positive impact.”

Burns, who grew up in Matheny, West Virginia, lost her father to black lung disease. “I was still a teenager,” Burns said. “The magnitude of his loss on me and my family cannot possibly be put into words. It is a reality that is experienced all over the coalfields, far away from the urban centers that benefit from the ultimate sacrifices of coal miners like my father.”

“Like so many other families, we never received any money from federal black lung payments,” Burns said. “It is a cumbersome system with an extremely low number of people who actually benefit… The system is set up to turn down many people who actually have the disease.”

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“If these new standards keep even one other family from having to experience what my family has experienced, they will have an enormously positive impact.”
—Shirley Stewart Burns, author of Bringing Down The Mountain and daughter of a black lung victim

Short term gains and long term loss

Story and photo by D.A. Hawkins

Coal mining is dangerous work.

Spend any length of time talking with a group of underground coal miners and you are sure to hear “war stories” about close calls with severe injury or even death. Every aspect of the job requires a constant vigilance for potential hazards. Numerous miners have been killed by sections of the mine roof or coal ribs falling suddenly on them. Many others have been killed when crushed by heavy machinery in confined spaces.

As a coal miner, for the longest time I worried more about the easiest ways to be killed suddenly rather than the long term debilitating health effects of mining. Whenever the subject did come up, it often centered upon Coal Worker’s Pneumoconiosis (CWP), also known as “black lung.” I eventually realized there was a much bigger picture, with CWP being the tip of the iceberg. Underground mining not only fills a miner’s lungs with dust, it wears their body out and can even give them cancer.

With ever increasing production quotas, coal mining has become faster paced during recent years. The rigorous work required in confined spaces leads to joint deterioration, especially within the lower back, knees, shoulders and neck.

Newer generation miners suffer from such injuries despite only a few years of experience in the mines. Those who are financially bound to their jobs rely upon pain medications to continue working. As a result, prescription medication abuse within the coal industry has steadily risen over the past decade and spread throughout the surrounding communities.

“I can’t get on disability,” one young miner, wishing to keep his anonymity, explained. “There is no way I can afford my house payments and support my family on social security checks. I have to do what is necessary to keep going an’ keep working.”

Also of concern is the constant exposure to various chemicals in the mines. Ted Mullins, a retired electrician who worked in an underground coal mine/prep plant complex in eastern Kentucky, is fighting an ongoing battle with leukemia.

“I sometimes wonder if a lot of the cancer me and many of my friends have been diagnosed with came from chemicals we were exposed to in and around the mines,” Mullins, who now lives in Lexington, Ky., said. He listed off several names; all were men he knew from the mines who have since died from cancer.

“Miners today don’t think about their health years down the road,” he said. “I’m just glad I retired union and have [United Mine Worker’s Association] retirement medical coverage. If I didn’t, there is no way I could afford to fight my leukemia.”

To make matters worse, the National Institute of Occupational Safety and Health (NIOSH) has lately examined the increased usage of diesel equipment in underground mining. A website published by NIOSH on the subject of diesel exhaust reveals potential links between diesel exhaust and cancer. According to the website, underground miners may be exposed to 100 times the amount of diesel exhaust as compared to the rest of the population.

While the U.S. Mine Safety and Health Administration and various state mining agencies have put various laws regarding diesel equipment in place, miners are left to wonder if it will be enough. “NIOSH cannot definitely determine that current diesel regulations will result in the elimination of all diesel health concerns,” stated Ed Blosser, Public Affairs Officer for NIOSH. “The reason for this uncertainty is that there is still incomplete information concerning the level of exposure to diesel emissions that may cause health effects.”

Anyone living within the coalfields will tell you that a coal miner who spends his or her life working in mines will be left with little health to enjoy retirement. Many miners make every effort to warn their children about following their footsteps into the mines, hoping the next generation will strive for a better education and avoid a similar fate.

As life would have it, many of those children become enticed by the high wages of coal mining as compared to other jobs in the coalfields. They look only at the short-term gains while ignoring the long-term losses.
As one of those young miners so eloquently put it, “You’ve got to die someday.”

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Dangers On the Surface

Surface mining, while not as unhealthy as its underground counterpart, is still considered one of the more hazardous professions in America.

