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Public Health in Appalachia
Appalachia's Public Health
Report Card
While the Appalachian Mountain region is one of the most beautiful landscapes in the United States, people living in the region have some of the highest rates of infectious disease diagnoses, chronic illnesses, and preventable deaths in the United States.
Across Appalachia's 13 states, 423 counties, and 8 independent Virginia cities, a "perfect storm" of factors, including labor-intensive jobs, a lack of both general practitioners and specialist physicians, chronic underfunding of public health systems, a near-total lack of underlying public health infrastructures, low levels of education, and environmental circumstances have resulted in a population that leads the nation in many adverse health outcomes.
Health Issues in Appalachia
Barriers to Care and Treatment in Appalachia
Appalachians face significant barriers to accessing care and treatment, including geographic, transportation-related, communication, income, and age/disability-related barriers.
In many cases, the very mountains we call home can present a barrier to care, particularly during the winter when roads may become impassable.
Additionally, the mountainous terrain has made modernizing parts of Appalachia incredibly difficult. This means that many areas lack access to reliable mobile phone coverage and sufficient Internet infrastructure. In those areas, even were those services readily available, many residents would be unable to afford to access them.
An example of this occurred during the COVID-19 pandemic. When schools made the transition to virtual schooling, thousands of students were unable to access Internet services at home in order to attend. This required a unique solution: turning unused school buses into mobile WiFi hotspots. Students would park in vehicles around these buses and attend school using school-provided laptops.
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The Social Determinants of Health
While people living in the Appalachian Mountains face significant barriers to actually accessing healthcare services, there are also underlying circumstances that increase the likelihood of adverse health conditions:
These are called the Social Determinants of Health (SDOH)
The basic concept behind the SDOH is that underlying factors, such as education, where we live, where we work, the language that we speak, and how much we earn, all contribute to our health outcomes.
For example, children born to parents who have not completed high school are more like to live in an environment that poses barriers to health, such as a lack of physical safety, high levels of stress, and substandard housing.
These circumstances can then lead to long-term and even generational adverse health outcomes.
Another example of the SDOH impacting health outcomes is how Appalachia's reliance upon the coal industry has had long-standing impacts on the health of those not only working in the industry but those living in areas where coal is the driver of the local economy.
Nearly every study conducted has found that people working in and living near the coal mining industry have an increased risk of developing and dying from numerous conditions, including:
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Neoplasms (abnormal growths)
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Circulatory and respiratory disease
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Metabolic Diseases
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Diseases of the eyes and skin
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Perinatal conditions
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Congenital and chromosomal abnormalities
Cortez-Ramirez, J., Naish, S., Sly, P.D., & Jagals, P. (2018, June 11). Mortality and morbidity in populations in the vicinity of coal mining: a systematic review. BMC Public Health 18, 721. https://doi.org/10.1186/s12889-018-5505-7
Developing Practical Solutions