According to a Department of Labor coal fatality report, surface mining incidents accounted for approximately 30% of total “on-the-job” coal mining deaths in the last 5 years. The most common surface mining risks include falling from highwalls, electrocution and crushing injuries from heavy machinery or large rocks.

Additionally, a report by NIOSH shows that during a special screening between 1996-97, 6.7% of surface miners were diagnosed with silicosis, a potentially fatal lung disease caused by exposure to silica dust. Dust samplings taken by the MSHA from 2003-2008 showed that dust overexposures continued to occur, with drillers and driller helpers having the highest risk of exposure.

Story by Bill Kovarik

Lawsuits against the Tennessee Valley Authority are continuing in the wake of the coal ash disaster two years ago.

Currently, 58 lawsuits against TVA have been consolidated into a class action suit alleging various health, economic and environmental damages from the collapse of a poorly-built dam and release of one billion gallons of coal ash on Dec. 22, 2008.

The suit will be heard by a federal district court judge—not a jury as plaintiffs requested—sometime in 2011 or 2012 in eastern Tennessee. The court denied TVA’s earlier attempt to dismiss the lawsuits.

At present, plaintiffs are taking pre-trial depositions from Tom Kilgore, chief executive officer of TVA, and other TVA officials, according to the law firm Beasley-Allen. Among the evidence to be presented at the trial are positive tests for heavy metals in some residents’ bloodstream, Beasley-Allen said.

In a related lawsuit, federal courts dismissed a request for an injunction this September that would have compelled better handling procedures in the Perry County, Ala., waste dump that is receiving the TVA coal ash waste. The firms handling the waste have declared bankruptcy and must deal with bankruptcy before they can be sued on other matters, the court said.

Dr. Robert D. Bullard, director of the Environmental Justice Resource Center at Clark University in Atlanta, and a coalition of Southeastern environmental groups issued an urgent call for the reform of the EPA’s regional regulatory agency this November, noting the need for more transparency and accountability. According to Bullard, these and other coal-ash issues need to be seen in the context of the struggle for environmental justice
Meanwhile, a decision on whether to regulate coal ash as a hazardous waste is due from the EPA sometime in December, 2010 following a round of public hearings this summer and fall.

Story by Jillian Randel

Elisa Young discovered coal ash innundating her community of Meigs County, Ohio, shortly after moving to her family’s farm. She has since dedicated her life’s work to stopping the discriminate dumping of the ash in her community. Photo by Daniel Shea (dsheaphoto.net)

Elisa Young walked to the front of the room, slammed down a jar of blackberry ginger crepe syrup and a ziploc bag of coal ash in front of the three Environmental Protection Agency government officials.

“Think about the blackberries growing in the unlined coal ash ditches of Meigs County when you eat that,” she said. “And the chickens who can’t free range anymore for fear of drinking out of the puddles, or dusting their feathers in the coal ash.”

Forces on the Front

Elisa Young is an eighth generation Appalachian. Her German ancestors—a group of nine brothers—all fought in the revolutionary war. Six generations ago, her Welsh ancestors immigrated here and started a boarding house for Welsh miners and a school for local young women. She is the great-great-granddaughter of a coal miner. Young’s roots are as embedded in this land as the coal itself.

In 2000, Young moved to Meigs County, Ohio, to be caretaker of her family’s farm. Meigs County lies on the Ohio River, separating Ohio and West Virginia. The area is home to the second largest concentration of coal-fired power plants in the country. Four of the 18 plants along the Ohio River are located within 12 miles of Young’s home.

Young’s grandfather ran a dairy farm on their land. When she moved, Young brought her chickens and heirloom plants with her. She had plans to turn the farm into a sustainable living and teaching center.
“Since I had as much to learn as anyone it made sense to me to start with workshops to bring people in to teach so that many of us could learn together,” said Young. She began hosting native teachers to do herb walks and started construction on a straw bale structure.

Her plans were soon dashed when she discovered coal ash in her community.

“I had seen those smoke stacks on the horizon for as long as I can remember as a child, but I never thought anything about it,” said Young. “When I asked my grandma what they were, she shrugged and said, ‘Oh, honey, that’s just where they make the electricity.’”

Coal Ash Communities

Coal ash is the waste produced from burning coal. The U.S. Environmental Protection Agency (EPA) estimates that approximately 150 million tons of coal ash is produced each year, most produced from coal-fired electric power plants. Coal ash is laden with heavy metals and poisons such as arsenic, lead, barium, cadmium, mercury and chromium.

Coal ash is currently disposed of in impoundments known as coal ash ponds, or as a “beneficial use” product. The coal ash labeled as beneficial use can be applied to fill in road gullies, to build up land for construction, as fill for abandoned mines, or in products such as cinder blocks, running tracks and roofing shingles. Young first noticed coal ash being used in her county for road maintenance.

“The coal ash that comes into Meigs County proper is from the power plants in Mason County, W.Va., and across the Meigs County line in Gallia County, Ohio,” said Young. “None of it is being generated in Meigs. We have no idea how much is making its way into our county, or where it’s coming from—including outside of our direct area.”

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According to the Physicians for Social Responsibility report on coal ash:
“If eaten, drunk or inhaled, these toxicants can cause cancer and nervous system impacts such as cognitive deficits, developmental delays and behavioral problems. They can also cause heart damage, lung disease, respiratory distress, kidney disease, reproductive problems, gastrointestinal illness, birth defects, and impaired bone growth in children.”
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Mason and Gallia County are littered with coal ash ponds and landfills, some of which are on the EPA’s potential high hazard list. There is currently no federal regulation on lining the ponds and landfills, which would add a barrier between the earth and ground and water supplies. A report by Earth Justice confirmed toxic leaching at 137 coal ash ponds in 34 states.

Further complicating the matter is that Meigs County is the only county in the state that does not have a Toxic Release Inventory (TRI) report.

“If you were a power plant and wanted to get rid of waste where no one would have to keep a record of receiving it, do you think you might prefer a county with no TRI inventory accounting?” questioned Young. “I do.”
Coal ash became a widely recognized toxin when it hit the media during the 2008 Tennessee Valley Authority coal ash spill—5.4 million cubic yards of coal ash broke out of an impoundment and flooded 300 acres of land and two nearby rivers.

A Likely Carcinogen

According to EPA reports, “If you live near an unlined wet ash pond and you get your water from a well, you may have as much as a 1 in 50 chance of getting cancer from drinking arsenic-contaminated water.”

It didn’t take long for Young to realize that something was seriously wrong. “I’ve lost 6 neighbors to cancer,” said Young. “Every Sunday more people are added to the prayer list.”

“I’ve had melanoma,” continued Young. “I’m past the seven year mark for survival, but I also now have precancerous conditions for breast and thyroid cancer, but no health insurance to get the recommended follow-up treatment since the biopsies. I try not to think about it.”

Ohio Department of Health reports show that Meigs County has the second highest rate of death from cancer in the state (second to Perry County, also a large coal-producing area) and the highest rate of death for lung and bronchus cancer.

Young obtained the tax plot map of the townships in her county and started highlighting the people on her road that had been touched by cancer. Most of the lands were highlighted.

“I remember when Helen got cancer, she lived just around the corner—less than a 1/2 mile away,” said Young. “My heart sank. She was the closest person to a saint I’ve ever known.”

“You could see the power plant emissions from [Helen’s] porch. It’s a hard thing. Her husband retired from AEP (American Electric Power) as an electrician. There are several people on our road who worked for them. But we all feel the consequences—whether it was us that collected the paycheck or not.”

Another factor contributing to poor health in Meigs County is the high rates of uninsured residents. The state health department lists Meigs among the eight Ohio counties with the fewest primary care physicians per person.

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According to the Ohio Dept. of Health:
Meigs County has the highest rate of uninsured children (18.6% compared to the state average of 9.8%) and second highest rate of uninsured people for all ages (17.9% compared to the state average of 11.2%). Patient ratio: 3,852 people per physician compared to the state average of 852 people per physician).
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The county also suffers from one of the highest rates of asthma incidence in the state and has no hospital. Without primary care physicians or health insurance, people in Meigs County are less likely to have early detection of illness and have less of an ability to afford care once they have been diagnosed.

It isn’t just humans that are affected by coal ash either. Several of Young’s neighbors report cattle and poultry losses to cancer, and many hunters have found tumors in the deer they’ve shot. Young’s dog, Charlie, was found with inoperable cancer in his brain and throughout his digestive track and lungs. She lost him six months after he was diagnosed.

Rewriting the Regulations

Last fall, the EPA held several public hearings and commentary on two proposed regulations for handling coal ash. One option would require that coal ash be federally regulated and would classify the ash as a hazardous material. A second option will allow coal ash to remain a non-hazardous waste and would continue to be regulated state by state.

Young favors the first option, but only if there are additional regulations for beneficial use. Stricter regulations will make storing the ash more costly for the coal industry, so without any provisions for this, more of it will be applied as beneficial use in communities like hers.

“It may be beneficial to industry,” said Young. “But not to us.”

Taking Action

Young is among the most outspoken opponents of the coal industry, focusing her most recent efforts on coal ash. “The people who get active are the people who know how they are being affected,” she said.

She has been involved in community organizing and educational outreach to civic, state and national groups, and worked on various documentaries including Coal Country. In 2006, she received the Women of Peace Power Foundation Award for her activity in the True Cost of Coal tours.

“Every time another person dies, it’s made it harder for me to ignore what the consequences of trying to stay here are,” said Young. “But, I don’t think any industry has the right to render an entire region unsuitable to sustain life. No one has that right.”

To find the distribution of coal ash ponds in your area, visit www.sierraclub.org/coal/coalash

Story by Jared Schultz

At the Grandfather Home for Children in Watauga County, N.C., evidence of the devastation that addiction can wreak on families and communities resides in the residents, some as young as infants.

One baby, less than a year old, went through a multi-week detox process when he first arrived—his mother had shared her drugs with him as a way to lull him to sleep. The boy was removed from a home drenched in chemicals used to make meth; exposed to the harsh chemicals, his skin was so sensitive and painful he would not allow anybody to touch him.

Three siblings between the ages of three and six also reside in the center; the Department of Social Services took them into custody when they were found wandering the streets alone at two o’clock in the morning. Their parents were out doing drugs.

“The vast majority of children have come here not because of their particular actions but because of things that have been done to them,” said Jim Swinkola, CEO of the Grandfather Home for Children. “If you’re a kid, it’s unfair that you’re the one who has to go to a new school or a new place to sleep.”

The problem is not unique to the children of the Grandfather Home, or to Watauga County. Family and cultural disintegration due to substance abuse and addiction have been booming in Appalachia over the past ten to fifteen years. The term ‘meth orphan’—now regularly used in stories such as these—has become more and more common.

This image of a region full of families shattered by meth addiction is only enhanced by reports of dramatically increasing numbers of meth lab busts. Maps found on the United States Drug Enforcement Administration website of meth lab incidents show that, in Kentucky alone, the number of lab incidents more than doubled between 2007 and 2009.

Pharmaceutical Abuse

Appalachia’s decade-long increase in substance abuse-related problems can be attributed to one specific development—the advent of opiates.

A study conducted by the National Opinion Research Center on health disparities in Appalachia found painkiller abuse between 2002 and 2005 to be of primary concern, contradicting beliefs about methamphetamine abuse as the biggest problem. Most telling was the finding that painkiller abuse was particularly bad in central Appalachia, where the coal mining regions of eastern Kentucky and southern West Virginia had the highest rates.

“In Appalachia, we have a number of hard labor kinds of jobs that tend to produce injuries or long-term effects for which prescription painkillers are often prescribed,” explained Kris Bowers of the Coalition on Appalachian Substance Abuse and Policy.

In addition to the mining industry, Bowers pointed a finger at jobs such as long distance trucking, as well as at increasing numbers of cancer and arthritic patients.
“Those kinds of things require heavy doses of pain meds which can also be subverted to sell on the street,” Bowers said.

“The problem is the culture of substance use in Appalachia which then turns into substance abuse,” said Bruce Behringer of the Division of Health Sciences at Eastern Tennessee State University. When policies are created to crack down on illegal substances like meth, lab busts go up and when the meth becomes scarce, the drug problem appears to initially go away.

Unfortunately, taking away one drug does not take away the substance abuse culture. People still have easy access to equally addictive and destructive substances like opiates that are legal and advertised.

High rates of painkiller abuse, mental illness and poverty afflicting the same regions in Appalachia suggest that regardless if the abused substance is meth, cocaine or painkillers, the overarching problem is not one of illegal substances or crime, but lack of economic and social opportunities. “We have a lot of people who have painful, debilitating lives filled with sorrow,” said Louise Howell, Executive Director of Kentucky River Community Care (KRCC).

Searching for Solutions

Advocates like Behringer are trying to take a ground-up approach to combating substance abuse in Appalachia by working with communities to identify and improve social and economic problems that could lead to substance abuse.

During a 2006 conference run by Behringer and colleagues, 26 different groups of people from six different states and a variety of professional backgrounds—including doctors and journalists—came together to brainstorm options for dealing with the problem. Following the conference, Behringer and colleagues received approximately $400,000 worth of regional grants to develop 16 different community programs to combat substance abuse.

Initiatives that emerged included project PEP, a program designed to instill community participation and Appalachian pride in the citizens of Lee County, Ky.

Despite this progress in developing community programs, one cultural barrier to a ground-up approach is ingrained in the mountains of Appalachia, according to Behringer; the view that substance abuse is an individual family’s private problem, rather than a community problem. “How are we going to address substance abuse issues if you can’t get people to think beyond the individual impact?” Behringer said.

A political culture that does not look at Appalachia as a region, but instead confines both data collection and actions to individual states, poses yet another barrier to decisive action at the community level.

Each state has different policies and laws for addressing substance abuse, raising the potential for finger-pointing between elected officials over who passed what laws. But substance traffickers and substance abusers do not care about state boundaries, particularly in a region as tightly knit as Appalachia.

The goal, according to Behringer and Bowers, is to draw different professions working together at the community level in order to address the problem of substance abuse, and then to convince lawmakers to work together across state lines.

The key to making all of this work, says Howell, is for professions and states to make the appropriate policy changes, such as integrating psychological health into physical health care, and to shift funding from correctional institutions to prevention and treatment programs.

“There are a lot of policy shifts that are pending and need to take place,” said Howell. “That’s where it’s at.”

Story by Jeff Deal

While the U.S. Congress wrestled with the question of uninsured Americans, many Appalachian residents were without health insurance in 2008 and 2009.

According to the U.S. Census Bureau’s Current Population Survey, the number of insured residents in the region ranges between one out of every five people in Georgia to one out of eight in Virginia, compared to a national average of one out of six. Growing concern regarding access to substantive health care is mounting.

To address the limited access to affordable healthcare, health professionals have united with local communities to address the shortfall of medical services within their communities at free health fairs and clinics around the region. Doctors, nurses and other providers team up with volunteers to donate their medical expertise to those lacking these critical services.

Wise, Va.,— lying in the southwestern corner of the state—hosted a 2010 Remote Area Medical Volunteer Corp “RAM” clinic in July. In just two and a half days, the confederation of volunteer community members and professionals met with more than 1,250 patients seeking treatment for ailments ranging from depression to pulmonary disease in the improvised examining rooms of the county’s fairgrounds.

Wise will once again offer this service when they hold the 11th annual health clinic July 22 – 24, 2011. Volunteers seeking to assist with the fair may submit their applications in April, 2011.

Grundy, Va.,—an hour and half northeast of Wise—is also the site of a yearly RAM clinic, taking place each October. According to RAM, his year’s Grundy clinic treated 766 patients an estimated $89,000 worth of medical care in just two days.

“Volunteering with RAM was a powerful experience that helped me decide to go to medical school,” says Patricia Feeney, a student at the Virginia College of Osteopathic Medicine in Blacksburg, Va., who volunteered at a Union, Tenn., RAM event last year. “We need more accessible and affordable long term care in Appalachia, and while we work for that, RAM gives us all a way to reach out to our neighbors and help meet immediate needs.”

Tennesseans in need of health services had opportunities to attend RAM clinics in Oneida, Knoxville, Nashville, Pigeon Forge, and Clinton; these sites will once again offer clinics during 2011.

RAM accepts all volunteers, in addition to physicians and health care professionals. RAM clinics provide eye exams, prescription eye glasses, and dental care, as well as primary care visits. For more information on the Remote Area Medical Volunteer Corp, visit: ramusa.org or call 1-877-5RAM-USA.

For a comprehensive step-by-step guide to available health insurance options by state, as well as an explanation of the health care reform legislation enacted by the U.S. Congress, visit healthcare.gov

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Clinics Around the Region

In addition to the volunteer medical clinics organized by RAM, other free and/or accessible clinics offer health care for Appalachian residents in need.

The West Virginia Association of Free Clinics offers medical services at 13 sites throughout the state (www.wvafc.org or call 304-414-5941).

Fifty-nine member clinics, spread over the state, make up The Virginia Association of Free Clinics (www.vafreeclinics.org or call 804-340-3434).

North Carolina also has an Association of Free Clinics (www.ncfreeclinics.org or call 336-251-1111).

Residents without health insurance in Kentucky may contact Health Kentucky to gain information regarding health care opportunities in their area (www.healthkentucky.org or call 1-800-633-8100).
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Community Caregivers

A number of organizations are working to combat health disparities and improve the physical and emotional well-being of people in Appalachia. From public universities to statewide nonprofits to community clinics, there are programs throughout the region that provide medical care to the uninsured, advocate for healthcare legislation and educate children about the importance of healthy behaviors.

Appalachia Community Cancer Network is an initiative funded by the National Caner Institute aimed at reducing cancer disparities in the region through community participation in education, research, and training.

They focus on the prevention and early detection of cervical, lung and colorectal cancers, all of which have high incidence rates in the region. Based at the University of Kentucky, ACCN serves the northern and central Appalachian regions. www.accnweb.com

Health Kentucky works with a statewide network of volunteer health care providers, dentists, pharmacies, and pharmaceutical companies to provide free health care and medication to uninsured residents of Kentucky. Since 1984, they have provided free health care to more than 300,000 patients Visit: www.healthkentucky.org

Appalachian Regional Healthcare operates a system of hospitals in eastern Kentucky and southwestern Virginia. In 2010 they were named an Outstanding Rural Health Organization by the National Rural Health Association. www.arh.org

Healthy Appalachia Institute – part of UVa-Wise – provides policy makers, healthcare workers, educators and community members the necessary tools, resources, ideas and strategies to foster a healthy population. They provide community based research opportunities, service learning and health education. www.healthyappalachia.org

The Center for Rural Health Development Inc. provides leadership on rural health issues in West Virginia. They work with community health centers, hospitals, private physicians and dentists to improve the health of WV residents. They also work with banks to provide financing for healthcare providers strengthening rural health infrastructure. Visit: www.wvruralhealth.org

Rural Health Association of Tennessee advocates and educates on rural health issues including substance abuse, mental health, health professional education, disease prevention, oral health and emergency preparedness. Visit: www.rhat.org

An End-of-the-Decade Checkup on the Wellbeing of Our Region

Story by Parker Stevens and Jeff Deal

How much money would you take in exchange for 40 years of your life? $1 million? $1 billion? Would any sum of money be sufficient to replace the years with your family and friends, the laughter and the love we all hope to share? In Appalachia, there is an alarming trend of lower life expectancy and higher disease rate than in most other parts of the country. Poverty, lack of education, a spotty regional medical infrastructure and polluting industry are all contributors to the numbers that are stacking up against us. The real question is, how do we reverse the trend?

It’s often remarked that if you have your health, you’ve got everything. As I watched my grandmother die of bone cancer at 63 years of age, I realized just how profound, for me, this cliché is.

When you think of the ancient rolling green tree clad mountains that form the backbone of the Eastern seaboard, what do you imagine? Most find Appalachia a premiere vacation destination, a land of flora, fauna and four distinct seasons—a landscape of near indescribable loveliness, where one can relax, “get away” and “breath easy” while fishing a trout stream, swimming in a hole, hiking to a waterfall or daydreaming lazily under the lone tree of a serene mountain pasture.

It is ironic to consider the health challenges faced by many living in or near this most enchanted natural wonder.

Poverty and poor health have long plagued Appalachia. Quality of health concerns in the region have been influenced by issues of prosperity, education, physical landscape, culture, history, medical infrastructure, health insurance, occupation and daily behaviors.

The Appalachian Regional Commission (ARC) classifies one in four Appalachian counties as “high poverty.” Per capita income in Appalachia consistently falls below the national average. Impoverished residents in the region have a life expectancy equal to that of Panama and Mexico. A report released by the ARC indicates that people living in poverty and without health insurance are more likely to die prematurely, particularly from cancer or cardiovascular disease, than people with higher incomes.

Exposure to harmful substances in coal mines, chemical factories, and agriculture—common occupations in the region—can also prove damaging to the health of an individual.

A study published in the Californian Journal of Health Promotion found that, on a cultural level, there is a general sentiment of mistrust among Appalachian people with respect to health care professionals.

According to the study, some residents fear being taken advantage of or exploited by the health care system—or being unfairly, or unjustly, stereotyped. Many Appalachians are reluctant or lack the time and means to participate in preventive screenings—such as mammograms—without showing acute symptoms of an illness.

Geography also isolates Appalachian communities from urban ones, where health care resources are more abundant. According to the ARC, nearly half of all rural Appalachian counties are designated as health professional shortage areas.

Wayne Myers, founder of the University of Kentucky Center for Rural Health, says that there is a lack of municipal hospitals and community clinics in the region. “Most rural counties don’t have community health centers,” Myers says. “Only two or three Appalachian counties have academic medical centers or a teaching hospital.”

The shortage of doctors is particularly difficult for Medicaid patients, as many doctors will not accept Medicaid due to low reimbursement rates. Patients often have to travel long distances to larger cities and urban areas in order to seek treatment covered by Medicaid.

Education improvements do provide access to jobs that raise families and communities above poverty and illness, but must develop apace with other economic opportunities—or the newly educated leave for greener pastures.

With the betterment of health care access and public campaigns encouraging healthy lifestyles, Appalachian communities can gain prosperity, good health, and well-being.

A recent study by Dr. Michael Hendryx and other researchers at the West Virginia Rural Health Research Center found that rural areas in Appalachia have more exposure to agriculture-related pollution than urban and metropolitan areas.

The study also found a significant correlation between areas with water pollution and both cancer and total death rates. In addition, sites within these rural regions that are monitored as air pollution sources “were associated with greater cancer mortality rates” for inhabitants.

In areas of Appalachia where coal is mined, the study found higher mortality rates for non-mining residents, and not simply those working in the coal mines.
The report concluded that health care professionals working in rural Appalachia will need “appropriate training and resources to diagnose and treat environmentally-instigated or mediated disease.”

Story by Jamie Goodman

Kentucky citizens attend an air permit hearing press conference for the Smith plant last February. Eastern Kentucky Power Cooperative reached a settlement with several groups and agreed to cancel plans to build the 278MW power plant. Photo by Kentuckians for the Commonwealth

Environmental groups in Kentucky are celebrating a major victory over a proposed coal-fired power plant slated for Clark County.

Eastern Kentucky Power Cooperative (EKPC) reached a settlement with environmental groups, three individual co-op members, the Kentucky attorney general and Gallatin Steel—EKPC’s largest industrial customer—agreeing to halt plans for the utility’s proposed Smith coal-fired power plant.

EKPC also agreed to commit $125,000 toward a joint effort between the involved parties to evaluate and recommend new energy efficiency and renewable energy programs.

In exchange, Kentuckians for the Commonwealth (KFTC), Kentucky Environmental Foundation and the Sierra Club agreed to drop a number of lawsuits and administrative challenges against the cooperative.

According to EKPC representatives, the decision was based on financial concerns and not environmental pressure. Estimates for the total cost of constructing the Smith plant were around $819 million, with $150 million already spent on materials.

“I believe this decision by EKPC is the right one for Kentucky,” said KFTC member Tona Barkley. “I am heartened by this new development and the commitment EKPC has made to work in a collaborative fashion with co-op members and the other parties to the agreement.”

“This new openness and more democratic method will, I believe, help bring the co-ops back to their original purpose–serving its rural members in a transparent fashion,” Barley said.

The groups involved in the settlement also agreed to not oppose the utility’s efforts to recover costs already spent on the plant, including selling turbines and other parts that were already purchased.